Luis Adrian Quiroz Castillo

Adrian Quiroz is working to change the Mexican public health system to improve access to timely and effective healthcare for all patients. Through a participatory model, he provides a medium for receiving complaints and reports as well as an electronic platform for access to public government information and processes.

Adrian launched the community-based Beneficiaries of the Mexican Social Security Institute Living with HIV (DVVIMSS) and has achieved impressive improvements in healthcare and drug supply in a remarkably short time. Since then, Adrian has dedicated his time and efforts to improving public health systems through innovative mechanisms and methodologies, evolving the mission of the program to address public health challenges around Mexico.

Adrian is giving patients of the entire Mexican public health system the opportunity and leverage to demand their rights to effective care. The Mexican Social Security Institute (IMSS) is the health insurance provider for more than 40 million non-government employees throughout Mexico. Through Adrian’s organization DVVIMSS, IMSS patients can use electronic platforms, complaint modules, and workshops to report issues and help DVVIMSS to identify the most recurrent problems within the health sector. DVVIMSS, relying upon the existing institutional mechanisms and freedom of information tools, is able to access, track, and organize government and statistical information. Armed with this new knowledge, Adrian’s organization can build solid cases against the faults and abuses of the healthcare system.

These cases are documented and channeled to the decision-makers of health agencies to begin the steps to improve or transform the services and system alike. In most cases management resolves the disagreements. Only in a few rare cases have they had to turn to agencies, such as the Internal Control Unit, Human Rights Commission or the National Council to Eliminate Discrimination, to obtain additional leverage. This model has been highly successful, resolving more than 750 complaints of shortages of medicine, and 400 more on issues such as insufficient medical care, discrimination and denial of medical services. These cases are closely followed to ensure systemic improvement. For example, Adrian has helped create a “work table,” consisting of both health professionals and the IMSS supply chain provision team, to organize and monitor IMSS supplies to ensure that 100 percent of medicines are dispensed to patients in an efficient and timely manner. Unlike other models that attempt to reform the healthcare system, Adrian’s organization is the only one that involves the beneficiaries, so that individuals are able to demand their rights as informed citizens.

The Mexican public health system is complex, fragmented, and divided among many different agencies. Although the Mexican constitution guarantees all Mexican citizens the right to healthcare and Mexico has maintained a universal health system for decades, individuals that rely on the public system have to deal with severely faulty services. These include long wait times for diagnosis and care; medical negligence; shortage of drugs; denial of medication and care for certain conditions; discrimination, especially against those affected by diseases that carry a stigma, such as HIV; and violations of confidentiality and other patient rights. These issues directly impact the quality of life of people who come to public hospitals and clinics.

Too often unaware of their rights, citizens rarely demand any compensation or reparations from the Ministry of Public Health for their inadequate care. They fear mistreatment or outright rejection of care by service provides. Mexicans are deeply skeptical that the national authorities will resolve their complaints, or that their complaints will produce tangible improvements within healthcare institutions. The lack of formal complaints from patients thus allows internal authorities responsible for investigating human rights violations and shortcomings in the healthcare system to overlook severe functional problems and violations of rights. Without these important patient reports, little societal pressure exists to improve the Mexican healthcare system.

In addition to a lack of accountability, both the public and private systems lack a relevant reporting system on the number of cases or types of diseases they treat. The dearth of statistical analysis prevents healthcare providers from developing prevention techniques, adequately allocating resources, providing effective care, and understanding the demand placed on their systems. Finally, service providers and staff members at public health agencies fail to receive appropriate training to provide care to patients. This delays diagnoses, worsens communications between patients and doctors, and critically decreases the quality of care in public health. Ultimately, patients suffer most from systems that are slow, costly, and ineffective.

Adrian has built a model aimed at transforming the public healthcare system into one that prevents disease, educates its citizens, and provides fair treatment. Beneficiaries understand and are able to demand their rights from the government and healthcare providers. Adrian’s model enables citizens to request their rights through the Social Comptroller’s Office, and is thus changing the way patients interact with the health system.

Adrian’s model demonstrates that citizen participation to monitor institutions, access public government information, and demand their healthcare rights are effective tools to improve processes and services within public health authorities. However, to effectively build responsible citizens, DVVIMSS has had to develop training strategies for both citizens and service providers on topics such as human rights, public health law and regulations, oversight of healthcare providers, non-discrimination, and rights to transparent information. To date, DVVIMSS has trained more than 3,000 patients, advocates, and staff members of twelve IMSS delegations. Adrian was also able to advocate for the inclusion of human rights and non-discrimination material in medical doctors’ coursework (achieving admission in 2006). This advocacy of patient rights has not only resulted in increased demand for health rights, organizational changes, and public policy improvement, but has succeeded in creating meaningful opportunities for collaboration between civil society and government in the field of public health.

Adrian has worked to monitor the supply chain and distribution of medications in the Social Security system. Through an agreement with IMSS, Adrian has access to real-time information about the buying and allocation of medications. This, along with the work of the joint medical providers and supply chain management team, means the system has incentive to properly manage the supply chain and can identify and correct supply chain gaps, thus ensuring timely and sufficient access to necessary medications. Using this information and the monitoring system, Adrian was able to increase the supply of medications by up to 25 percent in some hospitals. DVVIMSS also works with the Federal Superior Audit to carry out joint actions to prevent the diversion of funds and corruption in the bidding, purchase, distribution and delivery of IMSS medications.

Adrian acts as an advocate outside the healthcare system, and as a reformer within. To help his advocacy, Adrian has successfully enlisted the media as a strategic ally. Through the media, he has been able to publicly denounce abuses, stimulate social pressure, and create awareness of the issue. DVVIMSS is currently launching a national campaign against healthcare discrimination in partnership with the National Council for the Prevention of Discrimination (CONAPRED) and IMSS, as well as the collaboration of a number of associations. To reform, Adrian has also developed printed materials, such as The Participatory Patient Guide, created with the help of the pharmaceutical company Pfizer, a clinical practice guide used within the IMSS, and another publication about the shortage of expensive drugs, in collaboration with the Superior Audit Office of Mexico.

DVVIMSS has made a number of notable advances for the rights and improved care of HIV/AIDS patients. One such victory was enacting major policy changes to protect the confidentiality of medical records of persons with HIV, an important step in preventing discrimination and protecting their rights. Adrian set a national standard when he helped to create the first and only genotipification laboratory in an IMSS hospital, a lab that helps to improve the timely diagnosis of HIV and optimal administration of drug dosages. Adrian was also responsible for instituting an IMSS census in order to furnish advocates, healthcare providers and government institutions with reliable data on the number of HIV cases, and will expand to include data on other diseases.

So far, Adrian has focused on implementing his model within IMSS. Once his team of eleven employees and an extensive network of volunteers have perfected the model, they will implement it to improve other institutions, such as the Institute of Security and Social Services of State Workers, which provides healthcare to about twelve million government employees. He also plans to develop partnerships with other social organizations that aim to improve public health policy at the national level. Additionally, Adrian expects to found a watchdog group to monitor citizen health rights violations, create a program enabling citizens to monitor their own medications, and establish a national registry of diseases, compelling health institutions to generate disease and treatment statistics.

Initially, Adrian developed this model to resolve disagreements between healthcare providers and HIV patients, especially disputes regarding patients’ need for antiretrovirals. Now, DVVIMSS fights for the rights of all patients, in collaboration with institutions such as the Mexican Association for the Fight Against Cancer, the Mexican Cystic Fibrosis Association, the Jajax Association (for children living with lysosomal storage diseases), the CIMAB Foundation (Breast Cancer Association), and the Organization of Children with Growth Hormone Deficiency and Turner Syndrome. DVVIMSS currently obtains its funding from national and international foundations, as well as from support from the pharmaceutical industry, consulting projects, and capacity workshops. The organization will continue to diversify its funding sources to maintain the sustainability of its projects in the future.

From a young age, Adrian participated in the National Children’s Union, an organization dedicated to fighting for the rights of Mexico’s young people. This experience was impactful and the first time that he advocated for his rights and the rights of his peers. As a teenager, Adrian also organized various activities for youth around the issues of justice and citizenship.

Some time after, Adrian was diagnosed with HIV. Following his diagnosis, a social worker asked him to sign a document renouncing all of his rights to health services. Depressed and uninformed, Adrian conceded. This mistake motivated him to improve his health condition and fight for his health rights. With the help of a social organization, Adrian was able to access care in the IMSS. This experience motivated him to continue to work on behalf of those who had been discriminated against within health institutions.

Adrian worked as a volunteer at the National Front of People Living with HIV, which later became the Mexican Vanguard Organization of People Affected by HIV and was in charge of relations with the IMSS for southern Mexico. Adrian signed a number of agreements with the IMSS that the agency never implemented. As a result of this experience, Adrian studied the regulatory framework of the IMSS in order to understand the best ways to achieve concrete results when negotiating with this government institution.