Gustavo Nigenda

• Universidad Autónoma del Estado de Morelos

Background Tackling social impacts derived from gender disparities is a pathway to universal health coverage (UHC). Gender intersects with other factors behind social and health inequalities, exacerbates them and influences health systems’ performance. However, there is scarcity of gender-based studies that assess the social and economic impacts of...

Background The model of obstetric care predominant in Mexico in most public and private healthcare institutions is particularly focused on a physiological perspective of the female body that does not respond to women's need for emotional comfort and satisfaction. In the last decade, however, various initiatives that provide obstetric care centered...

Background: Equitable health service utilization is key to health systems' optimal performance and universal health coverage. The evidence shows that men and women use health services differently. However, current analyses have failed to explore these differences in depth and investigate how such gender disparities vary by service type. This study...

Background Despite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10–54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reprod...

Background The role of human resources for health in the operation of health systems is crucial. However, training and incorporating them into institutions is a complex process due to the continuous misalignment between the supply and demand of health personnel. Taking the case of the Latin American and Caribbean region countries, this comment disc...

Resumo: Objetivo: Este estudo tem como objetivo descrever um conjunto de indicadores relacionados ao mercado de trabalho de enfermagem em seis países da América Latina, a fim de identificar padrões comuns e aspetos únicos entre eles. Métodos: Foi realizado um estudo quantitativo, descritivo e transversal em 2021. A população do estudo consistiu em...

Objetivo Explorar la percepción de los profesionales de enfermería respecto a los facilitadores y las barreras para la implementación de funciones ampliadas de enfermería en una entidad federativa de México. Métodos Estudio cualitativo de tipo descriptivo con enfoque fenomenológico. Durante el 2022 se realizaron 18 entrevistas semiestructuradas a...

The Mexican government implemented a strategy to increase nursing staff in response to COVID-19, including the early graduation of university students, to incorporate them into the care frontline. This exploratory qualitative study aimed to analyze nursing students’ experiences recruited by health institutions to care for COVID patients. It include...

Resumen El gobierno mexicano, como parte de la respuesta al COVID-19, puso en juego una estrategia para aumentar la dotación de personal de enfermería que incluyó la graduación prematura de estudiantes universitarios para incorporarlos en el frente de la atención. El objetivo del estudio fue analizar las experiencias de estudiantes de enfermería co...

Background: There is scarce gender-disaggregated evidence on the burden of disease (BD) worldwide and this is particularly prominent in low- and middle-income countries. The objective of this study is to compare the BD caused by non-communicable diseases (NCDs) and related risk factors by gender in Mexican adults. Methods: We retrieved disabilit...

Latin America has experienced a rise in noncommunicable diseases (NCDs) which is having repercussions on the structuring of healthcare delivery and social protection for vulnerable populations. We examined catastrophic (CHE) and excessive (EHE, impoverishing and/or catastrophic) health care expenditures in Mexican households with and without elderl...

Background The influence of the work environment on missed care and service quality has been well documented. However, available evidence concerning this relationship comes mostly from developed countries. Few studies have been conducted in low- or middle-income countries. We assessed the relationship between the work environment and missed nursing...

Introduction It has been widely recognized that adolescents exhibit a low coverage rate for continuous maternal health services as a result of structural social disadvantages, often exacerbated by age-related discrimination. Notwithstanding its importance, this fact has received little attention during quantitative evaluations of health system perf...

El resumen ejecutivo que aquí se presenta ofrece información sobre los principales resultados y recomendaciones derivadas de un proyecto de investigación realizado entre 2019 y 2021, el cual tuvo como propósitos realizar un análisis integral del problema de depresión y trastorno de ansiedad de la población adolescente y joven de 14 a 20 años de las...

Objective: To assess the status of missed nursing care and the reasons for its occurrence in a highly specialised public hospital in Mexico. Materials and methods: An observational cross-sectional analysis with data collected from January to June 2019 at the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra in Mexico City. We ass...

The COVID-19 pandemic has placed nursing at the forefront of public attention across the globe and has highlighted the critical role of nursing in healthcare service provision. Advanced practice nursing has been recognized for more than 50 years, but the rate of its growth and development varies significantly across the world. One of the key aims o...

Introduction We examined the continuum of maternal health care by identifying the relationships among four maternal and reproductive health behaviors in Mexican primiparous adolescents and young adults: using preconceptional contraceptive methods (PreCs), frequently using skilled and timely antenatal-care (ANC) services with adequate contents, usin...

Introduction This paper analyzes the current sexual and reproductive health (SRH) situation of Mexican women according to their ethnic status and evaluates the effects, achievements, and challenges of relevant policies, programs, and interventions implemented over the last 25 years. Methods A repeated, retrospective cross-sectional study based on...

Background The close link between human resources for health and the performance of health systems calls for a comprehensive study of the labor market. This paper proposes a performance metric for the nursing labor market, measures its magnitude and analyzes its predictors over the last 15 years. Design and methods A repeated cross-sectional analy...

Background Mexico has learned much from its five decades educating nurses, moving from nurses educated mostly at the technical degree level, to bachelor's degree prepared nurses educated in universities. Several salient lessons have emerged that may prove relevant for other countries seeking to increase their numbers of bachelors prepared nurses. T...

Introduction This paper examines ethnic disparities in the effective coverage (EC) of maternal healthcare for interventions carried out among Mexican women in the last decade. It also explores the proportion of this gap that can be explained by observable characteristics in indigenous and nonindigenous women, as well as by structural discrimination...

Background . Despite its direct relevance to quality of care, little is known about missed nursing care or its sociodemographic and work environment correlates at highly specialized hospitals in low- and middle-income countries. Objective . To analyze the frequency of missed nursing care among Mexican nursing professionals, and to assess its assoc...

This article examines the coverage in the continuum of antenatal-postnatal care for vulnerable women in Mexico according to indigenous status, and assesses the influence of public health insurance strategies on the evolution of coverage over the last 25 years. We studied a total of 19,613,567 Mexican women, aged 12-54 years at last birth, based on...

In order to achieve the Sustainable Development and Health Goals, it is essential to increase the technological capacity of the most disadvantaged populations. In the 21st century, the necessary technologies for this exist. The gap in technological capacity reflects the existence of a technological gradient between large- and smallscale production,...

Aim To compare the Advance Practice Nursing development in Mexico with the United Kingdom. Background In spite of the involvement of global and local bodies to establish and develop Advance Practice Nursing worldwide, progress remains variable due to the lack of homogeneity in healthcare systems and policies. Evaluation Using thematic analysis fr...

Objective: To describe the temporal and geographical patterns of the continuum of maternal health care in Mexico, as well as the sociodemographic characteristics that affect the likelihood of receiving this care. Methods: We conducted a pooled cross-sectional analysis using the 1997, 2009, 2014 and 2018 waves of the National Survey of Demographi...

Providing evidence on mental disorders in indigenous adolescents is critical to achieving universal health coverage (UHC). The prevalence of symptoms of depression and generalized anxiety disorder symptoms were estimated for 2082 adolescents aged 14–20 years in Chiapas, Mexico. Mental disorders were assessed using the 9-item Patient-Health Question...

Background The available literature suggests that diverse factors, including sociodemographic, academic, psychological, and occupational, can have impacts on nursing students’ academic performance. Therefore, it follows that the institutional environment can mediate on these influences. Objective Based on a 10-years student performance follow-up i...

Through quantitative and qualitative methods, in this article the authors describe the perspectives of indigenous women who received antenatal and childbirth medical care within a care model that incorporates a non-governmental organisation (NGO), Partners in Health. They discuss whether the NGO model better resolves the care-seeking process, inclu...

RESUMEN Para lograr los objetivos de desarrollo y salud sostenibles, es esencial incrementar las capacidades tecnológicas de las poblaciones más desfavorecidas. Entrado el siglo XXI, existen las tecnologías necesarias para ello. El déficit en capacidades tecnológicas se debe a la existencia de un gradiente tecnológico entre la producción de gran y...

Ensuring regular and timely access to efficient and quality health services reduces the risk of maternal mortality. Specifically, improving technical efficiency (TE) can result in improved health outcomes. To date, no studies in Mexico have explored the connection of TE with either the production of maternal health services at the primary-care leve...

Objective: The study hopes to contribute to the analysis of political, technical and social dimensions and sub-dimensions that affect the processes of adjustments to the health system model based on the renewed PHC (Primary Health Care) strategy, at the regional (meso) and local levels. (micro), levels where problems and obstacles are externalized...

Introduction Cancer Survivorship is a growing public health challenge. Effective responses from health care and social services depend on appropriate identification of survivors and their families´ specific needs. There are few studies on survivorship in low and middle-income countries, therefore, more evidence-based studies are necessary to develo...

Objective: To analyze the viability of incorporating genomic medicine technology into the process of detecting and diagnosing chronic non-communicable diseases (CNCDs) at primary-care facilities in Mexico, and to discuss its implications for health systems in other countries with similar characteristics. Material and methods: We conducted 29 sem...

‘Social efficiency’ (SE) denotes the capacity of health systems to ensure equitable access to quality health services at no financial risk to users. Mexico and other low- and middle-income countries have rarely studied the performance of their health systems from an SE perspective. We propose a metric for assessing SE in the production of maternal...

This paper aims to analyze the regulatory structure of nursing in Mexico through its legislation and perspectives of participant stakeholders. A case study was undertaken using qualitative and quantitative data sources, as well as from the review of official documents. The analysis included data from the sources according to the four realms propose...

Background: Over the last two decades, the Mexican government has released several efforts to achieve universal health coverage (UHC), based on the principles of fairness and social protection, to reduce the inequities in utilization, access, and quality of care existing in the health system. Two of the most important social public policies that h...

Background: Precarization of labor conditions has been expanding over the last three decades as a consequence of global economic transformations. The health workforce labor market is exposed to these transformations as well. In Mexico, analyses of the nursing labor market have documented high levels of unemployment and underemployment; however, pr...

We explored the role of men in supporting women with breast cancer (BC). We used a set of qualitative, exploratory studies conducted between August 2008 and March 2013 in six states in Mexico with women diagnosed with BC, their male partners, directors of civil society organizations engaged in BC and health service providers. Information was collec...

Objective: To analyze the barriers that indigenous women face in access to the network of obstetric services in the context of the implementation of integrated healthcare networks (IHN). Method: We designed a cross-sectional descriptive study including quantitative and qualitative methods. Sampling was intentional, no probabilistic. Data collect...

Objective To understand non-adherence to medically recommended diets among Mayans with diabetes. Design Using partially sequential mixed methods, questionnaires, semi-structured brief and in-depth interviews were applied. Questionnaire data were analysed with Pearson’s χ² and Student’s t tests and qualitative interviews with grounded theory microa...

Objective To analyze the formation of spatial clusters of technical efficiency (TE) in the production of outpatient maternal health services in México for the period 2008 to 2015. Methods We performed a longitudinal analysis of administrative and structural data related to the 243 Mexican health jurisdictions. We use window data envelopment analys...

We explored the role of men in supporting women with breast cancer (BC). We used a set of qualitative, exploratory studies conducted between August 2008 and March 2013 in six states in Mexico with women diagnosed with BC, their male partners, directors of civil society organizations engaged in BC and health service providers. Information was collec...

Introducción Llevar a cabo un estudio piloto para examinar el clima laboral de las enfermeras en México utilizando un instrumento comparable internacionalmente. Métodos La versión en español de la Escala de Práctica Ambiental del Índice de Trabajo de las Enfermeras fue el instrumento usado en este investigación. Un estudio piloto transversal de 45...

We assess technical efficiency (TE) level for Mexican Ministry of Health (MoH) primary care units. Assessment was focused on the production of adequate maternal health services defined as the coverage level of women who received timely and frequent antenatal care, and institutional and medical care during childbirth. We conducted a longitudinal ana...

This study contributes with original empirical evidence on the distributional and welfare effects of one of the most important health policies implemented by the Mexican government in the last decade, the Seguro Popular de Salud (SPS). We analyze the effect of SPS on households’ welfare using a decomposable index that considers insured and uninsure...

Predictors of participation in Seguro Popular de Salud (SPS). Note: Matching process was performed using single nearest neighborhood algorithm including: caliper = 0.001, non-replacement and common support. ΦAt municipality level. φProxy of household socioeconomic level. (DOCX)

Bias reduction and common support after propensity scores matching. A. Standardized bias (%) B. Propensity score histogram Note: Matching process was performed using all variables in Table 1 and using single nearest neighborhood algorithm including: caliper = 0.001, non-replacement and common support. HH: Head of household. (TIF)

OOP health payments dominance curves. (DOCX)

Decomposing distributional welfare impacts into subgroups. (DOCX)

This study analyzes the conduction patterns of implementing Primary Health Care (PHC) in Paraguay in three government periods (2008-2012, 2012-2013 and 2013-2017) and three management levels (national, regional and local). This is a qualitative study based on grounded theory. A priori categories on PHC stewardship and governance in Paraguay were an...

En 2015 se llevó a cabo el estudio de brechas en recursos humanos en primer nivel de atención. Los resultados del estudio mostraron la existencia de distintos tipos de brechas en relación a la disponibilidad de los recursos humanos y su relación con la carga de la enfermedad, la demanda de atención por servicios, la disponibilidad estatal y la capa...

Background The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. Methods We conducted a cross-sectional observationa...

The introduction of Seguro Popular de Salud (SPS) expanded the practice of contracting in the Mexican health system. Specifically, SPS established that formal relationships among institutional agencies should be mediated by written agreements and contracts. These contracts were supposed to ensure a technically sound interaction between financing an...

Objective: To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. Methods: We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis techniq...

This study provides evidence for those working in the maternal health metrics and health system performance fields, as well as those interested in achieving universal and effective health care coverage. Based on the perspective of continuity of health care and applying quasi-experimental methods to analyse the cross-sectional 2009 National Demograp...

In Latin America and the Caribbean (LAC), the sexual and reproductive health (SRH) of populations is a high priority for governments. Health information technologies (HITs) have been proposed as tools to close access gaps for SRH services. We developed an “evidence map” through a systematic search of articles published between 2005 and 2015 about t...

Objetivo: Analizar indicadores de eficiencia de los recursos humanos (RH) de la Secretaría de Salud de México. Material y métodos: Utilizando información secundaria se exploraron tres dimensiones de eficiencia: a) desperdicio de fuerza laboral, b) distribución de RH entre niveles de atención, y c) productividad. Resultados: El grupo de trabajador...

El presente documento ha sido elaborado desde la óptica de los sistemas de salud, priorizando los aspectos conceptuales relacionados con el mercado laboral de los recursos humanos de la salud, con el fin de discutir desde ese marco de referencia la importancia de la incorporación de las parteras técnicas/profesionales en el continuo de la salud sex...

Background The recent increase of breast cancer mortality has put on alert to most countries in the region. However it has taken some time before breast cancer could be considered as a relevant problem. Only in recent years breast cancer has been considered a priority in some Latin American countries and resources have been mobilized to confront th...

Background: In 2003, Mexico's Seguro Popular de Salud (SPS), was launched as an innovative financial mechanism implemented to channel new funds to provide health insurance to 50 million Mexicans and to reduce systemic financial inequities. The objective of this article is to understand the complexity and dynamics that contributed to the adaptation...

We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio -adjusted by coverage of adequate ANC- observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with a...

Objective: This study aimed to describe the ways social support works in the daily life of patients with type 2 diabetes living in conditions of social and economic marginality, in order to understand how that support relates to treatment compliance. Methods: Sequential mixed methods research was used. The sample of patients was obtained from pr...

Projections are considered a useful tool in the planning of human resources for health. In Mexico, the supply and demand of specialist doctors are clearly disconnected, and decisions must be made to reduce labour market imbalances. Thus, it is critical to produce reliable projections to assess future interactions between supply and demand. Using a...

Objetivo. Conocer la percepción que los estudiantes de salud pública en México y en Co-lombia tuvieron sobre el manejo de la epidemia de influenza A (H1N1), como una forma para indagar qué contenidos curriculares pueden ser mejorados en la formación en epidemiología. Métodos. Encuesta durante la epidemia, entre junio y agosto de 2009, a estudiantes...

In 2012, the Mexican government declared that Seguro Popular had reached the goal of providing health insurance to nearly 53 million individuals previously not enrolled with social security. This major achievement was reached in only nine years of operation of the new system. However, enormous challenges remain to guarantee that Seguro Popular will...

Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countrie...

Cada año se incrementa el número de mujeres que son diagnosticadas con cáncer de mama (Cama), tanto en países desarrollados como países en desarrollo. De esta manera, el Cama se ha convertido paulatinamente en la neoplasia maligna más fuerte en mujeres, desplazando a otros cánceres como el cervicouterino. Hoy en día la sociedad se enfrenta a un pr...

The role that human resources for health should play in future stages of the Mexican Health System reform is discussed. The following dimensions are considered to guide the discussion: the orientation of training, the institutions responsible for training, the mechanisms to link graduates to health institutions and the ways health workers should re...

One third of the primary care units in the public system keeps being covered exclusively by interns. It is shown that with the resources available in the System for Social Protection in Health it is possible to hire graduate health personnel for all Ministry of Health rural units. It is necessary to modify the current legislation to impede an inter...

Una tercera parte de las unidades de atención primaria del sistema público continúa siendo cubierta exclusivamente por pasantes. Se demuestra que con los recursos del Sistema de Protección Social en Salud es posible contratar personal de salud profesional para todas las unidades rurales de la Secretaría de Salud. Es necesario modificar la regulació...

The role that human resources for health should play in future stages of the Mexican Health System reform is discussed. The following dimensions are considered to guide the discussion: the orientation of training, the institutions responsible for training, the mechanisms to link graduates to health institutions and the ways health workers should re...

To estimate human resources (HR) needed to deliver prevention and health promotion actions to the population of 20 years and more in units of primary health care (UPHC). We included 20 UPHC; one urban and one rural for each of the ten selected Mexican states. HR were estimated based on the time to do prevention and health promotion activities, from...

Objetivo. Estimar los recursos humanos (RH) para brindar acciones de prevención y promoción de la salud a la población de 20 años o más en unidades de primer nivel de atención (UPA). Material y métodos. Se incluyeron 20 UPA, una urbana y otra rural, por cada uno de los diez estados seleccionados de la República mexicana. Los RH se estimaron en func...

México alcanzará la cobertura universal en salud en 2012. El seguro nacional de salud denominado Seguro Popular, introducido en 2003, garantiza el acceso a un paquete de servicios de salud integrales con protección financiera a más de 50 millones de mexicanos previamente excluidos de la seguridad social. La cobertura universal en México es sinónimo...

The aim of this study was to identify groups of users according to their degree of satisfaction with geriatric care services and determine the primary factors associated with satisfaction. This was a cross-sectional study of 181 people enrolled in 36 modules pertaining to the State Workers Social Security Institute (ISSSTE) in Mexico. Degree of sat...

Objective: To understand the public policy-making process as it relates to breast cancer care in five Latin American countries. Methods: An exploratory-evaluative study was conducted in Argentina, Brazil, Colombia, Mexico, and Venezuela in 2010, with the selection of countries based on convenience sampling. Sixty-five semi-structured interviews...

OBJECTIVE: To understand the public policy-making process as it relates to breast cancer care in five Latin American countries. METHODS: An exploratory-evaluative study was conducted in Argentina, Brazil, Colombia, Mexico, and Venezuela in 2010, with the selection of countries based on convenience sampling. Sixty-five semi-structured interviews wer...

Objective: This article describes the experience of the aval ciudadano "Citizens' Representative" (CR) in improving the Mexican health care system. Methods: This is a qualitative study which took place in eight Mexican states in 2008. It evaluates different aspects of a nationwide program to increase the quality of health care services (National...

El concepto de salud pública ha sido abordado desde tiempos antiguos y ha tenido muchas aceptaciones a lo largo de la historia. Un punto de vista más contemporáneo sustenta que el adjetivo "pública" no representa un conjunto de servicios en particular, ni una forma de propiedad, ni un tipo de problema; más bien hace referencia a un nivel de análisi...

La implantación del SPSS ha sido un proceso escalonado en su cobertura geográfica, paulatino en el ritmo de afiliación de la población blanco y fraccionado en términos de su potencial impacto en términos de los beneficios otorgados por la prestación de los servicios de salud. El dinamismo vinculado al mejoramiento de los procesos administrativos y...

The process of regularization of workers paid by the Social Protection Health System of Mexico is described and analyzed. Primary and secondary data collected by the external evaluation of the Mexican System for Social Protection in Health in 2009 were used. The regularization clearly improved the labor conditions of workers contracted by the syste...

OBJECTIVE: The process of regularization of workers paid by the Social Protection Health System of Mexico is described and analyzed. MATERIALS AND METHODS: Primary and secondary data collected by the external evaluation of the Mexican System for Social Protection in Health in 2009 were used. RESULTS: The regularization clearly improved the labor co...

Background Here, the educational and labour market characteristics of Mexican dentists are revised. Dentistry is a health profession that has been scarcely studied in developing countries. This analysis attempts to understand the relationships and gaps between the supply and demand of dentists in the country. Around 5000 new dentists graduate every...

Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with socia...

A pesar de los esfuerzos del Gobierno Federal y de los Gobiernos Estatales para ampliar la cobertura y el acceso a la atención médica, a comienzos del siglo XXI aún existían más de 50 millones de mexicanos que carecían de un sistema formal de protección en materia de salud. Entre otras consecuencias negativas, la falta de protección social en salud...

ABSTRACT: One of the components of the Health Observatory for Latin American and the Caribbean (HO-LAC) is the design and implementation of metrics for human resources for health. Under the HO-LAC initiative, researchers from nine countries in the region formed the Collaborative Community on Human Resources for Health in Latin America and the Carib...