In the global scientific community, we are witnessing a profound paradox. While the volume of biomedical literature has exploded over the last few decades, the translation of this knowledge into tangible improvements for public health systems—particularly in the Global South—remains frustratingly slow. This "implementation gap" is often exacerbated by a global research agenda that prioritizes the health needs of the Global North and the economic interests of the pharmaceutical industry, often leaving diseases that disproportionately affect the Global South underfunded and under-researched.

Against this backdrop, Mexico has launched a transformative initiative through IMSS-Bienestar, its unified national health system for the uninsured. The Strategic Research Plan (Plan Estratégico de Investigación, November 2025, in Spanish)¹ represents a bold attempt to redesign research policy from the ground up, moving away from fragmented, publication-driven efforts toward a mission-oriented framework designed to achieve “health sovereignty”.

The Context: A System in Transition

IMSS-Bienestar is a monumental undertaking in public health governance. By integrating services from 23 Mexican states and seven Regional Hospitals of High Speciality (HRAE) into a single network, Mexico has created an unprecedented platform for collaborative research. Prior to this unification, scientific activity was concentrated in elite specialized hospitals, often focusing on high-level clinical trials for indexed journals, with little connection to the operational realities of primary care or the social determinants of health affecting the broader population.

In 2024, a diagnostic assessment revealed the scale of the challenge. The infrastructure for research was found to be severely limited: less than 50% of primary care units had computer equipment or internet access, and a mere 11.4% of hospital units possessed an active Research Committee. Designing a world-class research policy in such an environment requires more than just funding; it requires a complete paradigm shift in how knowledge is valued and produced.

The Strategy: 10 Lines and 5 Axes

The Strategic Plan is structured around two main pillars: ten strategic lines of research and five integrated axes of action. These were not chosen in a vacuum but were developed through a participatory Delphi process involving health professionals from across the country who understand the specific needs of their regions.

The ten research lines act as a practical scaffold, covering everything from Primary Health Care (Line 1) and Implementation Science (Line 2) to Interculturality and Traditional Medicine (Line 9) and Planetary Health (Line 7). Unlike traditional academic categories, these lines are driven by the question: "What innovations—technological, social, or organizational—does our population actually need?".

To make these lines actionable, the Plan employs five integrated axes:

• Axis A: Governance and Institutional Articulation: Ensuring research follows strict ethical and regulatory standards while avoiding duplication.
• Axis B: Infrastructure and Institutional Visibility: Optimizing existing resources and creating digital bridges to overcome physical gaps.
• Axis C: Professional Development: Moving beyond traditional medical training to foster transdisciplinary scientific skills.
• Axis D: Social Appropriation of Knowledge: Ensuring that results reach decision-makers and the communities they serve, rather than sitting in a paywalled journal.
• Axis E: Strategic Collaborations: Building alliances with academia and civil society to enhance local impact.

Innovation: Linking Sovereignty to Participation

The most significant conceptual innovation of the IMSS-Bienestar model is its link between research and health sovereignty. In this context, sovereignty means the capacity of the Mexican state to respond to its own health needs without being dictated by external commercial interests or "Global North" biases.

This is exemplified by the system's approach to diseases like cervical cancer. While the Global North may focus on expensive, high-tech therapies, a mission-oriented approach in Mexico looks at the social and environmental determinants of the disease, seeking low-cost, culturally appropriate screening tools and participatory epidemiological mapping. The Plan asserts that "research is born where it is needed," placing the "users" of knowledge—patients and primary care providers—at the center of the design process.

Addressing the Infrastructure Gap through Open Science

A recurring challenge for public health systems in middle-income countries is the lack of a consolidated institutional editorial infrastructure. High "Article Processing Charges" (APCs) and the concentration of the scientific publishing market in the hands of a few private entities create significant barriers to visibility.

IMSS-Bienestar addresses this through Axis D, which emphasizes the social appropriation and communication of knowledge over traditional publishing metrics. By utilizing open science tools, institutional repositories, and digital identifiers (like DOIs), the system aims to bypass traditional visibility barriers. The goal is to democratize information, creating "offline" systems for data storage in low-connectivity areas and interactive dashboards that allow local managers to make evidence-based decisions in real-time. This "non-conventional thinking" is essential for executing research in settings where basic connectivity remains a luxury.

Challenges and Reflective Insights

The path forward is not without significant hurdles. The "inertia" of aligning research with international prestige rather than local utility remains a powerful cultural force within the medical community. Furthermore, the transition from a biomedical model—which focuses on molecular processes—to one that integrates traditional medicine and social epidemiology requires a deep cultural shift among researchers.

The 2024 diagnostic showed that the institutional framework is still under construction. The low coverage of Research Ethics Committees and the lack of laboratory infrastructure in primary care mean that, for now, much of the research must be operational or implementation-based rather than basic clinical science. However, this is precisely the type of research that public health systems need most to improve service delivery and equity.

Lessons for the Global Health Community

The Mexican experience offers several vital lessons for other nations attempting to reform their public-sector research policies:

1. Participation is Policy: A research agenda is only as good as the buy-in it receives from those on the front lines. Using participatory methods like the Delphi technique ensures relevance.
2. Redefine Excellence: Excellence should not be measured solely by citations, but by the ability of a project to reduce "waiting times" or bridge "cultural barriers" in health care.
3. Sovereignty Requires Strategy: Without a strategic plan, public resources often inadvertently subsidize private interests or foreign agendas. A mission-oriented policy reclaims those resources for the public good.
4. Open Science is an Equity Tool: For institutions without massive budgets, open science is not just an ethical choice; it is a pragmatic necessity for visibility and impact.

Conclusion: The Future of Public-Sector Research

The Strategic Research Plan of IMSS-Bienestar is a testament to the idea that a lack of infrastructure should not limit scientific ambition. By focusing on useful, applicable, and democratic knowledge, Mexico is attempting to build a system where science is not an elite pursuit but a fundamental tool for guaranteeing the right to health.

As we move toward 2030, the success of this model will depend on its ability to sustain institutional commitment and overcome the structural inequities of the global scientific landscape. If successful, it will provide a blueprint for health sovereignty that other nations in the Global South can adapt, ensuring that the next "knowledge explosion" actually reaches the people who need it most.

Reference

1. Cárdenas González, M. del C., & Fajardo-Ortiz, D. (2025). Plan estratégico de investigación de IMSS Bienestar. Servicios de Salud del Instituto Mexicano del Seguro Social para el Bienestar. https://doi.org/10.5281/zenodo.19394296 ISBN 978-607-69241-0-5