Background
Newborns | Children under 9 years | Teens 10–19 years | Women and men 20–59 years | Women and men over 60 years | Pre- and postpartum |
---|---|---|---|---|---|
1. Risk signs 2. Birth conditions 3. Complete physical examination 4. Birth defects 5. Umbilical cord examination 6. Neonatal screening 7. Eye prophylaxis and vitamin K 8. Vaccination 9. Promotion of breastfeeding and early stimulation 10. Card to follow child | 1. Weight and height 2. Complete physical examination 3. Visual acuity 4. Growth and learning disorders 5. Postural problems 6. Family factors of poor prognosis (<5 years) 7. Complete vaccination schedule 8. Micronutrients administration (<5 years) 9. Oral health 10. Healthy nutrition 11. Early stimulation (<5 years) 12. Physical activity and accident prevention 13. Individual and family hygiene education | 1. Tuberculosis risk 2. Nutritional status 3. Attention disorders and addictions 4. Complete physical examination 5. Identification of pregnancy 6. Detection of sexually transmitted infections and HIV/AIDS 7. Complete vaccination 8. Reproductive health and contraception 9. Promoting physical activity, oral health, and accident prevention | 1. Tuberculosis and BK 2. Sexually transmitted diseases and HIV/AIDS 3. Diabetes, hypertension, overweight, obesity, and osteoporosis 4. Climacteric and menopause (women >40 years) 5. Prostatic disease (men) 6. Complete vaccination 7. Papanicolaou and breast exam (women) 8. Sexual and reproductive health 9. Education for preventing cervical and breast cancer 10. Physical activity, accident prevention, alcohol, and tobacco smoke risk 11. Oral health | 1. Visual and hearing problems 2. Prostatic disease 3. Diabetes, hypertension, overweight, obesity, and osteoporosis 4. Tuberculosis risk and BK 5. Signs of cognitive impairment and depression 6. Complete vaccination 7. Breast examination 8. Oral health 9. Physical activity and accident prevention (falls) 10. Information about cervical and breast cancer. 11. Education on acute respiratory infections and vaccines | 1. Weight and blood pressure 2. Pregnancy confirmation 3. Pregnancy risks factors 4. Perinatal card 5. Laboratory studies (blood test, syphilis, complete urinalysis, and others) 6. Complete vaccination to pregnant women 7. Micronutrient administration 8. Oral health 9. Parental education 10. Care of the newborn 11. Family planning 12. Health education and treatment to HIV/AIDS |
Methods
Age group | Number of prevention and health promotion activities | Total of population attended in PHFs | Median of time used by individual per year (min) | Median of time required by individual per year (min) | Differences | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Total (a1) | Physician (a2) | Nurse (a3) | HP (a4) | Total (b1) | Physician (b2) | Nurse (b3) | HP (b4) | a1 − b1 | a2 − b2 | a3 − b3 | a4 − b4 | |||
Newborns | 10 | 5 601 | 55.50 | 24.00 | 27.00 | 5.00 | 90.00 | 41.00 | 43.50 | 10.00 | −34.50 | −17.00 | −16.50 | −5.00 |
Children under 5 years | 10 | 41 094 | 61.50 | 13.50 | 33.50 | 15.50 | 94.00 | 20.00 | 46.00 | 22.50 | −32.50 | −6.50 | −12.50 | −7.00 |
Children from 5 to 9 years | 10 | 24 266 | 71.00 | 30.00 | 20.00 | 14.00 | 94.50 | 40.00 | 30.00 | 22.50 | −23.50 | −10.00 | −10.00 | −8.50 |
Teen from 10 to 19 years | 10 | 50 508 | 97.50 | 60.00 | 17.50 | 27.50 | 131.00 | 77.50 | 25.00 | 35.00 | −33.50 | −17.50 | −7.50 | −7.50 |
Women from 20 to 59 years | 11 | 76 839 | 97.50 | 40.00 | 25.00 | 35.50 | 165.40 | 57.50 | 37.50 | 76.50 | −67.90 | −17.50 | −12.50 | −41.00 |
Men from 20 to 59 years | 11 | 39 459 | 83.50 | 37.50 | 32.50 | 25.00 | 152.50 | 51.50 | 30.00 | 62.50 | −69.00 | −14.00 | 2.50 | −37.50 |
Women and men over 60 years | 10 | 16 591 | 100.00 | 52.50 | 39.50 | 15.00 | 162.50 | 70.00 | 72.50 | 20.00 | −62.50 | −17.50 | −33.00 | −5.00 |
Pregnant women | ||||||||||||||
First visit | 10 | 7 610 | 61.50 | 46.00 | 10.00 | 5.00 | 85.50 | 67.00 | 10.00 | 9.00 | −24.00 | −21.00 | 0.00 | −4.00 |
Subsequent visit | 7 | 5 076 | 46.50 | 36.50 | 10.00 | 0.00 | 58.50 | 47.00 | 10.00 | 0.00 | −12.00 | −10.50 | 0.00 | 0.00 |
Postnatal care | 10 | 1 483 | 58.50 | 27.50 | 35.00 | 0.00 | 91.50 | 37.00 | 50.00 | 0.00 | −33.00 | −9.50 | −15.00 | 0.00 |
All groups | 99 | 268 527 | 73.00 | 40.00 | 25.00 | 22.00 | 105.00 | 51.00 | 35.00 | 30.00 | −32.00 | −11.00 | −10.00 | −8.00 |
e) Density function \( \text{\textit{\textsf{f}}}(\text{\textit{\textsf{x}}})=\frac{1}{\beta^{\alpha}\overline{|(\alpha)}}\ \text{\textit{\textsf{x}}}^{\alpha-1}\text{\textit{\textsf{e}}}^{\text{\textit{\textsf{x}}}/\beta} \)
where x > 0; α and β are positive parameters
x: used and required time function measured in minutes
α: form parameter
β: scale parameter
f(x): gamma function
e: exponential function | h) Sensitivity index: \( S=\frac{1}{1-\alpha } \)
tu = used time
tr = required time |
Results
Variables | Physician | Nurses | Health promoters | ||||||
---|---|---|---|---|---|---|---|---|---|
Available supply (As) | Ideal supply (Is) | Available supply (As) | Ideal supply (Is) | Available supply (As) | Ideal supply (Is) | ||||
Annual hours available 2009 | Annual hours estimated time used | Annual hours estimated time required | Annual hours available 2009 | Annual hours estimated timeused | Annual hours estimated time required | Annual hours available 2009 | Annual hours estimated time used | Annual hours estimated time required | |
(a) | (a1) | (a2) | (b) | (b1) | (b2) | (c) | (cl) | (c2) | |
Urban PHFs (n = 12) | |||||||||
Total hours | 141 600 | 373 462.6 | 562 069.7 | 220 800 | 231 150.6 | 332 150.6 | 27 600 | 243 449.9 | 406 915.0 |
Median (h) | 12 000 | 22 624.2 | 35 876.9 | 17 400 | 12 654.8 | 21 913.9 | 0 | 16 749.0 | 32 658.9 |
As − Is | −10 624.2 | −23 876.9 | 4 475.3 | 4 513.9 | −16 749.0 | −32 658.9 | |||
Wilcoxon (P value) | 0.0029 | 0.002 2 | 0.209 4* | 0.099 5* | 0.002 2 | 0.002 2 | |||
Friedman (P value) | 0.001 3 | 0.001 2 | 0.028 0 | ||||||
Rural PHFs (n = 8) | |||||||||
Total hours | 30 000 | 628 853.6 | 84 632.2 | 38 400 | 40 127.2 | 57 173.1 | 1 200 | 35 627.8 | 52 308.2 |
Median | 1 800 | 4 079.7 | 5 460.1 | 1 200 | 2 173.6 | 3 182.4 | 0 | 2 151.3 | 3 714.2 |
As − Is | −2 279.7 | −3 660.1 | −973.6 | −1 982.4 | −2 151.3 | −3 714.2 | |||
Wilcoxon (P value) | 0.049 9 | 0.017 3 | NA | NA | NA | NA | |||
Friedman (P value) | 0.026 2 | 0.083 7* | 0.170 5* | ||||||
Total PHFs (n = 20) | |||||||||
Total hours | 171 600 | 436 316.2 | 646 701.9 | 259 200 | 271 545.6 | 389 393.7 | 28 800 | 279 077.7 | 459 223.2 |
Median | 6 000 | 12 478.5 | 16 510.6 | 10 800 | 7 904.6 | 11 321.3 | 0 | 7 220.7 | 9 252 |
As − Is | −6 478.5 | −10 510.6 | 2 895.4 | −521.3 | −7 220.7 | −9 252 | |||
Wilcoxon (P value) | 0.000 4 | 0.000 1 | 0.262 7* | 0.018 7 | 0.000 1 | 0.000 1 | |||
Friedman (P value) | 0.000 | 0.000 1 | 0.016 7 |
Primary health facilities | Number of doctors | Number of health promoters | ||||
---|---|---|---|---|---|---|
Available supply | Ideal supply | Available supply | Ideal supply | |||
Time used | Time required | Time used | Time required | |||
Urban PHFs | ||||||
Tapalpa | 6.0 | 5.5 | 8.7 | 0.0 | 4.0 | 6.2 |
Jesus Rosal | 11.0 | 60.6 | 108.9 | 0.0 | 37.3 | 65.7 |
Satellite | 2.0 | 3.2 | 4.7 | 0.0 | 1.3 | 2.4 |
Coapa | 10.0 | 11.1 | 16.1 | 0.0 | 6.6 | 8.3 |
GR. Millan | 10.0 | 15.3 | 29.5 | 0.0 | 6.8 | 13.3 |
Zacatecas | 10.0 | 24.8 | 30.3 | 0.0 | 14.0 | 27.1 |
W. Escalante | 10.0 | 24.3 | 36.0 | 0.0 | 17.5 | 27.3 |
Industrial | 13.0 | 43.2 | 48.4 | 0.0 | 25.3 | 35.0 |
Rena II | 3.0 | 4.8 | 6.1 | 0.0 | 3.1 | 6.5 |
Pedro Escobedo | 23.0 | 81.0 | 119.9 | 1.0 | 55.2 | 79.8 |
Toluca | 16.0 | 22.4 | 33.4 | 9.0 | 17.8 | 36.7 |
San Rafael | 4.0 | 13.0 | 26.3 | 13.0 | 13.9 | 30.9 |
Median | 10.0 | 18.9 | 29.9 | 0.0 | 14.0 | 27.2 |
Rural PHFs | ||||||
Juanacatlan | 2.0 | 9.7 | 11.4 | |||
Mineral Chico | 3.0 | 6.8 | 10.5 | |||
Cuentepec | 4.0 | 2.0 | 2.9 | |||
Sta Elena | 1.0 | 2.1 | 2.2 | |||
Koben | 1.0 | 1.4 | 2.6 | |||
G. Victoria | 12.0 | 23.6 | 31.8 | |||
R02 Kilometro 30 | 1.0 | 4.3 | 5.2 | |||
P. Coyote | 1.0 | 2.5 | 3.9 | |||
Median | 1.5 | 3.4 | 4.6 | |||
General median PHF | 5.0 | 10.4 −5.4 | 13.8 −8.8 |