Obstacles and opportunities for monitoring ethnicity-based inequalities in maternal health care: Lessons from Mexico

• Published in: PloS one Vol. 14; no. 5; p. e0217557
• Main Authors: Armenta-Paulino, Nancy, Sandín Vázquez, María, Bolúmar, Francisco
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31.05.2019; Public Library of Science (PLoS)
• Subjects: Barriers; Bibliometrics; Biology and Life Sciences; Decision making; Decision Making, Organizational; Ethnicity; Evaluation; Female; Global health; Health care; Health disparities; Health Services Needs and Demand - organization & administration; Healthcare Disparities; Humans; Indigenous Peoples; Inequalities; Inequality; Information systems; International organizations; Maternal & child health; Maternal Health; Maternal Health Services - organization & administration; Maternal mortality; Medicine; Medicine and Health Sciences; Mexico; Minority & ethnic groups; Monitoring; Observatories; People and Places; Pregnancy; Public health; Qualitative Research; Quality Improvement; Research and Analysis Methods; Research facilities; Research methodology; Resource management; Science Policy; Social Sciences; Socioeconomic Factors; Sustainable Development; Technical services; Technicians; Mexico; Latin America; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0217557

Monitoring and reducing inequalities in health care has become more relevant since the adoption of the Sustainable Development Goals (SDGs). The SDGs bring an opportunity to put the assessment of inequalities by ethnicity on the agenda of decision-makers. The objective of this qualitative study is to know how current monitoring is carried out and to identify what factors influence the process in order to incorporate indicators that allow the evaluation of inequalities by ethnicity. We conducted 17 semi-structured interviews with key informants from the health ministry, monitoring observatories, research centers, and international organizations, involved in maternal health care monitoring in Mexico. Our analysis was interpretative-phenomenological and focused on examining experiences about monitoring maternal health care in order to achieve a full picture of the current context in which it takes place and the factors that influence it. The obstacles and opportunities pointed out from the participants emerge from the limitations or advantages associated with the accuracy of evaluation, availability of information and resources, and effective management and decision-making. Technicians, coordinators, researchers or decision-makers are not only aware of the inequalities but also of its importance. However, this does not lead to political decisions permitting an indicator to be developed for monitoring it. As for opportunities, the role of international organizations and their links with the countries is crucial to carry out monitoring, due to political and technical support. The success of a monitoring system to help decision-makers reduce inequalities in health care depends not only on accurate evaluations but also on the context in which it is implemented. Understanding the operation, obstacles and opportunities for monitoring could be a key issue if the countries want to advance towards assessing inequalities and reducing health inequities with the aid of concrete policies and initiatives.