Over the last several years, the Mexican national health system has faced complex structural problems arising from an increase in noncommunicable diseases, an aging population, insufficient financial and human resources, and institutional fragmentation, where multiple subsystems coexist with varying degrees of quality and access, as well as weak coordination among actors from the public and private sectors and civil society. According to the Mexican National Council for Social Development Policy Evaluation (CONEVAL), lack of access to health services is the second most significant form of deprivation nationwide, affecting 39.1% of the population, or 50.4 million people. 

Since 2025, however, the national health system has been undergoing reforms that are improving the quality of services available to millions of people across the country. Through the Diálogos por la Salud strategy—a collaborative process that brought together the public and private sectors, academia, and civil society—multi-sector agreements were reached to expand access to healthcare at the national level. These agreements have been implemented by various public sector entities with the aim of strengthening the national health system. 

Fundación Avina contributed to this process by helping consolidate a shared vision and by fostering spaces for trust and collaboration. It acted as both convener and participant, and provided logistical support through the SURGE Alliance, helping to facilitate the meetings that led to the final document. Members of Avina also participated directly in the Dialogos por la Salud process. 

The agreements reached were captured in the document titled, "Reflexiones y recomendaciones para mejorar el sistema nacional de salud pública" ("Reflections and recommendations to improve the national health system"), which was presented to public health officials. In 2025, the agreements began to be implemented: the Federal Commission to Protect Against Health Risks (COFEPRIS) simplified and digitized paperwork processes, shortening response times; access to medical supplies and pharmaceuticals became faster and easier thanks to a consolidated purchasing system; and the National Compendium of Healthcare Supplies was updated to include innovative products and technologies to improve service delivery. 

Diálogos por la Salud became a crucial space for fostering collaboration between historically isolated stakeholders, often with opposing interests. The formation of a diverse group with a shared objective, along with confidentiality throughout the process, were key factors in building trust and laying the groundwork for transforming the national health system. Deliberative practices inherent to democratic processes—such as dialogue—play a critical role in ensuring high-quality public goods.