Background: Restricting antibiotics sales to those with medical prescriptions only is a central strategy for promoting appropriate use and containing antibiotic resistance; however, many low and middle income countries have not enforced policies that prevent widespread self-medication with antibiotics. In 2010, the Mexican government announced the enforcement of antibiotic sales regulations, a policy that gained media prominence. This study analyzes media coverage of issues, stakeholder representation, and positions taken during policy agenda setting, drafting, and implementation to shed light on policy making to promote appropriate antibiotic utilization. Methods: We carried out a quantitative content analysis of 322 newspaper articles published between January 2009 and December 2010 in 18 national and regional newspapers. Additionally, we conducted a qualitative content analysis to understand the positions adopted and strategies developed by nine key stakeholders. Framing theory guided the analysis. Results: The Ministry of Health dominated media coverage, justifying the enforcement policy by focusing on risks of self-medication, and to a lesser degree dangers of increasing antibiotic resistance. Pharmacy associations appeared to be the leading opponents, arguing that the policy created logistical difficulties and corruption, and had negative economic impact for pharmacies and their clients. The associations developed strategies against the regulation such as attempting to delay implementation and installing physicians’ consultation offices within pharmacies. While medical associations and academic institutions called for a comprehensive strategy to combat antibiotic resistance, improve prescription quality, and create public awareness, these issues had little impact on media coverage. Consumer groups and legislators received very little media coverage. Conclusions: The narrowly-focused and polarized media coverage ─centred on problems of self- medication and economic impact ─ was a missed opportunity to publicly discuss and to develop a comprehensive national strategy on antibiotic use in Mexico. It highlights the need for discussing and developing interventions within the framework of a pharmaceutical policy.

Objectives.To examine published antimicrobial stewardship (AMS) initiatives in hospitals in Latin America and the Caribbean (LAC) in order to characterize AMS terminology usage, geotemporality, and elements of structure (human resources), process (interventions), and outcomes, and to set priority areas for improving AMS reporting. Methods.This was a scoping review that searched PubMed, LILACS, EMBASE, and 12 other databases, along with a manual search for academic and grey literature to identify documents on AMS initiatives in hospitals in 33 countries of LAC, up to August 2019. Keywords included ‘antibiotic’ or ‘antimicrobial’ AND ‘stewardship, policy, strategies, management, control, rational use, appropriate use, surveillance, or interventions’ and 33 country names. Results.Selected articles totalled 147 studies published in 1985 – 2019; of those, 22% used ‘antimicrobial stewardship’ in the title. Eighteen countries published AMS hospital initiatives, one-half of which were implemented in capital cities. Brazil, Argentina, Colombia, Cuba, Mexico, and Chile, in descending frequency, made up > 59% of published initiatives. Educational interventions were the most frequently reported, followed by persuasive and restrictive strategies. Antimicrobial consumption was the most common outcome measure reported. About one-third of the studies (35%) referred to baseline measures-only in preparation for AMS interventions. Fifty-nine studies from 6 countries reported AMS comprehensively, using structure, process, and outcome (SPO) elements. Conclusions.Published hospital AMS initiatives have increased over time and have expanded across LAC. However, more programs need to be developed. Complete reporting of SPO elements is imperative to evaluating and replicating AMS actions.

Objectives To compare the sociodemographic characteristics, reasons for attending, perception of quality and associated out-of-pocket (OOP) expenditures of doctors’ offices adjacent to private pharmacies (DAPPs) users with users of Social Security (SS), Ministry of Health (MoH), private doctor's offices independent from pharmacies and non-users. Setting Secondary data analysis of the 2012 National Survey of Health and Nutrition of Mexico. Participants The study population comprised 25 852 individuals identified as having had a health problem 15 days before the survey, and a random sample of 12 799 ambulatory health service users. Outcome measures Sociodemographic characteristics, reasons for attending healthcare services, perception of quality and associated OOP expenditures. Results The distribution of users was as follows: DAPPs (9.2%), SS (16.1%), MoH (20.9%), private providers (15.4%) and non-users (38.5%); 65% of DAPP users were affiliated with a public institution (MoH 35%, SS 30%) and 35% reported not having health coverage. DAPP users considered the services inexpensive, convenient and with a short waiting time, yet they received ≥3 medications more often (67.2%, 95% CI 64.2% to 70.1%) than users of private doctors (55.7%, 95% CI 52.5% to 58.6%) and public institutions (SS 53.8%, 95% CI 51.6% to 55.9%; MoH 44.7%, 95% CI 42.5% to 47.0%). The probability of spending on consultations (88%, 95% CI 86% to 89%) and on medicines (97%, 95% CI 96% to 98%) was much higher for DAPP users when compared with SS (2%, 95% CI 2% to 3% and 12%, 95% CI 11% to 14%, respectively) and MoH users (11%, 95% CI 9% to 12% and 32%, 95% CI 30% to 34%, respectively). Conclusions DAPPs counteract current financial protection policies since a significant percentage of their users were affiliated with a public institution, reported higher OOP spending and higher number of medicines prescribed than users of other providers. The overprescription should prompt studies to learn about DAPPs’ quality of care, which may arise from the conflict of interest implicit in the linkage of prescribing and dispensing processes.

Background: More alternatives have become available for the diagnosis and treatment of cancer in low- and middle-income countries. Because of increasing demands, governments are now facing a problem of limited affordability and availability of essential cancer medicines. Yet, precise information about the access to these medicines is limited, and the methodology is not very well developed. We assessed the availability and affordability of essential cancer medicines in Mexico, and compared their prices against those in other countries of the region. Methods: We surveyed 21 public hospitals and 19 private pharmacies in 8 states of Mexico. Data were collected on the availability and prices of 49 essential cancer medicines. Prices were compared against those in Chile, Peru, Brazil, Colombia and PAHO’s Strategic Fund. Results: Of the various medicines, mean availability in public and private sector outlets was 61.2 and 67.5%, respectively. In the public sector, medicines covered by the public health insurance “People’s Health Insurance” were more available. Only seven (public sector) and five (private sector) out of the 49 medicines were considered affordable. Public sector procurement prices were 41% lower than in other countries of the region. Conclusions: The availability of essential cancer medicines, in the public and private sector, falls below World Health Organization’s 80% target. The affordability remains suboptimal as well. A national health insurance scheme could serve as a mechanism to improve access to cancer medicines in the public sector. Comprehensive pricing policies are warranted to improve the affordability of cancer medicines in the private sector.

Purpose: Drug utilization research (DUR) contributes to inform policymaking and to strengthen health systems. The availability of data sources is the first step for conducting DUR. However, documents that systematize these data sources in Latin American (LatAm) countries are not known. We compiled the potential data sources for DUR in the LatAm region.Methods: A network of DUR experts from nine LatAm countries was assembled and experts conducted: (i) a website search of the government, academic, and private health institutions; (ii) screening of eligible data sources, and (iii) liaising with national experts in pharmacoepidemiology (via an online survey). The data sources were characterized by accessibility, geographic granularity, setting, sector of the data, sources and type of the data. Descriptive analyses were performed.Results: We identified 125 data sources for DUR in nine LatAm countries. Thirty‐eight (30%) of them were publicly and conveniently available; 89 (71%) were accessible with limitations, and 18 (14%) were not accessible or lacked clear rules for data access. From the 125 data sources, 76 (61%) were from the public sector only; 46 (37%) were from pharmacy records; 43 (34%) came from ambulatory settings and; 85 (68%) gave access to individual patient‐level data.Conclusions: Although multiple sources for DUR are available in LatAm countries, the accessibility is a major challenge. The procedures for accessing DUR data should be transparent, feasible, affordable, and protocol‐driven. This inventory could permit a comparison of drug utilization between countries identifying potential medication‐related problems that need further exploration.

Establishing a robust One Health (OH) governance is essential for ensuring effective coordination and collaboration among human, animal, and environmental health sectors to prevent and address complex health challenges like zoonoses or antimicrobial resistance. This study conducted a mixed-methods environmental scan to assess to what extent Mexico displays a OH governance and identify opportunities for improvement. Through documentary analysis, the study mapped OH national-level governance elements: infrastructure, multi-level regulations, leadership, multi-coordination mechanisms (MCMs), and financial and OH-trained human resources. Key informant interviews provided insights into enablers, barriers, and recommendations to enhance a OH governance. Findings reveal that Mexico has sector-specific governance elements: institutions, surveillance systems and laboratories, laws, and policies. However, the absence of a OH governmental body poses a challenge. Identified barriers include implementation challenges, non-harmonised legal frameworks, and limited intersectoral information exchange. Enablers include formal and ad hoc MCMs, OH-oriented policies, and educational initiatives. Like other middle-income countries in the region, institutionalising a OH governance in Mexico, may require a OH-specific framework and governing body, infrastructure rearrangements, and policy harmonisation. Strengthening coordination mechanisms, training OH professionals, and ensuring data-sharing surveillance systems are essential steps toward successful implementation, with adequate funding being a relevant factor.