Orientation and Support Services Network for Families of Migrants Vete Sano, Regresa Sano Orientation and Support Services Network for Families of Migrants in Mexico Dr. Romeo S. Rodríguez Suárez General Director, Centro Nacional para la Salud de la Infancia y la Adolescencia Guatemala, October 18 – 19, 2004

Legal Framework In Mexico: Political Constitution United Mexican States Art. 4 Health is a Constitutional Right. General Health Act Social Health Protection System Official Mexican Norms Planning Act National Development Plan (PND) 2001-2006

Marco Institucional Reduce backwardness that affects the poor PNS 2001-2006 Action Program: Vete Sano, Regresa Sano (“Go Healthy, Return Healthy”) Strategy: Reduce backwardness that affects the poor Marco Institucional PND 2001 2006

Objective Contributing to protect the health of migrants’ families in their country of origin, in transit and in the country of destination.

Migration Mobility Characteristics: Increasing at the national and international level (south to north) Flow of immigrants from Central America and other countries, Southern Border Covers practically all 32 federative entities +/- Families, not individuals Rural and urban California, USA is not the main destination anymore. Impact in morbidity and mortality Multiple factors: Social Economic Education Family Tradition Inter-cultural

Migrant Municipalities in México 1 Population 23.6 External Migration Municipalities 492 Population 3.8 Internal Migration Municipalities 1 046 Population 18.4 Municipalities with Internal and External Migration Municipalities 200 Population 1.0 1 SG.CONAPO. E INEGI 2000

Economic Sectors Destined for: 60 % Agriculture 20 % Industry 10 % Services 10% Informal

Principales causas de enfermedad, Municipios Migrantes 2003 1 Diagnosis Total 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Acute respiratory infections Intestinal infections by other micro-organisms and not well defined infections Urinary tract infections Ulcers, gastritis, and duodenitis Intestinal amoebiasis Otitis media acuta Other Helminthiasis Hypertension Streptococcal Angina and Tonsillitis Conjunctivitis 21,282,493 3,938,824 2,714,497 1,001,013 670,532 534,288 483,768 414,552 379,868 326,272 Represent 81.12% of the 34.7 million diagnoses notified in a year. 1. SSA. DGE. SUAVE. Cierre 2003

Morbidity A conclusion for México: The morbidity control for migrants represents at least 42.62 % of what occurs in the country’s 2454 municipalities. Las condiciones de marginación e inequidad de estos grupos determinan de que se enferman y por ende las demandas de consultas destacándose las enfermedades infecciosas, el control del embarazo y el control del niño sano con menor frecuencia. 1. SSA.DGIS. SISPA 2002-2003

Main Causes for General Mortality, 2002 Mortalidad 2002 Main Causes for General Mortality, 2002 National 457,680 1 CAUSES NUMBER 1. Diabetes Mellitus 54,828 2. Isquemic heart disease 48,285 3. Cerebrovascular disease 26,526 4. Cirrhosis and other liver disorders 26,142 5. Perinatal disorders 18,569 6. Chronic obstructive pulmonar disease 16,851 7. Traffic accidents 14,372 8. Acute respiratory insufficiency 13,662 9. Hypertension-related diseases 10,696 11. Agression 9,975 12. Malnutrition 8,891 16. EDAS 4,679 17. HIV/AIDS 4,463 Las condiciones de marginación e inequidad de estos grupos determinan de que se enferman y por ende las demandas de consultas destacándose las enfermedades infecciosas, el control del embarazo y el control del niño sano con menor frecuencia. 1. Defunciones INEGI/SSA. DGIS.CONAPO 2002

durante el tránsito y destino Riesgos y exposición durante el tránsito y destino Addictions Incomplete vaccination schemes Mental disorders HIV/AIDS STIs (sexual transmission infections) Women’s health Violence Accidents Pulmonar Tuberculosis Diarrhea Respiratory infections Gastroenteritis Dermatomycosis Las condiciones de marginación e inequidad de estos grupos determinan de que se enferman y por ende las demandas de consultas destacándose las enfermedades infecciosas, el control del embarazo y el control del niño sano con menor frecuencia. 1. SSA.DGIS. SISPA 2002-2003

Support Service Network for Propuesta Proposal Build and Operate Support Service Network for Migrants

Origin-Transit-Destination Prevention and Health Promotion Approach EDUCATION COMMUNICATION Focalized Bilingual Origin-Transit-Destination INFORMATION Basic-orientation TRAINING Leaders-families PREVENTIVE CARE Life line

Characteristics Health has no Borders Gender Equity Perspective Migrants’ Families Prevention and Health Promotion Self-Health Care Culture Health Units: Preventive Care and Treatment: Lifetime Disease Prevention, Detection, and Control Scheme: Booklet Simplified Surveillance

246 Sanitary Jurisdictions Operational Model SPPS- CENSIA-VSRS 32 State Secretariats of Health 246 Sanitary Jurisdictions Medical Units Mobile Units Direct Care National Health Weeks Campaigns Fairs Medical Brigades Migrants’ Families Communities Camps Hostels Commando Groups

Health Service Infrastructure SS

National vs. 1338 migrant municipalities 64 % in migrant municipalities (MM) 80% Hospitals in MM 64 % First Level Units

Support Service Network for Migrants Promote prevention and health promotion during life of migrants’ families 23.6 million Mexicans Newborn (less than 1 month) 5 - 9 years 10 – 19 years 20 - 59 (Women and Men) 1 months to 5 years 60 and more

Support Service Network for Migrants Distribute four national booklets on health in country of origin, transit, and country of destination in Mexico, and promote their use (1338 municipalities). Yes Booklets. Yes Health. The Booklets of Mexican Families Presidential Decree Dec. 24, 2003

Support Service Network for Migrants Migrant Municipalities Maintaining vaccination coverage in migrant municipalities Developing parallel prevention and health promotion actions in migrant municipalities: Health Fairs, Education Sessions, Contests, Murals, etc.

ABC of Migrants’ Health Support Service Network for Migrants 60 Health Topics Risk Factors Recommendations ABC of Migrants’ Health

Support Service Network for Migrants

Family Health Passport Support Service Network for Migrants Family Health Passport General Information (5) Folio No. Date and Record of Prevention, Detection, and Promotion Interventions National and international origin, transit, and destination Travel

Support Service Network for Migrants

Support Service Network for Migrants Health Routes 50 maps to localize medical units in the main cities. Increase the amount of maps in the second phase to include municipalities with more than 10,000 inhabitants.

National telephone service operation Support Service Network for Migrants National telephone service operation 01 800 26 72 583 “MI SALUD” Free of charge First stage, national coverage and assistance by specialists; 8:00 to 18:00; Second stage, international and bilingual translators; Links with ISMECAL, Paisano and Infotur. Operations begin. August 04

Community Health Projects Support Service Network for Migrants Agricultural Fields Accreditation with White Flags of Campos Agrícolas 492: Community Health Projects Health Education Communication for Education General Prevention and Detection Control of the Environment Community Mobilization

Support Service Network for Migrants Actions on the Road Prevention and First Aid Manual on highways. Prevention and First Aid Package (for example, preservatives, paracetamol)

Support Service Network for Migrants Training Model for Migrant Populaton Leaders Modules Information and Awareness-Raising Health Care Model for Mobile Population Organization of Migrant Groups Self-Health Care 1 – 3 days According to Morbidity

Support Service Network for Migrants Campaigns Radio communication campaign, bilingual spots: Spanish, Mixteco, Zapoteco, and Náhuatl. Co-Production of Radio Program, together with IMER. Radio station: Sin Fronteras 1570 AM. Coverage Texas and Mexico.

Promotional materials Support Service Network for Migrants Promotional materials Signs and 60 spots y and short radio programs on various topics produced by SSA and others in coordination with the Instituto Mexicano de la Radio Short TV program, 5 minutes In progress: El Mensajero de la Salud para las y los Migrantes

Health Information Sharing Support Service Network for Migrants Health Information Sharing Operate web Vete Sano Regresa Sano and link www.saludmigrante@salud.gob.mx

Support Service Network for Migrants Consulates in USA Evaluation of the “Ventanillas de Salud” in the US Consulates Developing Operational Model and Guidelines Printing and distribution of booklets ABC de la Salud de las y los Migrantes in the “Ventanillas de Salud” in the US Orientation posters

Red de Servicios en Apoyo a Migrantes 1338 de 2454 municipios Incorporation to the SUAVE 2004 Nominal Census for Migrants

Support Service Network for Migrants Methodology Guidelines for needs assessment of the migrant population Invitation to participate in the Diagnóstico Mesoamericano de Salud de las y los Migrantes 2005, within the framework of the Programa Mesoamericano de Cooperación con Centroamérica 2005-2006, Secretaría de Relaciones Exteriores.

¿ With whom ? ¿With whom? International and National Comisión de Salud Fronteriza Conferencia Nacional de Gobernadores Sistema de Cooperación con Centroamérica-SRE Instituto Nacional de Migración Iniciativa de Salud México-California (ISMECAL) Instituto de Mexicanos en el Exterior (IME) Patrón de movilidad 12 Estados con mayor movilidad: Estado Población en millones Tasa de emigración % Total migrantes miles Guanajuato 5 8.5 425 Colima 0.5 4.8 24 Chihuahua 3.0 3.5 105 Durango 1.5 8.1 122 Guerrero 3.2 5.9 166 Jalisco 6.6 5.2 343 Michoacán 4.3 8.0 344 Morelos 1.6 4.8 77 Nayarit 1.5 6.0 90 Oaxaca 3.6 2.8 101 SLP 2.5 8.7 218 Zacatecas 1.5 10.8 162 Total 12 Edos 34.8 6.3 2’177 ¿With whom?

Ofnas Atención Migrantes APF3 CONCERTATIONS Secretaría de Gobernación Secretaría Relaciones Exteriores Secretaría de Turismo Secretaría del Trabajo y Previsión Social Secretaría de Desarrollo Social Coordinación Nacional de Pueblos Indígenas Coordinación Nacional de Oficinas Estatales de Atención a Migrantes Colegio de la Frontera Norte y Sur Paisano IMER IME Ángeles Verdes Training Agricultural workers Radio Indígena Ofnas Atención Migrantes Research Patrón de movilidad 12 Estados con mayor movilidad: Estado Población en millones Tasa de emigración % Total migrantes miles Guanajuato 5 8.5 425 Colima 0.5 4.8 24 Chihuahua 3.0 3.5 105 Durango 1.5 8.1 122 Guerrero 3.2 5.9 166 Jalisco 6.6 5.2 343 Michoacán 4.3 8.0 344 Morelos 1.6 4.8 77 Nayarit 1.5 6.0 90 Oaxaca 3.6 2.8 101 SLP 2.5 8.7 218 Zacatecas 1.5 10.8 162 Total 12 Edos 34.8 6.3 2’177 3. FEDERAL PUBLIC ADMINISTRATION and OTHER ORG.