Due to the lack of sufficient staff for community action (AC) created by the neoliberal period, today the few human resources are sent from the IMSS-Program of Welfare (PIB) to integrate – by decree and from above – the state health of the boards in which From April 2022 the appropriate presidential order on the federalization of healthcare.
This distorts the spirit of the primary health care (PHC) strategy. Not by forming a committee with the community and designing a local health diagnosis with it, that community will never see them again. This dilutes the sense of belonging in order to activate the true APS.
Of the states that Zoé Robledo – IMSS director general and responsible for the presidency – reports on in 25 Health Pulses (mornings, May-October), only Nayarit was part of the original BDP. Not Colima and Tlaxcala. In this census, the absence of the community factor is notable.
Ceremonial opening of the General Hospital in Tlaxcala ( The Economist7/14/22) Robledo assured that he wanted to guarantee a
minimum floor care and offering basic specialties. It is no longer APS. It is PIB-led medical care without experience in certain third-level services. The structural preventive component of PHC and AC disappears from his vision, while he strengthens the care of specialists.
APS calls for more community action to prevent disease with communities trained to take care of their own health. And then, with the community already diagnosed, the strengthening of the first level continues. This is what is urgent in a real APS.
The same applies to his statement (morning, 6/21/22) that AC is an aspect
little seen. Put like this, Robledo ignores that it stems from the PAN/PRI administration (2000-18) of BDP and that is exactly what he should be explaining. It
little seen it refers precisely to the PHC equipped with AC aimed at people/families and the way in which the community is involved as a preventive measure of disease.
However, for Robledo, CA culminates
improving one’s medical care by which he unsuspectingly ends up stoning what he intended to show: what
little seen of community action as a preventive tool. Effective CA culminates, rather, in improving the impact on what determines the health of the community. It does not improve medical care: it removes it for prevention. It is not her task to improve medical care, which the IMSS director still does not understand.
In addition to this poor outlook of the AC, he assumed (morning 6/21/22) that 240 health boards, 212 patient/relative education sessions for disease detection, 62 workshops for pregnant women, 309 cleaning days, 51 orchards and 32 garden of medicinal plants. But with what preventive effect? Where are the midwives and traditional healers?
Since Nayarit was part of the original GDP, it is clear that with the exponential expansion of services that the federalization of Andrés Manuel López Obrador (AMLO) entails, not 240, but five thousand health boards are needed! not one, but five additional regions, barely created, grow from one to 11 hospitals and from 92 to 260 first-level medical units.
So, the AC that – after 25 Pulses of Health – assumes Zoé Robledo is more unknown than certainty. His insistence on the lack of experts is unrelated to AC. Before, it should have been explained how many general practitioners are needed for the first level of service. Something he has not yet managed to establish in his haste to fulfill the order.
If this happens in Nayarit, what will happen in Oaxaca when, with AMLO’s federalization, it grows at the same rate as Nayarit?
This unusual Community NeoAction produced – hastily – by Robledo can also be seen in his speech (morning, 7/19/22) in which he admits that AC
It has a component that has begun to be sidelined and even downplayed: community involvement. All first level GDP units, more than 3500 rural medical units with CARA program. Is that true? It’s not. In Sánchez, Leal, Escobar and León, Community Action in IMSS-B. The operational visions of the second story (2021) document that the PAN/PRI administrations (2000-18) of the GDP completely medicalized the actions of CARA.
After 25 health pulses, it is clear that Robledo’s NeoAcción Comunitaria – as the main person responsible for the presidential commission – is not APS: it is more welfare. It is not 4T and it does not inaugurate a new health regime.
In order to ensure the sustainability of AMLO’s mandate, it is essential to design a federal model of care that is truly based on PHC. Something recently published by Mas-Bienestar ( Official Gazette of the Federation10/25/22): Decreeing health boards from above does not lead to automatic federalization.