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Mexico

Best Global Practices for Tobacco Control - National Institute for Respiratory Diseases, Mexico (Fall 2019)

Best Global Practices for Tobacco Control - National Institute for Respiratory Diseases, Mexico (Fall 2019)

National Institute for Respiratory Diseases, Mexico

Project Background:

The Tobacco Clinic (TC) at the National Institute of Respiratory Diseases (INER) aims to provide support to all smoking patients so that they can quit such a habit in Mexico. Currently, TC provides care to more than 300 patients with an 85% success rate once treatment is finished, 50% at 6 months and 35% at one year after treatment. Through a multidisciplinary team of medicine, psychology, nursing, and nutrition, the Clinic has a cognitive-behavioral program made of 10 group or individual sessions for 5 weeks. This program also includes medical consultation along with pharmacologic treatment to improve therapy outcomes. The whole Clinic’s program is available to the general population: any patient can enter the program. The cost of the sessions is decided according to a socioeconomic level study which varies between $20 and $200 USD. In case pharmacologic treatment is required, the patient will probably spend between $40 and $400 USD depending on his or her needs.

Furthermore, there is a monthly support session for ex-smokers to strengthen addiction cessation through three objectives: 1) Continuous professional interaction with patients so that follow up can be completed; 2) Connection with people ranging on different stages of the smoking cessation process; 3) Provide information regarding the impact tobacco has on patients’ health so that abstinence can be reinforced.

Besides its welfare component, the Clinic has a very important clinical research component, trying to associate different consumption patterns with genetic and functional variations, symptoms and patient prognosis. The TC is currently including dual users (patients that smoke both tobacco and marijuana) in its research and care groups. Moreover, the Clinic is nowadays the headquarters for the Interinstitutional Committee for Tobacco Control, a working group that gathers key stakeholders in private, public and hospital Institutions around Tobacco Control policies.

Definition of Opportunity:

Despite its 30 years of experience, the TC has not compared its model to other successful models for tobacco cessation. Nor has it expanded its influence through e-health. The TC has a limited impact mostly because its population comes almost exclusively from the patient population from inside INER. This limits most of its focus on patients older than 50 years with an already existent pulmonary and/or chronic disease. Thus, there is a need to attract younger populations. Moreover, there is a wide gap of knowledge regarding a patient who has drug addictions that can affect the lung such as inhaled polymers, cocaine and others. For this, the Clinic is currently trying to launch an app that can provide support for patients who want to quit smoking and at the same time feed the TC with data useful for research. Additionally, our Interinstitutional Committee has important and yet unused talent due to a lack of social communication and PR strategies.

Initial ideas:

Comparative work from what the TC does, compared with what other evidence-based centers are doing is extremely useful. Moreover, being able to compare what differences exist between developing and developed countries can help the Clinic find the middle ground that could scale its impact. Specifically exploring the following topics:

  • Best examples of Tobacco Cessation Group Session strategies

  • Tobacco Cessation Center’s outcome tracking and impact measurement

  • Use of e-health strategies to scale the Clinic’s impact

  • Successful Strategies for Tobacco Control Committees.

What does success look like:

Specific deliverables regarding the four areas shown above would help the Clinic greatly. Any further development of each one of these comparative tasks into an actual application to the TC would be most welcome. For example, if based on a comparative table of other Tobacco Center’s main impact measures, the team could aid the Clinic in creating its own or our joint project would really make a lasting difference.

Civic Participation Skills and Mobility - Via Educacion, Mexico (Fall 2019)

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Civic Participation Skills and Mobility - Via Educacion, Mexico (Fall 2019)

Project Background:

Vía Educación is a non-profit organization in Mexico seeking to improve people’s quality of life by promoting sustainable social development through education. The organization believes that every person is capable of improving their opportunities in life as well as those of their communities.

Vía Educación developed a methodology for social transformation based on building problem-solving capacities on communities of youth and adults. The methodology aims to increase individual and collective self-efficacy among community members; develop civic competencies through solving relevant community needs; and strengthen social capital. This methodology is the backbone of the organization and is applied in a variety of programs and settings in Mexico.

Definition of Opportunity:

With that in mind, the Investigation and Evaluation team at Vía Educación would like to explore the link between these acquired skills (teamwork, democratic and citizenship participation, conflict resolution, assertive communication, collective organization skills, among others) and mobility (social, educational, economic). An emerging body of literature suggests that civic engagement may affect peoples’ wellbeing. Are our participants expanding their opportunities in life? The team would like to further learn about this, and even possibly incorporate a tool we could apply with our alumni network and current participants to test this potential relationship.

What does success look like? Success for us would look like a clearer picture of the relationship between civic participation skills and mobility (e.g. a couple of pages concisely stating what literature has to say about this relationship as well as the mechanisms behind it – that is, if there is a positive relationship, how do civic participation skills contribute to expanding an individual’s opportunities in life?). We also would appreciate a concrete tool that we could use to test in the field to measure this relationship in a variety of settings (e.g. urban, indigenous, marginalized, rural communities, etc.) and populations (from students in high school to teachers and authorities in Mexico’s public school system as well as neighborhood community members).

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Building a new university-based, interdisciplinary center for global health - ITESM, Mexico (Fall 2018)

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Building a new university-based, interdisciplinary center for global health - ITESM, Mexico (Fall 2018)

Client Profile

The Tecnológico de Monterrey and its network of campuses throughout Mexico is committed to providing quality education, world-class research, and building innovative models for the benefit of society. With the leadership of ITESM’s School of Medicine and the School of Government, the University is looking to build a new interdisciplinary center for global health training and research with strong links to practice.

The DGHSM aims to be a global center of excellence that generates health through training, research, innovation and knowledge translation, addressing in a profound and interdisciplinary way the existing inequities in Mexico and the world, based on health as a human right.  The DGHSM aspires to lead in training, research, implementation and public policy development in Global Health and Social Medicine in Latin America, through the creation of integral solutions to address social factors and strengthen health systems with a preferential option for vulnerable populations.

Definition of Opportunity

ITESM’s DGHSM is currently exploring the possibility of partnerships with the Program on Global Surgery and Social Change (PGSSC) and the Partner In Health’s sister organization, Compañeros en Salud in Chiapas, Mexico.  The Program on Global Surgery and Social Change (PGSSC) is a collaborative effort between the Harvard teaching hospitals, Harvard Medical School/ Department of Global Health and Social Medicine, Boston Children’s Hospital (BCH) and Partners In Health (PIH).  This organization emerges out of work of the Lancet Commission on Global Surgery, tled by Dr. John Meara at Harvard Medical School (a 1986 ND graduate).  PGSSC’s objective is to advocate for Universal access to safe, affordable surgical and anesthesia care when needed. Compañeros en Salud is affiliated with Partners In Health and works in rural Chiapas Mexico to provide quality health care to underserved communities and hopes to serve as an inspiring model to train and accompany health professionals and community health workers, and to deliver quality health care in low resource settings in Mexico and elsewhere. Both PGSSC and PIH have deep ties to Notre Dame, and have served as clients on DAT projects over multiple semesters.

Initial Ideas

The ITESM Department of Global Health & Social Medicine is looking for models of university-based, interdisciplinary centers that work in the international context in close partnership with health service providers and policy makers.

●      ITESM is interesting in exploring different models of partnership that have been established for developing, first-rate, interdisciplinary global health centers that have strong links to practice, that highlight different institutional structures, incentives, and potential partnerships.

●      ITESM hopes to explore and expand partnerships with international development and health organizations, such as Compañeros en Salud, the Harvard Medical School and the University of Notre Dame, consistent with its strategic objectives.

●      ITESM is interested in implementing a framework to develop international partnerships.

Definition of Success

That ITESM uses the systematic examination of different examples and models for building an interdisciplinary, university based Center for Global Health with a strong link to practice in ways that it might serve as a roadmap for a path forward.

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Healthcare Delivery Expansion in Rural Mexico - Partners in Health (Fall 2015)

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Healthcare Delivery Expansion in Rural Mexico - Partners in Health (Fall 2015)

Client Profile

Partners in Health (PIH) is a global healthcare NGO founded in 1987 to provide a preferential option for the poor in healthcare. The organization originally developed as a community health project in Haiti and has since expanded to several countries around the world—Mexico being one of the most recent in 2012.  In Mexico, PIH operates through its sister organization, Compañeros en Salud (CES).  CES partners directly with the Mexican government to strengthen healthcare delivery in the rural state of Chiapas (the southernmost and poorest state in Mexico) by providing mentorship to recently graduated Mexican medical students serving in primary health clinics, training community health workers to support chronic diseases patients, and accompanying patients requiring higher level care as they navigate the health system.  

Definition of Problem

A young organization, CES is still working to develop new programs and expand its existing services in order to better deliver care to rural communities in Chiapas.  Beginning in 2012 with clinics in just two communities, the organization now operates clinics in ten communities and supports community health workers in six.  For many years, it was nearly impossible to find medical doctors to serve the rural clinics in Chiapas. Today, CES’s global health education model attracts medical students from top medical schools throughout all of Mexico.  Through its “Right to Health” reference program, CES is able to assist patients requiring more specialized attention beyond just primary care coverage.  Given the diversity of these operations, there are many paths for CES to pursue in the future, and it is still uncertain where the organization should best invest its resources to maximize impact.  CES would like to work with a Development Advisory Team to investigate and evaluate different strategic options for the organization’s future.

 Initial Ideas and Options

  • Explore the costs and the benefits of options such as:
    • Expanding the number of clinics supported in Chiapas
    • Expanding the types of health coverage provided
    • Expanding services to another state in Mexico
    • Increasing focus on the policy level
    • Increasing focus on medical education
  • Work closely with CES staff to understand the organization and its current operations.
  • Identify organizations that have faced similar dilemmas in expansion and development.  Write short case studies that draw lessons from those experiences.

Definition of Success

 A systematic report exploring options for CES’s future activities, based on evaluation of each of the above potential options and comparative analysis of similar organizations, that helps us to understand how each strategy would increase our impact, and provide the basis for dialogue within the organization to consider these strategic options.

Recommendation 

Presentation

Report

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From Aid to Accompaniment - Partners in Health (Spring 2014)

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From Aid to Accompaniment - Partners in Health (Spring 2014)

Client Profile

Partners in Health (PIH) was founded in 1987 to bring quality medical care to rural Haiti.  Since then, PIH has expanded to several countries around the world including Rwanda, Lesotho, Malawi, Russia, Peru, and Navajo Nation in the United States.  PIH also partners with several sister organizations to increase its ability to further its mission.  In 2012, PIH launched its newest project in the Chiapas region of Mexico.  PIH draws on the world’s best medical institutions to provide a preferential option for the poor in health care.  According to PIH’s mission statement, its mission is both medical and moral, and it is based on solidarity rather than charity alone.

See all Development Advisory Team projects with Partners in Health

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Development Advisory Team Biographies

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