Defragmenting the Health Care System in Mexico: Universal Access for Obstetric Emergencies

Abstract

Background and Objectives: This article aims to analyze how the needs of Mexican women requiring emergency obstetric care (EmOC) can be fully met through initiatives such as the General Agreement on Inter-Institutional Collaboration for Emergency Obstetric Care (the Agreement). We compared EmOC-accredited facilities operating under the Agreement with facilities outside the Agreement which, although not accredited, provide their affiliates with EmOC services. Also, to determine whether Mexico could provide five EmOC facilities as proposed by the United Nations (UN), United Nations Population Fund (UNFA), and United Nations Children’s Fund (UNICEF). Methods: Based on an observational, descriptive, cross-sectional design, we analyzed the Agreement inter-institutional strategy within four different scenarios in order to verify whether Mexico was in compliance with UN recommendations on EmOC availability, namely,: five facilities, with at least one offering comprehensive services, per 500,000 inhabitants. Results: Taking into account all facilities in the Mexican health care system, we found that Mexico offered 75% of the required facilities and was therefore 25% short of compliance. According to data on hospital discharges, 734,438 cases of obstetric emergencies (OEs) were registered in Mexico in 2013, the vast majority of which were assisted by facilities unaccredited for that function. Meanwhile, the 466 accredited facilities, all operating under the Agreement, served a negligible proportion (0.07%) of these patients. Conclusion and Implications for Translation: The Agreement would undoubtedly reach its potential as a vehicle for universal EmOC coverage were its field of action not restricted to such a small number of services for women. The Mexican health care system is faced with the double challenge of increasing institutional coverage and upgrading installed EmOC infrastructure.