Health workers participation in a public insurance scheme promoting public health interventions in Mexico

In 2003 Mexico started an important reform of its health care system through the launching of the Popular Health Insurance (PHI) program. PHI has mainly worked as a financial instrument to provide resources to state health systems which are responsible of providing a package of services to the affiliated population all over Mexico. The majority of this population belongs to the first and second income deciles. The package of services includes 255 interventions most of them corresponding to primary care interventions. In order to provide this package, in all 32 states, by 2007 a total of 30,000 health workers of different categories have been contracted under a temporary basis. The results of a study undertaken in 2007, show that the majority of these workers fall in the broad category of public health workers. It also shows that the amount of personnel contracted in every state is related to the amount of families affiliated to the program; the majority of workers (70%) are doctors and nurses performing in primary care units; salaries range according to the type of category, from 2,700 USD to 500 USD; fringe benefits vary across the states but in most states they do not reach the minimum defined by the Mexican labor law; finally, continuous education is provided to all workers with strong preference to doctors and nurses and regarding to a reduced number of topics, particularly the structure of the package of services. PHI is already an important employer of public health workers in the country but still needs to adequate the way health workers are contracted in order to make the most from their participation in the provision of health services to the beneficiary populations. Lessons from this case could be relevant to the situation of similar programs in developing countries.