Pharmacy clinics are under official surveillance for the first time in Mexico.

For the first time in the history of Mexican health regulation, medical offices adjacent to pharmacies—better known as CAFs—will be incorporated into a comprehensive surveillance and quality policy by health authorities. These spaces, which have proliferated excessively in recent years, reaching some 18,000 nationwide, represent a phenomenon of uncontrolled expansion that has raised concerns about care standards, as they are, in principle, disconnected from the rest of the system.

Now, the General Health Council (CSG) includes them as one of the nine classifications of healthcare facilities, in a plan that seeks to reactivate the certifications that were paused since the end of last year.

This Wednesday, September 3, the CSG plenary session is expected to approve the first manuals, specifically those for hospitals and hemodialysis units, marking the beginning of a gradual reactivation. Dr. Patricia Clark, CSG secretary, explained to us in an interview that this pause was a strategic reorganization to make the process more practical and effective. "What we need is to simplify, but with scientific rigor," Clark emphasized, detailing how the previous Single Evaluation and Certification Manual (MUEC), with its 1,300 pages, proved impractical when attempting to apply uniform standards to such diverse realities.

The assessment made by Clark upon taking office revealed a decline in certifications: after a promotion between 2012 and 2018, applications dropped dramatically in 2019, with only 17 certifications approved out of 319 submitted. To understand the problem, focus groups were held with representatives of public and private institutions across the country. The consensus was clear: one-size-fits-all. "Assessing a basic clinic, where checking for running water, a locked medicine cabinet, and a certified physician is enough, is not the same as assessing a high-complexity hospital like the Magdalena de las Salinas Traumatology and Orthopedics Hospital at the Mexican Social Security Institute (IMSS)," Clark explained.

Hence the classification into nine categories, each with its own specific manual, is an adaptation to reality:

1. Hospitals (second and third level).

2. Hemodialysis units.

3. Primary care (including CAFs and the 9,330 public sector).

4. Outpatient care units.

5. Diagnostic and treatment units.

6. Rehabilitation units.

7. Mental health and addiction units.

8. Mobile units.

9. Establishments that provide home care.

CAFs fall into the category of primary care or outpatient units, depending on their scope, but their inclusion is a milestone. These clinics, which operate alongside pharmaceutical chains and serve millions of patients, not just low-income patients, have grown without supervision, leading to criticism for possible deficiencies in hygiene, training, and protocols. With this measure, the CSG seeks to extend surveillance to all units serving Mexican patients, encompassing not only the 18,000 CAFs, but also the 4,900 primary care units of the IMSS, the 930 of the ISSSTE, and the 3,500 of IMSS Bienestar.

The process of developing these manuals, the official explains, has been inclusive, involving quality experts and public and private institutions. "We are bringing together the entire health sector," recognizing the fragmentation of the Mexican system. Previous manuals, the Single Quality Assessment Model (MUEC), and even international standards such as those of the Joint Commission of Canada were analyzed. Each manual is reviewed by committees, commissions, and the full CSG, ensuring consensus. In addition, auditors will be retrained to efficiently assess these facilities.

Clark emphasizes that, although public and private institutions measure success differently—the former in terms of life years gained (QALYs, DALYs) and life expectancy, the latter in cost-effectiveness—the common goal is patient-centered care: caring, safe, and based on the best science.

Following the CSG's plenary approval today, at least two more manuals are expected to be incorporated before the end of the year, including the primary care manual, which is key for CAFs. This initiative not only addresses the uncontrolled proliferation of these clinics, but also seeks to connect and strengthen the entire healthcare ecosystem.

For the private sector, this reactivation could represent business opportunities. Major pharmacy chains with CAFs, from Dr. Simi, Walmart, Benavides, Soriana, etc., by certifying their operations, could gain credibility and attract more patients in a competitive market. However, it also entails challenges: meeting standards that prioritize safety and medical evidence, as well as channeling patients to secondary or tertiary care, which could drive investments in infrastructure and personnel.