Public Health Unit, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Spain.
PLoS One. 2019 May 31;14(5):e0217557. doi: 10.1371/journal.pone.0217557. eCollection 2019.
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.
自可持续发展目标（SDGs）通过以来，监测和减少医疗保健中的不平等现象变得更加重要。SDGs 为决策者将种族不平等评估提上日程提供了机会。本定性研究的目的是了解当前监测是如何进行的，并确定影响该过程的因素，以便纳入允许评估种族不平等的指标。
我们对来自卫生部、监测观察站、研究中心和国际组织的关键信息员进行了 17 次半结构化访谈，这些组织参与了墨西哥的孕产妇保健监测。我们的分析是解释性现象学的，重点是检查监测孕产妇保健的经验，以全面了解当前的背景和影响因素。
参与者指出的障碍和机遇源于评估准确性、信息和资源可用性以及有效管理和决策方面的限制或优势。技术人员、协调员、研究人员或决策者不仅意识到不平等现象，而且意识到其重要性。然而，这并没有导致允许开发一个指标来监测它的政治决策。至于机遇，国际组织及其与国家的联系在开展监测方面发挥着至关重要的作用，这得益于政治和技术支持。
一个有助于决策者减少医疗保健不平等的监测系统的成功不仅取决于准确的评估，还取决于其实施的背景。如果各国希望通过具体的政策和倡议来评估不平等并减少健康不公平，那么了解监测的运作、障碍和机遇可能是一个关键问题。
