Reducing cervical cancer mortality in indigenous women and marginalized communities.

Cervical cancer is the second leading cause of cancer death in women in Mexico, only after breast cancer, every day between 11 and 13 women die from this disease, despite the fact that it is the only preventable cancer, 20% of cases are detected at an advanced stage, 1 in 3 sexually active women will be diagnosed with HPV and 10% of them will be at risk of developing cancer.

The State of Mexico have more than 10% of cervical cancer deaths in our country, which is a major public health problem, and is the second entity with the highest prevalence of cervical cancer in Mexico, only after Mexico City.

Our country has more than 13,000 cases of cervical cancer per year. Limited access to facilities and specialists results in a high prevalence of infection. Unfortunately, new cases are mostly at an advanced clinical stage and have a much higher prevalence among lower-income segments of the population, especially indigenous women, due to the lack of good facilities and adequate medical care in their communities.

This disease is detected and prevented with Pap smears and colposcopy, however, indigenous population face limited access to these. In Mexico, there are two health services: public and private. The public is overcrowded and the services inadequate. The private service provides care at costs that are not affordable for the majority of the population, since only 5% have health insurance.

Preventive care in public health institutions is deficient, more than 20 weeks pass between diagnosis and treatment, we have managed to reduce it to 4 weeks. Public institutions do not have a system that allows them to monitor or deliver the results to patients, many times patients undergo the study, but never receive their results.

This problem is more visible in indigenous women in the State of Mexico, as they suffer more from situations of discrimination of poverty, marginalization and violation of their human rights, in addition to the difficulty of access to specialized health services such as gynecology.

In summary, the problem for indigenous women in terms of health is that they do not have access to specialized services for follow-up, detection and timely treatment, as well as the consequences of socioeconomic inequalities that hinder access to education, vaccination, prevention and treatment, mainly in rural and marginalized areas.

Another of the great problems of indigenous women is that they face social inequality due to communication with their languages and dialects, it becomes a complex issue, especially in the health sector, since doctors and specialists or even the public health system of the communities is designed for non-indigenous women.  That is why many women choose not to have these kind of services. 

With the intention of providing early detection and prevention of cervical cancer and human papillomavirus in indigenous, low-income women and women from marginalized communities, we seek to implement "Free Care Campaigns" and "Mobile Clinic Care Days". With the intention of reaching the greatest number of indigenous women, we will have two lines of attention; The first, in a fixed way, campaigns in one of our branches where we will take patients by transport and the second, with visits to remote communities in a mobile clinic.

We hope to benefit more than 1,500 indigenous women who live at the base of the socioeconomic pyramid and who, if it were not for our project, would not have access to specialized gynecological services, since most of these indigenous women live in very vulnerable situations and do not have access to health services in their communities.

The benefits of our project are:

• Reduction of cervical cancer morbidity and mortality, especially among indigenous women.
• Prevent HPV complications by diagnosing precancerous lesions early and avoiding risk factors.
• Promote a culture of prevention and detection among marginalized communities.
• Strengthening primary health care systems in communities

Our project is comprehensive, we not only screen, diagnose and treat our patients, we also follow up with them about their health and emphasize the importance of annual check-ups. It is important to mention that in Mexico, public health institutions do not follow up with patients in terms of the delivery of results. We place special emphasis on raising awareness among our patients with positive results of the risks and possible treatments. Likewise, we know the importance of working together with the primary health systems of the communities, which is why our solution also includes the strengthening of these, with training on: the importance of pap smears and colposcopy for the timely detection of human papillomavirus and cervical cancer, reinforcing this awareness with easily accessible information resources for community liaisons. The objective of this strengthening is for the health liaisons and centers to be a voice bearer and one more tool for the reduction of mortality of women due to this disease in their communities.

Our project focuses on indigenous women, due to lack of access to quality public health services, misinformation or taboos, do not have their check-ups constantly or even have never had any in their lives, which is why we believe that we can positively impact their gynecological health and consequently on their life and that of their family.

Thanks to previously implemented projects, we know that our solution serves low-income patients, more than 92% have a family income of less than 760 USD and 83% have children, in terms of health issues, 66% do not have access to health services, just over 83% do not have any vaccine for the human papillomavirus,  In addition to the fact that 43% have never had a gynecological check-up, this is because they live in communities far from health centers or do not have access to public services.

In Mexico, more and more women are heads of families, so we are sure that keeping the mother healthy is keeping an entire family healthy, in health, emotionally and economically. It has been proven that more than 32.6% of households in Mexico have a woman as the head of the household and of indigenous households, 73.9% are male the head of the family and 26.1% are the female head of the family, year after year, this last percentage goes up, that is why we are sure that the project will have an enormous impact on all aspects of your life and those of your family.

We have an interdisciplinary team that has more than 5 years of experience in supporting vulnerable communities and populations, their capacity for resolution, their passion for helping those who need it most and their experience in the field, allow projects with social impact to happen successfully, our team is made up of: 
The social impact area, which is the one that coordinates the entire social project, having as a key piece the communication between the communities and the specialist team to ensure health care services, coordinates the care calendar with community leaders, generates alliances with the associations involved in the project in addition to measuring impact with monitoring and evaluation strategies,  ensuring that all social impact indicators are met, as well as seeking their sustainability and scalability to benefit more women. 
Volunteer Colposcopist Doctors, they are the health agents, who will be directly in the cytology of the detection tests, the volunteer doctors added to these projects are Colposcopists, our "Reina Madre Heroes" who seek the reduction of this disease in women from disadvantaged conditions.
The Marketing team provides all the necessary dissemination to communicate the value and objective messages of the projects, as well as rescue the necessary evidence to generate impact testimonies. 
Systems team in charge of the entire technological area of software and hardware, implementing a colposcopy results system that makes delivery and timely follow-up efficient. This work is achieved in a comprehensive way by the biomedical team focused on all technological solutions for the prevention, diagnosis and adaptation of medical equipment. 
It’s important to mention that we establish alliances as part of the team, collaborating with government health institutions to raise awareness about the importance of seeking medical care and receiving quality care. Since 2019 we have developed an agreement with a government association that helps women and children in vulnerable situations, which have allowed us to get closer to the neediest communities and low-income patients, being recognized by community leaders, which allows us to establish lasting relationships that are not only for prevention and diagnosis campaigns,  but also for other health needs and if as an institution we can attend to them in services such as gynecology, pregnancy or pediatrics, we do so. This union with the government system brings us closer to health centers, liaisons and municipal communities that have direct attention to the most vulnerable population in each area and has allowed us to attend to women who are in a critical health situation or who have never had a gynecological consultation in their lives.
Social Impact area addresses Civil Society Organizations that provide care to women in vulnerable situations, currently 62 alliances have been generated with different ONG´s. The relationship with the associations that join the campaign is so strong that since 2019 many of them have been continuously attending and seeking our attention. Both the associations have local partners who are the main spokespersons for our campaigns, helping us to reach more and new women year after year and free of charge.

The social impact area began in 2019 with free social programs, thanks to our training program for Colposcopist doctors, we managed to serve 250 vulnerable women and detect 8 precancerous lesions. This first project was carried out in collaboration with a government agency focused on health, in an equipped mobile clinic we visited 12 marginalized communities in the State of Mexico that did not have access to this specialized health service.

We moved forward with our project with points of care, establishing fixed clinics in communities that did not have access to specialized gynecology services, thanks to a partnership with government agencies and community liaisons.

These different alliances in social programs that since 2019 have allowed us to have the following impact data:

• More than 11,000 women benefit from free gynecological check-ups
• More than 680 lives saved by cervical cancer
• 20 marginalized communities benefited from health days
• 51 partnerships with foundations and associations
• 170 free mammograms for early detection of breast cancer
• 11 diploma campaigns with 80 colposcopist graduates
• More than 25 community center liaisons trained on cervical cancer prevention and early detection.

Además de los diferentes proyectos sociales que hemos logrado en el área de impacto como:

• Circulo de ayuda socioemocional para muejres con diagnóstico de cáncer, en el que beneficiamos a 18 pacientes con pláticas y talleres de acompañamiento psicológico.
• Programa de financiamiento para mujeres de escasos recursos, en el que logramos ayudar a 26 mujeres a financiar su parto o cesárea en nuestro hospital.

Queremos convertimos en fundación para hacer nuestros proyectos sostenibles y poder beneficiar a más mujeres.

Also we have achieved different social projects in the impact area as:

• Socio-emotional help circle for women diagnosed with cancer, in which we benefit 18 patients with psychological support talks and workshops.

• Financing program for low-income women, in which we managed to help 26 women finance their birth or cesarean section in our hospital.

One of our goals is we want to become a foundation to make our projects sustainable and be able to benefit more women.

Este es un proyecto que empezó en el 2019, debido a la pandemia paramos un año, sin embargo, en el 2021 regresamos con mucha más fuerza. Nos interesa postular a Solve porque nos parece una plataforma con muchas fortalezas que sin duda nos permitirá adquirir conocimientos y habilidades para escalar el proyecto y hacerlo sostenible y aumentar el impacto, llegar a más mujeres que sobre todo con este proyecto queremos. para beneficiar y llegar a las mujeres indígenas.

De la misma manera, este proyecto nos inspiró a crear la Fundación Grupo Reina Madre, una organización sin fines de lucro que nos permitirá generar más proyectos con impacto. Estamos seguros de que Solve nos brindará el asesoramiento necesario para que la base funcione y comience con todo el éxito necesario para aumentar los resultados y llegar a más comunidades necesitadas.

Buscamos en Solve no solo apoyo económico, sino también usarlo para hacer nuestro proyecto escalable y beneficiar a más mujeres en el futuro, nuestro compromiso con las mujeres indígenas es enorme, sin embargo, a veces no contamos con los recursos para poder implementarlo. nuestros proyectos con el impacto que deseamos, Solve puede brindarnos las habilidades para lograrlo.

It is true that in Mexico there are different associations and government institutions that carry out free gynecological campaigns, however, these consist of performing only the Pap smear, they do not perform colposcopy, biopsy or treatment. This system leaves all women in a situation of vulnerability, especially those who have some alteration in their studies, since they do not have the possibility of carrying out additional studies that confirm the existence of an injury, much less receive timely treatment; leaving them with the possibility of their lesion progressing to a precancerous lesion or advanced cancer. On the other hand, the patients we see in our campaign receive the results of their pap smear, colposcopy and biopsy (where applicable) four weeks after they have attended, once they receive them, the Social Impact Coordinator communicates with who presented alterations to explain their results and offer them the treatment for free. Once they attend their treatment, each patient is called for follow-up as many times as necessary, until they are discharged, this entire procedure has no cost to the patient.

It should be noted that indigenous women who have access to public health suffer a problem in their follow-up, their results usually take too long or simply do not reach them and consequently they do not obtain treatment. In our project, the women have their results in less than 4 weeks, receive their treatment and follow-up in the following month, optimizing and providing patients with less time and quality care.

This is possible thanks to our IT team who developed a unique system for colposcopy and pap smears. This system contains all the necessary information so that doctors can safely control both the study and the treatment performed on patients and automates the sending of results to patients.

With our innovation we ensure that patients receive their results, know their health status and their solutions, we have the information that allows us to ensure that all patients receive the treatment they need and that we make the necessary decisions to act, for example, to know if the patient did not attend her biopsy or treatment,  call her and know the reasons, because the system allows us to have that control.

To ensure our impact, we use the theory of change as a methodology, we apply this ladder as a visual representation of our social intervention, in which the different components and the link between them are identified, which is broken down as follows: 

In the first three steps, the focus of our approach is "What we offer and who benefits from it" with: 1.- Services delivered, 2.- Target that use the services offered and 3.- Satisfaction of our target.

In the following three, it focuses on "What we want to achieve for our target" with: 4.- Acquisition of knowledge and skills, 5.- Change in the behavior and habits of our patients and 6.- Social, economic and security improvements.,

In this step is where we begin to impact the quality of life of our patients. We achieve this with the services we provide such as: timely detection of cervical and breast cancer, prenatal follow-ups, pediatric consultations, etc.

In the last step, the focus is on impact with "What we want to contribute in society", in which our indicator is: 7.- Improvement in an established region or population.

We have a specific area in impact measurement, through the area impact indicators are established and measured, we work under the methodology of the theory of change and we work comprehensively with areas such as IT and Business Intelligence, to generate systems and applications that allow us to measure and monitor our impact.

We have currently measured the changes in the knowledge that patients acquire when they come to us, the changes in their behaviors and habits, the impact on communities, among others.

In addition, this same area is responsible for downloading resources that allow us to carry out social projects that allow us to attend free of charge to women in vulnerable situations such as: victims of human trafficking, violence, prostitution, migrants, indigenous people, among others. Every quarter we prepare an impact report with the following indicators:

• Patients Served
• Services Provided
• Treatments Provided
• Prevention and gynecological care workshops.
• Workshop Attendees
• Socio-demographic information
• NPS
• Baseline questionnaires and surveys
• Questionnaires and surveys to find out what knowledge patients acquire.
• Questionnaires and surveys to learn what changes patients made to improve their gynecologic care.
• Quizzes and surveys to find out how much the quality of life of our patients has changed.

In addition, with the aforementioned impact ladder, we established indicators to measure each impact step, which are broken down as follows:

1.- Services delivered.

• Quantities:
• Number of consultations provided.
• Number of treatments and biopsies delivered.
• Number of patients attended by consultations.
• Number of patients atteded by treatments and biopsies

2.- Target that use the services offered.

• Total number of patients attended.
• Total number of female patients attended.
• Number of new patients.
• Patients by municipality, age, education and socioeconomic level.

3.- Satisfaction of our target.

• Number of patients that came for recommendation.
• Number of patients that recommend us. (On a scale of 0-10, how likely are you to recommend RM to a friend? See how the net promoter score is derived.)
• ###i#< promoter patients, % passive patients, % detractor patients.
• Number of patients that have had some difficulties with RM.
• Number of patients that use more of one service.

4.- Acquisition of knowledge and skills.

• Health and hygiene habits acquired.
• Knowledge acquired of CaCu and HPV
• Changes acquired after treatment.
• STD courses and workshops.
• Contraceptive campaigns.

5.- Change in the activities of our patients.

• Number of patients returning to check up.  (% more than year before)
• Number of patients returning to their treatment. (% more than year before)
• Number of couple of patients attended.
• Number of IUD insertions.

6.- Social, economic and security change.

• Number of pre-cancer detected.
• Number of pre-cancer cured.

7.- Change in an established region or population.

• Number of lives saved. ###i#< of check up delivered vs State of Mexico

Our solution can be carried out since the IT area developed a colposcopy system that talks to the colposcope used in the campaigns.

First, the patient is registered in this system, all her sociodemographic data is taken, when the colposcopy and pap smear are taken, the photographs of the colposcopy are recorded in the patient's profile and labels are prepared with all the data of the pathological samples (cytologies and biopsies) to be handed over to the pathologist. The pathologist has a username and password that allows him to upload the results of each patient. Once this is done, the system sends a notification to the doctor to validate it and as soon as it does, the patient will automatically receive their results via SMS or email. In the same way, the system has a programming that allows the traffic light to be given to the patient according to the results recorded by the pathologist. This allows the system to automate a dashboard so that we know all those patients who come out green (healthy), yellow (low-grade lesion), red (high-grade lesion and cancer).

With this we give a timely follow-up to our patients and know who we should schedule an appointment for biopsies and treatments, making sure that as many patients as possible come, locating those who do not attend to call them and know the reasons why they did not attend.

Unlike other health campaigns, our project provides all the close follow-up with the patients, from their call and invitation to the medical discharge.  

Our team is made up of: two specialists in social impact, one person in biomedicine and maintenance, two people in systems, one person in marketing and two colposcopist doctors.

Since 2019 we have started with gynecological health projects and campaigns, starting with the diploma in colposcopy in which we were able to visit communities that do not have access to specialized health services with a mobile clinic, then we established clinics thanks to agreements with non-profit organizations and the government, we also established care campaigns in two of our branches that allow us to continue providing care to vulnerable women. Our journey in cervical cancer prevention is 5 years. 

We are a company that promotes respect and solidarity, we offer equal opportunities without discrimination, we recognize that diversity and inclusion enrich work teams.

Our philosophy is based on the values of professionalism, empathy, ethics, humility, camaraderie, joy. We seek to provide an environment free of discrimination and exclusion; We have a code of ethics that allows us to prevent all types of discrimination and harassment, as well as an anonymous portal called "trusted ears" that allows employees to expose any case of non-conformity, violence, discomfort, etc.

We are the only model of private, high-quality gynecological care, accessible to socioeconomic levels below C+.

Reina Madre plays a unique role in the health care scene in Mexico. We offer high-quality, low-cost gynecologic care to a population that would otherwise be restricted to neglected and inefficient services. We are now striving to expand accessibility to health care for Mexican women.

Reina Madre Group began operations in 2015 seeking to offer comprehensive care to women at all stages of their lives and that their socioeconomic level is not a determining factor for comprehensive and quality care, being the main specialties; Gynecology, Obstetrics and Pediatrics. Our founders Juan and Vicente wanted to provide quality, affordable healthcare to women in Mexico. We started operations with a small hospital and outpatient clinic in Toluca, State of Mexico (approximately 50 km from Mexico City), with 15 collaborators, in our first month we achieved 105 consultations and 6 deliveries.

In 2016, our first full year of operations, we provided 22,000 consultations and 871 births, since then, things have skyrocketed. We began a rapid expansion in Mexico City with our model of outpatient clinics and today we are more than 800, providing more than 30,000 consultations and more than 300 deliveries per month at affordable prices. In 2020 we expanded our line of business to dermatology and to date we have 1 hospital and 13 clinics between the different specialties. With this business model, we were able to close 2023 with the following impact data:

• 287,225 queries
• 192,366 patients
• 4,534 births
• Early detection of 50 women with cancer
• 61% of our patients belong to a low economic level, (less than 760 USD)

Today, Reina Madre has been characterized as a promoter of a third model of health services that is not expensive or exclusive to a certain economic sector, such as some private hospitals, but neither does it fall into being like the public one with deficiencies in quality, poor training of collaborators and excessive bureaucracy. On the contrary, it takes the best of the two models that have existed for years in our country and creates this third model of health, where health is for everyone at very affordable costs, maintaining the philosophy of health for those you love the most.

In 2019 we carried out the project 100% financed by us, we attended to 250 women and diagnosed 72 injuries, the impact was so strong that we decided to put it in calls with foundations to be able to scale it and replicate it in more states. In 2021 we were selected by two foundations and with that donation we managed to serve more than 1,500 women and implement it in two different places, in the State of Mexico and in Mexico City, although we continue to finance a part, but in 2022, we managed to make it sustainable with an education project for doctors, the registration for the course allowed us to achieve 4 campaigns with a duration of 6 months each,  serving more than 3,000 women.

In 2023 we managed to benefit more than 5,500 women in a project to care for vulnerable women and rural communities in the State of Mexico, this project was sustainable thanks to alliances with non-governmental institutions, foundations and social enterprises, these collaborations have been consolidated since 2019 when we developed social responsibility programs.

In our colposcopy diploma project we have a recovery fee for our colposcopist doctors, a part is destined for the payment of diploma with university recognition and another for maintenance of medical equipment, in addition to having donations in kind with which we cover most of the medical supplies of the cytological tests and their treatments.  This allows us to make the project sustainable.

We are also looking at the creation of the foundation (non-profit organization), as this will allow us to generate more alliances and carry out more social projects that have a positive impact on communities and vulnerable populations.