Read the Conversation
Meeting Highlights:
- Ambitious World Bank Goals: The World Bank aims to expand its healthcare financing impact to reach 1.5 billion people by 2030, focusing on universal health coverage (UHC) and quality healthcare.
- Mexico’s Healthcare Priorities: The IMSS Bienestar system is a top government priority to provide access to quality, affordable healthcare for the uninsured population. Addressing the fragmentation in the health system and promoting efficiency through improved resource allocation and convergence of insurance schemes over time.
- Strategic Areas of Focus: Improving nutritional habits and combating obesity-related diseases with robust public policies. Regulatory reforms in the pharmaceutical sector to lower medicine costs and support national production of APIs, generics, biosimilars, and vaccines.
- Challenges and Recommendations: Overcoming flat health expenditures(5.5% of GDP) through efficiency gains and innovative financing including potential health taxes. Tackling workforce shortages, ensuring secure and favorable labor conditions for healthcare professionals.
- World Bank’s Role and Impact: Supporting Mexico with knowledge and financing.Leveraging global expertise to support the government’s efforts to improve access to quality, affordable healthcare for the vulnerable population. Inspire similar efforts in other nations in the region and globally.
EF: Looking ahead to 2025, what are the key priorities on your agenda? What challenges and opportunities do you see for the health sector in Latin America?
JV: As announced by our President, Ajay Banga, at the World Bank-IMF spring meetings in April 2024, the World Bank has set an ambitious target—to reach 1.5 billion people with quality, affordable health and nutrition services through World Bank financing by 2030. This is a stretch goal. This type of ambition highlights our commitment to advance Universal Health Coverage globally.
To achieve this ambitious goal, we are doubling down on our commitments at the regional level. While we are still determining specific targets for Latin America, they will be bold, requiring us to double or even triple the number of beneficiaries of our lending operations. This effort involves refining our strategy for universal health coverage and identifying opportunities to bridge existing gaps.
In Latin America, we are focusing on countries with significant potential for scaling impact for the most vulnerable population. In Mexico, we have been actively building an evidence base to support government initiatives such as the IMSS-Bienestar.
We are collaborating with government leaders, including Minister of Health Dr. David Kershenobich, IMSS Director Zoé Robledo, and IMSS-BIENESTAR Director General Alejandro Svarch, to advance these goals. Their leadership will be critical as we aim to significantly expand the reach and impact of our programs in Mexico and inspire other countries across the region to advance ambitious Universal Health Coverage programs.
The World Bank excels when it combines financing with knowledge to support our partners. In Mexico, we are working with the government to advance several priorities, chief among them the implementation of IMSS-BIENESTAR, a publicly funded system aimed at improving access to quality healthcare for the uninsured population. This initiative is a top priority for the government and us at the World Bank. We are fully committed to ensuring its success and are working closely with the leadership of the Ministry of Health, the IMSS-Bienestar and the IMSS.
Our support includes technical assistance, leveraging both regional and global resources to help the government navigate this transformative effort. The success of IMSS-BIENESTAR is crucial not only for advancing universal health coverage (UHC) but also for addressing the broader challenge of convergence between Mexico’s fragmented insurance schemes.
One significant hurdle remains the chronic underinvestment in health. For over two decades, healthcare expenditures have stagnated at around 5.5% of GDP, split more or less equally between public and private sources. While the 2025 budget allocates additional funds to IMSS-BIENESTAR, there is little fiscal space over the long-term trend for an increase in public health spending. Significant increases in health investment are unlikely in the short term given Mexico’s current macro-fiscal environment.
This makes the efficiency agenda critical. While some increased funding for IMSS-BIENESTAR is important to improve access to quality, affordable healthcare for the uninsured population, it is equally essential for the Mexican health system to deliver healthcare with greater efficiency.
The third key point is the critical focus on reducing risk factors of poor health and improving nutritional habits, as Mexico faces some of the worst health outcomes in the region.
Recently I was in Mexico for a two-day event organized by the Ministry of Health and the National Institute of Public Health. The meeting was focused on advancing the President’s commitment to implement a robust nutrition program targeting the first 1,000 days of life— focused on mothers and children. Mexico has already piloted this approach in a few states, but scaling it up nationwide is the next step. We are supporting this effort by providing technical assistance, including supporting government efforts to prioritize interventions, estimate their costs, and develop a detailed and actionable plan for broader implementation. This initiative is vital for improving long-term health outcomes, starting from the earliest stages of life.
We are starting to see some encouraging steps forward. For example, the government recently announced a ban on junk food in schools, accompanied by significant fines for non-compliance. Comprehensive efforts are also needed to address nutritional issues for adults, considering for example that over 40% of women in Mexico are obese. This poses substantial health risks and creates significant pressure on the healthcare system.
Implementing ambitious nutrition policies and tackling risk factors for non-communicable diseases will be essential, particularly in a rapidly aging population. Dr. Kershenobich, who previously led the Institute of Nutrition, brings a strong commitment to these issues, which gives us confidence that meaningful progress can be made. We are optimistic about advancing this agenda in collaboration with the government.
Another crucial issue is the regulation of the pharmaceutical sector. COFEPRIS, Mexico's regulatory agency, has been undergoing a significant transformation in recent years. Dr. Alejandro Svarch, who led COFEPRIS, played a key role in advancing the modernization of the agency before taking on his current role as Director General of the IMSS-BIENESTAR. A new director is now at the helm. Strengthening COFEPRIS will be critical for several reasons. Improved regulation is essential not only to ensure the safety and efficacy of pharmaceuticals but also to enhance efficiency in approval processes, which can have a substantial impact on healthcare access and innovation in Mexico. This transformation will be pivotal for the pharmaceutical sector's growth and for improving health outcomes nationwide.
Regarding COFEPRIS, there are two critical points to highlight. Firstly, as part of the government’s broader economic development strategy, there’s a strong push for nearshoring—enhancing manufacturing capacity in northern Mexico to enhance its role as a regional manufacturing hub Boosting the national production of APIs, medicines, biosimilars, and vaccines has the potential to create new jobs in the country and drive economic competitiveness and growth. In addition, to support universal, high-quality healthcare access, the government needs to ensure more affordable access to medicines and biosimilars. Strengthening domestic production will be critical for achieving this, making the Mexican healthcare system more sustainable in the long term. Achieving this goal is a critical component of the government’s universal health coverage (UHC) strategy.
However, for this to happen, Mexico needs stronger and more efficient regulatory processes. Currently, it can take over a year in some cases to approve market authorizations for new medicines. Reforming COFEPRIS will be crucial in addressing these delays, benefiting both the public and private sectors.
The appointment of a highly technical leader to head COFEPRIS is a promising signal. This leadership change suggests continuity with the reforms initiated by Dr. Alejandro Svarch, and we are optimistic that these efforts will drive progress. We are committed to supporting these regulatory advancements as part of the broader push to improve access to affordable, high-quality healthcare in Mexico.
EF: What decisions need to be taken now to have a healthier and more resilient Mexico in 2030?
JV: The government faces several interconnected challenges that require urgent attention. Mexico is aging rapidly, with one of the fastest rates in the world, and this is paired with significant health challenges. High levels of risk factors, such as obesity and diabetes, threaten not only the sustainability of the healthcare system but also the productivity of the workforce.
These issues have wider social implications, particularly for women. Without structured systems to provide health and social care for the elderly, caregiving responsibilities often fall on women. This keeps many from participating in the labor market, limiting their economic opportunities and hindering long-term inclusive growth for the country. Addressing these challenges will require coordinated efforts across health, economic, and social policies to ensure progress.
The country will need to make balanced investments with a significant focus on prevention. One area where progress can be made is through health taxes, particularly on tobacco, alcohol, and sugar-sweetened beverages (SSBs).
Mexico was a pioneer in implementing such taxes about a decade ago, but there have been few adjustments since then. Developing and implementing an integrated package of health taxes is an important public policy instrument. These taxes are highly effective at influencing behavior, but they must be carefully designed to achieve their goals without unintended consequences. We are collaborating with our global tax team to provide advice to the government in crafting carefully these potential policies.
While implementing such measures may be politically challenging early in a new administration, they represent essential tools for driving change. Proactive efforts to identify early risk factors through screening policies and broader health promotion and disease prevention initiatives will remain key components of a sustainable health strategy.
The government has introduced the Salud Casa por Casa program, which is currently being implemented. This initiative involves health professionals visiting seniors aged 65 and above in their homes, using an assessment questionnaire to assess their health risk profiles. Based on the results of these assessments, individuals are referred to primary healthcare centers for better-planned chronic disease control and preventive measures.
This program is an excellent start, particularly for the 65+ population, but its benefits could be amplified by extending it to include the broader adult population. Alongside this, developing a comprehensive plan to integrate healthcare services under initiatives like IMSS-Bienestar will be crucial. By doing so, care can become more effective in preventing avoidable diseases and better at managing chronic conditions, especially in underserved regions where access to healthcare remains limited.
While it is still early days, the discussions and strategies being shaped are encouraging. The focus on creating a truly integrated system that is both financially sustainable and capable of driving long-term progress in health outcomes is a positive step forward.
The government is carefully considering several critical aspects to transform the healthcare system from its current fragmented state into a more integrated model. This involves defining the managerial and organizational model, the service delivery modalities, and the financial framework required to improve effective coverage for the entire population. However, several challenges lie ahead.
A significant hurdle is addressing shortages and uneven distribution of health human resources. While the IMSS-Bienestar program is introducing better labor conditions, particularly for staff working in remote and rural areas, challenges extend beyond financial incentives. Security concerns in certain regions make it difficult to attract and retain healthcare professionals, and broader efforts will be needed to ensure safe working conditions and provide holistic support to healthcare workers.
These concerns will continue to pose challenges but remain a priority for the government.
Another critical aspect of transformation is digitalization. Implementing an interoperable electronic health record is a priority for IMSS-Bienestar. However, this effort must be accompanied by connectivity solutions for remote areas. Strategies like satellite internet could be crucial for ensuring consistent access to digital solutions across the entire territory.
Financial sustainability remains a complex and multifaceted challenge for Mexico's healthcare system transformation. There is a long-term need to gradually align per capita financing levels with the scope and quality of services offered by the ordinary IMSS regime. The ultimate goal is to move toward the most comprehensive service package available in the country.
Achieving convergence across a fragmented healthcare system will take significant time and sustained effort, but the government's initial steps in this direction are encouraging. It demonstrates a commitment to creating a more equitable, efficient, and sustainable healthcare system over the long term.
EF: Throughout your journey at the World Bank, what legacy do you believe you have created, and what accomplishment are you most proud of during your time with the organization?
JV: The World Bank offers a unique platform, one that combines top-tier knowledge with robust financing for governments. The World Bank stands out for its ability to bring together talented and passionate individuals who can identify key opportunities for development impact. By collaborating with governments, we can leverage both our financing and expertise to drive real change, which can yield remarkable results.
For example, in Colombia, we have used our financing and knowledge to advance several key agendas with tangible outcomes. One of the initiatives involved supporting the inclusion of migrants in the healthcare system. As a result of our efforts and the mobilization of parallel financing with the Inter-American Development Bank, the government was able to affiliate 500,000 migrants to the Social Security system. These were individuals who previously lacked access to healthcare and would only seek help through emergency rooms when very sick. Now, they have regular access to primary health care, which not only improves health outcomes but also ensures the financial sustainability of the healthcare system. Without this access, treating migrants in emergency rooms would be much more expensive, as the costs are borne by the insurance system.
Another example is our work on reducing maternal mortality in Colombia Through World Bank financing, the government implemented a plan that has already halved maternal mortality over the past two years. If these efforts continue, the country could meet the SDG target on maternal mortality by 2026. These are just a few examples of what the World Bank can achieve by bringing together expertise and strategic financing to create conditions for positive change.
One thing that I still find incredibly valuable is the ability to work across multiple sectors and continually learn from others. For instance, in Colombia, we are actively pushing the climate change and health agenda, focusing on both adaptation and mitigation. We are making real progress in positioning the health sector as a leader in adapting to the consequences of climate change.
To me, the last 10 years at the Bank have been an incredible opportunity to leverage this unique platform.
EF: Do you have a final message?
JV: I am truly excited about the opportunity to support the vision of the Mexican government in achieving effective Universal Health Coverage and defragmenting the health system. We have been working incredibly hard to build a strong evidence base to support the government. This is crucial, as it demonstrates that we can make a meaningful impact. Mexico is a country where the progress we help drive can inspire other countries to be more ambitious and take a more rigorous approach to designing and implementing health reforms. I genuinely believe this administration is on the right track, though I also recognize the challenges in implementing ambitious reform plans.
