Mexico´s “Ventanilla de Salud” (Health Desk/Window) program: Public-consular diplomacy that alleviates

 
Maribel (not her real name) went with her family to a Mexican consulate in the U.S. She was there to get a health referral to have a free mammogram at the local health clinic. Besides, her youngest kid, Jaime, needed eyeglasses, so she got a voucher for free prescription glasses from a well-known grocery store. On the same visit, Eduardo, a Guatemalan citizen and Maribel's partner received screenings for blood glucose and blood pressure. All these services were provided by the Ventanilla de Salud program (VDS -Health Desk/Window-)[i], a public-consular diplomacy effort that will celebrate its 20th anniversary next year.
 
Since its creation as a pilot program in Southern California in 2003, the VDS at the Mexican consulates (and mobile units) has provided more than 45.8 million health-related services to 18.3 million people. Its services are not exclusively for Mexicans, so many more people, including U.S. citizens, have benefited from this effort.
 
The VDS does not solve all the health-related barriers and issues faced by the Mexican migrants in the U.S.; however, it certainly alleviates some of their anguish and distress.
 
Background.
 
The primary motivation behind establishing the VDS is the unequal access to health services in the U.S. by Hispanics in general and undocumented migrants in particular, even after the enactment of the Affordable Care Act of 2010. In 2016, 24 million persons did not have health insurance, and the percentage of Hispanics uninsured of the total grew from 29% in 2013 to 40%. In 2019, two out of five Mexican migrants did not have insurance (38%), “compared to 20% of all immigrants and 8% of the U.S. born.”[ii] Two years later, the percentage of uninsured Mexican migrants diminished by 1% to reach 37% in 2021.[iii]
 
In the United States, an uninsured person typically pays full price for medical expenses, while an insured individual will receive negotiated discounts from their insurance, so the cost drops dramatically.
 
The passing of Proposition 187 in California in 1994 significantly impacted the Hispanic community, not only the undocumented Mexican population, although it never came into force.[iv] Most migrants stayed away from medical services due to the fear of being taken away by immigration authorities and the confusion regarding immigration’s public charge, particularly during the Trump Administration.[v]
 
Besides, the creation of the Binational Health Week in 2001 by the government of Mexico and the Health Initiative of the Americas (HIA) gave a big push for establishing a permanent health office at the Mexican consulates that could also provide information year-round (Link to the blog post about the Binational Health Week).
 
However, it was not that easy, as the VDS required having non-official personnel inside the consulate. Raúl Necochea López details the difficulties that had to be overcome to open the Health Desks in the consulates´ offices, as it was “a significant departure from the established restrictive norms about the use of consular resources,”[vi] The biggest issue was the permanent presence of non-consulate personnel at the consular premises.
 
After some time, finally, in February 2002, the Ministry of Foreign Affairs of Mexico accepted the idea, and a pilot program proposal was developed. In 2003, the Consulates of Mexico in San Diego and Los Angeles opened the first VDS as a pilot project. After their initial success, the Ministry of Health of Mexico has provided funds for the program since 2006.
 
Taking advantage of the hundreds of persons that visit the consulates every day was a determining factor for the health institutions in establishing a permanent health office at the consular premises. It provided access to hard-to-reach populations in a secure and culturally appropriate environment. “A key factor in the [partner organizations’] ability to reach this population is the fact that the consulate is generally considered a trustworthy space in the sense that a person´s migration status will not be at risk.”[vii]
 
What is the Health Window?
 
The VDS is a designed space inside the consulate, generally in the public waiting area, attended by personnel of the local partner. The Health Desk provides health-related information and personalized counseling, makes referrals to a health clinic and other specialized services, and offers the opportunity to receive different types of screening. “The VDS program is a multistrategy approach to providing personalized assistance and outreach to Mexican immigrants unfamiliar with the U.S. health system.”[viii]
 
The Health Desk program is a public-private partnership with the participation of Mexico´s Ministry of Health (providing funding and overseeing the program), the Institute of Mexicans Abroad (IME) through the consular network, and local government and non-government health care organizations, such as community health centers, hospitals, universities, migrant-serving institutions, and pharmacies. The local partners provide human and financial resources and knowledge, while the consulates offer a space for their activities.
 
“The aim of this initiative is to build a network of informational windows [Health Desks] to increase knowledge about health and access to services for Mexican migrants and their families residing in the United States.”[ix]
 
The VDS provides the following general services, which vary depending on several issues, most notably the available local resource and existing partnerships:

• “Personal counseling on preventive health
• Health screening [and immunizations]
• Referrals to health services (local health clinics)
• Personalized navigation of health insurance programs.”[x]

 
As the program evolved, more organizations began offering health-related services, from a wide variety of screenings and immunizations to access to quitting smoking programs and referrals to community health clinics. In 2015, the VDS served 1,525,504 persons who received 415,509 screening and 63,084 vaccinations.[xi]
 
The VDS provided a wide variety of information, including health insurance, domestic violence, hypertension, diabetes, substance abuse, obesity, birth control, and mental and women´s health, among other topics.[xii]
 
The evolution of the Heath Desk.
 
After its initial success, the VDS expanded rapidly like other successful consular programs. Eleven consulates established Health Windows between 2004 and 2007. And, from 2008 to 2011, an “additional 38 VDS opened for a total of 50 affiliated with the Mexican consulates that work closely and in partnership with local health-care organizations.”[xiii]
 
Two circumstances helped in the fast expansion of the program. The first one was the creation of a health commission of the Institute of Mexicans Abroad´s Advisory Council -CCIME- in 2003. The advisory council was the first of its type in the government of Mexico.[xiv]
 
The second situation was the increase in the reunification of women and children in the U.S.,[xv] significantly changing the demographics and needs of the Mexican migrant community. Health care has become increasingly critical for new migrant families. For example, in 2013, women were 63% of the people served by the VDS.[xvi]
 
An additional advantage of the Health Desk was that the IME organized several Jornadas Informativas (specific topic conferences) centered on health issues. It later created a special meeting of all VDS partner organizations, which was unique to the program. In December 2020, the 17th Annual meeting of the Health Desk program took place online due to the pandemic.
 
In 2012, a Health Advisory Board was established with nine members to define the priorities of the VDS and make recommendations to promote the program´s sustainability. The board was one of the first to be established to strengthen the programs implemented by the IME.
 
During the Covid-19 pandemic, the VDS played a crucial role in providing information to the community via social media and other forms of communication. In 2021, Mexico´s consular network in the United States helped provide 80,000 COVID-19 vaccines[xvii] not only to the Mexican community but also to Hispanics and from other countries.
 
Through the years, the VDS has continued to evolve. For example:

• In 2019, it established the Continuous Information and Health Report System of Mexicans in the United States (Sistema de Información Continua y Reportes de Salud de los Mexicanos en Estados Unidos -SICRESAL-MX), a unified database for reporting the VDS activities, managed by the Mexican section of the U.S.-Mexico Border Health Commission.
• In 2021, it expanded its services by establishing the Mental Health Window pilot program in 12 consulates.

 
The results of the Heath Desk.
 
From 2003 until August 2022, the VDS served 18.3 million persons and offered 45.8 million health-related services, as described in Table 1, with the collaboration of around 600 local partners.
 
Table 1. Ventanilla de Salud Program: persons serviced, and health-related services provided from 2003 to 2022
Period                                                                    Persons                             Services
2003-2017                                                         10 million*                         18.4 million**
September 2017-August 2018                 1.5 million                           5.8 million
January-July 2019                                         700,000                               1.8 million
September 2019-August 2020                2.0 million                         6.0 million
September 2020-August 2021                3.0 million                         8.5 million
September 2020-August 2022               1.1 million                           5.3 million
TOTAL                                                                18.3 million                     45.8 million

Note: A single person can receive multiple services. According to the Institute of Mexican Abroad, between 2003 and 2019, the VDS served 22 million persons who received 8 million health-related services. Instituto de los Mexicanos en el Exterior (2021). Ventanillas de Salud (VDS). 21 November.
Sources: *2003-2017. Instituto de los Mexicanos en el Exterior, 2017. Las Ventanillas de Salud reciben el premio de la OEA a la Innovación para la Gestión Pública. Boletín Especial Lazos. 11 October. **The number of services only includes from 2012 to 2016. Instituto de los Mexicanos en el Exterior, 2018. Resultados Programa VDS. 26 November 2016; updated March 2018.
09/2017-08/2018: Sexto Informe de Labores, SRE. 2018, p. 190; 01-07/2019; Primer Informe de Labores, SRE. 2019, p. 136; 09/2019-08/2020: Segundo Informe de Labores, SRE. 2020, p. 157; 09/2020-8/2021: Tercer Informe de Labores, SRE. 2021, p. 145; 09/2021-08/2022: Cuarto Informe de Labores, SRE. 2022, p. 142.

 
The impact of the VDS is more significant considering that health issues affect the family on both sides of the border, as illnesses and other health problems can result in a reduction of income and an increase in expenses.
 
Besides reaching out to millions of Mexicans in the U.S. through the VDS program, the consulates of Mexico have established long-term alliances with a wide range of health-related organizations, such as the American Cancer Society, the National Institute for Health, Georgia Lighthouse Foundation, and Emery University´s Rollins School of Public Health.[xviii] The program has also strengthened its collaboration with the Centers for Disease Control and Prevention and the National Alliance for Hispanic Health.[xix]
 
Recognizing the great benefits that the VDS provided, in 2017, the Organization of American States granted the “Inter-American Award on Innovation for Effective Public Management” in the Social Inclusion Innovation category.[xx]
 
The opening of the VDS was a defining moment in Mexico´s public-consular diplomacy, as it allowed, for the first time, the permanent presence of community health organizations personnel inside the consular premises. Shortly after, other groupings, such as the banking and financial sectors, assigned people to the local consulate. Various consulates also opened new specific-purpose windows focused on educational opportunities and financial education. More recently, some three consulates have created new desks to provide specialized care to indigenous migrants.
 
Conclusions.
 
The Ventanilla de Salud or Health Desk program is another example of an innovative public-consular diplomacy of Mexico, working as a bridge between the Mexican community living in the U.S. and its network of health partners.
 
Health referrals and screenings are not typical consular assistance programs. However, the VDS was a groundbreaking way for the government of Mexico, together with local partners, to care for the needs of the Mexican community in a country without universal health care. The VDS also initiated the consulates' transformation into community centers.
 
The VDS helps the Mexican community in the U.S. to alleviate their barriers to accessing healthcare and solving health-related issues. A visit to a Health Window in a Mexican consulate can be a life-changing event or at least an opportunity to learn how to navigate the U.S. health system.
 

 
[i] Other translations of the VDS program are Health Stations or Health Windows. Here it Desk and Window will be used.
[ii] Israel, E. and Batalova, J. 2020. Mexican Migrants in the United States. Migration Policy Institute. 5 November.
[iii] Rosenbloom, R. and Batalova, J. 2022. Mexican Immigrants in the United States. Migration Policy Institute 13 October.
[iv] Márquez Lartigue, R. 2022. Public-consular Diplomacy that heals: The Binational Health Week Program. Blog about Consular and Public Diplomacies. 5 March.
[v] Marina Valle, V., Gandoy Vázquez, W. L., and Valenzuela Moreno, K. A. 2020. Ventanillas de Salud: Defeating challenges in healthcare access for Mexican immigrants in the United States. Estudios Fronterizos, 21. July.
[vi] Necochea López, R. 2018. Mexico´s health diplomacy and the Ventanilla de Salud program. Latino Studies (16), p. 483.
[vii] Délano Alonso, A. 2018. From Here and There: Diaspora Policies, Integration and Social Rights beyond Borders, p. 78.
[viii] González Gutiérrez, C. 2009. The Institute of Mexicans Abroad, An Effort to Empower the Diaspora. In D. R. Agunias (Ed.) Closing the Distance. How Governments Strengthen ties with their Diaspora, p. 94.
[ix] Dávila Chávez, H. 2014. Comprehensive Health Care Strategy for Migrants. Voices of Mexico. Num. 98, Winter, p. 96.
[x] Secretaría de Salud and Secretaría de Relaciones Exteriores. 2019. Strategy: Ventanillas de Salud, p. 7.
[xi] Rangel Gómez, M. G., et. al. 2016. Ventanillas de Salud: A Program Designed to Improve the Health of Mexican Immigrants Living in the United States. Migración y Salud, p. 100.
[xii] Rangel Gómez, M. G., et al. 2017. Ventanillas de Salud: A Collaborative and Binational Health Access and Preventive Care Program. Frontier in Public Health. 30 June.
[xiii]  Rangel Gómez, M. G., et al. 2017. Ventanillas de Salud: A Collaborative and Binational Health Access and Preventive Care Program. Frontier in Public Health. p. 3. 30 June.[xiv] Délano, A. 2009. From Limited to Active Engagement: Mexico’s Emigration Policies from a Foreign Policy Perspective. International Migration Review, 43(4), p. 791.
[xv] Durand, J., Massey, D. S. & Parrado, E. A. 1999. The New Era of Mexican Migration to the United States. The Journal of American History, 86(2), p. 525-527.
[xvi] Rangel Gómez, M. G., et al. 2017. Ventanillas de Salud: A Collaborative and Binational Health Access and Preventive Care Program. Frontier in Public Health, p. 2. 30 June.
[xvii] Secretaría de Relaciones Exteriores. 2021. Tercer Informe de Labores, SRE, p. 146.
[xviii] Instituto de los Mexicanos en el Exterior 2018. Alianzas Estratégicas. Published 24 November 2016; updated March 2018.
[xix] Dávila Chávez, H. 2014. Comprehensive Health Care Strategy for Migrants. Voices of Mexico. Num. 98, Winter, p. 98.
[xx] Organización de Estados Americanos. 2017. V Premio Interamericano a la Innovación para la Gestión Pública Efectiva 2017. Acta Final de Evaluaciones. Instituto de los Mexicanos en el Exterior. 2017. Las Ventanillas de Salud reciben el premio de la OEA a la Innovación para la Gestión Pública. Boletín Especial Lazos. 11 October. Instituto de los Mexicanos en el Exterior. 2017. La OEA hace entrega de Premio Interamericano a las Ventanillas de Salud. Press Bulletin. 19 December.

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