Health-care guidelines and policies during the COVID-19 pandemic in Mexico: A case of health-inequalities

Background: Heterogeneous government responses have been reported in reaction to COVID-19. The aim of this study is to generate an exploratory review of healthcare policies published during COVID-19 by healthcare institutions in Mexico. Analyzing policies within different health sub-systems becomes imperative in the Mexican case due to the longstanding fragmentation of the health-care system and health inequalities. Data and Methods: Policies purposely included in the analysis were published by four public health institutions (IMSS, ISSSTE, SSA and PEMEX) during the COVID-19 epidemic in Mexico (from February 29th to June 15th, 2020) on official institutional websites. Researchers reviewed each document and classified them into seven policy categories set by the Rapid Research Evaluation and Appraisal Lab (RREAL): public health response, health-care delivery, human resources, health-system infrastructure and supplies, clinical response, healthcare management, and epidemiological surveillance. Results: Policy types varied by health institution. The largest number of policies were aimed at public health responses followed by health-care delivery and human resources. Policies were mainly published during the community transmission phase. Conclusions: The pandemic exposed underlying health-care system inequalities and a reactive rather than prepared response to the outbreak. Additionally, this study outlines potential policy gaps and delays in the response that could be avoided in the future.