Setting The state of Baja California, Mexico had the highest prevalence of multidrug-resistant tuberculosis (MDR-TB) in Mexico in 2009. Objective To understand the socioeconomic burdens of MDR-TB disease and its treatment on patients in Tijuana and Mexicali, Mexico. Design From July to November 2009, qualitative interviews were conducted with 12 patients who were enrolled in a US-Mexico binational MDR-TB treatment program called “Puentes de Esperanza” (Bridges of Hope), which was designed to support MDR-TB patients. In-depth interviews were coded to identify major themes in patient experiences of MDR-TB diagnosis and care. Results While some patients were able to maintain their pre-MDR-TB lives to a limited extent, most patients reported losing their sense of identity due to their inability to work, social isolation, and stigmatization from family and friends. The majority of participants expressed appreciation for Puentes’ role in “saving their life.” Conclusion Being diagnosed with MDR-TB and undergoing treatment imposes significant psychological, social, and economic stress on patients. Strong social support elements within Puentes helped ameliorate these burdens. Improvements to the program might include peer-support groups for patients undergoing treatment and transitioning back into the community after treatment.

We describe the outcome of treatment of multidrug-resistant tuberculosis (MDR-TB) in Baja California, Mexico, by a United States-Mexico consortium. From June 2006 to December 2010, 42 patients started treatment. Strains were resistant to 4.15 ± 1.3 drugs; all patients achieved culture conversion on treatment after an average of 3.4 ± 1.6 months. A total of 19 patients (47.5%) were discharged as cured, 3 died (7.5%) and 1 defaulted (2.5%). MDR-TB cases can be cured under a well-organized out-patient program; in this consortium, the US partner introduced program elements that were gradually integrated into the Mexican state TB program.

La Secretaría de Salud (SSA), a través de la Subsecretaría de Prevención y Promoción de la Salud (SPPS), realiza transferencias monetarias y de insumos a las entidades federativas a través del Acuerdo para el Fortalecimiento de las Acciones de Salud Pública en los Estados ( AFASPE ). En este artículo se describe y analiza el desempeño del AFASPE 2012 en el Programa de Acción Específico Arranque Parejo en la Vida en Chiapas, a la luz del proceso de descentralización. La discusión se centra en el análisis de la planificación, entrega y ejercicio de los recursos, modificaciones del presupuesto, transparencia y rendición de cuentas, que involucran tanto a la SSA como los Servicios Estatales de salud (SESA) y a la Secretaría de Hacienda estatal.   TRANSPARENCY AND ACCOUNTABILITY IN MATERNAL CARE:  THE CASE OF AFASPE IN CHIAPAS The Mexican Health Department (Secretaría de Salud /SSA) through the Health Prevention and Promotion Sub-Department (Subsecretaría de Prevención y Promoción de la Salud /SPPS) conducts monetary and input transfers to the states through the Agreement for the Strengthening of Public Health Actions in the States (Acuerdo para el Fortalecimiento de las Acciones de Salud Pública en los Estados /AFASPE). This article describes and analyzes AFASPE’s performance in 2012 in the Equal Start in Life Specific Action Program (Programa de Acción Específico Arranque Parejo en la Vida) in Chiapas in the light of the decentralization process. The discussion is focused on the planning analysis, resource delivery and execution, budget modifications, transparency and accountability involving both the SSA and the State Heath Services (Servicios Estatales de Salud /SESA), as well as the Department of Finances of Chiapas State.

Certain factors which impede better TB control seem amenable to change, others, such as severe poverty, particularly among peasants and indigeneous people, as well as the current political disruption, will require much broader intersectorial interventions.

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