Interview: Dr. José Armando Ahued Ortega – Secretary of Health, Mexico City

Dr. José Armando Ahued Ortega, Mexico City's Minister Health (2)Spearheading the key governmental organization in charge of safeguarding the health of the Mexican capital, Minister of Health of Mexico City, José Armando Ahued Ortega, speaks about manoeuvring through the key challenges plaguing the country’s healthcare system. He shares his insights on the strategic areas focus of his mandate, the holistic approach of the “médico en tu casa” program, as well as his view on necessitating a paradigm shift within the healthcare system to cater to Mexico’s most vulnerable.

Mr. Ortega, you have led the Ministry of Health of Mexico City for two consecutive years. Given the fact that the current government has two more years in power, what is your strategic area of focus in this time frame in order to concretely strengthen the Mexican health system?

“The healthcare system in Mexico is large and complex and each day brings its own set of challenges”

I have held the position of the secretary of health for the last ten years, serving as the sub-secretary for health for the first 1.5 years and as the secretary for the subsequent eight year thereafter. Though it is a position I hold in pride, the last decade has been laden with its own set of complex challenges and severe crises. The most noteworthy of which is the H1N1 influenza epidemic in 2009 wherein Mexico City had to resort to being completely closed down. Nevertheless, we were able to forge ahead and move forward given the fortunate circumstance of having eventually found the appropriate medicines and vaccines to eradicate the virus. Moreover, another tragic calamity that I had faced since assuming the position is the fateful explosion of the pediatric hospital in Cuajimalpa in 2015 wherein much of the tragedy revolved around the level of contamination accrued by the incident.

The healthcare system in Mexico is large and complex and each day brings its own set of challenges. We currently boast 32 hospitals, 380 clinics and 37 million healthcare professionals dispersed throughout Mexico City. We cater to about 22 million patients daily and the challenges faced are commensurate to the size of being in one of the largest cities in the world. Although the city’s population officially lists 9.2 million people, close to 23 million people are in the city each day, which poses a large challenge for the public health system.

The challenges plaguing the healthcare system as a whole in Mexico City parallel those of the major cities in the world, predominantly consisting of conditions such as cardiovascular, cancer and chronic degenerative diseases. Diabetes has been one of the biggest contributors to the mortality rates in Mexico, with a fatality figure of 98 thousand people last year due to the disease. Vehicular accidents account for 6 million medical aid each year as well. Women’s health in Mexico is anchored on the high rate of breast cancer prevalence. Cases of obesity are also on the rise accounting for 7 out of 10 females, 6.7 out of 10 males and three out 10 children being overweight.

Sexual and reproductive health are also of paramount importance as there are worrisome trends of younger and younger women getting pregnant, at times as young as nine to 13 years old. In the same vein, health literacy for sexually transmitted diseases such as HIV and human papilloma virus is also a priority in the agenda. Combatting addictions to toxic substances such as alcohol and drugs, especially for very young children are also an issue of concern.

At the crux of our organization’s objective is to safeguard the health of the population of Mexico City. The best way in which we can achieve these goals is to implement the strategies with a more proactive approach of detection, prevention and protection at or before the onset of any of these diseases. Secondly, providing better opportunities for healthcare such as free medical check-ups, which are strategically-located near metro stations because five million people use this means of transportation on a daily basis. In the context of hospitals and clinics, we encourage the population to avail the free medical checkup annually. The system currently boasts 19 different laboratories tests that can detect up to 66 commonplace diseases. Moreover, we instill a mentality amongst the community to build a culture of co-responsibility for each other’s wellbeing.

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Ultimately, the healthcare system, as it stands today, is reactive by nature. Many of the treatments in place are interventionist once a disease has already started and caters predominantly to treating a disease. A paradigm shift needs to occur through conveying the important message people need to be more proactive with their health. We have implemented programs in hospitals and clinics in order to promote the idea of exercise, better nutrition and overall healthy living. There is a saturation of services in the clinics and hospitals ignite the population to take better care of themselves and only necessitate medical help if they are sick. Health is our most important asset in life and early detection is key.

Mexico is currently experiencing a demographic and epidemiologic transition as a result of a heightened prevalence of chronic and non-communicable diseases such as diabetes, cancer, and cardio-vascular diseases. Given that the government has recently announced budget cuts for the healthcare expenditure of 2017, what is your action plan to ensure the high performance of the health system in Mexico City?

This year, we have allocated close to 300 million pesos. We are faced with the unfortunate reality of needing to cut 1,900 people in the workforce in order to be able to maintain a decent level of salary for the current workforce, as supported by Mexico City. Our goal is to be able to work more efficiently and create strategies that are more economical and have a higher impact. It will take time and collaboration to actualize all the changes but ultimately it begins with proper health literacy.

I am convinced that incorporating obligatory health education in school should be the primary step in maneuvering the complexity of the Mexican healthcare system. The education needs to cover a broad range of topics from basic biology for children to the necessary measures to be taken in order to live healthy lifestyle, as well as proper reproductive health and risk associated to improper nutrition. It is imperative that the greater population begins to have a fuller grasp of the health issues that can impact them.

From an economic standpoint, it is also far more cost-efficient to treat than to prevent, and therefore we always try to encourage more proactive approaches to treatment whilst taking into account various demographic and epidemiological changes. Diseases such as diabetes and cancer are closely linked to societal changes and the added pressures of modern-day living. At the core of the problem of the health system is being able to detect cases early and facilitate changes accordingly.

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Cardiovascular diseases, cancer, diabetes and obesity are the top five causes of death in Mexico and such impact could be reduced through early detection and healthier lifestyle. What are the measure you are promoting in to minimize the footprint of such diseases in Mexico City?

The strategies implemented by Mexico City emphasized the importance of primary care, such as medical check-ups. Even the 4.2 million people who do not have social security in Mexico, but are actively living in the country, have the right for a proper medical check-up. We have launched several campaigns to promote physical activity through events held publicly at the Revolutionary Square on the weekends through dance, cycling, skating and other such exercises. The central theme of these events is to promote healthy living and deter people from improper nutrition and addictive habits.

Patients’ market access to healthcare services is a national burden and, in this regard, you launched “médico en tu casa” initiative. Could you explain to our international readers the rationale behind such program as well as the results obtained so far?

The idea behind this initiative is to be able to increase the access of healthy options to the greater population. For example, minimizing the availability of salt shakers in restaurants as a means to counter hypertension and law was passed obliging restaurant to serve a free glass of water for every customer. These are done in parallel with the efforts to increase health literacy amongst the population.

Furthermore, we also work closely with the large pharmaceutical companies in Mexico in order to create synergies and better cater to the patients. For example, we supported Sanofi-Aventis in opening the first clinic specialized in diabetes, alongside the participation of Novartis. Moreover, we have also worked with companies like Bayer to promote sexual health, as well as Janssen and Merck in the context of the human papilloma virus. It is through the receptiveness and strong collaborative force of the pharmaceutical companies that we were able to establish the necessary protocols for the “médico en tu casa” initiative.

Could you please share with our international executive readers how this initiative has progressed and its stance today?

“Médico en tu casa” is an exciting program that has been implemented approximately two years ago. Its inception has stemmed from the idea of the rampant maternal and infant mortality rates in Mexico City, which stood at 57 percent in 2013. In the past, when problems arose, they were addressed by obstetricians only in emergency situation. Exacerbated by the fact that most of these women do not receive prenatal care at the onset of their pregnancies. Of the 28 million women who are pregnant annually, 8,670 have never visited a physician and approximately 3,000 are at risk for maternal mortality. This is an anomaly for us given the fact that there are 32 hospitals throughout the city wherein they can gain access for care. Of the 16 municipalities in Mexico, most of the social and economic problems are concentrated on two boroughs wherein approximately two million people are devoid of proper care. The concept behind “médico en tu casa” in to have a better breadth of understanding of the level of care needed from home to home.

In the two years and two months since the inception of the program, there had been 2,600 visits to the most vulnerable segments of the population through first-hand door-to-door visits. The program boasts a participation of 3,6000 doctors, healthcare practitioners and medical students. An astonishing number of 2,504,800 people in the city are found out to be in dire need of medical attention. 2,400 of those most vulnerable are not able to go outside of their respective houses, nor afford any form of public transportation to travel to healthcare centers. 4,800 are physically disabled and 4,500 are terminally ill. One of the achievements of the program is being able to amend the law to be able to allow to bring morphine to patients who are bed-ridden as it is typically a hospital product.

The intrinsic idea behind the “médico en tu casa” is to provide holistic palliative care to people at home. Five American universities are actively involved an engaged in the program, including Harvard University. The overarching objective is to be able to create a replicable model of home care that can be transferred to different cities in Mexico, and eventually across Latin America. We have also signed agreements internationally ranging from Cuba, Panama and Ecuador, to Paris and Madrid. The breadth of our reach has even gone to three cities in China, as well as Ukraine, Lithuania and Israel. There are 17 universities in Mexico that are actively participating in the program, including the renowned Instituto Politécnico Nacional, which contributes about three thousand talent medical students to the program. The program encompasses a broad range of medical field, such as psychologists, nutritionists and opticians in order to have a holistic view to care.

The Mexican constitution stipulates that every citizen has the right to health but reality has shown that it has been an infeasible goal thus far. However, one of the key advantages of the program is the inherent longevity of the strategy that allows for the program to continue regardless of the political party in power, thus creating sustainability through co-accountability and co-responsibility amongst different parties. In essence “médico en tu casa”, reignites the human dimension back into healthcare through having a better grasp of the mundane, daily hindrances that some of the most vulnerable part of the population face.

What are the key healthcare objectives in Mexico City that you would like to achieve in the upcoming three years?

Our overarching priority today is to consolidate the healthcare system of the city and continue increasing the level of literacy in this regard. I believe that one of the most formidable ways to counter these challenges is to educate the population in a multitude of topics ranging from toxic chemicals to the basics of reproductive health. From a very young age, people need to grasp the importance of a healthy, balanced diet and active living. Proactive living and prevention is the best lines of defense for problems such as obesity, cardiovascular diseases and cancer.

It is also of prime importance to us to increase the level of access to the plethora of health clinics in the interest of improving patients’ lives. When patients achieve better care, they are able to be functioning members of society and return to school, work and contribute to the socio-economic wellbeing as a whole. There needs to be a paradigm shift that places detection, prevention and protection at the epicenter of the healthcare discussion in order to reform a highly complex healthcare system.

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