COVID-19 policy response: Perspectives of key stakeholders in Mexico's health system and implications for resilience.

Purpose: This study aims to analyze the perspectives of key stakeholders within Mexico's health system regarding the policy response to COVID-19 in 2020 to inform future policy formulation.

Methods: This qualitative study is based on a secondary data analysis (SDA) derived from a broader primary research on governance in Mexico during the COVID-19 pandemic. The analysis adopted a grounded theory approach to examine 15 semi-structured interviews with prominent figures in the health system between June and November 2020. The interviews were audio-recorded and analyzed through the lens of the Health Policy Triangle which includes context, key actors, and the Mexican health policy process. Moreover, the analysis was enriched by incorporating the framework outlined in the World Health Organization's COVID-19 Strategic Preparedness and Response Plan (SPRP).

Results: The findings indicate that key stakeholders perceived a centralized approach to policymaking with a strong emphasis on cross-sector communication, expert panels, equity-focused measures, accessibility to healthcare services (promoting portability), and improvements in the health information system.

Conclusion: Key stakeholders recognized the response to COVID-19 was complex, involving multiple dimensions and levels of action. The importance of preparedness and response in building health system resilience is emphasized. Recommendations include explicitly integrating resilience into national and local policy agendas, addressing systemic structural deficiencies, promoting equity in the pandemic response, improving risk governance, strengthening coordination mechanisms, ensuring supply chain resilience, improving personnel training, and enhancing local diagnostic capacity to better prepare for future public health emergencies.