Mexico is facing numerous challenges related to the COVID-19 pandemic and, simultaneously, a historically high burden of non-communicable diseases (NCDs), including some of the highest prevalence rates of hypertension, obesity, and diabetes. People with underlying chronic health conditions have a higher risk of severe COVID-19 symptoms or dying of COVID-19. The pandemic has put the issue of health inequities and access to high-quality care into sharp relief, as NCDs tend to be more prevalent in less advantaged socioeconomic groups.

In this context of uncontrolled risk factors and scarce doctors, having a well-trained and appropriately sized nursing workforce is crucial. So the UKaid-funded Better Health Programme Mexico (BHPMx) designed a comprehensive strategy to foster an advanced nursing practice in Mexico.

The strategy has four pillars:

• Diagnosis and planning
• Knowledge exchange
• Education and training
• Advocacy and communication

Nursing and midwifery cadres are essential to achieving high-quality universal healthcare. Because nurses and midwives are predominantly women, our team is striving to make nursing an accredited career option for secure employment. A cross-cutting emphasis on gender equality and social inclusion has been considered within these four policy pathways.

The Mexican health sector has wanted to expand the advanced practice nurse (APN) role for some years, yet there are currently very few qualified APNs at work in Mexico. APNs enable task shifting, reduce the pressure on doctors, and cut costs for the health system; more emphasis on APNs also means more career options for nurses. COVID-19 brought the need for the APN role into sharp focus: with so many people hospitalised, there is a clear need for more nurses with advanced treatment skills.

Increasing the numbers of highly trained nurses leads to better health outcomes. Photo: USAID.

Diagnosis and Planning

In 2020, BHPMx began working with the National School of Nursing and Obstetrics (ENEO) to research the barriers to expanding the APN role in Mexico. ENEO teamed up with researchers and students at the prestigious Universidad Nacional Autónoma de México (UNAM), and the resulting research was used in a comparative analysis of the APN role in the United Kingdom and Mexico. This analysis also mapped the constraints and opportunities facing Mexico, generating data to enable the design of a national policy on the APN role.

BHPMx brokered the support from the  U.K. National Health Service Joint Unit, Health Education England, and the  General Medical Council to identify U.K. experts who could share their experience and provide feedback on the research design and policy recommendations—an example of knowledge exchange in action.

“We are very proud to be involved in an international project within the Better Health Program,” said Rosa Zárate, Director of the National School of Nursing and Obstetrics, ENEO. “It is an excellent learning opportunity between Mexico and the United Kingdom to contribute to the expansion of the role of nursing in our country and to start training a new generation of researchers.”

BHPMx has also participated in the Mexican Secretariat of Health Strategic Group, the technical group that is helping draft the National Plan for the advanced nursing practice rollout in every Mexican state.

Education and Training

Among the project’s other achievements to date:

• BHPMx and our partners UNAM, TecSalud, and Primary Care International have developed e-learning modules on leadership, teamwork, and digital skills, which will be available later this year for all health professionals in Mexico.
• A self-directed diploma in nursing care in diabetes, based on a primary healthcare approach, will be delivered to thousands of practising professional nurses thanks to synergies encouraged by BHPMx.
• Nursing and medicine undergraduate and graduate programmes are being reviewed to enhance interprofessional training and promote a more equitable health workforce framework.
• A healthcare model based on advanced nursing practices will be piloted in the poorer southern state of Chiapas this year. This will generate the practical evidence needed in a low-resource setting to scale the model to a national level eventually.

Emphasising partnership every step of the way, BHPMx has linked high-level representatives of the government, academia, nongovernmental groups, regulatory bodies, and international organisations. Our communication and advocacy campaign will supplement efforts to increase awareness of the importance of the advanced nursing practice within the health system.

The empowerment of nurses within the Mexican health care system is an excellent example of how BHPMx is simultaneously helping to improve access to high-quality care and promote gender equity while building a sustainable UK-Mexico collaboration agenda for better health.

Eduardo Gonzalez-Pier is the Team Leader for BHPMx and Alejandro Sanders is the Human Resources for Health Lead.