Information, Counseling and Referrals to Health Services in the United States for Mexicans and their Families

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Information, Counseling and Referrals

to Health Services in the United States

for Mexicans and their Families

Ventanillas de Salud

GOVERNING DOCUMENT

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First edition: October 2012

Lieja Nº 7, colonia Juárez, delegación Cuauhtémoc, C. P. 06600, México, D. F.

IMPRESOEN MÉXICO / PRINTEDIN MEXICO

Germán Fajardo Dolci

Deputy Secretary of Integration and Development of the Health Sector

Miguel Limón García

Head of the Coordinating Unit of Social Correlation and Participation

Hilda Dávila Chávez

Director General of International Relations

Jorge Humberto Hernández Luna

Advisor to the Secretary of Health

Eduardo Jaramillo Navarrate

Advisor to the Secretary of Health

Gudelia Rangel Gómez

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Information, Counseling and Referrals

to Health Services in the United States

for Mexicans and their Families

Ventanillas de Salud

GOVERNING DOCUMENT

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Index

FOREWORD ... 9

BACKGROUND ... 13

Organization of the Programa de Acción Específi co 2007-2012. Salud del Migrante ... 15

Mission... 15

Vision ... 15

General Purpose ... 16

Specifi c Objectives ... 16

Ventanillas de Salud ... 17

Description of the Ventanillas de Salud program ... 18

Mission ... 21

Vision ... 21

Essential Functions ... 21

Health Information ...23

Impact of the Ventanillas de Salud Program ...24

INITIATIVESFOR STRENGTHENINGTHE PROGRAM ... 33

Second Generation of Ventanillas de Salud Project ...33

Call Center in Collaboration with National Alliance for Hispanic Health (NAHH), United States ...36

Seguro Popular for Families of Mexican Immigrants ... 37

Advertising Strategies ...38

Mobile Ventanillas de Salud ...40

Community Clinics ...42

Establishment of the Advisory Board of the Ventanillas de Salud Federal Program ... 47

Binational Health Week ...49

Research Program on Migration and Health (Pimsa by its Spanish accronym) ... 52

CHALLENGESAND OPPORTUNITIESOFTHE PROGRAM ... 53

VENTANILLAS DE SALUD PROGRAM LEGACY ... 55

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Foreword

I

f there is one area in which the enormous complexity of globaliza-tion and interdependence is manifested, it is in the health fi eld. The emergence of pandemics, combined with the growing phenomenon of migra-tion, has made health a topic that requires inter-sector and global answers. Within the new global architecture, which has a wide variety of govern-mental and non-governgovern-mental organizations, it is necessary to strengthen the capacity for innovation with new patterns of international cooperation in public health that meet the challenges of the global agenda.

Migration and health are a critical dimension of the referred process in which the Mexican government has taken signifi cant actions through in-novative public policies in order to improve the living conditions of Mexicans abroad.

We have worked in a coordinated manner with the Secretariat of For-eign Relations and the Mexican Embassy in the United States of America in building a strong network of 50 Ventanillas de Salud (health modules), one in each Consulate, which supports health promotion, prevention and care of the Mexican immigrant community in the United States.

The Ventanillas de Salud program represents an innovative collabora-tion design which is co-fi nanced with resources of the Mexican Federal Gov-ernment, involving the Consulates in the United States and local health service providers and community clinics that are focused on immigrant as-sistance.

Around the Ventanillas de Salud network operates a set of more than 500 public and private U.S. agencies, which through local partnerships per-form actions to improve the health of Mexicans residing in the United States of America.

The program has become the main promoter of health prevention and promotion in the United States, in order to guarantee the constitutional right to health for all Mexicans, regardless of the country where they live.

The Ventanillas de Salud are located within all the Mexican Consul-ates, which are visited daily by thousands of people, many of them lacking

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social security (including health services) due to their immigration status and the work activities that most of them perform (construction, agricul-ture and manufacturing), which are statistically among the most hazard-ous to health.

During periods of formalities at the Consulates, the Ventanillas de Salud

offer Mexican families services such as tests to measure blood pressure and glucose, analysis of HIV / AIDS, screening for breast cancer, provision of

cer-tain vaccines, or if necessary, the referral to Community Health Centers in the United States, regardless the immigration status of the recipients.

The information and assistance provided through the Ventanillas de Sa-lud are focused on the higher incidence diseases of the Mexican population in the United States, which are non-communicable diseases caused by risk fac-tors such as obesity, which is present among our fellow citizens due mainly to severe metabolic changes produced by changes in diet and lifestyle.

For critical cases, the program provides referral, according to their con-dition, to federal health centers in Mexico City or hospitals within Mexico in order to provide the required medical care as quickly as possible.

Likewise, the Ventanillas de Salud have implemented prevention pro-grams and psychological counseling to strengthen protection factors against the use of drugs among school age young people in populations with high migration rate as in destination cities in the USA.

Furthermore, the Ventanillas de Salud include an electronic platform to provide immigrants the possibility of pre-affi liation to the Seguro Popular

(Public Health Insurance) from wherever they are, as well as to seek that family members who remain in Mexico may receive health services in their place of origin.

Thanks to these services, an in situ empowerment of Mexican communi-ties in the United States is being achieved, where local prioricommuni-ties are defi ned in each city, responding fl exibly to their specifi c needs. The main purpose is to broaden the knowledge of preventive health that Mexican families have on both sides of the border and to promote its timely and effective use.

The broad participation of agencies has consolidated a strong network of preventive health for our communities abroad, which has allowed a grow-ing assistance coverage, which has been enriched with mobile Ventanillas de Salud, allowing to bring health services closer to agricultural workers in distant places.

The Ventanillas de Salud are evidence of shared responsibility that the Mexican Government undertakes to seek the welfare of immigrants in

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Information, Counseling and Referrals to Health Services in the United States for Mexicans and their Families

the United States. Much remains to be done. Mexico and the United States need to follow up and work further with the innovative and effective pro-grams that have been implemented, such as the Ventanillas de Salud; and mainly they need to join bilateral efforts to continue guaranteeing the right to health for their population. The establishment of a pilot program of sec-ond generation: Ventanillas Second Generation, aims in this direction. This program, among other innovative actions, seeks the participation of Mexi-can entity governments where migration originates.

This publication tells the story of the Ventanillas de Salud. It also rais-es the challenge ahead for the institutionalization of this assistance model with imagination and commitment, with the purpose of helping to raise the quality of life of our fellow citizens living abroad, extending the generous arms of the Mexican government and its associates in the United States of America. It considers the positive externalities of our actions for the society of that country as a whole.

Salomón Chertorivski Woldenberg

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Background

T

he constant fl ow of Mexicans to the United States and the growing volume of illegal immigrants highlight the vulnerability to which they are exposed in the neighboring country. Extreme weather conditions and public safety can become potential hazards affecting the health situa-tion of immigrants.

Sometimes, the journey without legal documents to the north of the con-tinent could become a permanent risk, more than an opportunity, due to the conditions to which immigrants are exposed to all the way from their departure point of origin to their destination in the United States. Such con-ditions may affect their health, which is a priority for the full development of the physical, social and cultural potential of the immigrant and his family, risking specifi c factors identifi able to public health.

According to the population census of the United States for 2008, the Mexican-origin population had the highest percentage (34.6%) of uninsured people living in the U.S. (U.S. Census Bureau, 2008). It stands out that al-most half (48.3%) of the people of Mexican origin and 61% of those born in Mexico in the most productive age group (18 to 64 years old) reported that they had no health insurance. Insurance and service access is limited even among the group of children under 18. For example, in the health needs sur-vey conducted at the Mexican Consulate General in Los Angeles, in 2004 (Secretariat of Foreign Relations, 2004), it stands out that 49% Mexican children born in the United States had no health insurance, even when the State of California had a free insurance coverage program for low-income children between 0-18 years. This fi gure clearly refl ects the underutilization of health services among these families.

The target population of this program is formed by those Mexicans liv-ing in the United States and their families. In 2010, there were about 31.8 million people of Mexican origin in the United States. The potential scope of the Ventanillas is very signifi cant, since the consular network serves an average of 1 500 000 people annually through its 50 Ventanillas de Salud

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Overall, the Secretariat of Health proposed the Programa de Acción Es-pecífi co 2007-2012. Salud del Migrante (Secretariat of Health, 2008), which seeks to promote the health of Mexicans in the United States of America.

To implement this program, the following institutional framework, related to legal fundamentals, was considered. In its general sense, it is based in Article 4 of the Constitución Política de los Estados Unidos Mexi-canos (Honorable Union Congress, 2012), which states that “every person has the right to health protection”. Likewise, specifi cally, Articles 3 and 13 of the Ley General de Salud (Honorable Union Congress, 2010), highlight the obligations of the Secretariat of Health for maintaining the health of Mexicans.

In particular, the “Reglamento interior de la Secretaría de Salud” (Fed-eral Executive, 2011) was considered, including the competencies, objectives and actions for the International Relations Department of the Secretariat and its functions in the work to improve the health of fellow citizens abroad.

Another important link that the Programa de Acción Específi co 2007-2012. Salud del Migrante (Secretariat of Health, 2008) has, is the Plan Nacional de Desarrollo 2007-2012 (Mexican United States Government, 2007)–, which establishes national objectives, strategies and priorities that should govern the actions of the current government. Thus, this program is aimed to promote the means to achieve the protection and attainment of immigrants’ health, for both, those who arrive in Mexico, and national immigrants in the North American region. In consequence, we will have a favorable environment for prevention and health care that allows individual and social development, as well as seizing of opportunities for the benefi t of immigrants and their families.

Lastly, the Programa Sectorial de Salud 2007-2012 (Prosesa, Spanish acronym) was considered within this international framework. Such pro-gram aims to address health needs of Mexican immigrants, primarily in North America and those who enter the country. Its strategy 4.9 points out the implementation of a program for immigrant’s health, through which “in-ternational cooperation regarding health may be seized to help achieve the objectives of the sector”.

The following are specifi c actions proposed by Prosesa:

• Strengthen collaboration and cooperation with the Border Health Com-missions Mexico-United States and Mexico-Guatemala on issues of epide-miological surveillance and control.

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• Strengthen multilateral and bilateral ties to offer and receive interna-tional cooperation to fulfi ll the objectives of Programa Sectorial de Salud 2007-2012.

• Consolidate the organization and development of the Binational Health Weeks, which have broadened the access of immigrant population to health services in the United States.

• Promote the affi liation of migrant families to the Seguro Popular through the Ventanillas de Salud within the consulates throughout the United States.

• Improve the health care that is provided to ill fellow citizens who need to be repatriated.

• Strengthen Mexico’s active participation in major international health or-ganizations, including the World Health Organization (WHO) and the Pan

American Health Organization (PAHO).

Through these actions, the Migrant Health Program becomes a key ele-ment in achieving the goals and complying with the Programa Sectorial de Salud 2007-2012.

Organization of the Programa de Acción Específi co 2007-2012. Salud del Migrante

Mission

To protect the health of immigrants and their families in their destination places through the establishment of specifi c binational collaboration strate-gies to promote health care in a culturally sensitive manner.

Vision

Mexican immigrants and their families have timely information on health promotion and disease prevention, and in their communities they have ac-cess to quality health services to achieve the full development of their physi-cal, mental and social potential.

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General Purpose

To guarantee access to health services and protect the health of immigrants through binational actions in their places of origin, transit and destination.

Specifi c Objectives

• Coordinate, support and monitor the various health related programs of the federal public administration that are carried out to benefi t the Mexi-can immigrant population.

• Promote communication strategies and information regarding education and health promotion aimed at the Mexican immigrant population with cultural sensitivity.

• Promote and strengthen the binational relationship among health care providers in order to increase accessibility to health care of immigrants. • Encourage and facilitate the management of binational agreements with

governmental and nongovernmental organizations and academic institu-tions, which have the purpose to promote health and improve the access to and quality of health services aimed at the Mexican immigrant population. • Provide medical care and hospital services to ill fellow citizens on both

sides of the border.

• Foster the research related to the health of immigrants.

This program includes ten strategies, each with specifi c lines of action and the following subprograms:

1. Ventanillas de Salud (VDS).

2. Binational Health Week (SBS).

3. Repatriation of seriously ill fellow citizens.

4. Research Program on Migration and Health (Pimsa, Spanish acronym). 5. Modules for the prevention and health promotion of immigrants in border

cities.

6. Seasonal Agricultural Workers Program Mexico-Canada (PTAT).

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Ventanillas de Salud

The Ventanillas de Salud materialize strategy 7 of the Programa de Ac-ción Específi co 2007-2012. Salud del Migrante (Secretariat of Health, 2008), which seeks to promote and strengthen the health care of the immigrant population. It is also a contribution from the Mexican government to provide prevention services to their fellow citizens in the U.S.

The establishment of the Ventanillas de Salud seeks to supply health information and education to Mexican immigrants in the United States, with the purpose of providing and improving access to health services that are available for this population and harmonize the information that both health systems –the Mexican and the American– have on a same patient.

Regarding this strategy, and within the lines of action that are consid-ered in the Programa de Acción Específi co 2007-2012. Salud del Migrante

(Secretariat of Health, 2008), the following are highlighted:

FIGURE 1. Institutional framework for the approach of Ventanillas de Salud

LegalBases

xConstituciónPolíticadelos

EstadosUnidosMexicanos

(art.4º)

xLeyGeneraldeSalud(arts.

3y13) x“ReglamentoInteriordela SecretaríadeSalud” PlanNacional deDesarrollo 2007Ͳ2012 ProgramaSectorial deSalud2007Ͳ2012 (Prosesa). Strategy4.9

ProgramadeAcciónEspecífico2007Ͳ2012.SaluddelMigrante

VentanillasdeSaludͲStrategy7:

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Inauguration of the fi rst Ventanilla de Salud, San Diego, California, 2003.

1. Strengthen the strategic program Ventanillas de Salud in coordination with the Institute of Mexicans Abroad of the Secretariat of Foreign Re-lations.

2. Increase fi nancial resources in order to implement this project in all U.S. Consulates.

3. Monitor and evaluate the proper functioning of Consulates services. 4. Manage and promote the Ventanillas de Salud (VDS) model in all U.S.

Consulates.

5. Opening of 25 Ventanillas de Salud in U.S. Consulates.

Description of the Ventanillas de Salud program

Since 2000, the Mexican government began a series of actions to improve the living conditions of Mexicans abroad. Three years later, through its consular representative in San Diego, California, and as a goodwill

ini-tiative, the Ventanillas de Salud program is tested as a center to provide informa-tion on health issues.1

Having the support of the Mexico-United States Border Health Commission (CSFMEU)2 and the

Mexico-United States Health Ini-tiative (currently known as the Health Initiative of the Americas), the University of California and The California Endowment,3_a

subsidy for a pilot phase in the mentioned Consulate was approved.

1_{The term}_{Ventanilla de Salud}_{comes from the initial proposal to act as a channel of}

communica-tion among the immigrant, the health promoter and the Consulate to provide guidance and infor-mation on health issues.

2_{The Mexico-United States Border Health Commission is a binational agency of the Secretariat of}

Health committed to improve health on the border, being a meeting point between Health State Offi cials and personalities from the community and their federal counterparts to share informa-tion and create agreements regarding specifi c public health issues with the United States. The

CSFMEU has six regional offi ces along the Mexico-United States border (http://www.saludfronteriza.

org.mx/).

3_{The California Endowment is an institution based in Los Angeles that seeks to broaden the access}

to quality health care for individuals and communities, to promote fundamental improvements in the health status of all Californians.

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The County of San Diego sup-ports the program by providing ba-sic health education and conducting health prevention and promotion activities for Mexican immigrants in order to provide them with timely information regarding health, and access to basic quality services to

achieve the full development of their physical, mental and social potential (Secretariat of Health, 2008).

Ventanillas de Salud is a Mexi-can government program developed by the Secretariat of Health and the

Secretariat of Foreign Relations and implemented by the 50 Mexican Con-sulates in the United States and local health organizations. It provides reli-able information regarding health prevention, counseling and referrals to health services that are available and accessible in the community. It was also designed to improve physical and mental health of Mexicans who live in the United States and to improve their access to primary and preventive health services and health insurance coverage, and guarantee culturally sensitive services to decrease the use of emergency services.

After a two-year development, two evaluation studies and an adaptation process of the pilot phase, the Mexican government initiated the expan-sion of this model to other Consulates. In 2004, the Mexican government provided “seed money” to keep and open modules in other Mexican Consul-ates in the United StConsul-ates. Each year, the Mexican government provides the program with about two million dollars in cash contributions and approxi-mately one million dollars of in-kind contributions. This resource is in turn matched at different levels by local organizations, foundations and sponsors of each Ventanilla de Salud.

The Ventanillas de Salud program has had an extraordinary acceptance and growth since its pilot phase began in the Mexican Consulates in San

Measuring blood pressure to a user of Ventanillas de Salud.

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Inauguration of Ventanilla de Salud number 50, San Bernardino, California, 2011.

Diego and Los Angeles. Cur-rently, 50 Ventanillas de Salud

have been offi cially opened and are operating. This service is available throughout the whole Mexican consular network in the United States.

This coverage, in addition to the culturally sensitive na-ture, the confidence environ-ment that Mexican Consulates inspire to fellow citizens, and the link among several organizations and two countries, make this program an excellent vehicle for the promotion, health prevention and disease control

SOURCE: http://ventanillas.org/index.php/es/.

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in a binational level, including Mexico and the United States. The location of the Ventanillas de Salud throughout the country is shown in fi gure 2.

Mission

Improve access to primary and preventive health services, increase public insurance coverage, and promote a preventive health culture of Mexicans living in the United States and their families through information, educa-tion, counseling and quality referrals, in a safe and friendly environment, by creating local and binational collaborations between the U.S. and Mexico.

Vision

Improve the physical and mental health of Mexicans living in the United States by increasing access to primary and preventive services, public in-surance coverage, the supply and quality of culturally sensitive services, reducing the use of emergency services and establishing the ventanillas

network as a reliable and sustainable home-based program that provides information, education and referral on health issues.

Essential Functions

• Issue health prevention and promotion programs.

• Promote access of migrants to Community Health Centers in the United States through a network of 6 500 medical units.

• Dissemination and pre-affi liation to Seguro Popular for migrants and their families.

• Provide Mexicans in the United States the ability to affi liate their family members and themselves to Seguro Popular, from their place of residence, in order to re-ceive health services in national

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• Reduce drug consumption among school age young people both in populations with high migration rates as well as in destination cit-ies in the United States, reinforc-ing protection issues to prevent the use of drugs, considering the cultural aspects common in Mexi-can families.

• Issue information about the

ser-vices offered by Community Health Centers.

• Take action in specifi c areas, including issues related to migration and health, as well as in areas of research and academic exchange.

• Give follow-up to patients with serious health problems until they recover. • Establish a preventive program in elementary and secondary level schools,

targeting potential immigrants.

• Implement an early psychological intervention program in existing care centers in border crossing cities.

• Implement a preventive and psychological counseling program in order to strengthen protective factors as-sociated with the use of drugs. The content of this program are sensi-tive to Mexican culture and fami-lies through networks, associations and clubs of Mexicans in the United States.

• Direct seriously ill patients, ac-cording to their disease, to federal health centers in Mexico City or state hospitals in order to provide them with the required medical care as quickly as possible.

Young Volunteers Program for the creation of a healthy Latino community. Mobile Ventanilla

de Salud, Kansas City, 2012.

Promoting access to healt services through community centers in the United States,

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Health Information

Priority issues on which information is delivered to the fellow citizens, are closely related to the disease profi le of those who move to the north of the continent. These are:

• Substance abuse (alcohol / drug addiction). • Arthritis / rheumatism. • Asthma / allergies. • Cancer • Prenatal care. • Diabetes. • Heart disease.

• Sexually transmitted diseases (HIV / AIDS, other).

• High blood pressure. • Infl uenza.

• Nutrition and physical activity • Obesity / metabolic syndrome /

cholesterol

• Family planning

• Back and neck problems • Women’s health. • Dental health • Mental health (depression / anxiety / stress). • Occupational health (prevention of work accidents). • Smoking. • Tuberculosis. • Ulcer / gastritis. • Domestic violence. • Visual health.

Promoting and doing an HIV screening. Promoting healthy habits for chronic

diseases prevention.

Meeting for the presentation of services offered by Ventanillas de Salud and challenges that they face. Denver, Colorado, 2012.

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Impact of the Ventanillas de Salud Program

The following data is intended to highlight the impact that the Ventani-llas de Salud program has had among compatriots living in the U.S. The source of information used in this section corresponds to that contained in the “Indicators Report of the Ventanillas de Salud Program”, which pres-ents average data of 40 Ventanillas de Salud modules between July 2011 and September 2012.

• The total population covered in the reference period was 903 919 persons. Its should be mentioned that the population covered by each of the avail-able Ventanillas de Salud is different according to the size of population and the consulate. According to a diagnosis made between 2010 and 2011 by Consultant Knowledge is Power, 40.4% of the VDS attended on average

more than 200 people a week. 19% of the VDS attended weekly between 50

and 100 users, and another 19% between 100 and 150 people. Only three

VDS serve on average 150 to 200 people.

• The total number of 3 108 379 services was distributed as follows:

- 68% focused on guidance and counseling on specifi c topics on health is-sues that are priorities for the Latino population living in the U.S., such as diabetes mellitus, obesity, high blood pressure, some determinants of risk for chronic diseases such as eating habits, sedentary lifestyle,

HIV / AIDS and sexually transmitted infections, mental health, addictions,

women’s health, access to health services: references, health insurance, etc. (see graphic 1).

- Likewise, 16%, helped for an early detection of diseases such as diabetes mellitus, obesity, high blood pressure, cholesterol, HIV / AIDS and sexually

transmitted infections (see graphic 1).

- Of those treated, 9% were referred to health services in the United States (see graphic 1).

- Another 6% were treated in mobile consulates where they received guidance, detection or reference to some kind of health service (see graphic 1).

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- The remaining 1% received other services such as vaccines or affi liation to some health insurance in the United States (see graphic 1).

903,919 2,103,101 488,484 25,542 287,484 12,697 191,071 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 1,100,000 1,200,000 1,300,000 1,400,000 1,500,000 1,600,000 1,700,000 1,800,000 1,900,000 2,000,000 2,100,000 2,200,000 2,300,000 Popu la ti on se rv e d Populationserved Totalcounselingsessions/

departments Totaldetections

Totalvaccinesapplied Totalreferralsforhealthservicesin

theU.S.

Totalpeopleenrolledinhealth

insuranceintheU.S. Totalmobileoroutpatient services

SOURCE: “Indicators Report of the Ventanillas de Salud Program”.

Period from July, 2011 to September, 2012.

Number of Ventanillas per period: 35 July-August 2011, 39 October to December 2011, 48 January-March 2012, 50 April-June 2012 and 52 July-September 2012.

GRAPHIC 1. Number of Users Treated in Ventanillas de Salud by type of Service Received

TABLE 1. Prevalence of the leading causes of morbidity in the migrant population

treated at the Health Windows Program. July 2011 and September 2012

Test Type Measurements _Performed Positive tests_{High levels} _(percentage)Prevalence

Measurement of glucose in blood 64 435 9 736 15 Obesity and overweight 41 967 15 312 36 Arterial hypertension 84 171 17 043 20 Cholesterol 15 078 3 667 24 Heart diseases 19 584 4 286 22 HIV / AIDS 8 522 95 1.1 STI 2 443 49 2 Tuberculosis 282 9 3

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903,919 195,664 64,435 9,736 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Popul at io n se rv e d Populationserved Counseling sessions on diabetesprevention Glucoselevelsmesurements

Withhighlevelsofglucose/

hemoglobinA1c

GRAPHIC 2. Number of Users Treated in Ventanillas de Salud on Diabetes Prevention

903,919 136,036 161,203 41,967 15,312 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Po pul at io n se rv e d Populationserved

Counselingsessionsonobesityprevention/

metabolicsyndrome/cholesterol Counselingsessionsonnutritionandphysical

activity BMImeasurements

Overweightand/orobese

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• On average, three attentions were given counseling, prevention or refer-ence to some kind of service per person who attends to an available Ven-tanilla de Salud.

• 195 664 people were provided guidance or counseling specifi cally on dia-betes mellitus. In addition, 64 435 glucose level meassurings were made, 15% of which presented high levels (see graphic 2 and table 1).

• For prevention of obesity, there were 297 239 guidances or counselings on specifi c issues such as metabolic syndrome, cholesterol levels, nutrition and physical activity. 41 967 body mass index meassurings were practiced in which a 36% prevalence of overweight and obesity was registered (see graphic 3 and table 1).

• On the issue of the high blood pressure prevention, 125 781 users were help-ed and providhelp-ed guidance and counseling on the subject. Blood pressure

903,919 125,781 84,171 17,043 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Po pul at io n se rv e d Populationserved

Counselingsessionsonhypertension

prevention

Bloodpressuremeasurements

Withhighbloodpressure

GRAPHIC 4. Number of Users Treated in Ventanillas de Salud

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was measured on 84 171 people and high blood pressure was detected on 20% of them (see graphic 4 and table 1).

• 15 078 blood cholesterol meassurings were performed and nearly a quarter of them presented high levels.

• 150 334 people were oriented on breast, cervical uterine or prostate can-cer. 589 detection tests were performed. As for heart diseases, 60 290 peo-ple were provided guidance and a prevalence of 22% was recorded among those people who underwent a heart test.

• For specifi c issues such as HIV / AIDS and sexually transmitted infections,

8 522 people were tested for the fi rst and 2 443 for the latter. It is im-portant to highlight that 1% of these testings were positive on HIV and

2% were positive on sexually transmitted infections (see graphic 5 and table 1).

903,919 107,696 8,522 95 2,443 49 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Popul at ion se rv e d Populationserved

Counseling sessions on prevention of sexually

transmitteddiseases(HIVandothers) DetectionofHIV/AIDS

TestedpositiveforHIV(referredfordiagnostic

confirmation)

Detectionofsexuallytransmitteddiseases PositiveresultsofSTD(referredfordiagnostic

confirmation)

GRAPHIC 5. Number of Users Treated in Ventanillas de Salud on Prevention

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• Regarding the prevention of tuberculosis, 9 270 users were oriented of which 282 underwent detection testings that reported a prevalence of 3% on this disease (see table 1).

• 311 378 women received guidance and counseling on health related topics. Thus, 43% of the attention corresponded to specifi c issues on their health; a quarter of them received information on family planning; 20% was ac-quainted with domestic violence issues and the remaining 11% received information on prenatal care (see graphic 6).

• For guidance or counseling about mental and oral health, 67 570 and 63 307 people, respectively, were provided orientation and counseling, 15% of which received second and third level services related to mental health and 84% received specialized dental treatments.

• Regarding prevention of the abuse of psychoactive substances consump-tion, 18% of the 73 053 people who received orientation were referred to

903,919 134,877 63,783 80,071 32,647 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Po pu la ti on se rv e d Populationserved Counseling sessions on women'shealth

Counseling sessions on prevention of sexuallydomesticviolence

Counseling sessions on family

planning

Counseling sessions on prenatal care

GRAPHIC 6. Number of Users Attended in Ventanillas de Salud

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(see graphic 7). Likewise, 48 854 users were oriented on topics related to nicotine poisoning and prevention of asthma and allergies; 0.2% of them were tested for asthma detection.

• It is also important to highlight that the Ventanillas de Salud also provid-ed orientation to 35 089 immigrants on preventing infl uenza, and approxi-mately half of them were vaccinated. For other diseases, 7 560 vaccines were applied, 63% of which were for the adult population and 37% for the child population.

• For the promotion of occupational health, 18 934 users were oriented. Social work programs provided 107 325 people with orientation, 22% of which re-ceived information on municipal health service, 13% were benefi ted with transportation services, 12% counted with fi nancial support, 10% with dis-ability assistance, and the remaining percentage received assistance in other topics.

903,919 73,059 13,067 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Po pul at io n se rv e d Populationserved

Counseling sessions on substance

abuseprevention

Referralsforservicesofsecondand

thirdlevel

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• Regarding access to health services, second and third level services were referred to 29 969 users who needed specifi c health care. On the other hand, 80 723 people received orientation on social work programs; 65% obtained discounts on medication; 17% corresponded to women, infants, and children referral; 3% received medical-legal assistance regarding debt for services; the same percentage participated in the breakfast and lunch delivery program, and the remaining 12% received other welfare services (see graphic 8).

• Finally, 6.02% out of 184 477 informed people pre-affi liated to Seguro Popular; 17.47% out of 29 823 informed adults got registered for a public health insurance in the U.S. and 29.14% out of 19 595 oriented children under 18 enrolled at a public health insurance.

903,919 52,985 3,040 14,096 2,587 8,015 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Po pu la ti on se rv e d Populationserved

Numberofpeoplereferredto

secondandthirdlevelfor

prescriptiondiscountprograms Numberofpeoplereferredto

secondandthirdlevelforlegal

servicesonmedicaldebt Numberofwomen,infantsand

childrenreferrals(WIC)

NumberofpeoplereferredtoLunch

orBreakfastProgram

Other

GRAPHIC 8. Number of Users Attended in Ventanillas de Salud that Were Referred

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Initiatives for Strengthening the Program

G

iven the results obtained with the implementation of the 50 Venta-nillas de Salud (VDS)by the Secretariat of Health, the Secretariat

of Foreign Relations and the Institute of Mexicans Abroad, it became neces-sary to develop new initiatives to ensure the strengthening of the progress that has been achieved so far. Such initiatives are described as follows:

Second Generation of Ventanillas de Salud Project

This project was developed in order to strengthen the VDS Program in its

second phase and to improve the access to health services for immigrants in the United States, in collaboration with various health initiatives, and through the implementation of training, dissemination, access to preventive services and technical assistance.

In March 2012 the Second Generation of VDS Projectis implemented and

its objectives are:

• Specialized care through a global concept that allows the standardiza-tion of criteria and concepts on priority issues, such as cancer, obesity and diabetes, occupational health, mental health, addictions, child health, HIV / AIDS, tuberculosis and access to services.

• Training the Ventanillas de Salud staff on health care reform in the U.S., so they can provide more information to users about the benefi ts and dis-advantages that such reform will bring for immigrant population.

• Provide technical assistance so that the Ventanillas de Salud Program can compete for federal support (grants).

• Strengthen the dissemination of VDS and Seguro Popular.

• Progress in standardization of processes and protocols in each Ventanilla de Salud.

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• Promote that referrals to com-munity clinics fl ow in both di-rections and be able to reach for a privileged channel that enables VDS to pre-affi liate

us-ers in health clinics.

• Proceed with the alignment of the VDS network with national

strategies for public health, such as the National Preven-tion Strategy, and to main-tain recognition of the VDS as a

member of such strategy. • Analyze the challenges and opportunities of strengthening VDS.

The implementation of this project started in fi ve VDS located in the

following cities: Kansas City, KC, New York, NY, Washington, DC, Port-land, Oregon, and Fresno, California. In order to select these Ventanillas de Salud, some variables were considered such as the total population of each of these cities, the number of population served, the operating time (choos-ing different periods of startup), experience work(choos-ing with prosecut(choos-ing agen-cies, success stories and best practices.

The fi rst trainin session for the Second Generation of Ventanillas de Salud was held in Washington, DC, on June 18 and 19, 2012, in order to fulfi l the aforementioned objectives.

The main topics that were cover-ed during the session are describcover-ed as follows:

• The inaugural address approached issues related to the second

gen-Health promoter orienting and counseling about diabetes prevention, 2012.

Blood pressure measuring.

Providing information about services offered by Ventanillas de Salud and Seguro Popular.

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eration of VDS, fi nancial participation, technical support to states like

Puebla, Oaxaca and Chihuahua, and the strengthening of technological elements. It was highlighted the importance of Ventanillas de Salud and its correlation with the Seguro Popular, as a Mexican government mecha-nism in order to implement the right to health in the country.

• In behalf of the Health and Human Services (HHS), it was highlighted the

importance of identifying the characteristics of both countries, specifi cally the needs of the population, and to encourage good collaboration practices in Health. The experience with China, called “The Management Manual Process; Getting to ‘Yes’”, was presented, which allowed to identify that public health problems bring nations together, since fi ghting for the same purposes. During the third intervention by the HHS Offi ce of Minority

Health, it was stated that its mission is to improve the health of racial and ethnic minority populations through the development of health policies and programs that help eliminate health disparities. The Promotores de Salud Initiative Program was also presented, which considered the work of promoters work ing in Ventanillas de Salud, who are close to members of the Latino and Hispanic low-income communities to set forth preven-tion and health promopreven-tion acpreven-tions. It is emphasized that this offi ce leads

efforts to build and fi nance partner-ships with various organizations in order to help individuals, families and communities in need. Finally, from the Embassy of Mexico in the United States, the recent health re-form law made in that country was

First training session for the Second Generation of Ventanillas de Salud, Washington, DC, June 18 and 19, 2012.

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presented, which recognizes the right to enjoy the best health quality pos-sible, without discrimination, which may result in signifi cant benefi ts on the health of Latinos living in the United States.

• The issues presented by the Secretariat of Health of Mexico were: confor-mation of the Health System in Mexico and the reform to Ley General de Salud in 2003 that included the creation of Seguro Popular. It emphasized that the function of Seguro Popular is to serve every person who has no health coverage or access to services because of their employment status. On the other hand, the functions of regulation and fi nancing of the Na-tional Health and Social Protection Commission were highlighted.

Finally, the highlighted results obtained in this training session were: • Confi rmation of the commitment of the Secretary of Health regarding

health of Mexican immigrants in the United States.

• Training of representatives of the fi ve selected VDS on priority and common

health issues.

• It was agreed the development of a Logical Model of Ventanillas de Salud. • Agreements were reached on priority health issues such as obesity, cancer,

diabetes, HIV, sexual health and vaccination.

• It was concluded that Ventanillas de Salud are currently a network and should move towards a mode of intervention.

• Consolidation of the agreement with Su Familia: National Hispanic Fam-ily Health Helpline (call center) and the respective training for attendants.

Call Center in Collaboration with National Alliance for Hispanic Health (NAHH), United States

This collaboration began in June 2012, and it consists in that the National Al-liance for Hispanic Health, through the Call Center funded by HHS, provides

guidance on prevention and health promotion of immigrants, and refers to the VDS and community clinics, and supports the diffusion of Seguro Popular.

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Another service offered through collaboration with this initiative is to spread health information through printed media, which is distributed in all VDS.

Su Familia: National Hispanic Family Health Helpline call center re-ceived 874 calls between July and October 2012. Every caller was provided with information on health, regardless of their country of origin; 40 of them identifi ed themselves as Mexican immigrants without health insurance and 15 people were suggested to visit the Ventanillas de Salud. They were informed about their eligibility to receive health benefi ts through Seguro Popular, service provided by the Mexican government.

Seguro Popular for Families of Mexican Immigrants

This program is part of the social protection system on health or Seguro Po pular, proposed by the Secretariat of Health, which aims to “Ensure the constitutional right to the protection of the health of Mexicans, through the fi nancing of interventions and treatments operated by the health ser-vices of the 32 states of the country”.

Specifi cally, the Seguro Popular for Families of Mexican Immigrants program seeks to:

• Make known to Mexicans living in the United States about the actions taken by the Federal Government in order for their families, living in Mexico, to have access to health services provided by the Social Protection in Health System (Seguro Popular).

• Let immigrants know that by being Mexicans they have the right to health protection in Mexico.

• That Mexicans living in the United States do not worry about the health of their families in Mexico, since they will be treated through medical ser-vices funded through Seguro Popular.

As a response to the aforementioned problems, the diffusion project of the Seguro Popular program is accompanied by health prevention actions that are carried out with the immigrant population, seeking to reduce the burden of infectious diseases, chronic degenerative and addictions.

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• Medical care for the immigrant’s family living in Mexico.

• The immigrant, when visiting Mexico and requires it, may affi liate and receive medical attention.

• If the immigrant is seriously ill, covered by the Fund for Protection against Catastrophic Expenses, he will be able to return to Mexico and receive the required treatment.

During the period from July 2011 to September 2012, 184 477 people were informed about the availability and benefi ts of Seguro Popular, 6% of which were pre-affi liated to the program (see graphic 9).

Advertising Strategies

The implementation of the strategy has two aspects, one in the U.S. and one in Mexico.

903,919 184,477 11,111 79,591 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Popu la ti on se rv e d Populationserved

SeguroPopular:populationoutreach SeguroPopular:preͲenrollments Numberoffamiliesinformedabout

IMSS

GRAPHIC 9. Number of Users Attended in Ventanillas de Salud

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For the U.S., we have the following strategies:

• The work was carried out in close collaboration with the Consulate of Mex-ico in the four most important cities as recipients of Mexican immigrants: Los Angeles, Chicago, New York and Atlanta.

• The Seguro Popular program printed 100 000 brochures in the form of comics targeted to immigrants who live in urban areas, and a print run of 50 000 more to serve rural areas population.

• In coordination with the Institute of Mexicans Abroad (IME by its Spanish

acronym) of the Secretariat of Foreign Relations, an informative broadcast was created about the benefi ts of Seguro Popular for immigrants and their families, which is transmitted through the network of screens of Saber es Poder (Knowledge is Power), which is transmitted on all U.S. Consulates. • Informative radio spots were produced, which are transmitted by radio

stations of Mexico with presence in the United States.

• Information about Seguro Popular has been included in the Consulate monthly newsletter.

• Several meetings were also held between Seguro Popular offi cials in the states and immigrant organizations (with home base organizations in Jalisco, Zacatecas, Michoacan, Puebla and Yucatan, among others) residents in major immigration destination cities in the United States of America, in order to contribute to a close-up among those responsible for the operation of Seguro Popular and the immigrant population, in order that, on the one hand, public servers get to know fi rst hand, the needs and expectations of immigrants, and on the other hand, to disseminate the available at the immigrants’ place of origin and promote affi liation and to exercise the right to health protection both for their families living in Mexico and for themselves.

• An investigation project was also held between the Baruch College of the City University of New York and the Economic Teaching and Education Center (CIDE, by its Spanish acronym), to identify the knowledge that

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As for the proposed strategies for Mexico, the following are highlighted: • Meetings held with the directors of health social protection from the place

of origin of immigration in Mexico for the development of materials that are being delivered to the Consulate.

• Directory of Information and Orientation Modules by State.

• Catalogue of diseases and interventions fi nanced by the Seguro Popular

(CAUSES dynamic explanatory).

• Coverage of Seguro Popular by State and Municipality.

• Inventory of medical infrastructure by level of state, municipality and local. • Preparation of an informative brochure to be distributed massively to the

families of immigrants residing in municipalities of immigration origin, so that families will inform their immigrants in the United States about

Seguro Popular, thus closing the circle.

Mobile Ventanillas de Salud

The program Mobile Ventanillas de Salud began in Kansas City, which is intended to serve farmworkers living in rural areas or areas far from the city. They are also present in mobile consulates, health fairs and community events.

In November 2011, the Consulate of Mexico in Kansas City, Missouri, and Juntos Projects signed an agreement to establish the Mobile

Ventanilla de Salud. The opening ceremony was held on March 6, 2012 in Garden City Community College.

The Mobile Ventanilla de Salud

was installed in the Smoky Hills Education Service Center in Salina, Kansas, on April 28, 2011. As part of the activities of this Ventanilla de

Inauguration of the Mobile Ventanilla de Salud, Garden City, Kansas, 2012.

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Salud, four stations were set to de-tect diseases such as diabetes mel-litus, high blood preassure, obesity and HIV / AIDS It provided

informa-tion related to cancer preveninforma-tion,

Ventanilla de Salud in Garden City, Kansas, May 12, 2012.

903,919 51,337 191,071 2,672 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Popul at ion se rve d Populationserved

NumberofMobileConsulates

Numberofpeopleserved

Numberofparticipatingagencies

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nicotine poisoning, healthy lifestyles, skin care and oral hygiene. The Mo-bile VDS counted with the presence of Dr. Edward Ellerbeck, who provided

individual consultations to event participants.

Seventy people attended in total, whom received information about health or detection screenings such as blood glucose, blood pressure, body mass index and HIV / AIDS.

On May 12, 2012, in Garden City, Kansas, the collaboration of the city health promoters took place, offering information to the Latino population on cancer prevention and nicotine poisoning. They took tests for HIV / AIDS,

blood glucose, blood pressure levels, BMI and skin damage.

Finally, it may be highlighted that during the reporting period 51 337 mobile consulates were installed, involving 2 672 governmental and nongov-ernmental agencies, in which 191 071 people were helped (see graphic 10).

Community Clinics

In 2010, the Ministries of Health of Mexico and the United States agreed to work together in order that Mexican immigrants were able to access health services offered by the Community Clinics Network (7 000 clinics), operated by the United States federal government. This collaboration begins with the organization of Ventanillas de Salud (VDS) regional meetings with the

Health Resource and Services Administration with the purpose of increas-ing the access of Mexican immigrants to the health care services network in community health centers for immigrant. Therefore, a strategy for dissemi-nation of services offered by community centers as well as training provided in these centers is established.

The activities being undertaken in collaboration with HRSAR Community

Clinics are:

• To disseminate information about the operation of community clinics man-aged by the HRSAR, services offered, appropriate reference of users of Ven-tanillas de Salud, as well as health promotion and prevention.

• Regional meetings involving federal institutions in the United States and Mexico, state government, tax agencies and civil society organizations working in the area of immigrant’s health. Up to date, two meetings have been held: the fi rst, in Dallas, Texas, on July 28 and 29, 2011, and the second on January 20, 2012, in San Francisco, California.

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• During the meeting in, Texas, held on July 28 and 29, 2011, the fi rst approach between Fiscal Agen-cies operating the VDS and HRSAR

managers in region 6 took place,

covering the states of Texas, New Mexico, Louisiana, Oklahoma and Arkansas in order to strengthen the activities and operation of the VDS, where it is intended that, through

com-munity clinics supported by the HRSAR, a greater number of Mexican

immi-grants and their families have access to health services, providing specifi c guidance for every population’s health need. About 70 people attended the meeting, including health promoters, health sector and government repre-sentatives from Mexico and the United States. Also involved via Internet were other regions in which the HRSAR operates, such as Boston, New York,

Kansas, Philadelphia, Denver, Atlanta and San Francisco. The main ob-jective was to initiate a cooperation based on good will of serving immi-grants on the specifi c issue of access to health services. It was highlighted the the importance of including immigrants, through the VDS and HRSAR

Community Clinics, to offer them information on health prevention and promotion. It was emphasized the importance of collaboration between tax agencies and NGOs in order to sensitize, train and educate people to get

in-volved in their health care, family and environment. Some programs were presented such as: Seguro Popular and its pre-enrollment mechanism, by which it is intended that the families of Mexicans who are abroad are able to receive medical care and counseling on health prevention and promo-tion in Mexico; Administrapromo-tion for Children and Families (ACF), Centers

for Medicare and Medicaid (CMS), Food and Drug Administration (FDA),

U.S. Administration on Aging and the National Institute for Occupational Safety and Health (NIOSH), which seek to empower, strengthen, produce,

and integrate a specifi c job in order to improve the needs in health services

First Regional Meeting for strengthening the labor of community clinics, Dallas, Texas, July 28 and 29, 2011.

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and commit to the community, specially with immigrants, to strengthen skills in children and families. As a conclusion, it was emphasized the im-portance of continuing with the approaching of other regions in which the

HRSAR operates in order to promote the approach of the more than 6 000

community clinics and to link the 50 VDS currently available, and sign the

Letter of Intent between both institutions.

• The second Regional Meeting between Ventanillas de Salud and the Health Resources and Services Administration was held in San Francisco, Cali-fornia, on January 20, 2012, in order to strengthen collaboration activities among these organizations, the VDS functioning, share best practices and

give follow up on the fi rst meeting, held on July, 2011. Operational and directive staff of the VDS and the HRSAR, as well as offi cials from the

Sec-retariat of Health of Mexico and the United States, attended the meeting. The main activities developed were: presentation of the general overview of the Institute of Mexicans Abroad, structure and services available in the VDS for the immigrant population, description of the infrastructure of

the current Mexican health system, especially on the subject of universal coverage in Mexico and the pre-affi liation service of Seguro Popular for health care in this country.

• A discussion in groups by states, was held, in order to discuss the opportu-nity areas for the strengthening of the VDS.

- In the group of Arizona, the following issues were highlighted: a) im-prove access to the immigrant community using mobile clinics, public service announcements, dissemination of religious organizations and community groups; b) increase training opportunities, which must be

Participants on the First Regional Meeting in Dallas, Texas.

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culturally sensitive; c) improve communication among Ventanillas de Sa lud through the development of a record that includes diffi cult cases, best practices and populations that are being helped; d) dissemination of information; e) availability of resources, the HHS-HRSAR, information

resources, funding opportunities, private foundations and corporations;

f) Mental Health and abuse of health threatening substances; g) promot-ers, and defi ning roles and training opportunities; h) fundraising and how to apply for grants on a large scale, among other funding opportunities. - The California group, identifi ed opportunities similar to those proposed

by the previous group and also highlighted the following: a) improve access of immigrant population to the VDS, which must be used as a

communication network, and promote interventions such as vaccination campaigns; b) create partnerships with local governments (it was noted that the VDS may be part of the “Affordable Care Act” of the United

States); c) share best practices through newsletters, website and quar-terly reports; d) verify training opportunities; e) evaluate the available materials and include the indigenous population that does not speak Spanish; and f) mental health.

Finally, the following commitments were highlighted: • Increase awareness on

immi-grant population about VDS and

the available services, such as: references, medical insurance, pre-affi liation to Seguro Po pular,

Plenary session about collaboration of the

United States Federal Government (HHS and HRSA)

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among others. As following steps it was considered to strenghten the im-pact and strategic partnerships with institutions such as HRSAR, ACS, NIOSH,

and CDC; strengthening efforts and

outreach activities as well as plan-ning and subsequent execution of Mobil VDS that reach further to the

immigrant population.

• Work with the Institute of Mexi-cans Abroad and the Secretariat of Health to identify relevant top-ics such as: prevention, access to services and the development of

grant proposals, so that the staff of the VDS can be trained by HRSAR / HHS

on relevant issues and a work plan is developed.

• Create a directory by states, targeting VDS staff so that the appropriate

references for immigrant population can be made.

• Create a detailed training program about the Mexican health system for the VDS staff, including the Seguro Popular.

• Strengthen collaboration between the VDS program and border health

de-partments in order to jointly support to the immigrant population and their needs.

Arizona Group discussing opportunity areas for strengthening Ventanillas de Salud.

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• Develop a proposal to include the strengthening of the VDS program as part

of the projects of the Mexico-United States Border Health Commission. It should be mentioned that in medical homes or community clinics, 31 236 users were oriented; 110 968 people were referred to those services, and only the attention of 12% could be confi rmed on their fi rst visit. The major proportion of references corresponded to adult people (84%) (see graphic 11).

Establishment of the Advisory Board of the Ventanillas de Salud Federal Program

The establishment of the Advisory Board of Ventanillas de Salud (CAVDS by

its Spanish acronym) was held on September 18, 2012, in Washington DC, comprised of specialists, leaders in the health care and immigrant atten-tion sector, related to philanthropic sectors to provide their experience and

903,919 10,500 20,736 92,771 10,900 18,197 _2,662 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 1,000,000 Po p u la ti on se rv e d Populationserved

Numberofcounselingsessionsonsocialservices

(nonͲhealthrelated)

Numberofcounselingsessionsonaccessto

healthcareintheU.S.

Adultsreferralstocommunityhealthcenters

Adultsattendedatcommunityhealthcenters

Childrenreferralstocommunityhealthcenters

Childrenattendedatcommunityhealthcenters

GRAPHIC 11. Number of Users Attended in Ventanillas de Salud Referrals

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vision in public health issues and strengthen the objectives of the Ventani-llas de Salud.

For proper operation, a proposal of a plan of action of the Advisory Board will be developed, as well as a follow up program by its Technical Secretariat.

The CAVDS, is a collegiate body established to advise the VDS Program

in different management processes, innovation, management and bination-al strengthening. Its purpose is to contribute, bination-along with the Government of Mexico, in strengthening VDS program objectives, which daily ensure,

through better access to preventive services, that immigrants and their families enjoy a better life quality in the United States and when going back to Mexico.

The following are the powers under the CAVDS:

• Have regular communication with the person designated by the Secre-tariat of Health, the Institute for Mexicans Abroad and the Embassy of Mexico in the United States, where some or all members of the Council have a topic of interest which they consider relevant for the strengthening of the VDS Program.

• Report on training opportunities which, as counselors, they consider that contribute for the strengthening of the VDS, as well as facilitate, when

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necessary, the support for the participation of the VDS Program in such

trainings.

• Support the VDS Program in identifying contact points in the different

units of the Department of Health in the United States so they can in-teract and solve problems of VDS when promoting U.S. public health

pro-grams. These contact points must recognize the strategic role of the VDS in

their programs.

• Assist in the dissemination of the role of the VDS Program and its

contribu-tion to health services in the U.S. Hispanic populacontribu-tion.

• Assist in the management required to achieve greater technical coopera-tion so that the VDS can compete for public and private support.

Binational Health Week

Binational Health Week (BHW) is one of the largest efforts mobilization of

community organizations, state and federal agencies, and volunteers in the Americas to improve the health and welfare of Latin American immigrant population in the United States, which is held annually in October in all 50 states of the USA, under the leadership of the Secretariat of Health, the

Secre-tariat of Foreign Relations and the Americas Health Initiative, of the Uni-versity of California, in Berkeley.

Advisory Board Meeting for the Ventanillas de Salud Program, Washington, DC, 2012.