Strengthening preventive care programs: a permanent challenge for healthcare systems; lessons from PREVENIMSS México.
BACKGROUND
In 2001, the Instituto Mexicano del Seguro Social (IMSS) carried out a major reorganization to provide comprehensive preventive care to reinforce primary care services through the PREVENIMSS program. This program divides the population into programmatic age groups that receive specific preventive services: children (0-9 years), adolescents (10-19 years), men (20-59 years), women (20-59 years) and older adults (> = 60 years). The objective of this paper is to describe the improvement of the PREVENIMSS program in terms of the increase of coverage of preventive actions and the identification of unmet needs of unsolved and emergent health problems.


METHODS
From 2003 to 2006, four nation-wide cross-sectional probabilistic population based surveys were conducted using a four stage sampling design. Thirty thousand households were visited in each survey. The number of IMSS members interviewed ranged from 79,797 respondents in 2003 to 117,036 respondents in 2006.


RESULTS
The four surveys showed a substantial increase in coverage indicators for each age group: children, completed schemes of vaccination (> 90%), iron supplementation (17.8% to 65.5%), newborn screening for metabolic disorders (60.3% to 81.6%). Adolescents, measles - rubella vaccine (52.4% to 71.4%), hepatitis vaccine (9.3% to 46.2%), use of condoms (17.9% to 59.9%). Women, measles-rubella vaccine (28.5% to 59-2%), cervical cancer screening (66.7% to 75%), breast cancer screening (> 2.1%). Men, type 2 diabetes screening (38.6% to 57.8%) hypertension screening (48-4% to 64.0%). Older adults, pneumococcal vaccine (13.2% to 24.9%), influenza vaccine (12.6% to 52.9) Regarding the unmet needs, the prevalence of anemia in children was 30% and a growing prevalence of overweight and obesity, type 2 diabetes, and hypertension was found in men, women and older adults.


CONCLUSIONS
PREVENIMSS showed an important increase in the coverage of preventive services and stressed the magnitude of the old and new challenges that this healthcare system faces. The unsolved problems such as anemia, and the emerging ones such as overweight, obesity, among others, point out the need to strength preventive care through designing and implementing innovative programs aimed to attain effective coverage for those conditions in which prevention obtains substandard results.
Gutiérrez
Gonzalo
G
Hospital Infantil de México Federico Gomez, Dr, Márquez 162, Colonia Doctores, México DF, México.
Pérez-Cuevas
Ricardo
R
Levy
Santiago
S
Reyes
Hortensia
H
Acosta
Benjamín
B
Cantón
Sonia Fernández
SF
Muñoz
Onofre
O
D000293:Adolescent; D000328:Adult; D002648:Child; D003625:Data Collection; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009313:National Health Programs; D011314:Preventive Health Services / Q000592:standards*; D016730:Program Development; D055815:Young Adult