Cancun Manifesto


Proposal as a result of previous work and developed during the pre-conference of the 43rd Annual Meeting of the North American Primary Care Research Group.

Cidronio Albavera Hernández, Alma Ethelia López Caudana, Sergio Arturo Juárez Márquez, Diana Baro Verdugo, Raúl Fernando Gutiérrez Herrera,  Francisco Javier Gómez Clavelina, Homero de los Santos Reséndiz, Guillermo Franco Gil

Effective support for primary care is an important component of the process of changing health systems (1). With this approach in mind the North American Primary Care Research Group (NAPCRG) as part of its 43rd Annual Meeting, organized a pre-conference with the aim of supporting the Mexican College of Family Medicine (CMMF) in the acquisition of skills to drive the process of changing the Mexican Health System (SSM). For this, the CMMF convened a special working group, consisting researchers and academic leaders of the country who gathered on October 24, 2015 in Cancun Quintana Roo Mexico. They developed this proposal, in order to fix its position on the reform of the SSM and propose strategies for implementation.

Four working sessions were developed through discussion groups, coordinated by representatives of NAPCRG and under the direction of Dr. Chris vanWeel. In the first the needs, strengths and weaknesses of SSM were analyzed. In the second session, Dr Jon Salsberg allowed us to reflect on the philosophical support for participatory research, which emphasizes practice-based evidence (as opposed to the view that the practice should be based on evidence), and recognition of the capacity of self-determination of the members of a group, to facilitate identification of their needs as well as the interpretation and application of the results of a research process (2). 

In a third session, doctors Rick Glazier and Andrew Bazemore shared with us two strategies for change in the health systems of Canada and Honduras. They showed how a proper diagnosis of the health services demand for a population shown to decision-makers, allowed them to show that it was necessary to propose alternative strategies to the current model of care, which being voluntarily accepted by service providers, improved conditions of their professional performance and above all, allowed to impact favorably on the health conditions of the population.

In another scenario, the work done by the Robert Graham Center Group (3) was an example of the benefits of interaction between members of the health team and the community.

The work done showed the complexity of the determinants of health proposed by the WHO (4). Inevitably, we contrasted these experiences with our health care system, which although has had important achievements such as universal vaccination, increased life expectancy and reducing maternal mortality (5) has also shown a system characterized by a low capacity to resolve health problems in primary care, heterogeneity in its implementation, fragmentation and inefficiency, high cost benefit, and inability to achieve universal coverage.

Recognizing the role of the different factors that determine the health of the population, and we have had insufficient discharge of our social responsibility, we believe that the first step is defining which of these determinants are likely to be addressed; therefore, we issued the following manifesto:

1.     The purpose that guides our actions must be to improve the health of the population. 

2.     Primary Health Care (PHC) is the model that we must follow.

3.     Our involvement in the future implementation of the reform of the Mexican Health System (RSSM) must be proactive.

4.     All health institutions involved in RSSM must establish an agreement for their participation.

5.     All the stakeholders involved in the care of the health and disease processes should be summoned.

6.     In the immediate term, we must:

6.1 Conduct a situational analysis of suppliers and users of the health system.

6.2  Discuss and build consensus about the definition of Primary Health Care among all stakeholders in the health and healthcare sectors.

6.3 Evaluate the organization of health care, medical education and research under the framework of the Ecology of Medical Care (6).

6.4 Highlight the perceptions of patients about the benefits of primary care and family medicine.

6.5 Develop participatory-research with providers of health services; starting with family physicians.

6.6 Assess all actions taken, and with scientific rigor address the processes involved in the different settings of the practice of Family Medicine.

6.7 Specify the formation of the Mexican College of Family Medicine as a registered professional organization, to have a solid legal standing, and therefore stronger representativeness.

6.8 Convene meetings and discussion fora about the role and function of family physicians in the Mexican context, with the participation of other potential stakeholders and decision makers interested in supporting the consolidation of Family Medicine and the implementation of the PHC model in the country.

Undoubtedly, these actions will strengthen our health system and must link with subsequent actions, all sustained by a constant self-critical and reflective attitude.


Cancún, México, 

October 24, 2015. 


1.     North American Primary Care Research Group. New York: The Association. Disponible en:

2.     Jagosh J,  Bush PL,  Salsberg J,  Macaulay AC, Greenhalgh T,  Wong G et al. A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. BMC Public Health. 2015;15:725  doi:10.1186/s12889-015-1949-1

3.     The Robert Graham Center, 1133 Connecticut Avenue, NW, Suite 1100, Washington, DC 20036, E-mail: Washington, DC: The Association. Disponible en:

4.     Organización Mundial de la Salud. Informe sobre la salud en el mundo 2008: La atención primaria de salud, más necesaria que nunca. Ginebra: OMS; 2008.

5.     Juan M. Hacia un sistema nacional de salud universal. Cir Cir. 2014;82:98-108.

6.     Green LA, Fryer JE, Yawn BP, Lanier D, Dowey SN. The ecology of medical care revisited.  N Engl J Med.  2001;344(26):2021-2025.

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