Valle Adolfo Martinez
Economic Analysis Unit, Ministry of Health, Mexico City, Mexico;
Glob Health Action. 2016 Feb 23;9:29030. doi: 10.3402/gha.v9.29030. eCollection 2016.
Monitoring and evaluation (M&E) have gradually become important and regular components of the policy-making process in Mexico since, and even before, the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) called for interventions and policies aimed at tackling the social determinants of health (SDH). This paper presents two case studies to show how public policies addressing the SDH have been monitored and evaluated in Mexico using reliable, valid, and complete information, which is not regularly available. Prospera, for example, evaluated programs seeking to improve the living conditions of families in extreme poverty in terms of direct effects on health, nutrition, education and income. Monitoring of Prospera's implementation has also helped policy-makers identify windows of opportunity to improve the design and operation of the program. Seguro Popular has monitored the reduction of health inequalities and inequities evaluated the positive effects of providing financial protection to its target population. Useful and sound evidence of the impact of programs such as Progresa and Seguro Popular plus legal mandates, and a regulatory evaluation agency, the National Council for Social Development Policy Evaluation, have been fundamental to institutionalizing M&E in Mexico. The Mexican experience may provide useful lessons for other countries facing the challenge of institutionalizing the M&E of public policy processes to assess the effects of SDH as recommended by the WHO CSDH.
自世界卫生组织（WHO）健康问题社会决定因素委员会（CSDH）呼吁制定旨在解决健康问题社会决定因素（SDH）的干预措施和政策以来，甚至在此之前，监测与评估（M&E）已逐渐成为墨西哥政策制定过程中的重要且常规组成部分。本文介绍了两个案例研究，以展示墨西哥如何利用可靠、有效且完整的信息（此类信息并非定期可得）对解决健康问题社会决定因素的公共政策进行监测与评估。例如，“机会均等计划”（Prospera）从对健康、营养、教育和收入的直接影响方面，评估了旨在改善极端贫困家庭生活条件的项目。对“机会均等计划”实施情况的监测还帮助政策制定者确定了改善该计划设计与运作的机会窗口。“大众健康保险”（Seguro Popular）监测了健康不平等现象的减少情况，并评估了为其目标人群提供经济保护的积极效果。诸如“进步计划”（Progresa）和“大众健康保险加强版”（Seguro Popular plus）等项目影响的有用且可靠证据，加上法律授权以及一个监管评估机构——国家社会发展政策评估委员会，对于在墨西哥将监测与评估制度化起到了至关重要的作用。墨西哥的经验可能为其他国家提供有益借鉴，这些国家正面临着按照WHO CSDH的建议将公共政策过程的监测与评估制度化以评估健康问题社会决定因素影响的挑战。
