In the first three weeks of January 2020, a group of 8 Harvard students and 5 Mexican students participated in the seventh year of the GHP Winter Session Course on the Mexican Health System. The course introduced participants to the history of Mexico’s health reform, Seguro Popular, and the ongoing major restructuring of the Mexican health system, which includes elimination of Seguro Popular.
Adopted in 2003, Seguro Popular provided financing for a comprehensive and specific package of health services to over 50 million Mexicans who previously lacked insurance. The new government of President Andres Manual Lopez Obrador, which began its term in December 2018, revised the National Health Law to remove Seguro Popular and in January 2020 created a new health agency called Instituto de Salud para el Bienestar (INSABI) or the Institute of Health for Wellbeing. This year’s course gave students direct knowledge about the challenges and uncertainties of major health system reform in Mexico.
During the first week of the course, the group travelled to the southern state of Chiapas, the poorest in Mexico. In Chiapas, the students learned about the complexity of health services in Mexico’s periphery through site visits to the autonomous Zapatista community of Oventic, a tertiary pediatric hospital in the capital city of Tuxtla Gutierrez, various health facilities in the multicultural city of San Cristobal and nearby San Juan Chamula, and the rural community of Jaltenango, where Partners in Health Mexico is based.
The course spent the next two weeks in Mexico City observing public health practice and policy experience through seminars and discussions with key decision makers and stakeholders from leading governmental institutions, non-governmental organizations, and private companies. In our seminars, we met with the current and former Vice Ministers of Health, with the medical director of a major multinational pharmaceutical company, with the President of FUNSALUD, the Director of Economic Benefits at IMSS (social security for the private sector), the director of Mexico City’s public clinic for persons with HIV, the Minister of Health for Mexico City, the former director of Mexico’s National Cancer Institute, and top academic researchers involved with health law, pharmaceutical policy, and nurses in the health system.
Students also joined three applied research projects during the two weeks in Mexico City. The teams were embedded in health organizations to work under policy leaders on a focused problem-solving exercise. The students presented their reports and findings on the final day of the course, in front of the supervisors and colleagues from the host organizations.
The students from Harvard included people from several departments and programs at the School of Public Health (GHP, SBS, HPM, and clinical effectiveness), as well as from the Kennedy School and the Divinity School. The Mexican participants included a practicing hematologist/oncologist, a law school graduate, current Masters and Doctoral students from the National Institute of Public Health, and a medical doctor with experience in quality improvement organizations. The diversity of participants and their experiences added much to the formal discussions and informal interactions.
The course is co-taught by Research Professor Michael R. Reich and Adjunct Associate Professor Martin Lajous. The Teaching Fellow for the course is Mario H. Flores, a first year PhD student in Population Health Sciences.