Background on the Issue
The ongoing shortage of medicines in Mexico’s public health sector has left an open wound, exacerbated by the recent cancellation of a consolidated purchase agreement just four months into 2025. This sudden reversal has left public hospital staff, who have been facing patients’ struggles with essential supply shortages for over six years, feeling betrayed. The cancellation, due to alleged errors leading to overpricing of 165 medications, has raised concerns about potential corruption, with an estimated overcost of 13,000 million pesos.
Government’s Response and Plans
The Secretariat for Anti-Corruption and Good Governance, led by Raquel Buenrostro, must now present compelling evidence to dispel suspicions that the decision was more politically motivated than technically sound. The government has outlined three main strategies to tackle the immediate crisis:
- A new international tender with clear rules and strict supervision, expected to be launched soon.
- A public digital platform introduced by Subsecretary Eduardo Clark, which will enable real-time tracking of the procurement process to increase transparency and rebuild trust with suppliers.
- Closer collaboration with the private sector to expedite production and distribution, acknowledging that the state cannot single-handedly resolve the issue.
While these steps are positive, the inherited debt from the eliminated INSABI ($12,000 million) poses a significant challenge for manufacturers and limits their capacity to respond.
Historical Context and Skepticism
Since dismantling the consolidated purchase model led by IMSS in 2019, which, despite its flaws, had achieved historic savings and maintained a stable supply between 2014 and 2019, the acquisition system has been in disarray. Multiple failed attempts to stabilize supply since 2019, including the unsuccessful megaconsolidation led by Buenrostro, the UNOPS alliance in 2020, the failed Insabi, Birmex’s logistics experiment, and the Bienestar megapharmacy in 2023, have all contributed to a history of failure.
President Sheinbaum’s ambitious plan, announced a day after the cancellation, aims for the government to not only procure medicines but also become a producer of medications and vaccines. Although this sounds promising, given the track record, it raises skepticism. Producing medicines and vaccines requires substantial investments, specialized infrastructure, and expertise that the public sector currently lacks. Collaboration with the private sector would be expected, but given the austere budget constraints on public health, this seems unlikely.
Structural Issues and Future Success
The success of new plans hinges on overcoming structural shortcomings that have plagued previous efforts: inadequate planning, excessive centralization, and over-reliance on industry financing—which has always existed but was more formal through contracts with distributors, now becoming informal and implicit.
The government must take responsibility and prioritize efficiency over rhetoric. Society demands clarity: was the cancellation a brave act against corruption or a hasty decision that worsened the crisis?
Reforms to National Compendium of Medical Supplies Norms
Recent Changes to National Compendium of Medical Supplies Norms
The recent amendments to the Organization and Functioning Norms of the Interinstitutional Commission for the National Compendium of Health Supplies aim to update medical supply management, but they also raise concerns about potential discretionary powers. According to Dr. César Cruz, an expert on the subject from his previous position in the Council of Health, the most significant change is the increase in voting members from 8 to 13 in the mentioned commission. This includes five representatives from various health institutions such as the Secretariat of Health, National Health Institutes, Cofepris, Modernization Directorate, and the Economic Analysis Unit, along with UNAM and IPN. This alteration undermines equity as institutions like IMSS and ISSSTE, which cater to the majority of patients, become a minority compared to entities without an apparent clinical context.
A Technical Exclusion Group for Supplies has been created, but without clear guidelines, which could lead to arbitrary decisions. The evaluation period for supplies has extended from 60 to 80 business days, and discretionary updates are allowed for orthographic or coding reasons. Other changes include authorizing distributors to request updates, requiring comparison of supplies with clinical guidelines, and eliminating the transparency concept, reducing the obligation to report dictamen dates.
Key Questions and Answers
- What caused the recent cancellation of the medicine purchase agreement? The agreement was canceled due to alleged errors leading to overpricing of 165 medications, with an estimated overcost of 13,000 million pesos.
- What are the government’s strategies to address the medicine shortage crisis? The government plans to launch a new international tender with clear rules and strict supervision, introduce a public digital platform for real-time procurement tracking, and collaborate more closely with the private sector.
- Why is there skepticism regarding the government’s new plan to produce medicines and vaccines? Given the history of failed initiatives, such as producing ventilators during the pandemic and developing the Patria vaccine, skepticism arises due to the substantial investments, specialized infrastructure, and expertise required—none of which are currently available within the public sector.
- What structural issues must be addressed for future success in managing medical supply shortages? Previous efforts have struggled with inadequate planning, excessive centralization, and over-reliance on industry financing. Overcoming these challenges is crucial for future success.
