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1.  Mexican Pharmacies and Antibiotic Consumption at the US-Mexico Border 
Southern Med Review  2012;5(2):9-19.
Objective: To study antibiotic dispensing to US and Mexican residents, at Mexican pharmacies at the US-Mexico border, and the pharmacy clerks’ capability to promote appropriate use.
Methods: The site selected was Ciudad Juarez, Chihuahua (pop. 1.2 million) separated from El Paso, Texas (pop. 800,000) by the Rio Grande River. A convenience sample of 32 pharmacies located near the international bridges, major shopping centers, and interior neighborhoods was selected. Pharmacy clients were interviewed (n=230) and 152 interactions between clients and pharmacy clerks were observed. Information was obtained about education and pharmaceutical training of 113 clerks working in 25 pharmacies. A senior pharmacy clerk in each of the 25 pharmacies was interviewed and asked for their recommendations to clients presenting two clinical scenarios and seven diagnoses.
Findings: Professionally trained pharmacists only spend a few hours a week in some pharmacies. Clerks’ education levels are very low; some have only completed primary education. There is no required pharmaceutical training and their knowledge about pharmaceuticals comes mostly from representatives of the pharmaceutical industry. Clerks’ knowledge of antibiotics, the most frequently sold class of medicines (65% without prescription), is very limited. Clients trust pharmacy clerks and tend to follow their advice.
Conclusions: The findings raise concerns about dispensing of antibiotics at Mexican border pharmacies and antibiotic overuse due to lack of control. Because inappropriate antibiotic use contributes to increased resistance, pharmacy clerks should receive independent training to dispense antibiotics and promote their appropriate use.
PMCID: PMC3606934  PMID: 23532456
antibiotics; pharmacists; pharmacy clerks; US-Mexico border; Mexico9
2.  Twenty-Five Years of Convoluted Health Reforms in Mexico 
PLoS Medicine  2009;6(8):e1000124.
Núria Homedes and Antonio Ugalde discuss 25 years of reform to the Mexican health care system and argue that although costs and accessibility have increased, health inequities, efficiency, productivity, and quality of care have not improved.
PMCID: PMC2719806  PMID: 19688039
3.  Human resources: the Cinderella of health sector reform in Latin America 
Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform.
This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region.
The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside.
PMCID: PMC548503  PMID: 15659241

Results 1-3 (3)