Guatemalan Health System

The health system is still obviously underfunded and understaffed. For example, for the country as a whole, for every 10,000 people, there are are only 9 doctors, only 3 professional nurses, and only 10 hospitals beds. The ratios are far worse for rural areas—for example, only 20% of the doctors work outside the cities, and many communities have historically received no service at all.

The SIAS/EC model for bringing basic health coverage to communities without service proposes that for each 10,000 people there would now be:

One traveling doctor (full time, on salary)
One institutional facilitator (sometimes full time, on salary)
Four community facilitators (volunteers)
84 health guardians (volunteers)
At least 5 midwives (volunteers)
1 malaria volunteer

Clearly there have been some positive changes with the introduction of SIAS/EC—many communities are now seeing doctors for the first time, and vaccinations and basic medications are more widely available than in the past.

How well the government is fulfilling it obligations continues to be a matter of debate.

The SIAS/EC targets themselves are pitifully low by international standards.
One can find examples of communities that are not served even to the level promised by SIAS/EC.
Professional staff are overwhelmed.
Given that most of the proposed staff are volunteers, they cannot devote the time needed for the job.

Participation

Participation rates in the health system by the poor are low, even for pregnant women and women with young children.. Although no doubt much of the reason for low participation is the lack of access to services, there are evidently other contributing factors:

Quality of service. The lack of services and supplies at health posts and health centers may offer little incentive for participation.
Economic. Although services themselves may be free, the cost and time required to attend may be judged to be not worthwhile.
Education. People may think participation is just not important, or may not understand when they should attend.
Expectations. People may have low expectations of health, particularly having lived with poor health for so long.
Traditional practitioners. Indigenous people may trust traditional health practioners—the ajq’ij (priest), the curandero (herbalist), the comadrona (midwife)—rather than the public health system. (In SIAS/EC there are attempts to link the traditional practioners, particularly the midwives, with the public system.)


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Health & Equity Guatemala Overview History of Armed Conflict Recent History Society Health System Alta Verapaz Health Projects Social Justice BC Coast	Health System, Policies and Plans The health system comprises three sectors: A public sector, which is mainly under the Ministerio de Salud Pública y Asistencia Social (MSPAS). There is also the Instituto Guatemalteco De Seguridad Social (IGSS) which provides retirement benefits and health services to those workers and their families in the formal sector who are covered. (MSPAS and IGSS were both established during the 1944-54 social democratic era.) A private for-profit sector. A private nonprofit sector, which comprises some 1100 nongovernmental organizations, 82% of them national. Neither the public nor the private sector is currently providing adequate health services to the population, given that only 11 percent of the population has effective access to health services, based on the World Health Organization’s definition of travel time to a health facility. The MSPAS has a central administrative level, eight regions, and 27 health areas. The delivery system has several levels of facility. The simplest, the community centers which provide only preventive and primary health care are located in remote areas. They are staffed by trained volunteers, and to be visited at least once a month by a doctor and health technicians. Health posts, which provide mainly preventive and primary health care, are usually staffed by an auxiliary nurse and in some cases a rural health technician. Health centers are typically staffed by a doctor, a nurse, an auxiliary nurse, a rural health technician, administrative personnel, and, in some cases, a laboratory technician and a dentist. Type A health centers may have a few beds, mainly for maternal care; type B health centers have no beds. Finally, there are the general and specialized hospitals. The health code approved following the 1996 Peace Accords, which have specific sections concerning health (Link), calls for MSPAS to provide free health care to persons without means, to increase public expenditure and improve the efficiency and equity of service, together with increased decentralization and community participation. Emphasis must be placed on extending coverage to the rural poor with no access to health care, and upon health care for indigenous people with particular emphasis on women. Health Sector Reform Health Sector Reform required loans from the international financial institutions, who in fact directly participated in the design and implementation of the system, and therefore imprinted their philosophy upon it. Based on their analysis, the government in 1997 introduced the Sistema Integrado Atención de Salud (SIAS), and most importantly its Programa de Extension de Cobertura de Servicios Basicos (SIAS/EC), which was intended to bring basic services to indigenous rural populations. In many cases, MSPAS contracted out the delivery of services mandated by SIAS/EC to various qualitying NGOs. By 2002 MSPAS had signed 160 contracts with 91 NGOs, who were in turn responsbile for delivering services to more than 3 million people—roughly one quarter the population of the country.	The health system is still obviously underfunded and understaffed. For example, for the country as a whole, for every 10,000 people, there are are only 9 doctors, only 3 professional nurses, and only 10 hospitals beds. The ratios are far worse for rural areas—for example, only 20% of the doctors work outside the cities, and many communities have historically received no service at all. The SIAS/EC model for bringing basic health coverage to communities without service proposes that for each 10,000 people there would now be: One traveling doctor (full time, on salary) One institutional facilitator (sometimes full time, on salary) Four community facilitators (volunteers) 84 health guardians (volunteers) At least 5 midwives (volunteers) 1 malaria volunteer Clearly there have been some positive changes with the introduction of SIAS/EC—many communities are now seeing doctors for the first time, and vaccinations and basic medications are more widely available than in the past. How well the government is fulfilling it obligations continues to be a matter of debate. The SIAS/EC targets themselves are pitifully low by international standards. One can find examples of communities that are not served even to the level promised by SIAS/EC. Professional staff are overwhelmed. Given that most of the proposed staff are volunteers, they cannot devote the time needed for the job. Participation Participation rates in the health system by the poor are low, even for pregnant women and women with young children.. Although no doubt much of the reason for low participation is the lack of access to services, there are evidently other contributing factors: Quality of service. The lack of services and supplies at health posts and health centers may offer little incentive for participation. Economic. Although services themselves may be free, the cost and time required to attend may be judged to be not worthwhile. Education. People may think participation is just not important, or may not understand when they should attend. Expectations. People may have low expectations of health, particularly having lived with poor health for so long. Traditional practitioners. Indigenous people may trust traditional health practioners—the ajq’ij (priest), the curandero (herbalist), the comadrona (midwife)—rather than the public health system. (In SIAS/EC there are attempts to link the traditional practioners, particularly the midwives, with the public system.)