Governance obeys a process of decision-making in centralized policies, formulated and coordinated from the highest federal health authorities, with a single vision of policies. The truth is that the political vision is not always positive. Decision-making and public policies in times of pandemic have been controversial. Who has the absolute truth? Nobody and everyone at the same time, let’s see.
Senior managers regularly exercise their power to summon representatives of the health system and other social actors, but not all those summoned attend the call, which denotes a differentiated scope of convocation between diverse actors and causes a bias in decision-making and their respective frictions given the difference of ideas, as is the case of Jalisco, or Nuevo León, to mention an example.
Responsiveness has definitely represented a global challenge. “Healthy Distance Days”, “the New Normal”, and the “Epidemiological Traffic Light” are examples of immediate public policies to mitigate the pandemic with an evaluation biased by the will of the actors, that is, not all people follow these indications and / or measures, right?
Governance and its strengthening are defined by the joint actions of the various sectors of the health system, the public and private sectors, and citizens for a common interest. Do you think that your local deputies understand the scenario I’m talking about? Do you think they understand the impact factor that their decisions and implementation of public policies could have? Neither do I.
At the international level, the relevance of governance in policies as a response to the epidemic has been reported, but no evaluation studies were identified since they are time-consuming and biased, and therefore, it is unknown to what extent the decisions affect containing the spread of Covid-19 disease.
The governance approach in health systems demands to have a delimited, observable, reproducible and generalizable object; that is to say: be clear about the objective towards where public policy is going. In Mexico there is scant evidence on governance in the health system, its segmented structure in various sectors and levels of care, the system confers greater complexity to the decision process, due to the interaction of multiple actors, with diverse interests and different roles.
The issue of drugs, installed capacity, beneficiaries, workforce, among others, are issues that are linked but in turn made up of actors who have nothing to do with each other, I know it sounds complex and that is how it is.
Sometimes the failure is so simple with collateral damage so complex that the cause was just a “broken phone.” This represents a greater challenge in a changing public policy scenario, such as the current pandemic.
To strengthen governance, it is necessary to provide greater autonomy to state decision makers, to formulate and manage their policies, incorporate strategies in a coordinated and collaborative way with both federal actors and civil organizations, so relevant in this context. Incorporating social actors within the local context, such as civil organizations, strengthens that policies are comprehensive and sustainable in the long term, in addition to promoting the values of equity, reciprocity, co-responsibility and solidarity. This scenario of trust would encourage greater commitment and responsibility among actors, strengthen transparency and accountability.
Otherwise, it is inferred that there is confusion in the levels of responsibility of decision-makers, and a limited scope in them, which affects a partial response, both from the health system and society to Covid-19.