Ausencia Díaz Gómez (right) with her family.
Photo credit: Nicolas Villa Thirion/Save the Children.
Ausencia Díaz Gómez is a mother of six children including her baby Natalia. As part of the government anti-poverty conditional cash transfer programme (known as “Oportunidades”), she goes to meetings with other women to receive some counselling by the doctors. Her story illustrates that if the care provided by health workers is not acceptable to the community then those in greatest need may be deterred from accessing services.
Ausencia is from a minority indigenous group and doesn’t speak Spanish very well. She feels frustrated having to travel an hour every two weeks to see the doctor measuring her baby without knowing why he is doing that and then being scolded but not understanding exactly why. According to the doctor, baby Natalia is underweight and he has prescribed infant formula. Ausencia can’t afford it so she prefers not to attend the doctor’s appointments, avoiding the discomfort of this process. She doesn’t buy the formula, instead feeding Natalia other food while she is still breastfeeding.
|Neonatal mortality rate (per 1,000 live births) (2011)||7|
|Under-five mortality rate (per 1,000 live births) (2011)||16|
|Maternal mortality ratio (per 100,000 live births) (2010)||50|
|Number of doctors, nurses and midwives per 10,000 people (2010)||59.4|
|Births attended by skilled personnel (2009)||95.3%|
|Total expenditure on health as a percentage of gross domestic product (2011)||6.2%|
|General government expenditure on health as a percentage of total expenditure on health (2011)||49.4%|
In Mexico, the health system comprises different sub-systems with access linked to employment status. The contributory sub-system, financed by employers and employees, is mandatory for salaried workers and covers 46.7% of the population. The non-contributory sub-system (Seguro Popular-SP), covered a 63.6% of the uninsured population in 2011, and has enabled some progress in access to services in poorer and rural regions, and among the indigenous population, even though further improvements are possible. Out-of-pocket payments represent up to 49% of total health expenditure.
The burden of some communicable diseases is high and despite good progress towards meeting the health MDGs, there are still challenges regarding maternal mortality and gender equality. There are various strategies for health workforce planning but no formal HRH Plan. There are important variations in the density of physicians among regions. The ratio of nurses to physicians at 1.9 is below the OECD average. There are mechanisms for regulation and licensing health workforce which differ between cadres.
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