AMALFI MARTINEZ MEKLER
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INTERNATIONAL CONGRESS OF
ADMINISTRATIVE SCIENCES, IIAS, 2012
THEME: SOCIO-ECONOMIC PRIORITIES AND PUBLIC ADMINISTRATION
SUBTHEME: Democratic Governance for Social and Economic Development
Co-responsibility between state and society. Political culture of
participation.
PAPER: THE IMPORTANCE OF SOCIAL PARTICIPATION IN
PROGRAMS FOR A NEW CULTURE OF HEALTH.
Contribution No. 193
Professor Amalfi Martínez Mekler
Sociologist Development Consultant
Associate of INAP
(5255) 5291-0405
Parque de Cádiz No. 96-11, Parques de la Herradura
Huixquilucan Estado de México, CP 52786
México
AMALFI MARTINEZ MEKLER
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The Importance of Social Participation in Programs for a
New Culture of Health
ABSTRACT
Epidemiological transition, greater life expectancy and social transformation require a
change of paradigm in the health system: from a curative and reactive medicine to a
preventive:"New culture for health", which is in the process of implementation. Mexico
faces a critical juncture, in which citizen participation is essential to achieve democratic
governance capable of redefining strategies and promoting socioeconomic development in
a more accelerated and competitive world.
The State has had an active role in the heath sector, yet what it has accomplished is
insufficient to meet the needs and expectations of citizens. Health programs require
modern governance and the strengthening of social capital to face this challenge with new
schemes of co-responsibility and innovative processes of government-society interaction.
This document reinforces the above statements with the results of an evaluation of six
programs of prevention and promotion of health in three States of Mexico. The responses
are of users/beneficiaries, reflecting the voice of State officials who implement them, as
well as of the people that receive services of the Ministry of Health in traditional health
centers and hospitals. It privileges the study of new medical units created recently with a
holistic approach to the management of addictions, maternal death, cervical cancer,
HIV/AIDS, HINI influenza, and obesity.
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Table of Content
INTRODUCTION ......................................................................................................................... 4
THE DIFFICULTIES OF PARTICIPATION ............................................................................... 5
COMPLEXITY IN THE DESIGNING OF PUBLIC HEALTH POLICIES ................................. 5
TO ILLUSTRATE THE ABOVE I PRESENT A RECENT STUDY OF: PUBLIC POLICY
ASSESSMENT OF DISEASE PREVENTION AND HEALTH PROMOTION ........................ 6
METHODOLOGY ........................................................................................................................ 6
OPINION OF THE BENEFICIARIES ......................................................................................... 7
CRITICAL OPINION OF BENEFICIARIES ............................................................................... 8
KEY FINDINGS FROM THE EVALUATION IN THREE STATES: HIDALGO, PUEBLA Y
QUERÉTARO. ........................................................................................................................... 10
CONCLUSIONS ........................................................................................................................ 10
REFERENCES .......................................................................................................................... 12
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INTRODUCTION
Mexico faces critical moments. It requires a definition of strategies and the design of a
roadmap to boost its economic growth more rapidly. The challenge is to leave the
economy of medium income, and move to a higher model of increased productivity and
international competitiveness, and in the process it must consolidate a welfare system for
the population.
Citizen participation is essential to achieve democratic governance. It is a right that has
been on the public agenda for over three decades. However, building social participation is
not easy. There is not a culture of inclusion, there is apathy and it is an organizational
change still difficult to convince public policy decision makers.
Health is one of the pillars of welfare and human development The Mexican health system
requires a systemic response to its transformation, in order to consider financial and
structural emerging risks. The strategy undertaken by the Federal Government is through
the design and implementation of 23 cross-cutting programs for equal number of key and
strategic diseases that affect society.
Yet social participation alternatives are even more complex in the field of health, as its
nature is highly professional and specialized.
Also because of the huge dependence that is created by the recipients to those who
provide them with medical care. All Mexicans are entitled to be incorporated into the
Health Protection System in accordance with Article Four of the Constitution of the United
Mexican States, regardless of their status.
But In reality, what is happening with the delivery of public medical services?
There are two dimensions: at a national level, regulations are designed for multiple
fragmented programs, and since the health sector is decentralized, on a state level, the
operation of the Health Services System faces great pressure from citizens' demands,
which are difficult to meet.
The changing epidemiology, the increased life expectancy and social transformation
require a paradigm shift in the health system: from curative and reactive to a preventive,
"New Culture for Health".
This paper is supported by direct research and it confirms that citizen participation is an
important political element to achieve socioeconomic development, particularly in the
sphere of welfare.
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State actions and programs alone are insufficient to solve public problems and the
expectations of the population..
It is required that there be:
Improved schemes of responsibility between state and social actors in planning,
implementation, follow -up, monitoring and evaluation of health public policies.
A strengthening of human capital so that local citizens are empowered and are the ones
who identify and understand specific needs of their environment.
New approaches to collective action that is able to demonstrate the rationality of
collaboration and encourage citizen intervention in the delivery of best quality public
services.
A new public management where there is control, efficiency, and democracy in the
processes of interaction between government and society.
THE DIFFICULTIES OF PARTICIPATION
Social organization in Mexico is still in a stage of underdevelopment.
9 out of 10 Mexicans say they have not sought to influence decision making within their
community, this reflects a culture of apathy.
In a comparison of 35 countries of the world, Mexico is in the last place regarding the
number of associations in the field of non-profit performing actions.
COMPLEXITY IN THE DESIGNING OF PUBLIC HEALTH POLICIES
Building social participation is not easy, especially if it is to be genuine, active and
legitimate .Also because
They address large scale problems and are of general application.
The number of beneficiaries is also of a large scale.
They involve a great responsibility.
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TO ILLUSTRATE THE ABOVE I PRESENT A RECENT STUDY OF: PUBLIC
POLICY ASSESSMENT OF DISEASE PREVENTION AND HEALTH
PROMOTION
At the end of last year, I coordinated a study to evaluate six of the major programs for a
“New Culture of Health” from the point of view of the people that implement and those that
receive the benefits of the services. As I mentioned before, since 1982, the heath sector
has been decentralized, this means that legislation and normatively are discussed and
created at a federal level, but the operation, resources and responsibility are managed at
the State level. The main results of this study are summarized in this paper.
METHODOLOGY
The study is orientated to evaluate six preventive health programs from the point of view of
public servants and state authorities, as well as of the people who attend health centers,
hospitals, and new specialized medical units” UNEMES”.
The research instruments used consisted of:
Auto diagnosis, sessions of analysis with working groups that included different levels of
administrative officers: state, jurisdictional and local members of health projects.
Application of questionnaires to the specific target population of the six programs of
prevention and promotion of health: addictions (Centros Nueva Vida) Cervical Cancer,
maternal death (Arranque parejo a la Vida), HIV/AIDS (CAPASITS), Influenza HINI, and
obesity (Unidades médicas especializadas (UNEMES).
Interviews with open population that make use of public heath spaces.
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OPINION OF THE BENEFICIARIES
The general public interviewed responded by more than 80%, that they are satisfied with
the services of health centers because they solve their health problems in most cases.
They consider that treatment and care is adequate and that they receive information about
prevention and early detection of critical illnesses.
Yet there is resistance to self-care and taking responsibility for their personal and family
health.
There is not a favorable coordination and communication between the health centers,
hospitals and the new specialized units.
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The hospitals are overcrowded, with lack of space, material and human resources
The new health units for the prevention and treatment of obesity, UNEMES are not clearly
positioned or well known. This is important to solve because they are designed to manage
metabolism with a holistic approach in order to prevent diabetes, heart diseases, cancer,
and other chronic and degenerative problems.
CRITICAL OPINION OF BENEFICIARIES
The main problems mentioned are:
Frequent absence of medicines in health centers, they have resource problems or delays
in the supply chain, which affects patients and causes anger.
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There is a constant complaint in relation to lack of specialized human resources in the
medical field, the need for a greater number of spaces in general and particularly for
pregnant women and patients in the area of gynecology and obstetrics. This becomes
critical in the emergency area.
There is need of more systematic impact assessments in regard to Groups of Mutual
Support (GAM) hospitals, volunteer citizens, extramural activities and interdisciplinary
teams in the area of psychology, nutrition, exercise, recreation and social work.
Finally there is a repeated insistence that there should be more studies and evaluations of
this kind in order to convey opinions, perceptions, problems and needs to the Central
Government and be taken into account in the formulation of public policies and decision
making a state, local and regional level.
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KEY FINDINGS FROM THE EVALUATION IN THREE STATES: HIDALGO,
PUEBLA Y QUERÉTARO.
At the state level there is acceptance and understanding of the six programs, each state
operates them according to its epidemiological profile. The problem is their
implementation with a functional operational structure and sufficient flexibility to suit
regional characteristics and conditions. There is need of more communication and
understanding between national and state authorities as well as among multiple
institutions that offer heath services.
A failure to recognize the importance of professionalizing health promoters and volunteer
citizens who are in direct contact with the urban and rural population and the different
public officials.
The scheme of “Seguro Popular” created during the last two periods of government, has a
growing demand that provokes pressure on the health system which does not grow at the
same speed that the population needs. This program has generated high expectations that
cannot always be met.
.CONCLUSIONS
Strategic assessment of the programs that we studied for the Federal Health Secretary
with the collaboration of three State Governments point out that one of the most important
factors for achieving the goals and success in performance is through an active
participation of society. To stay healthy and learn to handle degenerative diseases is a
responsibility of individuals and families, as well as of communities, society and
Governments.
The rise of life expectancy, and increase in the number of people with chronic diseases
determine that no public institution alone can meet the challenge of offering the population
efficient attention.
Social involvement becomes very important as well as self awareness and empowerment
of the population.
It is essential to strengthen the figure of health promoters in the states, and of volunteer
citizens (“Avales Ciudadanos”) in Mexico City. They play a major role in two ways:
towards the institution (public policy) and in connecting with the population (participation)
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seeking to create consciousness and empower the people in the direction of assuming
more responsibility for their health and welfare
The management, administration and delivery of health care programs are a complex task.
The New Culture for Health which includes the promotion of a comprehensive and
preventive approach is not yet consolidated.
The current policy of an open government and administration based on transparency,
collaboration and participation is an option for democracy and a better quality of life, both
important priorities for our new government.(2012-2018)
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REFERENCES
SPECIALIZED STUDIES
Evaluación desde el punto de vista del usuario/beneficiario de seis programas prioritarios
de salud. Instituto Nacional de Administración Pública A.C. (INAP) para la Subsecretaría
de Prevención y promoción de la salud. Secretaria de Salud, Gobierno Federal.
Diciembre 2011.
Informes de la evaluación específica del desempeño 2009-2010, Sistema integral de
calidad en salud. Consejo Nacional de Evaluación de la política de desarrollo social.
CONEVAL.
Información, programas y evaluaciones de salud de los gobiernos del Estado de
Guanajuato, Hidalgo, Puebla y Querétaro.
La salud en México 2006/2012 Visión de Funsalud. Organismo de la sociedad civil:
Fundación Mexicana para la Salud A. C.
INSTITUTIONS
Comisión Nacional de Protección en Salud. Seguro Popular.
Unidades de Especialidades Médicas (UNEMES), Unidades entre los hospitales
regionales y los Centros de Salud. Plan Maestro de Infraestructura Física en Salud.
LAWS
Constitución política de los Estados Unidos Mexicanos.
Ley General de Salud del Estado Mexicano. Sistema Nacional de Salud.
Reglamento de la Ley General de Salud en materia Protección Social en Salud.
Leyes estatales de Salud.
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PROGRAMS
Programa Nacional de rendición de cuentas, transparencia y combate a la corrupción
2008-2012, Secretaría de la Función Pública.
Programa sectorial de salud 2007-2012, Secretaría de Salud, Gobierno Federal.
Programa de Acción Específico 2007-2012. Promoción de la salud: “Una nueva cultura”.
Secretaría de salud, Subsecretaría de Prevención y Promoción de la Salud.
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