1. Mexico´s strategy to Health Services for Migrant Populations 7th Summer Institute on Migration and Global Health Los Angeles, California June 26, 2012

2. + ¼ of Hispanic adults lack a usual health care provider (69% are male) (41% 18-29 years) 69% of those with no usual place for health care are of Mexican origin More than 8 in 10 receive health info from radio or TV Hispanic women are more likely to get health info from doctors and medical community (77%) Source: PHC: Hispanics and health care in the US Health care and Hispanic population

3. 45% of Hispanics with no usual place for health care have health insurance. 23% who received poor treatment cited 4 reasons: inability to pay, race or ethnicity; lack of English proficiency and medical history 1 in 4 Hispanics who get no health information score low on diabetes knowledge, compared to 1 in 11 who get some information. Health Information of Hispanic population

4. Health Determinants Risks for migrant health Changes in lifestyles Sedentary lifestyle Lack of proper housing (overcrowding) High consumption of saturated fats (fast food) Increase comsumption of alcohol and drugs Changes in lifestyles Sedentary lifestyle Lack of proper housing (overcrowding) High consumption of saturated fats (fast food) Increase comsumption of alcohol and drugs Vulnerability due to: Lack of education Social isolation Occupational hazards Language and cultural barriers Vulnerability due to: Lack of education Social isolation Occupational hazards Language and cultural barriers Health conditions Obesity Diabetes Depresion and addictions Workplace accidents HIV/AIDS Other sexually transmitted infections Health conditions Obesity Diabetes Depresion and addictions Workplace accidents HIV/AIDS Other sexually transmitted infections

5. To protect its nationals abroad Building health bridges: Information exchange Training and education Health prevention and promotion Binational health research projects Objectives

6. Components 1.VENTANILLAS DE SALUD (Health windows) 2.BINATIONAL HEALTH WEEKS 3.REPATRIATION OF SERIOUSLY ILL MIGRANTS 1.VENTANILLAS DE SALUD (Health windows) 2.BINATIONAL HEALTH WEEKS 3.REPATRIATION OF SERIOUSLY ILL MIGRANTS

7. Information centers to increase awareness and access to health centers among the Mexican population living in the US and to disseminate programs of health prevention and promotion. Health Windows Program Ventanillas de Salud In the year 2002, the pilot program in the Mexican Consulates of San Diego and Los Angeles By September 2011, 50 Health Windows were in operation at Mexican Consulates in the US. Goals: -Strengthen VDS -Permanent training on priority topics. - Offer alternatives for access to health care to users. -Provide information and guidance for prevention through different media tools. - Technical assistance - Create a Technical Advisory Board.

8. Health Window Program Ventanillas de Salud (VDS) Actions Increase dissemination of the VDS through Communication Strategy Radio spots, television and Printed media VDS websitewww.ventanillas.org VDS Communication Plan and Training Plan Webinars, Obesity, Seguro Popular (Popular Insurance Scheme) and Cancer VDS OperationDiagnosis of VDS, Operating Manual and reporting indicators Developing Migrants’ Health GuideGuide for migrant health care in Mexico and USA Free Discount CardProvide discounts on prescription drugs. (300 medicines) Discounts also provided on generic drugs; VDS operating staff will be trained

9. MAIN SERVICES OFFERED (data until Dec. 31st 2011) TOTAL Number of individuals Services Asistance and inscription to Medical Services in the United States:  Adults16,00026,000  Minors10,000 Establishment of medical homes:  Adults referred60,000  Minors referred7,00067,000 Asistance and Inscription to the “Seguro Popular.”  Informed40,00040,600  Pre-Afiliated600 Early Detection (Screening) 400,000 Education Sessions on prevention topics (in groups) 1,014,400 1,200,000 Total population and services offered 1,548,000 1,733,600 Source: Ventanillas de Salud: Reporte de indicadores/Health Windows Indicator Report *The population attended and the number of services given do not coincide with the total of the population attended (1,548,000), on occasions more than one service is given to each person. Source: Ventanillas de Salud: Reporte de indicadores/Health Windows Indicator Report *The population attended and the number of services given do not coincide with the total of the population attended (1,548,000), on occasions more than one service is given to each person.

10. Health Windows Program Ventanillas de Salud Total number of Ventanillas in operation 50 Each ventanilla offers services to Between 100 to 300 people Free screening tests during health fairs and health training workshops. More than 138,000 People refered to community clinics, health centers, and public hospitals. More than 137,000 Information about health insurance programs to which the population is elegible for. 136,000 people Pre-afiliation to the “Seguro Popular.” 1,200 migrants.

11. Health Windows Program Ventanillas de Salud New Projects Project “Second Generation VDS” Washington, D.C., New York; Kansas, City; Portland, Oregon; Fresno, California; and strengthening the VDS in the Border. Project “Second Generation VDS” Washington, D.C., New York; Kansas, City; Portland, Oregon; Fresno, California; and strengthening the VDS in the Border. o Plan for continuous training, through distance and face to face workshops on: Priority topics (HIV/AIDS, Obesity, Addictions, Mental Health, Reproductive Health, Occupational Health, Child Health, Cancer, Tuberculosis) Access to Health Services o Technical Assistance to Manage Resources. o Advisory Board for the VDS integrated by the different partnerships that support the VDS and the Federal Government. o For the VDS at the border an additional component to increase the population attended.

12. NEXT STEPS  Logic Model developed to reflect the Second Generation Programming.  Top three health concerns identified by all 5 VDS are:  Diabetes (includes obesity, nutrition,.)  Cancer (includes breast, cervical.)  Sexual Health (includes HIV, STDs, Woman’s reproductive health)  Based on the success and effectiveness of the influenza vaccination campaign, through the VDS in collaboration with the National Vaccine Program Office and the Office of Minority Health, identify new immunization campaigns' Identify available tools that assist in tracking immunizations for immigrants in the U.S. and Mexico.  Template report for funding purposes

13. Binational Health Week Perform intensive actions on prevention and health promotion for migrants and their families in Mexico and the United States All participants are given printed information on basic health care and self-care measures Participation of various government agencies, academic institutions, philanthropic organizations and civil society organizations from both countries. Participation of the Mexican Consular Network in the US. All participants benefit with talks, lectures and advice on prevention and health promotion

14. Binational Health Week Results Approximately 500,000 people received health information 6,000 activities on prevention and health promotion Chronic degenerative diseases Communicable Diseases Mental Health Women's Health Health Services in the US Oral Health

15. Binational Health Week (2012) XII Edition of the Binational Health Week Inaugural Ceremony: Oaxaca, México Closing Ceremony: United States Topics:  Access to Health Services  Women’s Health  Obesity and Diabetes  HIV/AIDS  Adolescent Health  Addictions  Occupational Health

16. Repatriation of Seriously Ill Mexicans Ensure the medical treatment of ill repatriated nationals to the country Decrease in time to answer the petitions for support. Target Strengthening coordination channels (Ministry of Foreign Affairs, Consulates, State Health Services) Actions

17. ARTICULATION OF ACTIVITIES AND INFORMATION NETWORKS SYNCHRONIZATION FOR MULTIPLYING EFFECTS SUSTAINABILITY OF INSTITUTIONAL EFFORTS SIMULTANEOUS PUBLIC HEALTH INTERVENTIONS ARTICULATION OF ACTIVITIES AND INFORMATION NETWORKS SYNCHRONIZATION FOR MULTIPLYING EFFECTS SUSTAINABILITY OF INSTITUTIONAL EFFORTS SIMULTANEOUS PUBLIC HEALTH INTERVENTIONS

18. BUILDING BINATIONAL PARTNERSHIP: SHARING PERSPECTIVES AND RESOURCES DECISION MAKING CAPABILITIES EVIDENCE: SOLID BASIS FOR ACTION BUILDING BINATIONAL PARTNERSHIP: SHARING PERSPECTIVES AND RESOURCES DECISION MAKING CAPABILITIES EVIDENCE: SOLID BASIS FOR ACTION

19. hilda.davila@salud.gob.mx