“Diagonality” in Practice: Julio Frenk on “Diagonal” Health System Reform in Mexico
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In his introduction to Bill Clinton’s keynote address on day 2 of the International AIDS Conference, Mexico’s former Minister of Health, Julio Frenk, made an impassioned plea for the virtues of “diagonality.” Frenk argued that the intense attention and relatively lavish funding being directed at tackling the global pandemic offer an opportunity to settle the long-standing debate between horizontal and vertical (or disease-specific) approaches.
He praised the new “diagonal” strategy, “whereby explicit priority interventions are used to drive improvements into the health system.” Speaking specifically of Mexico’s diagonal health systems reform, Frenk highlighted the technological, political and ethical “pillars” underpinning his country’s success, and noted that Mexico is on track to achieve universal health coverage by 2010. Something, President Clinton later noted wryly, ‘I hope [your] neighbors to the North [will] soon have.’
So, how did the diagonal strategy help bring about such profound reforms in the Mexican health system? Frenk explained that by focusing on a high priority problem such as HIV and AIDS the public was able to link abstract notions of health reform with concrete deliverables. By putting a human face on reform, Mexico was able to mobilize the political support – the political “pillar” - needed to pass a major piece of legislation and appropriate the budgetary resources needed to make it real.
And the results are indeed impressive. Mexico plans to add one percent of its GDP to its health budget over the next seven years. The #1 priority in Mexico’s planning, he said, is HIV and AIDS, which will see funding levels increase 14 times over that same period. Mexico’s efforts will be directed toward prevention, promotion of condom use, reduction of stigma and discrimination, and comprehensive treatment including ARV provision.
Last but not least Frenk underscored the importance of the ethical pillar in bringing about the reform. Health system reform must be fueled not only by ideas but also by ideals Health care, “…cannot be seen as a commodity…but as a social right” and the fight against HIV and AIDS is inextricably linked with battling stigma and discrimination, violence against women, and homophobia.
Dr. Frenk laid out a challenge for health systems to do a better job reaching all people – especially those affected by and vulnerable to HIV and AIDS. He enthusiastically drove home the point that, “If we can turn the tide on this epidemic, it will unleash a burst of energy that will spill over into TB…and anything else you can imagine.” This is the essence of the diagonal approach. Dr. Gilbert Kombe of Abt Associates made this very point in a recent BBC interview when asked if HIV and AIDS weren’t in fact receiving too much attention, Gilbert replied in the affirmative adding that's why we need to strengthen health systems.
