Interprofessional training for the delivery of community health services in Mexico: the experience of Partners in Health

ABSTRACT

Interprofessional training in health is scarce in Mexico. Partners in Health (CES in Spanish), is the branch of an international civil society organization that provides health services to poor and rural populations. CES runs a set of ten health centers in Chiapas, Mexico, in partnership with the local Ministry of Health. A key component of the provision strategy is to train healthcare providers, mainly medical and nursing students in their final year of training, to create healthcare teams that work together while fostering their individual capacities. CES offers a diploma on Global Health and Social Medicine, where medical and nursing students -also called pasantes- interact to discuss jointly the effects of global and social determinants of health in local communities, as well as specific clinical topics. A qualitative study including interviews and nonparticipant observations was undertaken to identify initial achievements and challenges of the experience. CES has achieved important benefits related to teamwork as well as clinical capacities of individuals as healthcare providers. However, challenges have emerged: differences in social origin, personal development expectations, professional identity and institutional roles hinder team cohesion. Consequently, CES has introduced adjustments to reduce the negative impact of these differences. Although the training model needs further development, the possibility of transferring some of its good practices to non-CES scenarios should be seriously considered by health authorities.

KEYWORDS:

• Interprofessional training
• health services
• physicians
• nurses
• Mexico

Acknowledgments

The authors would like to express their gratitude to Partners in Health Mexico for the support they received to carry out interviews and observe teaching environments. They are also grateful for those individuals who shared their time to perform the interviews.

Declaration of Interest

The authors declare no conflicts of interest. The authors alone are responsible for the writing and content of this article.

Notes

1. IMSS Prospera is an institution dedicated to provide health care services to indigenous and poor populations in various states of Mexico. It is fully subsidised by the federal government and their management is carried out by the Mexican Institute of Social Security.

2. In Mexico, there are three levels of nursing: ancillary, technical and professional. The last two nursing categories have to complete a social service period in their last year of training as a requisite to obtain the degree. Unlike physicians, nurses tend to complete their social service in hospital units, so to be able to attract them to rural areas, it requires special negotiations with federal and state authorities.

3. Obstetric nurses are trained at university level. They receive a training composed of three years as general nurses and a fourth year focused on obstetrics.

Additional information

Funding

The authors did not receive any funding to perform the study or produce the article.The study was fully financed by Partners in Health.

Notes on contributors

G. Nigenda

G. Nigenda PhD. Full-time Professor at the School of Nursing and Obstetrics of the National Autonomous University of Mexico. Research advisor of Partners in Health, Mexico.

P. Elliott

P. Elliott MD, MPH, DTM&H. Is an Internal Medicine Physician in the Division of General Medicine at The Royal Darwin Hospital. Darwin, Australia.

H. Flores

H. Flores MD is an Associate Physician at the Brigham and Women´s Hospital and an instructor of Medicine at Harvard Medical School.

P. Aristizabal

P. Aristizabal NR, MA. Is a PhD (candidate) in the National Institute of Public Health of Mexico. Associate Professor, Faculty of Higher Studies Iztacala, National Autonomous University of Mexico.

A. Martinez-Davalos

A. Martinez-Davalos MPH, is a research assistant at the Center for Health Systems Research, National Institute of Public Health of Mexico.