Spotlight on Global Health Initiative Plus Countries: Guatemala

Spotlight on Global Health Initiative Plus Countries: Guatemala


The Global Health Initiative (GHI), with its plans for integrated programs across the spectrum of infectious diseases, maternal and child health, family planning and health systems, seems like it was designed specifically to meet Guatemala’s challenges.

Guatemala, with approximately 14.3 million people, has the largest population of all Central American countries.  Despite facing the age-old and ongoing problem of social inequality, reflected in the high poverty levels and poorer health of many of its citizens, Guatemala has managed to reduce infant mortality in recent decades from 79 to 34 per thousand live births. Maternal mortality has likewise declined, but is still high at 119 per 100,000 live births. The total fertility rate has fallen from 5.6 to 3.6 children.  While these changes indicate progress, rates of child and maternal mortality remain much higher within Guatemala’s poorest rural areas.

Other health indicators also cry out for improvement.  Nearly half of all children under age five suffer from some degree of chronic malnutrition. Malaria and tuberculosis are increasing. The HIV & AIDS epidemic is concentrated in highly vulnerable urban populations, but is expanding into new geographic areas. In 2007, with 612 cases of AIDS and 592 people testing HIV-positive, we recognized that there was potentially a rate of 50 percent underreporting of cases. Clearly there is work to be done.

Guatemala’s Ministry of Health currently directly serves 48 percent of the population. Another 38 percent are being reached by providers contracted by the Ministry of Health, social security, and private services.  More than 13 percent of the population remains without health care. The health sector is fragmented, with significant resource constraints, institutions with structural problems and poor functional outcomes cannot meet the health needs of the country.

The government has proposed a comprehensive process to strengthen the Ministry of Health and adapt their structures to facilitate stewardship of the health sector and respond to the country’s social demands.  Among their priorities they are developing the Multisectoral Strategies for the Reduction of Maternal and Neonatal Mortality and Chronic Malnutrition and increasing coverage of service networks to the 177 poorest municipalities of the country.  These priorities demonstrate a holistic approach to the public sector and are oriented to obtaining integrated results for the health system, which in the long term, allows for greater impact on morbidity and mortality.

Despite these clear aspirations, the Ministry of Health has not yet succeeded in integrating the programmatic, financial and operational planning systems necessary for an integrated approach, nor have they been able to refocus the planning of inputs and processes in order to gear them to the achievement of results.

By maintaining current conditions, it is unlikely that Guatemala will achieve the Millennium Development Goals, especially the reduction of maternal mortality. The needs and challenges within the health sector are large and surpass the country’s limited resources and capabilities. Here is undoubtedly where GHI will have a significant role.

By providing Guatemala with more resources and enhanced opportunities to build upon existing programs, the GHI is sure to help the country strengthen health system performance and better respond to the needs of all Guatemalans.

Hector Colindres, MD, is a principal program associate with MSH’s Leadership, Management and Sustainability Project.  He lives and works in Guatemala.


Patricia Paredes
Dr. Colindres' comments present an excellent summary of the main constraints to achieving scaling up of successful programs, particularly related to the integration of planning, financial and operational tools within multiple sectors in countries. It shows that despite political will to integration of programs, still there is room to improve. The identification of this gap, particularly, where it is located, is not easily detected by policy makers when devising integrated strategies.
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