Date Published: May 31, 2019
Publisher: Public Library of Science
Author(s): Nancy Armenta-Paulino, María Sandín Vázquez, Francisco Bolúmar, Shelina Visram.
Monitoring and reducing inequalities in health care has become more relevant since the adoption of the Sustainable Development Goals (SDGs). The SDGs bring an opportunity to put the assessment of inequalities by ethnicity on the agenda of decision-makers. The objective of this qualitative study is to know how current monitoring is carried out and to identify what factors influence the process in order to incorporate indicators that allow the evaluation of inequalities by ethnicity.
We conducted 17 semi-structured interviews with key informants from the health ministry, monitoring observatories, research centers, and international organizations, involved in maternal health care monitoring in Mexico. Our analysis was interpretative-phenomenological and focused on examining experiences about monitoring maternal health care in order to achieve a full picture of the current context in which it takes place and the factors that influence it.
The obstacles and opportunities pointed out from the participants emerge from the limitations or advantages associated with the accuracy of evaluation, availability of information and resources, and effective management and decision-making. Technicians, coordinators, researchers or decision-makers are not only aware of the inequalities but also of its importance. However, this does not lead to political decisions permitting an indicator to be developed for monitoring it. As for opportunities, the role of international organizations and their links with the countries is crucial to carry out monitoring, due to political and technical support.
The success of a monitoring system to help decision-makers reduce inequalities in health care depends not only on accurate evaluations but also on the context in which it is implemented. Understanding the operation, obstacles and opportunities for monitoring could be a key issue if the countries want to advance towards assessing inequalities and reducing health inequities with the aid of concrete policies and initiatives.
Indigenous women are among the most vulnerable groups in Latin America. They live in contexts where different social determinants such as poverty, low education, gender roles and cultural factors are combined. Indigenous women experience significantly worse maternal health outcomes (including high risk of maternal mortality) and have more limited access to health services than majority populations.  Besides, historically, indigenous populations have not been made visible in the statistics, which could hide deep inequalities concerning other populations groups that would require a prompt response from governments and health systems. 
Our use of a qualitative method means that our findings derive from our respondents’ experiences and cannot, therefore, be generalized. One of the main limitations is that only one of the public health service providers was included in the study, albeit the main provider of services to groups at risk of suffering inequalities in health care as well as the provider responsible for the Mexican health sector. It is, therefore, possible that the obstacles and opportunities for other institutions may differ from those that emerge in this study; that said, having achieved discursive saturation; we have obtained the most significant opinions in this field of activity.
As we have argued, the success of a monitoring system to help decision-making aimed at reducing maternal health inequalities seems to depend not only on accurate evaluation but also on the context in which it is carried out and the actors involved, which is why it is fundamental to take their perspectives into account.