In July 1990, the Mexican Declaration on Cancer Pain Relief recognized that the cancer pain problem was a public health concern.³¹ This declaration emphasized the need for implementing national policies and strategies to guarantee appropriate medical education to achieve adequate cancer pain relief.³² The initiative created a political and logistical framework to promote developments to improve the management of cancer pain as well as of other types of persistent pain. As a result, pain clinics grew throughout the country and further interest in palliative care emerged.

In 1992, one of the earliest palliative care programmes that aimed at controlling symptoms as well as providing psycho-social and spiritual support started at the New Civil Hospital in Guadalajara. Led by Dr Gustavo Montejo Rosas, this programme was encouraged by Dr. Eduardo Bruera and presented to the hospital authorities in Guadalajara by Dr Montejo Rosas in 1989.³³

In 1993, a pain and palliative care programme was started at the National Institute of Nutrition in Mexico DF encouraged by Dr Guevara, who is its current director. This initiative was initially undertaken as a pilot experiment and it consolidated as a palliative care service in the hospital in 2000.³⁴

During the early 1900s, the palliative care team at the National Cancer Institute also emerged as a programme attached to the hospital’s pain clinic subsequently directed by Dr. Ricardo Plancarte, Dr. Silvia Allende and Dr. Francisco Mayer.³⁵

In 1996, a group of regional authorities in Jalisco and the WHO director of Palliative Care for Latin America signed the Declaration of Guadalajara, which recognized the problem of advanced cancer patients’ struggles and the need for providing palliative care.³⁶ This declaration, however, concerns only the Mexican western coast. Nevertheless, the initiative encouraged the development of other palliative care efforts in Guadalajara, such as Cristina Hospice in 2000 and the hospital palliative care team at the University Centre for the Study and Treatment of Pain at the Universidad Autonoma de Guadalajara, in 2002.³⁷ In 2004, the Palia Institute emerged also in Guadalajara as one of the first palliative care programmes to be funded by the government in Mexico.

A regional project named “Mexico sin dolor” (Mexico without pain) has been suggested by a group of active health professionals at the University Centre for the Study and Treatment of Pain at the Universidad Autónoma de Guadalajara in Jalisco, with the aim of teaching health professionals the principles of pain control and palliative care in rural areas and with the objective of supporting the less served areas in better caring for their dying people.

Despite progress made in opioid availability and some political initiatives, palliative care in Mexico remains scattered. The Federal District and Jalisco have the highest concentration of services, while in the rest of the country palliative care is very poorly provided or non existent.

Coherent efforts and strategies to improve and formalize training and education as well as the development of national standards for practice and a Mexican Palliative Care Association to formally represent the country’s palliative care initiatives are still much needed.