Estrategia Nacional para la Consolidación de la Calidad en los Establecimientos y Servicios de Atención Médica

Objectives

The 2013–2018 Specific Action Programme, the National Strategy for Consolidating Quality in Medical-care Establishments and Services, aims to lead and operate a national quality strategy that improves effective access, quality, safety and user satisfaction in Mexico’s health services while integrating the education, training and continuing development of health professionals.[1][2]Its mission is to improve, harmonise and consolidate quality in medical-care establishments and services in compliance with regulations and in accordance with demographic and epidemiological needs.[3]

• Align with the National Development Plan 2013–2018 goal of an Inclusive Mexico and effective access to quality health services, and with Sectoral Health Programme objectives on access and the effective use of health resources.[1][4]
• Improve quality and patient safety, including technical and interpersonal aspects of care, responsiveness to users’ needs, prevention of adverse events, and continuous quality improvement.[5][6][3]
• Promote innovation and continuous improvement in clinical, administrative and managerial processes, using evidence-based clinical practice guidelines and information for decision-making.[7][3][8]
• Establish risk-management mechanisms addressing structural, biological, environmental, clinical and other hazards affecting patients, families, professionals, suppliers and visitors.[6][9]
• Consolidate accreditation of fixed and mobile health establishments as a means of improving quality, safety, service capacity and effective access according to population needs.[10][11]
• Strengthen health regulation by coordinating Mexican Official Standards for medical care, social assistance and health education, and by defining consistent requirements for technical capacity, infrastructure, staffing, equipment and health technologies.[12][5][3]
• Develop health education, workforce planning, continuing education and professional competencies, including better alignment of training, clinical placements, social service and specialist education with population health needs.[13][14][15]
• Advance equitable, person-centred and financially protective care, recognising health protection as a human right and addressing geographic, socioeconomic, cultural, ethnic and workforce inequalities.[16][14][17]

Implementation

Implementation combines national stewardship by the Ministry of Health and its General Directorate of Quality and Health Education with coordinated action by federal and state health authorities, public and private institutions, education providers, professional bodies, communities and citizens.[2][18][19]Delivery is organised through six connected components: quality and patient safety; innovation and continuous improvement; medical-care risk management; accreditation; health regulation; and health education.[5][4]

• Coordinate sector-wide quality policy through inter-institutional planning, clearer responsibilities between federal and federative authorities, and collaboration across health, education and other sectors.[20][12][17]
• Use the General Directorate of Quality and Health Education to coordinate planning, operations and evaluation; lead national quality policy; operate accreditation mechanisms; propose standards; and promote compliance with training and service regulations.[13][19]
• Organise state-level implementation through designated quality areas, State Health Quality Committees, state quality and health-education officials, and sanitary jurisdictions that plan, coordinate, supervise and evaluate services territorially.[21][22]
• Deliver integrated, primary-care-based service networks linking promotion, prevention, treatment and rehabilitation, with coordinated referral between units according to patient needs.[23][10][24]
• Standardise care through Mexican Official Standards, Clinical Practice Guidelines, manuals, guidelines, technical-quality standards and patient-safety standards, supported by dissemination, training and implementation activities.[10][3][8]
• Apply accreditation, supervision and verification to assess establishments, identify infrastructure and equipment needs, and align accreditation with wider quality-assurance arrangements.[25][9]
• Strengthen workforce capacity through certified programmes, competency development, national information on medical residencies, improved management of clinical placements, and coordination between health and education institutions.[14][15]
• Engage citizens through service-user feedback, citizen endorsement arrangements and commitment letters between community representatives and care units.[26][8]

Monitoring is intended to use sector-wide quality and patient-safety standards and indicators, continuously adapted evaluation and follow-up systems, reliable health information, performance assessment and feedback at all levels of the National Health System.[5][3][27]Accreditation, adverse-event reporting, risk-management reviews, compliance assessment against Mexican Official Standards, citizen feedback and monitoring of Clinical Practice Guideline use are identified as accountability and improvement mechanisms.[8][9][15]The programme includes annual monitoring for selected indicators, such as health-workforce planning, preventive training and specialist-training implementation.[18][28]

Selected 2013–2018 targets included raising compliance with Aval Ciudadano commitment letters from 63% in 2013 to 68% in 2018 and increasing the proportion of accredited eligible establishments from 69.87% to 90%.[29]The supplied material does not specify a total programme budget, comprehensive costed implementation plan, funding gap or detailed financing allocations, although it links federal financing to identified needs and compliance with quality and patient-safety standards.[9]

Monitoring & Evaluation

The programme establishes a quality-monitoring framework centred on strategic indicators, accreditation, process follow-up, reliable health information and feedback for continuous improvement across Mexico’s National Health System. It seeks to assess both the effectiveness of public policies and transversal dimensions of quality, safety, access, equity, timeliness and responsiveness.[5][30]

• Develop and continually adapt a sector-wide evaluation, monitoring and follow-up system for quality and patient safety, supported by standards, indicators and information technology for decision-making.[3]
• Use the National Health Evaluation System to generate reliable, timely information on the effects of health policies on population health, support policy reformulation and improve institutional performance.[23][20]
• Assess health establishments through accreditation, including standards on safety, effectiveness, accessibility, timeliness, equity and responsiveness to patient and community needs.[30][25]
• Monitor implementation of quality and safety actions through accreditation audits, evaluations, supervision, adverse-event reporting, risk-management assessment, compliance with Mexican Official Standards and feedback to state health services.[31][8][9]
• Use patient and community feedback through Aval Ciudadano, citizen commitment letters, complaints and service-user opinion to identify deficiencies in facilities, cleanliness, dignified treatment, waiting times and other aspects of care.[26][32][29]
• Assign monitoring roles to state health services, sanitary jurisdictions, state quality officials and the Directorate-General for Performance Evaluation, alongside the General Directorate of Quality and Health Education’s national coordination role.[33][19][21]

Available evidence shows that SICALIDAD used annual results opinions and its Performance Evaluation System to review implementation and financing. A 2012 external evaluation found broad awareness and application of its structures and tools, but no fully functioning national system for evaluating and comparing quality across health services.[34]

Historical indicators covered participation of medical units in SICALIDAD projects, budget execution, citizen representation, fulfilment of citizen commitments, quality-of-life surveys, patient-safety participation and infection-risk management.[35]Patient-safety project participation among public hospitals with at least 60 beds rose from 31.8% in 2008 to 84.9% in 2012, while 61.1% of Ministry of Health hospitals of this size had an infection-risk management model in 2012.[35]

The 2013-2018 framework specifies annual monitoring for several measures. Aval Ciudadano commitment-letter compliance was to be reviewed quarterly, with targets rising from 63% in 2013 to 68% in 2018.[29]The annual accredited-establishment target rose from 69.87% in 2013 to 90% in 2018.[29]Health-human-resources planning was also monitored annually using the National Health Information System, census data and population projections.[18]

Some indicator series require cautious interpretation because definitions and denominators changed, including accreditation measures and financed quality-project measures, while citizen-monitoring participation was voluntary.[36]Although the programme identifies accountability through transparency, citizen reporting, institutional follow-up and resource-allocation evaluation, many extracts do not specify universal numerical baselines, reporting schedules, independent assurance arrangements or detailed surveillance outputs.[5][3][15]

Costing & Financing

The programme emphasises efficient, transparent use of constrained financial, material and human resources to improve quality, safety, access and health-system sustainability, but provides limited explicit costing information.[23][20]

• Allocate resources to infrastructure, equipment, information quality, workforce development, accreditation, quality-improvement projects, training and operational research.[23][34]
• Use health-technology assessment, risk management, continuous improvement and integrated care models to improve efficiency, reduce response times and contain avoidable costs.[23][6][9]
• Link access to federal financing to identified needs and compliance with quality and patient-safety standards.[9]
• Increase investment in underserved services and improve coverage for catastrophic health expenditure to strengthen financial protection.[17]

SICALIDAD provided programme-budget support between 2007 and 2012 to medical units and central quality areas for quality commitments, awards, training, operational research and state quality forums. Its average budget for these activities was approximately 30 million Mexican pesos.[34]

The framework recognises financial pressure from restricted public financing, growing service demand, resource constraints and out-of-pocket spending by users of private services.[23][17]It defines catastrophic household health expenditure as health payments exceeding 40% of disposable household income.[17]

Budget transfers for some quality awards and prizes were not made where recipient institutions failed to meet regulatory requirements; from 2010, the related indicator counted only approved projects that received financing.[36]Beyond the identified SICALIDAD budget and catastrophic-expenditure threshold, the material does not specify total programme costings, expenditure allocations, financing-source amounts, funding-gap estimates, resource-mobilisation targets or economic assumptions.[34][17][9]