title: [Problems of the health system in Mexican states with high incidence of maternal mortality].
abstract: OBJECTIVE
  To identify and prioritize problems in states' health systems which limit the efficacy of interventions to prevent maternal mortality.
  
  
  METHODS
  We made a conceptual mapping of priority problems perceived as such by communities of practice (COP) in four states with high ratios of maternal mortality in Mexico. Then, the four COP reviewed the literature and refined their formulation of previously identified problems.
  
  
  RESULTS
  Priority problems focused on emergency obstetric care (EmOC), specifically: inadequate financial resources (Guerrero), substandard training among available EmOC providers (State of Mexico), inefficiencies in existing EmOC networks (Oaxaca) and inadequate knowledge of, and/or compliance to, standard EmOC protocols (Veracruz). The literature review confirmed the pertinence of problems previously identified by COP through conceptual mapping. CONCLUSIONS. The four COP showed a high level of congruency between their original perception of problems in the states' health systems and international scientific evidence. Identified problems and their reformulation based on evidence help identify solutions adaptable to local contexts.
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Mariel
authors.initials: M
authors.lastname: Rouvier
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: González-Block
authors.forename: Paola
authors.initials: P
authors.lastname: Sesia
authors.forename: Víctor
authors.initials: V
authors.lastname: Becerril-Montekio
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D015994:Incidence; D008428:Maternal Mortality / Q000639:trends*; D008800:Mexico