Local Health Service Response to COVID-19 in Mexico: Notes From an Exploratory Qualitative Study.

BACKGROUND: The main goal of a health system is to maintain or improve people's health. The COVID-19 pandemic showed the fragility of health systems worldwide. In Mexico, the pandemic affected the performance of the health system, along with the presence of contextual conditions such as its segmentation and high prevalence of chronic diseases. AIMS: To analyze from an approach to the functions of the health system, the service delivery, human resources, financing, and stewardship/governance in the local health services of five states of Mexico, from the perspective of the staff working in health centers. METHODS: This is an exploratory qualitative study conducted from November 2020 to August 2021, involving 124 health professionals from 39 health facilities (18 rural and 21 urban). The technique used was the semi-structured interview. Interview guides were developed according to core topics. Subsequently, the thematic analysis method was used. RESULTS: The lack of financial resources delayed prevention efforts and made it difficult for health centers to adapt to the crisis. Inequity was found in the distributive efficiency of staff between rural and urban areas and levels of care. In addition, there was evidence of capacity for coordination, capacity sharing, and joint participation between health institutions, civil authorities, and the population to face the emergency. CONCLUSIONS: We identified relevant public health actions that showed the capacity of local health services to organize a response to the pandemic at the level of the actors responsible for these services.

COVID-19 Disruption To Routine Health Care Services: How 8 Latin American And Caribbean Countries Responded.

Latin America and the Caribbean was one of the regions hardest hit globally by SARS-CoV-2. This qualitative exploratory study examined how the COVID-19 pandemic disrupted the delivery of routine health services from the perspective of health care system decision makers and managers. Between May and December 2022, we conducted forty-two semistructured interviews with decision makers from ministries of health and health care managers with responsibilities during the COVID-19 pandemic in eight countries in Latin America and the Caribbean. On the basis of these interviews, we identified themes in three domains: impacts on the provision of routine health services, including postponed and forgone primary care and hospital services; barriers to maintaining routine health services due to preexisting structural health care system weaknesses and difficulties attributed to the pandemic; and innovative strategies to sustain and recover services such as public-private financing and coordination, telemedicine, and new roles for primary care. In the short term, policy efforts should focus on recovering postponed services, including those for noncommunicable diseases. Medium- and long-term health care system reforms should strengthen primary care and address structural issues, such as fragmentation, to promote more resilient health care systems.

Local health systems resilience in managing the COVID-19 pandemic: lessons from Mexico.

The concept of resilience was applied to the public health field to investigate the way health systems are impacted by health crises, what conditions allow them to mitigate the blow and how they reorganize once the crisis is over. In 2020, the COVID-19 pandemic caused by the SARS-CoV-2 virus represented a global challenge demanding immediate response to an unprecedented health crisis. Various voices drew attention to the intensity of the crisis in countries with greater inequalities, where the pandemic converged with other social emergencies. We documented the experiences of health personnel who faced the pandemic at the primary care level while simultaneously maintaining the functioning of other areas of medical care. Our results derived from a qualitative study comprising 103 participants from five states of Mexico. We aimed to show through inferential analysis their perspective on what we call 'the resilience of local health systems'. We observed three stages of experience during the crisis: (a) Preparation (official guidelines received to organize care, training and planning of epidemiological surveillance); (b) Adaptation (performance of community-based prevention activities, infrastructure modifications, telehealth); and (c) Learning (participatory governance with city councils, business sector and organized population). The study suggests that the local health systems analysed benefited from the initiatives of health personnel that in some cases positively exceeded their duties. In terms of the resilience analysis, they were able to handle the impact of the crisis and cope with it. Their transformative capacity came from the strategies implemented to adapt health services by managing institutional resources. Their experience represents a lesson on the strengthening of the essential functions of health systems and shows a way to address successfully the increasingly complex health challenges of the present and future times.