The New Idea

Through the specialized hospital which he directs, Carlos Vargas García has developed new protocols for prenatal care which transfer responsibility from doctors to other specially trained health care professionals. His team of prenatal and obstetric nurses provides high quality prenatal services to low-income women and families without the high price and limited access associated with physician care. Carlos has managed to lower the cost of prenatal and obstetric services and simultaneously improve the safety of childbirth for mothers and children who otherwise lack access to adequate health care.

In addition to providing direct care to mothers and children, Carlos runs a community outreach program to educate women and their families about prenatal care, reproductive health, and child care. Carlos and his team design open workshops at the hospital and engage local volunteers to serve as maternal and child health promoters in their communities. This outreach enables Carlos's organization to serve 50,000 families in nearby neighborhoods. The result of his work has been an impressive decrease in both infant and maternal mortality among patients and a decline in the incidence of birth defects among infants among the population he serves.

The Problem

In Mexico, 5 of every 10,000 mothers die from complications during pregnancy or childbirth, more than twice the number of such deaths in First World countries. Approximately fifteen percent of newborn babies have some form of mental or physical defect. Of 2.5 million children born each year in Mexico, about ten percent are premature, ten percent have low birth weight, and five percent have hypoxia. Cases of preventable physical deformities and mental disabilities have psychological, health, and employment ramifications for the individual, the family, and the society. Just as it is possible to greatly reduce the infant mortality rate, it is also possible to reduce the number of children born with health problems.

Despite the great need for improvement of prenatal care in Mexico, there are a limited number of individuals working on this problem. In the Mexican health sector, many nurses graduate with a specialty in prenatal care. However, they cannot exercise their skills in this area, because prenatal care is normally provided only by medical specialists or by midwives with extensive practical knowledge.

The Strategy

To address the problems of mother/infant mortality, preventable birth defects, and limited access to prenatal care, Carlos has created a model of high-quality mother/infant care. His program is cost-effective, making prenatal care accessible even to the poorest Mexicans. His health services decrease health risks to both the mother and child during pregnancy, childbirth, and postpartum. Carlos has achieved this by re-engaging prenatal care nurses – many of whom have left mother and infant care for general-purpose nursing due to a lack of adequate job opportunities – in their specialty. Carlos builds on their previous training and increases their skills using his own methodology for detecting potential complications in pregnant women and improving the practice of prenatal care. The use of nurses instead of doctors as the primary health care providers contributes to the lower costs of his program.

Carlos offers practical training for nurses and takes advantage of the fact that in Mexico, most citizens perform six months to a year of social service in their fields upon completing their education. At the CIMIgen Hospital, which he directs, Carlos offers specialized training to prenatal nurses in the same hospital where they conduct their social service to encourage them to build their professional skills. Using risk tables that he designed, Carlos teaches the nurses how to detect risks among pregnant women or those considering pregnancy, and how to prioritize patients according to their level of risk. This allows Carlos and his team to detect potential problems at an early stage and either give the mother the appropriate treatment or refer her to other professionals within CIMIgen and other institutions.

The program is financed almost entirely by patient fees, which are adjusted to account for the economic circumstances of each patient. In some cases patients pay the real cost of the service in cash, while for other patients the hospital makes an allowance for barter transactions or accepts payment in the form of service to the hospital. Donations cover the remaining costs.

Carlos has expanded his program of improved prenatal care to include education in family planning, reproductive health, and children's health for patients and community members. One example of this type of community outreach is a series of round-tables which Carlos hosts on the patio of the hospital. He and his team invite people from the community and nearby areas to enjoy snacks and games, then use the opportunity to engage in discussions and answer questions about sexual and reproductive health. Communication with community members has helped him develop health education booklets with clear, easy-to-understand language.

To increase his outreach, Carlos also works with community volunteers to reach a broader segment of the population. He conducts training courses, conferences, and workshops to inform volunteers of the health issues that pregnant women face, and teaches them how to confront these problems. The volunteers then relay this information to neighborhood residents and organizations.

The most telling – and impressive – measure of Carlos's success is the reduction of mortality rates among mothers and their babies. The program has helped to manage to lower the infant mortality rate in his ward from a Mexican average of 30 per 1,000 babies to only 9 per 1,000, and has achieved a maternal mortality rate of zero within his hospital. In his hospital, the rate of babies born with health problems is significantly lower than the national average. Through establishing alliances within the health system, and providing ample documentation of his success, Carlos has been able to spread his model to different parts of the country, including Veracruz and neighboring regions. Other organizations performing related work in reproductive and maternal health have begun to adopt some of Carlos's methods, like distributing risk charts to midwives and mothers so that they can assess the likelihood of complications during pregnancy.

The Person

Carlos comes from a family with modest means but great ambitions. He has lived in rural communities and has experienced first-hand the deprivation and inadequate health care of the Mexican poor. He has been greatly influenced by teachers and colleagues who imparted moral values as well as technical skills. Carlos was a co-founder of the National Institute of Perinatology. When he took the position of Director General of CIMIgen, Carlos arrived at an abandoned institution. He transformed the hospital by developing his prenatal care training for nurses. The institution is now recognized as a hospital with a great variety of services and excellent prenatal care. He designed his program based on his experience of teaching about health, a detailed study of the field, research about the needs of the communities, and an overriding concern for social equity.