Programa De Acción Específico Enfermedades Cardiometabólicas 2019-2024

Objectives

The 2019–2024 Programme of Specific Action for Cardiometabolic Diseases integrates previously separate work on obesity, type 2 diabetes, cardiovascular risk and related conditions. It aims to prevent, detect, diagnose, treat and control obesity, type 2 diabetes, hypertension and dyslipidaemia among adults receiving first-level care, reducing morbidity, complications and mortality through a more effective, efficient and equitable National Health System.[1][2][3]

• Implement an integrated primary health-care model supported by Integrated Health Services Networks to improve access, continuity, quality, cultural appropriateness and non-discrimination in cardiometabolic care.[4][2]
• Promote healthier diets, physical activity, risk-factor awareness and recognition of early symptoms of diabetes, hypertension and acute myocardial infarction across the population, while giving particular attention to vulnerable and marginalised communities.[2][5]
• Strengthen timely detection, clinical follow-up, multidisciplinary management, rehabilitation and referral of complications, including acute myocardial infarction and end-stage chronic renal failure.[4][6][7]
• Improve food environments and support informed food purchasing through intersectoral action, front-of-pack labelling and initiatives addressing unhealthy diets and obesity.[3]
• Build health-worker competencies, introduce unified information systems and establish stewardship mechanisms for chronic cardiometabolic diseases within the National Health System.[2][8]

The programme is aligned with the National Development Plan 2019–2024, the Health Sector Programme 2020–2024, the National Strategy for the Prevention and Control of Overweight, Obesity and Diabetes, and Sustainable Development Goal 3 on reducing premature mortality from non-communicable diseases.[9][10][4]Its equity orientation includes universal and free access to health services, social assistance and medicines, founded on social participation, technical competence, medical quality and culturally appropriate, non-discriminatory care.[11]

The strategic rationale is the high and rising burden of cardiometabolic disease. Combined overweight and obesity prevalence among Mexican adults aged over 20 years was reported as 75.2% in the 2018–19 National Health and Nutrition Survey, while obesity, diabetes, hypertension and dyslipidaemia generate substantial health-service and household costs.[12][3]

Implementation

Implementation is centred on first-level services linked through Integrated Health Services Networks, combining population prevention with standardised, risk-stratified clinical care and specialist support. The programme uses the HEARTS strategy for hypertension and diabetes management and the Acute Myocardial Infarction Strategy, ¡AM Mx, to improve identification, transfer and timely treatment of myocardial infarction.[1][13]

• Deliver multidisciplinary chronic-disease care through primary-care units and specialised chronic-disease medical units, with teams that may include doctors, nurses, psychologists, nutritionists, social workers and physical-activity facilitators.[13][14]
• Use Diabetes Centres of Excellence networks, each linking a specialised chronic-disease unit with four to ten health centres, to strengthen prevention, timely detection and quality primary-care management.[15]
• Apply screening questionnaires, reinforce follow-up of positive results, support treatment entry, disseminate care algorithms, improve access to medicines and diagnostic procedures, and organise referral and counter-referral pathways.[16][17]
• Train first-level health professionals through a master training plan and public-health communication activities on healthy lifestyles, symptom recognition, timely service use and treatment adherence.[16][8][18]
• Coordinate transfers and distribution of resources for chronic cardiometabolic diseases transparently and equitably, while addressing requirements for infrastructure, trained personnel, multidisciplinary teams and medicine supplies.[13]

The Ministry of Health, the 32 State Health Services, first-level personnel, the Adult and Older Adult Health Programme, the Directorate-General for Health Promotion and other National Health System institutions have roles in delivery.[2][19]The extracts also identify the Mexican Social Security Institute, the Institute for Social Security and Services for State Workers, the General Directorate of Health Information and CENETRA as participating or reporting bodies for specified actions.[16][17][8]Technical support for HEARTS is associated with the Pan American Health Organization.[1]

Operational monitoring relies on unified information systems, including the Chronic Disease Information System for electronic nominal registration and follow-up, the National Health Information System Information Subsystem, and reporting on essential medicines and basic laboratory tests through ABASTONET.[15][20]Key quality measures include retention, effective consultation and health impact for diabetes and hypertension care.[15]Data systems are intended to support patient registration, service management, surveillance, trend analysis and evidence-based decision-making.[21]

Specified indicators include diabetes, hypertension, obesity and dyslipidaemia detection among people aged 20 years and over, as well as diabetes control, hypertension control, obesity-treatment control, staff training, premature mortality and acute myocardial infarction mortality.[22][23][24][25][26][27][20][18][28][29]Screening indicators are generally measured quarterly and disaggregated by sex, age group, national and federal-entity geography, and positive or negative result.[22][30]

All actions are to be financed from authorised budgets of participating spending bodies while the programme remains in force; the supplied material provides no total programme budget or allocation by activity.[10]

Monitoring & Evaluation

The programme establishes a monitoring architecture centred on unified information systems, routine screening and care-quality indicators, health-information platforms, and surveillance of chronic diseases and nutrition. It links monitoring to implementation through the National Health System, Integrated Health Service Networks, the Secretariat of Health, the Programme for Health in Adults and Older People, and CENETRA, although the extracts use inconsistent expansions for some institutional acronyms.[2][17][8][21]

• Monitor chronic cardiometabolic disease registration, individual follow-up and managerial performance through the Chronic Disease Information System, including electronic nominal records used by the Ministry of Health and the 32 State Health Services.[15]
• Assess diabetes and hypertension care using the Diabetes Care Quality Index and Hypertension Care Quality Index, which draw on patient retention, effective consultations and health impact.[15]
• Track availability of essential medicines and basic laboratory tests through the ABASTONET reporting system.[15]
• Harmonise data-capture forms and information systems to generate timely, reliable and linked chronic-disease information and indicators.[13]
• Support epidemiological surveillance of nutrition and epidemiological studies as part of non-communicable-disease prevention and control.[31]

The indicator framework covers detection, disease control, service capacity and mortality. Screening indicators measure completed diabetes, hypertension, obesity and dyslipidaemia detections against programmed detections among people aged 20 years and over for whom the Secretariat of Health is responsible.[22][32][33][34]Results are generally disaggregated nationally and across the 32 federal entities, by sex, age group and positive or negative screening result.[30][35][36][37]

• Measure diabetes detection quarterly, with a 2018 baseline of 27.7% and a 2024 target of 45%.[38][39]
• Measure hypertension detection quarterly, with a 2018 baseline of 28.3%, annual targets rising from 33% in 2020 to 45% in 2024, and reporting based on both positive and negative detections.[23][40][41]
• Measure obesity detections quarterly through the chronic-degenerative-disease risk-factor questionnaire; 9,322,502 positive and negative detections are reported, but the extract does not provide a clear percentage baseline or target.[24][36][42]
• Measure dyslipidaemia detection quarterly, but report conflicting figures across extracts: one series gives a 27.4% baseline in 2018 and a 45% target for 2024, whereas another gives a 7% baseline and 10% target.[25][43][44][45]

Care-control indicators assess glycaemic, blood-pressure and obesity-treatment outcomes. Diabetes control is defined as glycated haemoglobin below 7% and/or fasting plasma glucose of 70–130 mg/dl, while hypertension control is blood pressure below 140/90 mmHg; obesity control requires at least 5% loss of baseline body weight.[46][47][48]The supplied extracts contain differing baseline and target series for diabetes, hypertension and obesity control, so these values should be interpreted as distinct indicator specifications rather than consolidated programme totals.[26][27][20]

• Track diabetes control quarterly using SINBA-SIS, with one specification showing a 31.8% baseline in 2018 and a 45% target for 2024.[26][49][50]
• Track hypertension control using SINBA-SIS, with one specification showing a 62.8% baseline in 2018 and an 80% target for 2024.[27][51][52]
• Track obesity-treatment control using SINBA-SIS, with a 26.0% baseline in 2018 and a 40% target for 2024.[20][53][54]
• Track staff training every six months through the Institutional Information System; the calculation gives a 71.2% baseline, despite a source display of “712%”, and envisages progress towards 80%.[18][55][56][57]

Quarterly indicator data are collected for January to March, April to June, July to September and October to December, with availability in May, August, November and March of the following year respectively.[30][32][36][37]Mortality indicators use SINBA-SIS death records and National Population Council population projections, including premature diabetes and cardiovascular mortality and acute myocardial infarction mortality.[28][58][59]The programme also provides for inter-institutional monitoring of the HEARTS and IAM Mx strategies, transparency, accountability and oversight of chronic-disease targets.[6]However, the extracts do not specify an independent evaluation design, audit process, public reporting mechanism, corrective-action procedure, or comprehensive accountability consequences.[13][10][60]

Costing & Financing

Programme implementation is to be financed from the authorised budgets of participating spending bodies for the period in which the programme remains in force.[10]The extracts refer to transparent, effective, efficient and equitable transfer and distribution of financial resources for chronic cardiometabolic diseases, particularly for vulnerable populations.[13]They identify infrastructure, trained staff, multidisciplinary teams, medicines, diagnostic supplies and free care and medicines for people without social security as resource requirements or policy commitments.[13][2]

• Finance priority objectives, strategies, specific actions, implementation, operation, monitoring, reporting and inter-institutional coordination from authorised institutional budgets.[10]
• Provide resources for health infrastructure, human resources, multidisciplinary care teams and adequate medicine supply.[13]
• Prioritise equitable resource distribution and access for populations facing vulnerability or territorial barriers.[13][5]

No total programme budget, activity-level allocation, financing share, expenditure schedule, funding gap, additional resource-mobilisation mechanism or explicit economic assumption is specified in the supplied material.[10][4][16]The evidence nevertheless describes a substantial economic burden: obesity is estimated to account for 1–3% of health-care expenditure in most countries and 5–10% in the United States, while annual treatment of obesity- and overweight-related diseases in Mexico is estimated at approximately 3.5 billion US dollars.[61]Mexico’s reported total cost of overweight and obesity rose from 35,429 million Mexican pesos in 2000 to 67,345 million Mexican pesos in 2008, with a 2017 estimate of 150,860 million Mexican pesos.[61]

Cost evidence also indicates that outpatient diagnosis and treatment of prediabetes and type 2 diabetes cost approximately 6,659 Mexican pesos per patient annually in 2014–2016, while complications, particularly renal replacement therapy and transplantation, entail much higher costs.[62]The extracts characterise interventions addressing unhealthy diets and obesity, including school and workplace programmes, counselling, media campaigns, advertising regulation, nutrition support and food labelling, as cost-effective in the longer term, but provide no programme-specific cost-effectiveness estimates.[63]