In Mexico, strategies for dependent or disabled people are practically inexistent. The country does not have a publicly funded long-term care system at national level nor specific public services that provide care for people with loss of functional ability/capacity (disabled); and, as it will be described below, Mexico only offers very few day-centre services for older adults.

Regarding care legislation, there are no specific laws that guarantee the right to receive care, regardless of the age group or condition for which care is needed, or that give the health and social security system responsibility to provide them. Thus, there is a clear lack of public programs at the national/federal level that aim at providing care services for those with care needs, nor for their carers. On the other hand, strategies have been developed to address aging and disability that seek to influence the well-being of these population groups, encourage their participation, and maintain or recover their independence, but without intending to guarantee or provide care to these groups of the population.

While at national level no long-term care system is in place, there are different working groups collaborating towards the generation of a National Care System. Two main groups are working together, one led by the National Institute for Women (INMUJERES) focused mainly on a gender equity perspective. A second one within the health system is led by the General Health Council, CSG (Consejo de Salubridad General) at the Ministry of Health and the National Institute of Geriatrics (INGER) and focuses on attending care needs of people with disabilities and their carers. The work led by INMUJERES has recently focused on generating an analysis of care needs whilst targeting three groups: infants, people with disabilities, and older adults. Their aim is to raise awareness on the need to establish care as a right in local legislations as well as to identify current public programmes where new strategies could be included to generate a National Care System^[1]. On the other hand, in some forums (but still not in official communications), other institutions like the Social Security Institute IMSS, have presented their efforts towards generating care services for their affiliates, particularly older adults and people with disabilities.

After slightly more than a year of meetings with representatives from all the institutions/sub-systems that form the National Health System within the CSG-INGER collaboration, an agreement was achieved at the national level to define, design, and implement long-term care health policies within the National Health System and health and social security institutions. This agreement was published in the National Official Gazette^[2] in August 2018.

At the moment, both groups are joining efforts and exploring future pathways to generate one system where the health and social development work together. In 2016, Mexico City, changed its administrative status from a Federal District to a Federal Entity (state) at the local level. This changes its legal and administrative rights and obligations within the Federal Republic.

As part of these changes, Mexico City has now its own stale-level approved Constitution^[3] since 2017.  This represents the first to include the right to care in the country (Article 9, Item B). As for now, the specific policies and programmes that will be implemented are in the planning stage and will constitute the first universal (within the City) and publicly funded programs to support those who need care and their carers.

At the moment, there are only two strategies, one at the Mexican Institute of Social Security (IMSS) and one from Mexico City’s Health Secretariat that provide domiciliary services for people with functional disabilities. First, the IMSS Chronic Patient Care Program which began in 1990, aims at providing follow-up medical care after hospital discharge and/or palliative care for patients in terminal stages (Espinel-Bermúdez et al., 2011). According to the IMSS’ reports, the main conditions treated are chronic degenerative diseases and their sequelae, such as cerebral vascular type, chronic obstructive pulmonary disease (COPD), heart failure, chronic kidney failure, Alzheimer’s disease, and terminal cancer conditions.

Secondly, in Mexico City, the program ‘The Doctor in your House’ (Medico en tu Casa), has been in place since 2016. The main goal of the program is to provide ambulatory care by multidisciplinary staff, to all vulnerable individuals who, due to their disease condition or disability, cannot attend medical services. However, under the new federal government administration, this program is being modified and its specific attributions and scope is still unknown.

The absence of a public long-term care system, of a national level regulation agency and the lack of a national mandatory registry of institutions in Mexico has generated an absence of precise information on the total number of public or private permanent and temporary care institutions available in the country. As a result, in order to gather information on such institutions, there are few sources that can be consulted; however, data can be over or underestimated. Some of these sources are described below within the public and private services subheadings in items 03.01.03 and 03.01.04.

[1] http://aga.funcionpublica.gob.mx/aga/Home/Documento?doc=2.1%20RENAC.pdf

[2] Diario Oficial de la Federación ACUERDO por el que se establecen las acciones para el diseño e implementación de la política pública en salud para el otorgamiento de cuidados a largo plazo por las instituciones públicas del Sistema Nacional de Salud, published on 2 August 2018. [https://www.dof.gob.mx/nota_detalle.php?codigo=5533729&fecha=02/08/2018 ]

[3] Constitución Política de la Ciudad de México, p. Article 9, Item B. Right to care: Every person has the right to the care that sustains his life and gives him the elements material and symbolic to live in society throughout his life. The authorities will establish a care system that provides public services universal, accessible, relevant, sufficient and quality and develop policies public. The system will give priority attention to people in situation of dependency due to illness, disability, life cycle, especially childhood and old age and those who, in an unpaid way, are in charge of their care.

References:

Espinel-Bermúdez M.C., Sánchez-García, S., Juárez-Cedillo, T., García-González, J.J., Viveros-Pérez, A., & García-Peña C. (2011). Impacto de un programa de atención domiciliaria al enfermo crónico en ancianos: calidad de vida y reingresos hospitalarios. Salud Publica Mex , 53, 17–25. https://www.redalyc.org/pdf/106/10619407004.pdf