Mexico
Policies and programmes have generated large increases in the health workforce,33 beginning with the 1995 Health Sector Reform (1995–2000), which established agreements with educational institutions for the training of human resources and increased the number of health workers nationwide.34 The coverage expansion programme (PAC) initiated in 1996 to address accessibility employed thousands of workers to support health activities in underserved areas. Staff remuneration was initially covered by loans from the Inter-American Development Bank, but the health ministry committed to paying wages in subsequent phases of the programme. In 2002 the PAC was integrated into the new Programa de Calidad, Equidad y Desarrollo en Salud (PROCEDES) [Programme for Quality, Equity and Development in Health].35,36 The Sistema de Protección Social en Salud (SPSS) [System for Social Protection in Health] and the Seguro Popular de Salud (SPS) [Popular Health Insurance] were created in 2003 to pursue the goal of UHC, with encouraging results across all AAAQ domains.37
The number of nurses and physicians increased over 1990–2009. More than 250 000 additional professionals were trained and the 80% increase in nurses and the 170% increase in physicians outstripped the population growth of 30%. In the same period, infant mortality and under-five mortality more than halved: from 32.6 to 14.6 per 1000 live births and from 41 to 17.8 per 1000 live births, respectively.38–41 Maternal mortality fluctuated over the period but was reduced by more than 50% overall, according to data from 2011.42
Attrition between education and employment is an important workforce problem that remains to be addressed. According to an analysis of the 2008 Encuesta Nacional de Ocupación y Empleo (ENOE) [National Survey of Occupation and Employment], 87% of physicians are employed, but of those who are, approximately 10% work outside the health sector. Thus, nearly one in every five physicians is not participating in the health labour market, a rate that requires further scrutiny in light of the growing private sector for medical education. In 1990, only 7% of medical students were in private schools, but by 2010 the proportion had risen to 20%. Of the 27 new medical schools established during this period, five are publicly funded and the other 22 are funded by private investments.43–45