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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 Demographic Dynamics, collating sociodemographic and obstetric characteristics of 93 745 women aged 12-54 years at last delivery. We defined eight variables along the antenatal-postnatal continuum, both independently and conditionally. We used a pooled fixed-effects multivariable logistic model to determine the likelihood of receiving the continuum of care for various properties. We also mapped the quintiles of adjusted state-level absolute change in continuum of care coverage during 1994-2018. Findings We observed large absolute increases in the proportion of women receiving timely antenatal and postnatal care (from 48.9% to 88.2% and from 39.1% to 68.7%, respectively). In our conditional analysis, we found that the proportion of women receiving adequate antenatal care doubled over this period. We showed that having social security and a higher level of education is positively associated with receiving the continuum of care. We observed the largest relative increases in continuum of care coverage in Chiapas (181.5%) and Durango (160.6%), assigned human development index categories of low and medium, respectively. Conclusion Despite significant progress in coverage of the continuum of maternal health care, disparities remain. While ensuring progress towards achievement of the health-related sustainable development goal, government intervention must also target underserved populations. Objectif Decrire les schemas geographiques et temporels de la continuite des soins de sante maternelle au Mexique, ainsi que les caracteristiques sociodemographiques qui determinent la probabilite de recevoir de tels soins. Methodes Nous avons effectue une analyse transversale combinee fondee sur les editions 1997, 2009, 2014 et 2018 de l'Enquete nationale sur la dynamique demographique, et compile les donnees sociodemographiques et obstetriques de 93 745 femmes agees de 12 a 54 ans lors de leur dernier accouchement. Nous avons identifie huit variables au fil de la continuite prenatale et postnatale, tant de maniere independante que conditionnelle. Puis nous avons employe un modele logistique multivarie a effets fixes combines pour determiner la probabilite de beneficier de cette continuite des soins pour diverses proprietes. Enfin, nous avons cartographie les quintiles d'ecart absolu ajuste au niveau national dans la continuite de la couverture durant la periode comprise entre 1994 et 2018. Resultats Nous avons observe d'importantes augmentations reelles dans le pourcentage de femmes faisant l'objet de soins prenatals et postnatals au moment opportun (de 48,9% a 88,2% et de 39,1% a 68,7% respectivement). Notre analyse conditionnelle a revele que la proportion de femmes ayant recu des soins prenatals adaptes a double au cours de cette periode. Nous avons demontre que le fait d'avoir une securite sociale et un niveau d'education plus eleve etait associe a une amelioration de l'acces a la continuite des soins. Ce sont les Etats de Chiapas (181,5%) et de Durango (160,6%) qui ont connu les plus grandes augmentations relatives en matiere de continuite des soins, le premier appartenant a la categorie faible de l'indice de developpement humain, et le second a la categorie moyenne. Conclusion Malgre les progres considerables realises dans la couverture d'une continuite des soins de sante maternelle, des inegalites subsistent. Le gouvernement doit continuer a tendre vers l'objectif de developpement durable lie a la sante tout en focalisant son intervention sur les populations mal desservies. Objetivo Describir los patrones temporales y geograficos de la continuidad de la atencion sanitaria materna en Mexico, asi como las caracteristicas sociodemograficas que afectan a la probabilidad de recibir esta atencion. Metodos Realizamos un analisis transversal conjunto utilizando las curvas de 1997, 2009, 2014 y 2018 de la Encuesta Nacional de la Dinamica Demografica (ENADID), cotejando las caracteristicas sociodemograficas y obstetricas de 93.745 mujeres de 12 a 54 anos en el ultimo parto. Definimos ocho variables a lo largo de la continuidad prenatal-postnatal, tanto de forma independiente como condicionada. Utilizamos un modelo logistico multivariable de efectos fijos combinados para determinar la probabilidad de recibir la continuidad de la atencion para diversas propiedades. Tambien trazamos un mapa de los quintiles de cambio absoluto ajustado a nivel estatal en la cobertura de la continuidad de la atencion durante 1994-2018. Resultados Observamos grandes aumentos absolutos en la proporcion de mujeres que reciben atencion prenatal y postnatal oportuna (del 48,9% al 88,2% y del 39,1% al 68,7%, respectivamente). En nuestro analisis condicional, encontramos que la proporcion de mujeres que reciben atencion prenatal adecuada se duplico durante este periodo. Demostramos que tener seguridad social y un mayor nivel de educacion esta positivamente asociado con la recepcion de la atencion continua. Observamos los mayores incrementos relativos en la cobertura de la continuidad de atencion en Chiapas (181,5%) y Durango (160,6%), a los que se asignaron las categorias de indice de desarrollo humano de bajo y medio, respectivamente. Conclusion A pesar de los importantes progresos realizados en la cobertura de la continuidad de la atencion sanitaria materna, siguen existiendo disparidades. Al tiempo que se garantiza el progreso hacia el logro del objetivo de desarrollo sostenible relacionado con la salud, la intervencion del gobierno tambien debe dirigirse a las poblaciones desatendidas., Introduction Despite significant progress in the provision of maternal health care in low- and middle-income countries as a result of the millennium and sustainable developments goals (SDGs,1) significant challenges in [...]

Objective To analyse the effect of enrolment in the public health insurance scheme known as Seguro Popular [People's Insurance] on access to health resources, treatment and blood glucose control among poor adults with diabetes in Mexico. Methods We analysed cross-sectional data from the 2006 National Health and Nutrition Survey and compared health care access and biological health outcomes, specifically glycosylated haemoglobin (HbA1c) levels, among adults with diabetes who were enrolled in the Seguro Popular (treatment group) and those who had no health insurance (control group). Standard propensity score matching was used to create a highly comparable control group. Findings Adults with diabetes who were enrolled in the Seguro Popular had significantly more access than comparable uninsured adults to some type of blood glucose control test (by a difference of 9.5 percentage points; 95% confidence interval, CI: 2.4-16.6) and to insulin injections (3.13 more per week; 95% CI: 0.04-6.22). Those with insurance were also significantly more likely to have appropriately-controlled blood glucose levels (HbA1c [less than or equal to] 7%) than their uninsured counterparts (by a difference of 5.6 percentage points; 95% CI: 0.9-10.3). Very poor glucose control (HbA1c > 12%) was found in a significantly Smaller proportion of adults in the insured group than in the uninsured group (by a difference of 17.5 percentage points; 95% CI: 6.5-28.5). Conclusion The Seguro Popular appears to have improved access to health care and blood glucose control among poor adults with diabetes in Mexico, and it may have had a positive effect on the management of other chronic health conditions, but its long-term effects are yet to be demonstrated. Although the findings are most relevant to Mexico, they may also be applicable to other developing countries seeking to improve health-care coverage for the poor by expanding their public health insurance programmes. Objectif Analyser l'effet de la couverture par le schema d'assurance sante publique appele Seguro Popular (Assurance du peuple) sur racces aux ressources de sante, au traitement et au controle de la glycemie pour les adultes pauvres et diabetiques du Mexique. Methodes Nous avons analyse des donnees transversales provenant de l'Enquete nationale sur la sante et la nutrition de 2006 et compare l'acces aux soins de sante et les resultats biologiques, notamment les taux d'hemoglobine glyquee (HbA1c), chez des adultes diabetiques beneficiant de Seguro Popular (groupe traite) et chez des adultes diabetiques depourvus d'assurance sante (groupe temoin), On a fait appel a l'appariement par scores de propension standard pour constituer un groupe temoin hautement comparable. Resultats Les adultes diabetiques beneficiant de Seguro Popular disposaient d'un acces significativement plus important que les adultes comparables non assures a certains types de controles de la glycemie (difference de 9,5 points de pourcentage ; intervalle de confiance a 95 %, IC : 2,4-16,6) et aux injections d'insuline (3,13 de plus par semaine ;IC a 95 % : 0,04-6,22). Les individus assures avaient une probabilite significativement plus elevee de presenter une glycemie correctement controlee (HbA1c [less than or equal to] 7 %) que leurs homologues non assures (difference de 5,6 points de pourcentage ;IC a 95 % : 0,9-10,3). On a releve une proportion significativement plus faible d'adultes presentant un controle de la glycemie tres insatisfaisant (HbA1c > 12 %) dans le groupe assure que dans le groupe non assure (difference de 17,5 points de pourcentage ;IC a 95 % : 6,5-28,5). Conclusion l'assurance Seguro Popular semble avoir ameliore l'acces aux soins de sante et au controle de la glycemie pour les adultes pauvres et diabetiques du Mexique et pourrait avoir eu un effet positif sur la prise en charge d'autres maladies chroniques. Neanmoins, ses effets a long terme restent a demontrer. Si ces resultats concernent principalement le Mexique, ils peuvent aussi etre applicables a d'autres pays en developpement desireux d'ameliorer la couverture des plus demunis par les soins de sante a travers l'elargissement de leurs programmes d'assurance sante publique. Objetivo Analizar los efectos de la cobertura por el plan de seguro medico publico conocido como Seguro Popular en el acceso a los recursos de salud y el tratamiento y control de la glucemia entre los adultos pobres con diabetes en Mexico. Metodos Analizamos datos transversales de la Encuesta Nacional de Salud y Nutricion de 2006 a fin de comparar el acceso a la atencion de salud y el valor de variables biologicas, concretamente de los niveles de glucohemoglobina (HbA1c), en adultos con diabetes beneficiarios del Seguro Popular (grupo de tratamiento) y en una poblacion similar que carecia de seguro de enfermedad (grupo control). Se utilizo el metodo estandar de apareamiento segun propension para crear un grupo control altamente comparable. Resultados Los adultos con diabetes beneficiarios del Seguro Popular disfrutaron de un acceso significativamente mayor que los adultos no asegurados comparables a algun tipo de prueba de control de la glucemia (diferencia de 9,5 puntos porcentuales, con un intervalode confianza, IC, del 95% de 2,4-16,6) y a inyecciones e insulina (3,13 mas por semana; IC95%: 0,04-6,22). Los acogidos al seguro tenian tambien una mayor probabilidad de presentar una glucemia bien controlada (HbA1c [menor que o igual a] 7%) que sus homologos no asegurados (diferencia de 5,6 puntos porcentuales; IC95%: 0,9-10,3). En el grupo asegurado se observo que la proporcion de adultos con un control muy deficiente de la glucosa (HbA1c > 12%) era significativamente inferior a la hallada en el grupo no asegurado (diferencia de 17,5 puntos porcentuales; IC95%: 6,5-28,5). Conclusion El Seguro Popular parece haber mejorado el acceso a la atencion de salud y el control de la glucemia entre los adultos pobres con diabetes de Mexico, y puede haber tenido un efecto positivo en el tratamiento de otras dolencias cronicas, pero quedan por demostrar sus efectos a largo plazo. Aunque los resultados son de especial interes para Mexico, posiblemente pueden aplicarse tambien a otros paises en desarrollo que aspiran a mejorar la cobertura de atencion sanitaria de la poblacion pobre ampliando sus programas de seguro medico publico., Introduction Lack of health insurance can deprive the poor of access to services or put them at risk of financial hardship. To protect the poor against excessive health expenditures, many [...]

Introduction: The objective of this article is to present the rationale and baseline results for a randomized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection (STI) risk among male sex workers (MSWs) in Mexico City. Methods: Participants (n =267) were tested and treated for STIs (chlamydia, gonorrhoea, syphilis and HIV) and viral hepatitis (hepatitis B and C), received HIV and STI prevention education and were randomized into four groups: (1) control, (2) medium conditional incentive ($50/six months), (3) high conditional incentive ($75/six months) and (4) unconditional incentive ($50/six months). In the conditional arms, incentives were contingent upon testing free of new curable STIs (chlamydia, gonorrhoea and syphilis) at follow-up assessments. Results: Participants' mean age was 25 years; 8% were homeless or lived in a shelter, 16% were unemployed and 21% lived in Mexico City less than 5 years. At baseline, 38% were living with HIV, and 32% tested positive for viral hepatitis or at least one STI (other than HIV). Participants had a mean of five male clients in the previous week; 18% reported condomless sex with their last client. For 37%, sex work was their main occupation and was conducted mainly on the streets (51%) or in bars/discotheques (24%) and hotels (24%). The average price for a sex transaction was $25 with a 35% higher payment for condomless sex. Conclusions: The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs, given the market-based inducements for unprotected sex. This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts. Keywords: male sex workers; men who have sex with men; conditional cash transfer; conditional economic incentives; HIV/STI prevention; risk premium; compensating differential; Mexico., Introduction Mexico, a country of 112 million people, has a concentrated HIV epidemic [1] with an HIV prevalence of 0.3% in the adult population (15-49 years), 16.9% among men who [...]

Background: In this study, we described facility-level voluntary medical male circumcision (VMMC) unit cost, examined unit cost variation across facilities, and investigated key facility characteristics associated with unit cost variation. Methods: We used data from 107 facilities in Kenya, Rwanda, South Africa, and Zambia covering 2011 or 2012. We used micro-costing to estimate economic costs from the service provider’s perspective. Average annual costs per client were estimated in 2013 United States dollars (US$). Econometric analysis was used to explore the relationship between VMMC total and unit cost and facility characteristics. Results: Average VMMC unit cost ranged from US$66 (SD US$79) in Kenya to US$160 (SD US$144) in South Africa. Total cost function estimates were consistent with economies of scale and scope. We found a negative association between the number of VMMC clients and VMMC unit cost with a 3% decrease in unit cost for every 10% increase in number of clients and we found a negative association between the provision of other HIV services and VMMC unit cost. Also, VMMC unit cost was lower in primary health care facilities than in hospitals, and lower in facilities implementing task shifting. Conclusions: Substantial efficiency gains could be made in VMMC service delivery in all countries. Options to increase efficiency of VMMC programs in the short term include focusing service provision in high yield sites when demand is high, focusing on task shifting, and taking advantage of efficiencies created by integrating HIV services. In the longer term, reductions in VMMC unit cost are likely by increasing the volume of clients at facilities by implementing effective demand generation activities. [ABSTRACT FROM AUTHOR]

An abstract of the article "Economic Incentives to Reduce HIV Risks among Male Sex Workers: A Randomized Pilot in Mexico" by Omar Galarraga, Sandra G. Sosa-Rubi, Carlos J. Conde-Glez and colleagues is presented.

Many governments have health programs focused on improving health among the poor and these have an impact on out-of-pocket health payments made by individuals. Therefore, one of the objectives of these programs is to reach the poorest and reduce their out-of-pocket expenditure. In this paper we propose the distributional poverty impact approach to measure the poverty impact of out-of-pocket health payments of different health financing policies. This approach is comparable to the impoverishment methodology proposed by Wagstaff and van Doorslaer (2003) that compares poverty indices before and after out-of-pocket health payments. In order to escape the specification of a particular poverty index, we use the marginal dominance approach that uses non-intersecting curves and can rank poverty reducing health financing policies. We present an empirical application of the out-of-pocket health payments for an innovative social financing policy implemented in Mexico named Seguro Popular. The paper finds evidence that Seguro Popular program has a better distributional poverty impact when families face illness when compared to other poverty reducing policies. The empirical dominance approach uses data from Mexico in 2006 and considers international poverty standards of $2 per person per day., (Copyright © 2011 Elsevier B.V. All rights reserved.)