Conferencia matutina de AMLO, 25 de febrero de 2020

good afternoon, good morning, we are very pleased to be with you today, like every Tuesday, we are going to report on the situation of the health plan, how are we going, anyway, we are moving forward with this plan to improve the health system, which we lack in the doctors we have The facilities are improved, the service is improved, there is no shortage of medicines, we can guarantee the supply of medicines, all of this is complex, not so much why do we have to buy many medicines, there are not many, there are around 2000 for this, the diseases we have It is complex to address because of the interests.

Remember that President Obama could not fight today because of the created interests. Here there was a monopoly. We are talking about a business worth billions of pesos and we have faced resistance, but lower this plan and we are resolving it even if we have that buying medicines in other countries is going to be guaranteed by the abbot and we are also going to put an end to the abuses that were committed in the provision of famous subrogation services that even in daycare centers the surrogates handed out contracts to individuals to manage the health-related issues with Social security issues are so delicate that they were put on the market as if they were merchandise, all for money, for the ambition of filthy money, so that is what is being faced and we are doing well, so we are going to ask Dr.

Hugo López Gatell to inform us how we are doing. In this matter, with pleasure, President, very good morning, secretaries, directors, colleagues, very good morning to all of you, today is Tuesday of the pulse of health and we are going to report some of the recent advances of the transformation plan of the national health system in this first slide we continue each week to advance this preparation of health promoters who are 6000 and we already have 44 percent of them the map you can see the federal entities the states that have health promotion personnel who have been trained in this new model, remember that these personnel were previously hired by the popular insurance scheme and their functions were administrative, mainly of affiliation, such as the health system for well-being, affiliation is not required because all the people who live in Mexico are beneficiaries, so today they do more occupations important as health promotion substantive actions and we have a list of specific achievements and decisions that we would like to share with you this is the HIV treatment optimization strategy here I want to return your attention and your memory to the decisions we made in May of 2019, as you will remember and we have said it on other occasions, in May 2019 we began this process that we call triple optimization, which consists of guaranteeing the best medications for the greatest number of people and by doing it this way through consolidated purchases we have In addition, the fairest possible prices HIV was the first scheme that was transformed and today we have in Mexico the best treatment scheme in Latin America' comparable to that used in Western Europe but we also have it for the greatest number of people at the best price and The Mexican Social Security Institute has joined in very vigorously and this is what we want to highlight this week because this is historic in the Mexican Social Security Institute, which very proactively links to what is done for the entire sector and this It generates great optimism but more concrete results.

The idea is that our national council for the prevention and control of HIV/AIDS articulates in a functional and effective way the different institutions of the health sector. Today, of people living with HIV, we have two majority groups: of the uninsured population that is served in the outpatient centers for the prevention and treatment of HIV/AIDS and sexually transmitted infections, the capaits, but we also have the populations that have social security and what we have decided is to have an integration of health services. so that we can have an exchange of services that is the initiative in which we are working with a very determined and firm conviction on the part of the Mexican Social Security Institute as you can see there in the list of elements since last year we defined the antiretroviral management guide For HIV, which is of a sectoral nature, this had already happened in previous years, it had not been specified that it would become a reality because today we achieved it because we have a consolidated purchasing scheme so that all people living with HIV, regardless of their HIV status, Derechohabience Derechohabience will have the same medications that are the best medications for the treatment of HIV.

In the third step, what we are working on is building a unique information system, no matter how incredible it may seem, over many years, the 30 years or more that it has been in existence. This epidemic has different information systems and so there is no way to guarantee the continuity of treatment in this disease, just as in many others, it is essential that people have continuous treatment to achieve suppression of the virus and that drug resistance does not emerge. By having a single system that we are integrating, we will be able to have portability of services so that, regardless of eligibility, people have this continuity of treatment.

Clearly, this is not happening at this time, but we are building it and in the near future. date we will inform you when this comes into operation but the idea is through cross-billing invoices to guarantee the financial sustainability of this operation but that people can be treated in one place and another with the guarantee that in both cases they will have the best treatments now. The imms has made available this platform, which we consider extremely important. It is a platform for interaction and transparency with people living with HIV. Initially, it is made available in links, but in this spirit of integrated work, we will surely be able to have it for the entire sector.

The idea is that there can be immediate complaints about any anomaly, including the supply or shortage of medicines, and that we can be precise. We have insisted that complaints that are not accurate are noise and possibly serve other interests. Complaints that are clear and precise help us solve where there are problems or where someone is hindering the functioning of the national health system today the link has more than 96 percent of the prescriptions for HIV treatments filled in a timely manner with the medications prescribed by their treating doctors on this next slide what we see It is the list of medications or treatment groups that have followed this optimization process.

I insist on better medications for the greatest number of people at the fairest prices. We have already achieved this for HIV since last year. Also last year we managed to establish the conditions for a national hepatitis elimination program we also managed to have immunotherapy for hemophilia through an efficient mechanism of purchasing the best medications. Since 2009 19 we immediately began to work on the optimization of anti-cancer medications and we are also working on hypertension diabetes dyslipidemia three of the most common diseases in Mexico and the leading causes of death, as I will explain shortly, we have also optimized antibiotic treatments.

This is extremely important because antibiotics of different natures were used, some of which were very effective, and it was very important to do the same to get rid of less useful medications. not very effective to have the best medicines but also as many of you know, resistance to antibacterial medicines to antibiotics is one of the main threats to global public health as has been identified by the United Nations organization not only by its branch specialized in health side ms and contributing to combating or preventing antimicrobial resistance requires making good practice decisions and that includes optimizing antibiotic medications.

Likewise, contraceptives and psychotropic drugs are therapeutic groups that have been optimized. What does this mean in the medications that we will be using in

2020

we will have new treatment protocols that use the best medications, a concrete example and very for being the first cause of death in Mexico with more than 30 to 40 percent of the deaths that occur in Mexico are cardiovascular disease commonly known as heart attack both of the heart as well as the brain, an important thing is that the final or medical or biological cause of these heart attacks are alterations such as hypertension, dyslipidemia, which are having cholesterol and alterations in the metabolism of fats in the blood, and diabetes, which is also the second cause. of death and a very important condition of heart attacks today what we have is what is seen in many other countries that we have a percentage of people less than the ideal less than one hundred percent who are detected but in addition to them a lower percentage are treated or in treatment and an even smaller percentage that does not reach 4 40 percent enter into sustained control cascade or medically or a mechanism of loss of treatment efficiency leads to limited prevention of heart attacks everything we are looking for with the new treatment regimens Treatment also includes ensuring that we have above 85% success in the control, which is the final phase of the treatment.

It is not enough that they are taking the treatment but that the treatment works. We are therefore also simplifying the therapeutic schemes and the idea is to rise above the 85 to 90 percent of the people the percentage of people who are in control the istat had a very interesting and very promising contribution that is important to highlight is palliative care, one of the subjects long abandoned by the health sector for many years for many decades is Palliative care attention What does this mean? There are chronic degenerative diseases, some associated with problems such as cancer, others associated with simply aging, a significant loss of quality of life due to pain due to decreased functionality in any of the fundamental organs, mobility. vision, etc. and complementary efforts are required to attend to the medical part, the social part and the contextual part.

Ellis has given you this program called palliative to address these palliative medicine conditions. You can see on the slide the 12 elements for comprehensive management. of palliative conditions and in the next slide you can see that there is an operational regionalization, the east has 26 units already with the palliative care care protocol and as happens in each of the examples that we mention where an institution is successful today we work together and There are opportunities to export it to the entire health sector. Finally, I want to comment on some emerging issues to dispel some effects of the bad information that has been done throughout the recent week at the National Institute of Neurology and Neurosurgery, which depends on the Ministry of Health and which It is a decentralized public body, it has its own legal personality and a governing body whose governing board is together made an important decision to dismiss the then director of the hospital.

This decision, contrary to what has been claimed, is not a hasty decision nor does it have any It has nothing to do with events of the last 15 days, nor does it have to do with the fact that the hospital could have refused to join the free plan of the entire health sector. It has to do with something that has been analyzed for more than 4 months and that is performance. of the hospital management, the technical capacity in medicine is not in question and has nothing to do with this. The idea is that a person who directs a hospital has to direct it efficiently with transparency and in the service of making the hospital work, for what and the reasons. people are cared for may have the best technical capabilities in a specific field of medicine but the important thing is that he is an effective manager and very serious problems of technical incapacity were documented that led to local shortages in the hospital.

We have already explained that this hospital has a comprehensive pharmacy contract that repeatedly failed to comply with its obligations and had to be sanctioned and the private provider and the delivery of the elements was given to exist in the following the coordinator of the national health institutes doctor gustavo reyes terán here present has a plan in conjunction with the government board to effectively reactivate services and guarantee medical care supplies and of course also free services and the last element hit on the last element is this issue of fucam the Mexican foundation for the promotion and prevention timely treatment of breast cancer, let's explain it briefly.

This is a private, non-profit institution that received its financing from popular insurance, that is, from the taxes of all of you, from the taxes that we all pay, this entity could provide free services because We all paid for it, this was financed with public money and of course it has had successes in the quality of care that deserve to be recognized but in an administrative scheme that was precisely characteristic of popular insurance where public resources were spent directly for its operation. of the private entity this is not considered to be the most efficient and in some cases not the most transparent and this is the reason why this decision has been made to no longer continue hiring this supplier so that the new system no longer includes the hiring of private entities is notnothing specific against this institution now we also want to highlight that it was opportunely agreed between the health institute for well-being, which is the one that currently manages the financing and is a private institution, that continuity would be given to the treatment of women who are already undergoing treatment in flight No treatment is suspended and I want to make this obviously clear.

We believe that the concern of women who live with cancer or are in different phases of treatment is absolutely legitimate, respectable and understandable. Hopefully, with success, their service in this entity will not be suspended. and it will continue to be financed with public money now the new cases new women who present breast cancer the capacities exist in public institutions specifically there are three highly specialized hospitals that are in Mexico City and it is the geographical coverage area that had fucam, the juárez hospital in mexico that we talked about last week, the general hospital in mexico and the national cancer institute have made a careful analysis that they have the capacity to care for new cases, their bed would have about 1000 people in a thousand new cases and these new cases can perfectly be absorbed along with the nearly 22,000 cases of breast cancer treated in public hospitals.

The next one please and also the last one in supply. There has been a lot of misinformation this week in the idea that the shortage of medicines continues. oncological medications, as we have repeatedly explained, oncological medications, medications for children with cancer in the majority of the hospitals in question, the supplier is a private entity and this private entity, we have illustrated with the case of the Federico Gómez Children's Hospital in Mexico, has obligations of deliver the medications when a private company failed to comply with its obligations since last year, the federal government came to the rescue, it came to cover a non-compliance that the private company had and here we have also commented on the importance of the officials who signed the contracts exercising their obligation and sanctioning and demand from private companies that are suppliers, but in any case the federal government, the health secretary, in combination with the treasury secretary, through the higher official's office, came in to rescue this situation by making extraordinary purchases of oncological drugs and we have purchased them in countries that They have high-performance health regulatory agencies classified at the highest level by the World Health Organization.

There you can see the list of countries from which these medicines have been purchased. Also, how the technical protocol is followed. The Commission for Protection against sanitary risks of Mexico reviews all the batches of these medications when they arrive in the country that sometimes implies a delay of a few days 20-25 days because absolutely all the bottles of these medications have to be inspected since the beginning of the year we have been distributing the Directly there you can see the figures, in addition to 46 thousand pieces of which 32 thousand have already been distributed and delivered to hospitals.

This Wednesday, tomorrow we conclude this cycle of delivery of these extraordinary purchases that the government made to rescue a situation due to non-compliance by companies. private this is all because thank you very much on the subject thank you president please here we start here in front we follow each other here and here and women there are also very good morning Mr. President of Mexico good morning to the entire health cabinet leave the wells of l' or official molecule you spoke of clear details I have here several points that were sent to me through social networks and the first is Mr.

Román Rojas García, 80 years old with Parkinson's and high blood pressure, they did not pay attention to him in the East, this happens in The first of October hospital scheduled his care until June of this year to be able to attend to him. The man works this because he has not received his suspension either. That is a very specific case that happens at the first of October hospital. I also have a whole folder here about him. business in hemodialysis which can also be delivered very widely. On the other hand, Mexican oil retirees at the Pemex Regional Hospital of Veracruz denounce that there is a lack of medications, especially in chemotherapy.

On the other hand, section 9 workers do not agree. According to the union representation, I know that it is not from the health sector but it also has something to do with it. Today, on the other hand, workers from the union of the national health system from now on in section 4 denounce the secretary of health of Hidalgo for the refusal to recognize the union and jan and deny access to health system workers this in hidalgo and on the other hand on social networks they also ask me to investigate the money that the government of the health ministry gives to the national union of health workers both In scholarships the sum is 13 million pesos annually and also for social, cultural and sports activities these add up to 60 million pesos.

It is not clear what happens with those resources that are given to the union and they also ask me to do so. An investigation, if possible, into the efforts of the former directors of the Mexican Social Security Institute, José Antonio González Anaya, Mikel Arreola and To Feel, Miguel Ángel Ortega, who served as heads of Social Security, and finally, ask if the Jalisco government headed by Rijke Alfaro already joined this, someone knows this because there is also talk of mismanagement by the governor in the purchase of some and devices to cool this vaccines and to know how the issue of the states that have joined in urging and thank you very much thank you very much.

The last one answered, the other thing, I thank you, surely we must give general follow-up to Mr. President, if you allow me, correct that 26 of the 32 states joined the health institute for well-being and there were six that decided not to join this new health model as We indicated at all times what the president himself said. We were very respectful of the sovereignty of the states. We are convinced that having an integrated health system allows us great benefits. Just what I just mentioned is that the integration of national health institutions is historic. In these exchange schemes, adoption of best practices and models services gives us benefits immediately, but we respect that some states for the moment consider that they can individually and we hope that they are in the same general goal of ours, which is to achieve medical care and free medicines for the entire population, if they achieve it, well, if not, we will continue to insist that a comprehensive scheme is better, and above all, the complaints, I almost appreciate it if they let us, the social communication colleagues can support us here to receive them and then we will give them course please let's give a course there to a white woman Valadez and here to the colleague please how are you good morning everyone I have several questions one what is going to be the rescue plan for the national institute of neurology specifically so that it returns to function as what was an institute of excellence.

Ask you. There have also been complaints for several years against Félix but also against his de Sotelo that there was human experimentation with some patients. There are even recommendations from the Inter-American Convention on Human Rights so that If possible, if possible, please provide a file with the information. I want to know if there is an open investigation against Félix regarding this. Also, if there will be any specific sanction for having failed to comply and for having handled the public resources incorrectly within the institution and If you allow me, with all respect, yesterday information was handled that the indre is going to sample and identify some of these samples that did not test positive for influenza, to know if, well, in some way, the coronavirus has already entered Mexico through these samples that are being tracked. because they did not test positive for influenza know if yes if this is the case if yes what is going to be done because well in Italy an alarm situation is already being created in other countries alerts are being declared global alarms and in Mexico The speech has always been that it is catastrophic, thank you very much, thank you, thank you, Blanca answered both points on the subject of the neurology institute, as we also made public knowledge, there are different research processes from those that depend on the internal control body and has taken action.

In the matter, the secretary of the public service herself, on whom the internal control body depends, and several investigation files are open, at this moment we cannot reveal any specific element because we would violate the principle of due process. At the time, when responsibilities are defined, the public knowledge about this topic of the investigation here in our colleague Hernández had also said a statement from last week and what we responded is, of course, there are old files of all this. The Inter-American Commission on Human Rights has actually made some recommendations for Mexico and it is being Following up on the instructions of the President, we are in coordination with Undersecretary Alejandro Encinas precisely to review the response to the Inter-American Commission and continue with what corresponds here in Mexico.

The moment there are concrete results they will be made public regarding coronavirus. He took advantage of the timely comment to put in context the international news regarding the national context is not the first time that the director of the world organization since the new coronavirus epidemic began in China at the beginning of the year has made this statement that we must prepare for a pandemic, we must prepare for a difficult situation here it is essential to take into account the following the world health organization is an international organization that is made up of the membership of more than 195 member states, that is, practically the entire world and these countries, there are some that have robust installed capabilities in surveillance in attention in preparedness and response to emergencies and there are others that unfortunately not particularly on the African continent but it is not the only place in all the obligation of the world health organization is to ensure the capacity and solidarity between countries to protect those who They are in greater adversity.

This repeated statement is because it is feared and it is very likely that it will happen that the African continent and the countries that do not have these capabilities will be affected by the coronavirus. The situation in Mexico specifically may be that the coronavirus has not reached Mexico. We have until At the moment we have accumulated 18 suspected cases, each and every one of which has been ruled out. This was reported yesterday in our daily bulletin that we are going to do sampling because we have been recognized by the Pan American Health Organization as the first country to adopt a detection and we are at all times looking for different alternatives to make this protocol more efficient.

This is a general sampling, we received more than 5,000 samples from all cases of acute respiratory disease. Do not forget that influenza is a disease that occurs every year and we continue in the influenza season and we continue to receive influenza samples. All we do periodically is these samples to see if the coronavirus could be among the cases for which influenza was ruled out. This is not the first time we are going to do it. We have already done it in two cycles. and we have found everyone negative. The preparation in Mexico is a preparation that we have been very consistent with.

We already have the surveillance protocol, the laboratory protocol, the medical care protocol, and last week we published the infection control protocol that involves more that in the health sector we have the participation of many sectors and important social agents, we have active protocols in the health security committees of the 32 states and with emphasis on the five relevant international airports in Mexico that are carrying out the detection and closure protocol saying, as we have said on other occasions, 15,000 people arrive from China every month to Mexico and it is not recommended, according to international standards, extreme screening measures for each and every one of these passengers.

Italy sovereignly decided to have an extremely protocol. intensive that no European country has that Canada does not have and that almost none of the upper-middle-income countries have. We obviously respect the considerations that Italy has had but this does not correspond to the standards that the world organization has set for countries like Mexico. Regarding health, we can be calm in Malaga in the face of a precision, so if there is an open investigation against Félix and the group that formed around this human experimentation, we only know whether or not an investigation is open, I insist that the government's supervisory bodies periodically have investigation processes some are preventive some are derived from complaints or derived from institutional concerns all of this is in process and in due course it will be informed who is involved and what are the possible responsibilities that infinite qatar to the institute the rescue basically what it consists of is and here it is very important to highlight that there is also no prejudice against doctors and nurses and it is essential to be clear about this, not to allow oneself to be manipulated by the idea that the government is against doctors andThe doctors and nurses and all other members of the health personnel are extremely important.

They are the essence. They are the heart of the institutions. We have enormous respect for them. We are part of that community and the secretary, the commissioner, the health officials, we come from that community, the directors themselves. of social security although they are not doctors they have a very close familiarity with the health personnel so do not confuse we respect we value we greatly appreciate the valuable struggle work commitment that the health workers do every day they are our community all through of them is basically based on the complaints made both in the special visits that there were and in the ordinary procedures, we are seeing that we have a robust mechanism to activate the services that have been paralyzed by certain people who individually have not contributed to that, please Thank you, Arturo's undersecretary, for not seeing your image, Mr.

President, good morning, gentlemen, officials, good morning, colleagues. You comment that there are nearly a thousand cases that Ucam attended to each year of cancer and you say that all of these cases can be treated in the three hospitals that are there. specialized for this care if I understand correctly then these three hospitals have the capacity but we already know all of us here cases have been exposed to that some of them in which there are bottlenecks that prevent faster, more timely care than what It would be desirable if we are going to add a thousand more cases to these hospitals to this system, what guarantee is there that there will be better care for these people, these women who were already receiving care through the focam and who are now being assigned to a system that may be slower and in this case slowness because if it goes against your health Undersecretary and if it also allows me to avoid a question for the director of I will gladly clarify again the women with breast cancer who were treated in fucam and who are still undergoing treatment, they will continue to be treated there and the government, that is, the public resources, the money of all of us who pay taxes, is what financially supports the care of these women.

It is not charity, it is not generosity, it is not a situation of a private entity that gives away the services is all of us who pay taxes and pay for these services will continue to be understood there with respect to the guarantee of attending to new cases of breast cancer or any other entity of any other cancer or any other disease, the transformation of the national health system that we have been detailing and will continue to detail is comprehensive, there are different elements that have to do with service times. This is an international standard that is being reviewed by the National Cancer Institute itself last week, as you know.

In the voice of its director, he explained one of the interventions that are underway to shorten the time between the detection of a disease, the care of the disease and the guarantee that the disease is under control. What I have just presented regarding the prevention of heart attack that applies to chronic diseases it implies to cancer it applies to HIV etc. We are thinking that it is essential that people are at the center of the operation, not the institutions, the institutions are at the service of the people and precisely part of the transformation includes reviewing where there are bottlenecks remove bureaucratic obstacles make the process of reaching care much simpler this will be achieved through hiring more staff not opening hours days of care that are not contemplated many of these interventions many are the Mexican insurance institute social activated mechanisms to take advantage of lost time that existed before, for example the use of operating rooms, and this is allowing expansion of service coverage.

In some cases, in rural areas there are these medical-surgical days that allow the use of facilities that previously They were wasted. Now I want to highlight that much of the administrative inefficiency in some cases we have identified that was not accidental, that is, there is a part of administrative efficiency that is due to lack of management, lack of supervision, but there is another that is not so coincidental. Precisely from the Institute of Neurology there are some very illustrative elements of highly specialized surgical equipment, high-tech robots that were in disuse although they are in perfect condition and that apparently gave rise to pressure from doctors to hire external services and this type of abel, precisely then we have found this type of practices in various corners of the health system and it is precisely by controlling these bad practices that sometimes the capacity for attention immediately arises, Mr.

Director, if you allow me, last week I did not have the opportunity to ask you about This we published a note that the secretary of the public service reported damages to the public treasury of 50 billion pesos for transfers that are from public entities that were not making to the public treasury, including multiple fines on tax credits withholding of federal taxes and also the social security quota in the federal entities in several states that were not being transferred, what is this situation now, one of them that had the greatest delay in the transfer of all the taxes that are destined to the public treasury was the state of veracruz and so on, several reports you have about the transfers to the public city of everything that had to be transferred, the east are not taxes, they are fees and contributions, the east is fed by fees and contributions and the federal government through The treasury complements the operating expenses effectively.

Unfortunately, the institute presents a very serious problem in that the fees and contributions are not being reported by the entities of the different employers and this is evidently generating a problem in being able to invest in equipment and inputs. healing material and already the chamber of deputies and the ceo of the republic have in the income law established some mechanisms so that agreements can be made between the entities and the isste. Currently only three states of the republic have signed an agreement with the East San Luís Potosí Baja California Sur and Colima and the headquarters of the public service is going to support us to also be promoting in a much more intense way these agreements that allow, on the one hand, the entities to use the payment of contributions, but The most important thing is also to regularize the integers to the workers' accounts, so we are right now in a delicate important moment and obviously it is a good opportunity to urge the states of the republic to facilitate this approach and regularize the quotas and contributions to the 50 billion, according to the billion, he says that agreements are already being made about how much he would be talking about right now, I know what is missing from making those debt contributions at this moment, they are 60 billion pesos 60 thousand 7 million divided into this fovissste and individual accounts and it is for this reason that things are because we are trying to promote encourage these two ideas to be covered now I do want to clarify that most of these debts are seen accumulating throughout For many years now it has not been an issue of one year or two years but it is an issue that we have been dragging on for more than ten years and this is evidently generating a serious problem in the states because it does not allow us to invest, I insist in infrastructure, equipment and supplies, which is what What does the institute need the most?

Many times, thank you, I always feel if you allow me right now to ask a question about economic development. I just want to specify something that is interesting. I consider it, don't look at the question. For me, it is very good about whether the public health sector has the capacity to to attend to cases of breast cancer, what happened during the entire neoliberal period, to locate ourselves and to better understand what we are carrying out, the public health care system was completely abandoned, as was everything related to the educational system. how the production of electric energy by public companies was abandoned, how pre mix was abandoned, why the central purpose of neoliberal governments was to privatize, they did not want to promote the public, privatized, you have to look it up in the dictionary, it is converting the public into private, that was the The policy to be followed in education then proliferated in paying private schools.

If you had to pay tuition, especially at the higher level, enrollment grew to a certain point because the time came when the majority of people could not pay, and the enrollment grew much more. enrollment and that is easy to prove from private schools that in public schools, percentage-wise speaking, the same thing happened in health, there was no investment in the health sector throughout the neoliberal period, the large companies providing private medical services grew. I am not against that. Same in the case of education, those who have to pay DNI tuition to pay for a private medical service can do so within their rights, but the state is obliged to guarantee public education and health to all Mexicans, so what happened if it was not created new hospitals but investment to meet the demand for diseases such as breast cancer, then they did contract the service because there was no possibility of it being treated in public hospitals.

Now the change is that we are going to strengthen the public health system and we are going to investing in health centers first-level medical units in second-level hospitals to improve care in specialty hospitals that the state fulfills its responsibility to guarantee the people's right to health is another model, what neoliberal governments wanted was for the state would be diluted and leave the entire market that is why we are facing this situation of lack of bed spaces for hospital teams but that is what we are going to address until we completely improve the public health system because it is not a single issue. d medical care is an issue that has to do with the economic capacity of people to heal themselves, so if we are going to guarantee that people are well cared for in the time they require it and that there is no shortage of medicines and have the support of doctors And the same is true for those who have to pay a private hospital by extensive right and even provide facilities for them to continue investing in the construction of private hospital centers, but that is for a sector of the population, imagine we have almost 60% of the population.

Without social security, a peasant who goes on private Twitter, well, they don't even receive it and yes, they have it. No, it hurts me, no, no, what money he has, that is, that's the bottom line of the matter. Well, I'll say it, we have to regularize this treasury. He is already doing his job so that the ISSTE has enough resources because it was a looting, it's just a matter of remembering and I'll leave that to you because if not, this is no longer a joke who were the list directors who were the list directors There are so many complaints about that, so we have to put an end to this corruption and I am sure that things have to improve, it takes work, it takes time because these vices were well established, but we are going to clean up the corruption, well, but that health, yes, yes, but it was you and then here the companion and then women there until natal and 20 the please thank you very good morning Mr.

President and to the health cabinet also sending art of passion for business politics rock and roll radio project bridge of Sonora and last week I I even had to participate as a journalistic guest in a particular forum that was organized in my state called the serious Lynch crisis and alternative solutions. Here I bring you Rododo Este's conclusions so that you can have the opportunity to read them without However, this main conclusion of this forum and surely this is replicated in other states of the country is nothing more than in Sonora, the situation is apparently somewhat chronic and that is why the request is so reiterated that, well, given the serious lack of specialist doctors who They persist in insisting in my state and in the northwest region, I also understand the agreement that was reached in the eastern forum, including on behalf of the delegate, the new delegate who just entered last Saturday was also in the forum, the workers' beneficiaries were present, the workers' beneficiaries were also present.

The employer's part was the part, since the unions are also requesting that Sonora be considered specifically as an expensive living area, which is an issue where the very high turnover of good medical personnel has really become a problem to the extent that we have today 578 vacant positions a month ago were 400 only with the expansion of the provision of services because this problem also grew that Sonora is considered an area of ​​difficult access and finally that Sonora is considered a state that has security problems perhaps not in hermosillo but yes, for example, a city of obregón and perhaps yes in navojoa perhaps and in some border communities the specific question for the president for psoe if there would be a commitment on the part of the federal government to directly address this specific issue Now the thing is, I am entitled to the IMMS.

Last week, in fact, I told myself that it is now two weeks. Toucan had to attend to some medical matters and while I was standing in line democratically, a doctor approached me.and from there the imms is this and he tells me no this is that the situation of the supply of medicines is in Sonora is a problem he tells me this about all the oncological medicines he is a doctor who is an oncologist involved not to give his name just for the purposes of not give him bad publicity but he tells me that the beneficiaries are sorry, it's because I need to read the medications, I'm not very familiar with the names, they have been denied three types of medications in particular, and he says that they are denied for one by one.

An issue that he himself does not know because they are cheap medications, he says that he refuses to take lavín christina in particular cyclophosphamide riley and the es and pfos family so I have received a lot of feedback from people who have evidently oncological problems where they have repeated this complaint to me However, it caught my attention that the doctor who identified me that I came in the mornings, they told me and pointed it out to me, it will emerge and tell the president what is happening in the inss in son now I have an additional question for the president If you allow me, but I would like to know the position on this issue.

Thank you. I saw you and I will answer very briefly about cyclophosphamide and phosphamine vincristine. We have been saying it thanks to this doctor who is acting for the health of his patients and is helping them. Let all of us in the country be aware of the challenges we face. Vincristine and the cyclophosphamide family is something a little technical, but I believe that everyone is already becoming an expert in medicines. There are three medicines that in the global market suffered a reduction situation. of production the reason is simple and it is clear and it is perfectly documented.

You can see in countries like the United States this is a discussion that is present about this that happened two or three and a half years ago practically of the only two companies in the world, imagine one in India one in China produces the main components for these medicines one of them closed the one in China due to a meteorological phenomenon boom typhoon and then there was damage to the plant the Chinese health authority documented that the plant did not have the appropriate conditions to produce safe medicines good quality decided to temporarily close this plant the whole world the whole world is at the expense of a single plant that is in india and produces the active components for the whole world in particular the most affected were these three drugs this is the explanation for the oncologist a who we thank you now regarding what you said about the imms and it seems very respectable that you defend your state there are challenges regarding the generational change that exists in the personnel a non-hiring process of stagnation in hiring that leads to a freeze and obviously The staff aged, I am referring to the specialized medical staff and this has to do with the phenomenon that the president says that it is very clear to us that there was no interest in public institutions as the business was in private adventures I said it last week well There was no interest in strategically maintaining these periods, but there is good news.

The current director of the IMMS has a strategic vision, as we have already seen. His technical council supports all the councils made up of the three sectors that coordinate with the lynx or that are part of the IMMS. and the training cycle for specialist doctors in all institutions is just ending, but in limbo there are important decisions about refreshing this installed capacity and I am sure that the psoe teacher has important news, thank you very much with your permission, Mr. President, first about the forum, a forum Organized by the particularly by the leader of the there in Sonora Javier Villarreal there are a series of elements that I am interested in clarifying because they requested and it was an instruction that the new representative in Sonora, Dr.

Edgar, was there precisely to be able to clarify some things, first there was never Because one of those conclusions was just changed by the president. One of the proposals, curiously enough, is that services are subrogated, with all due respect, that we are never going to do. Javier Villarreal's approach in Sonora is that we subrogate surgeries, that we subrogate consultations. Even in very serious cases, for example in Puebla, where a 415-bed hospital was lost, where we greatly reduced our capacity, the solution was to look for other health institutions with a university hospital, even with the Red Cross, and right now we have just enabled 60 new beds in the Margarita hospital, this is how we should solve the problems.

We think it is serious that a process is being proposed that is contrary to what we should do in terms of institutional strengthening and I am very struck by the fact that it comes from the leader of the hospital. approach in Sonora in Obregón starting this year the doctors and it was a part of the negotiation of the collective bargaining contract will have a 20 percent bonus this in Obregón there is an approach for life face remoteness situations of extreme poverty and security that is established in principle for the issue of well-being in Sonora, the program and well-being does not exist for several years and a decision was made to take it to the health services for the open population, now without a doubt in the case of the area as mentioned by the undersecretary López Gatell and in many parts of the country there was a process, as has been said, in which a significant number of doctors retired last year, there was an estimate that there were going to be close to 9,000 and there were close to 11,000 with the government of the We have been working precisely to look for new incentives for the graduates who today are in a little while longer than their graduation, let's say from the medical residencies.

It is important to point out that in 2018, 3,740 graduated, he reports to 56% of the specialists in this country in this model of The medical residencies in 2018 were 3,740 in 2019 there were 3,1973 and now today 4,308 graduate these new doctors and specialists are an additional 15% which according to the second important part that we have to work to exceed the levels of the Let them stay in social security, we have a goal of about 85 percent of these 4,300, those are the ones we are going to additionally serve today, 7,000 enter the residences, 36 new doctors who are going to go to work in the hospitals in this medical residency program just to give an idea, last year there were 500, sorry, 5,429, that is an increase of about 22 percent.

We are betting a lot on that in the preparation of personnel where there are deficits. I want to point out that the program for these residents is with a scholarship, it is about 15 thousand pesos, it has a social security savings fund, vacation bonus, help for rent, help for books for their own preparation for other types of recreational activities, pantry, attendance at extracurricular events that They are part of their own preparation, they are generated from residency, they begin to generate seniority and there has been an increase in salaries in accordance with the increase made in the collective bargaining contract, that is, we are solving a historical deficit in the training of doctors, especially in the part of their hiring because in many cases, the link ended up preparing doctors who ended up in others in private hospitals.

What we want is to generate the best conditions. What I can tell you is about this forum organized by the es that no We share the idea that you have expressed about subrogating the social security service and on the subject that the doctor commented on, who is only in the specialty hospital there in Obregón, and it is also right in front of it. On Friday, there was a dialogue with parents of children with cancer, these types of medications, as they have already mentioned, have had this situation, but on the issue of highly specialized medical units and hospitals we are reviewing it every day to cover an important issue, the timely supply of prescriptions, which are many, a much better indicator is how many of those people who arrived with a prescription at the pharmacy were fulfilled within the period established by the prescription itself.

There are times when if it cannot be covered one day, it is resolved the next day or in two days. maximum without entering into life support problems, far from it, but we are also grateful that with this clarification that we can now review it directly in Sonora we are concerned because you know the dimensions of the state, the second largest state in the country and for example I have had the case of an oncology patient who had to travel from Salud Río Colorado to Ciudad Obregón, 900 kilometers away. This must be quite complicated for him and his family.

Or do we have only one gastroenterologist for the entire state? We are 1,300 in one. million 300 thousand beneficiaries in Sonora, the gastroenterologist of yore is in Nogales, not this one and for all the others, this one who needs this service because it is complex, that is not the reason for the persistence in seeking to resolve the problem of lack of personnel, there are 572 specialized doctors that are needed, no yes, and as I mentioned today, this number graduates and surely many will go there. Yes, there has been a situation in some very specific municipalities of Sonora where it has been complicated precisely because, in all honesty, sometimes The doctor is making an assessment and a calculation based on the possibility of there being an offer for private practice.

Not only are we fighting with that, but we are looking for a commitment to the institution that trained them and with all these working conditions that we are in. improving to a great extent if we believe that results have to be given, as I mentioned, with the state government we are looking for other types of incentives that range from housing loans offered by the state and a series of incentives so that they go, in some cases, return to the place from where they left their place of origin and can serve there just a clarification in the case of San Luís Río Colorado that is attended to in the delegation of the neighboring state of Exacta served in Mexican in Obregón let's see there has been an error in the transfer back yes Allow me, Mr.

President, to discuss an issue that is not health-related but is very important and the context forces me to ask you. Last Sunday in Hermosillo there was a demonstration of around 2,000 women who were outraged by the issue of femicides. We already know the narrative of what What has been happening with this, however, the demonstration that began peacefully was very orderly in the end because it led to a situation of violence. The ladies who were in the demonstration felt attacked by a situation that occurred on the esplanade of the building of the judicial power and this motivated some, which were not all, it must be said, also good, they caused severe damage to the facilities of the judicial power of the state of Sonora, to the extent that well beyond scratching the walls, breaking glass, destroying furniture, they also even burned judicial files This we have seen that this situation has been repeating itself this well in this case it was in Hermosillo previously well a few days ago it happened here in the national palace this one previously even because there was damage to the monument to independence this among other situations so obviously I want to ask you for your opinion of what happened in Hermosillo on Sunday, however, I am much more interested in asking you, Mr.

President, we know that the issue of violence against women and femicides has a deep cultural root that has to do with machismo, which I will see with the exclusion of women, which apparently has become so normalized in our country that we see it as something that is a commonly used currency and you ask me and I think my SDP colleague here commented on it the other day and a couple ago For months, I was asking you that if there is a possibility that the government, just as you have committed to combating, for example, addictions, will implement a series of campaigns that will allow us to go to the bottom of it, that is, culturally combat this scourge that affects us as society, which is not only violence, is the most unfortunate consequence, not only femicides, which are also obviously the most tragic part, but inequality, for example, it is common that all women earn less than men for the same work, discrimination is common. against women, the truth is that I am especially concerned about this issue since I am a father, I have girls, but I also live surrounded by women, including my partner and my multiple mothers because I have several, and at the end of the situations that really worry us in Sonora since it is one of the states with the highest incidence but obviously it worries the entire country so for the demonstrations that have been seen, thank you very much if you look before that just point out why in the newspaper of the country of Spain that has dedicated itself to questioning us one day in and the other it is also said that in the conferences we editorialize because yes I am very interested not only in informing but in raising awareness it is informing orienting raising awareness is a task of political pedagogy in the case of Health specialists, as has been made clear here, have a deficit and it is important to say that we lack doctors and specialists even though the conservatives and their two zeros question me, blaming neoliberalism for the whole fact, well it is the fault of the neoliberalismIt was a lie that they did not pass the admission exam because that can be proven.

In the medical schools here at UNAM, they asked 125 questions, but since there was only room for me, they decided to give admission to those who answered 120 questions correctly and those who answered correctly. against it was ok 119 no longer fit then ok 119 out of 125 failed in 6 no longer fit so it's not that I didn't pass the admission exam it's that there was no space there are no spaces so what is the result now we don't have doctors we don't have specialists so We are going to forget about that, do not suffer from amnesia, talking about fewer doctors, others, we are not going to forget all this that they did, this mess that they left, now we have to overcome all this delay and we have to do it as soon as possible, it will take time.

But for that reason, to create medical schools, expand the possibilities for specialization so that we can have doctors, specialists. I told you that in the Wellness Links hospitals, which are the best, there are many without specialists, why if there is a lack of specialists, what are they? Now imagine what happens in the rural hospitals in the marginalized areas. I have here in my memory there are three welfare hospitals in Yucatan 3 and in none of the three there were pediatricians in none of the three without a pediatrician because there are none, they do not want to fill the vacancies, no.

It is a matter of there being no places, now we are making an effort and I also take advantage because there are specialist doctors and general doctors, the call is already being made who are retired to help us with a six-year sabbatical, not five, and in the absence of this one, let them help us. There are many who have the desire to contribute and help support us by adhering to the program, but I also wanted to make this clear because it is one of the issues that we have to resolve little by little, not about what this raises, it is the whole question.

The reason we have to address the causes is what we have always said. The problems of femicides and violence originate from poverty, the disintegration of families, the abandonment of young people and we are working every day to address the causes that lead to all these problems. We are going to continue serving everyone, giving preference to the poor and the vulnerable population, girls, boys, the elderly and people with disabilities. We are already doing it not only in what has to do with freedoms with gender equality. I can say and I hope Let it not be misunderstood, I was the first ruler, well, I gave the same participation to women as to men.

When I was head of government, there were more women in the cabinet than men. Now, the same is true. I was part of a movement that was part of the opposition that led Now that half of the legislators are women, I promoted that it will be respected that half of the candidates were women. I apologize, don't think that I am bragging, but not only that, that is at the level of freedoms at the political level. social the social field I wish the data could be requested the 10 or 11 million scholarships that the government gave out, the majority are for girls and adolescents, that is, in the senior program, the majority are women of the 8 million women in the 'youth building' program the future, the majority of women have great respect for women and we go and collect what you are proposing, we see this saying to a question that they asked us that yes, just as a campaign is being carried out to prevent addictions and drug consumption. in young people that if in this way we can carry out an awareness campaign against machismo, of course we are in favor of women, we are not sexist, that is, we come from a left-wing movement, even if you don't like it, and I apologize for anticipating, you know where it is. machismo who are the machistas and those who discriminate conservatives for that reason and now that all this controversy has been generated the only thing we ask is that everyone demonstrates it is a right it is not about a conception more freedoms are won and they implore, they get us on our knees, they win by fighting standing up and walking forward.

Well, the only thing we propose is no to violence, nothing more, that's the only thing, no to manipulation, no to opportunism. If you have problems with us, don't disguise yourself as feminists for the sake of it. That is even immoral, more so because getting involved in a legitimate movement, grabbing flags because they are against us, letting them raise their movement, let the conservatives raise their movement, how the reaction has acted in the history of Mexico every time and a process is carried out. of transformation then that is the issue but you are absolutely right and we are going to help to raise more and more awareness and there are now unbeatable conditions because people want to help with everything about the unfortunate case of the girl who loses her life I am sure that the lady who helped clarify this unfortunate fact, the easy day girl of those involved, is a conscious woman who wants to help, that even her very important personal contribution was not recognized and so many people who want to help, who want to contribute because because there is an environment different this is another country and in exchange because there is a change in mentality when the mentality changes the people change everything then we have conditions for things to improve and to face the serious problem of insecurity of violence every day we are working for that and I have confidence and I have confidence because there is no longer corruption and there is no longer impunity, we no longer allow the authorities to be at the service of crime, there are no privileged people and now there is an authentic rule of law, not like it was before, a crooked state, so I have confidence that despite the seriousness of the problem, why and they refused to decompose the country in destroying the country, they did their best throughout the neoliberal period, in the best of cases, what can be said is that they dedicated themselves to looting and They were never interested in the town, they completely forgot about the town, so now things have to change little by little, let's see, please don't think I'm wrong, but no, no, you don't have the figures for the welfare program. 53 percent of them are girls. yes in relation to the population yes yes yes equal to equality but this shows that there is equality that it is not a sexist government 56 percent yes yes yes yes I already know all that but here are the data yes in the case of sowing life that is field work moving forward and not knowing how to build the future in the case of people 46% disabled you don't have that is, I think that even as my colleague comments, there are more women yes in the population but there are equality but yesterday I didn't realize it, I mean I didn't know and we left the children without this word s and now yes hello I'm very confident I'm 10 years old I'm from the periscope space team of Veracruz I come to represent the girls and boys of this country and well, I and my team prepared some questions for you.

First, I want to thank Mr. President for giving me the floor. Yesterday, I did feel a little disappointed, but today is another day and you have shown to be very persevering and I am too, and that is why it is I am here, as I already mentioned, we formulate three questions for you, I and my team are going to read the first one to explain it better and I believe that boys and girls need more spaces to participate in the media. I also believe that in our country our You are not prepared to listen to us.

I tell you this because on January 31, for example, the only children's program on the state radio of the state of Veracruz was suspended from live without giving us any notice or taking into account our efforts and our feelings in this context. I ask you how your government can guarantee that our right to participation, freedom of expression and access to information and communication technologies is enforced. Thank you again for giving you the word, well, this is how the right that people have is guaranteed. children to demonstrate express themselves to have information because with programs like yours and asking the governor in this case of Veracruz to maintain the program so that the program is not canceled that is what I can tell you and now we have the great advantage of what is there more possibilities to communicate than before, before it was only newspapers, radio and television, now there are social networks, the blessed social networks, so now we can all communicate through the internet, of course, the internet does not have the full reach, why in Veracruz, which has 212 municipalities?

Half of the municipalities do not have possibilities for internet communication, sometimes not even in the municipal capitals, the internet in Veracruz and this is what happens in Oaxaca and this is what happens in the majority of the country, so what we are doing now so that there is more communication and media to communicate is that there is a program that will allow us to have internet in all towns so that all girls and boys can communicate and that newspapers continue to exist. They cannot disappear. It is very important that the radio that is listened to a lot continues to exist.

The medium that is heard the most in the common sections and that television follows this, especially open television because lately they also promoted pay television a lot and not everyone has the possibility of paying for the service but well with the internet you will have greater coverage and in the case of your program, Governor Cuitláhuac is going to guarantee that your program continues. Our intention is not to force the same team of children again, but what I do want is for everyone to We children are given that guarantee that our rights are fulfilled if they have that right.

Yesterday I did not realize that you were there, why were the adults asking your questions and also this one, you did not warn me because you were here, so This is a shared responsibility, no, but it's good that returning will guarantee the right to information for girls and boys, and congratulations for having this program. It's very important because now there are games, there's knowledge of entertainment, but information is needed, communication. an adequate one ok thank you very much good morning Mr. President I am Fidel from Periscopio Espacio I am 7 years old and I come from Xalapa Veracruz and I care about the rights of the girls and boys in my country and my question is but before this we know that no He answered us because there was not much time and to wonder how the transformation door improves the lives of children.

It is a very good question. We are improving the lives of children. Why are we working to ensure that there is no poverty in the country and that all girls and all boys can eat well and can go to school and can study and finish a degree first that there are no poor their parents have income if they work in the fields that what they produce allows them to support the family that they can receive prices fair for their production that those who live in the city have work that the salaries are good yes there are good salaries because in the family there is well-being and food there is for clothing for the ticket for the expenses that are incurred in school for the expenses to times that are required for health and and our government is helping to have scholarships so that the poorest have support if they are in preschool if they are in primary school if they are in secondary school they have a scholarship students from poor families already when they reach school high school everyone has a beck and also those who are studying at the university 300,000 young people are receiving a scholarship of 2,400 pesos per month poor students so that is what we are doing for the girls for the boys and I can tell you that the only privileged ones there are Now it's the girls and boys and the respectable elderly, come on hello, good morning, I'm Andra Silva, I'm 12 years old and I represent the half periscope space of Xalapa Veracruz.

The girls and boys want to participate, be taken into account, make proposals, please send a message to the children. and the girls about what we have to do to contribute to the development of our country, thank you for having us, yes, it is your turn to be good, behave well, everyone, behave well, moms pay attention to parents above all branches and have fun playing why the game for girls and boys is like work for adults it is important to play have fun but I am not finished yet and studying is sometimes not possible because very poor children have to help their parents in the fields and others have to accompany them. their parents because they are day laborers if they are warriors it is where Oaxaca goes to work in Baja California Sonora and there sometimes they cannot study so you have to ensure that the children always study and think that the one who studies defends himself more in life than the that you don't study, sometimes they study you and finish a degree and can't find a job and they say well, why study if you don't have a job but studying helps a lot, it's not just about getting a job, it's about finding more meaning in life, being good citizens and I was very happy that you visited us here I am going to finish by telling you something we are countrymen you are not going to get jealous in Tabasco in my land in my water but I am going to tell you why I am from Veracruz because my mother is from Tabasco and my father was from veracruz from the papaloapan basin and according to the constitution of veracruz in its article 11 it is established that the children of veracruz are previously veracruzanos so you are my countrymen and I am very happy that you are here in the national palace and now with this I say goodbye, it's not going to be a tenth, look here are the scholarships for high school students, 50.8 are womenThis is also a good indicator not only because of the scholarship but because before, men always studied more than women and now there are more women or the same who are studying on the shoulders of the scholarships for those at a higher level, those who are studying in universities that There are 300,000 53.7 They are women but I am going to give you other data Those who manage all our flights are women The secretary of welfare is a woman who attends the program for older adults Woman who attends the program for people with disabilities Woman the scholarships Woman the program from Benito Juárez universities, women and men who have fought all the time for equality and to defend women, yes, that's why this was like a strange thing, the conservatives became feminists and we became sexists, or that's how they were made to believe, I saw one this one A cartoon tells me this guy said something like that, they said he was messianic and I didn't believe it, but now that the conservatives have become feminists, I do believe it, he's a messianic, well, thank you very much.