Situation Analysis

Despite significant improvements in the health of the general Guatemalan population over the past several decades, the health status of poor and indigenous Guatemalans, who comprise close to half of the total population, continues to be among the worst in the Western Hemisphere. 

Guatemala’s high maternal and infant mortality and chronic malnutrition rates are concentrated primarily among the poor and indigenous in the rural areas of Guatemala’s Western Highlands.  Key health indicators for Guatemala overall and for indigenous and non-indigenous populations highlight this disparity in health status:

The Government of Guatemala, through the Ministry of Health and the Guatemalan Institute for Social Security, is committed to universal, free health care for its citizens. 

In most rural areas, health care for underserved, vulnerable populations is offered largely through the public sector.  However, limited resources, infrastructure, personnel, and inadequate supplies of medicines and materials pose profound challenges within the health care system, especially for more remote, rural indigenous areas. 

Additionally, Guatemala’s health system focuses on treating diseases rather than preventing them, with the large majority of public health resources dedicated to hospital procedures.  The remaining resources, allocated to primary health care, are insufficient to address the high burden of chronic malnutrition and to reduce preventable maternal and child deaths in Guatemala.  Compounding these gaps, available health care from private providers is limited, health insurance coverage is low, and Guatemalans living in poverty are unable to afford the costs associated with accessing these services.  

USAID’s Response

USAID’s health and nutrition efforts are part of the Western Highlands Integrated Program, which focuses on reducing chronic malnutrition and improving food security through the implementation of three Presidential Initiatives – Feed the Future, the Global Health Initiative, and the Global Climate Change Initiative. 

The Western Highlands Integrated Program seeks to achieve sustainable rural development through parallel focus on agriculture, economic development, health care, education, nutrition, adaptation to the impacts of climate change, local governance, and gender equity. The Integrated Program works in 30 municipalities and more than 2,500 communities in Guatemala’s Western Highlands that suffer from the highest rates of poverty and chronic malnutrition, yet have the potential for economic growth. USAID collaborates with Guatemalan officials and leaders at the community, municipal, departmental, and regional levels to achieve shared goals, especially under Guatemala’s national plan to reduce chronic malnutrition, known as the Zero Hunger Pact. 

In the health and nutrition sector, USAID expands the adoption of beneficial health and nutrition practices, and improves availability and quality of sustainable, culturally sensitive health care and nutrition services for indigenous populations.  

• USAID provides technical support and training to non-governmental organizations contributing to the Ministry of Health’s Extension of Coverage Program to improve the quality and availability of primary health care services in the Western Highlands.     
• USAID continues to address the barriers to improved nutritional status of women and children by increasing access to micronutrient supplements, treatment of childhood illness, and education on improved nutritional practices and better hygiene, nutrition, and health behaviors.  USAID uses the “Thousand Day Window” approach, which focuses on the period of a mother’s pregnancy through the child’s second birthday to address adequate nutrition among pregnant and lactating women and children under two years of age.  USAID interventions also support public-private alliances to address maternal and child nutrition issues, such as improved access to potable water to combat high levels of diarrheal disease.   
• USAID also works to improve access to and quality of care for mothers and newborns during pregnancy, childbirth, and the post-partum period to reduce preventable child and maternal deaths.  USAID helps the Ministry of Health increase access to skilled birth attendants and scale up practices to reduce maternal and neonatal, infant, and child morbidity and mortality.    
• In the Western Highlands, USAID’s family planning activities expand access to and improve the quality of family planning and reproductive health information, education, counseling, and services.  Services include increasing men’s participation in family planning and reproductive health decisions, expanding the variety of available contraceptive methods including long-term family planning methods, and reducing cultural and medical barriers that limit contraceptive use.

Principal Results and Accomplishments

USAID’s efforts have resulted in:

• Increased access to basic health services for rural indigenous women and children – 19 local NGOs received grants to deliver high-quality services to 800,000 rural, indigenous customers in 2013.
• Improved access to maternal and child health and family planning services – Maternal deaths were reduced by 40% in the department of Alta Verapaz between 2012 and 2013.  More than 4,000 women were provided access to family planning services (natural and modern methods) for the first time in 2013. 
• Implementation of evidence-based nutrition and health interventions – USAID-supported nutrition programs reached 175,000 children under five in 2013.
• Increased civil society engagement – In 2006, USAID supported the establishment of the National Indigenous Women’s Alliance for Reproductive Health, Nutrition and Education to engage in advocacy, monitoring, and promoting policy dialogue to reduce maternal mortality rates among indigenous women.  In 2013, USAID supported the development of 5 local indigenous men’s advocacy networks for health, nutrition, and education with participation from 200 local organizations.
• Strengthened health systems – Guatemala’s health management information system has been streamlined to monitor trends, fill programmatic gaps, and improve availability of essential drugs and other essential supplies.  Close to 600 Ministry of Health personnel have been trained to manage the new information system and 44,000 personnel records have been entered.  

Health Reports

Nutrition Costing and Advocacy in Guatemala

In 2013–2014, FANTA and the Central American Institute of Fiscal Studies supported the Ministry of Health and Ministry of Finance in estimating the cost of scaling up essential nutrition interventions in Guatemala to address the high level of chronic malnutrition among children. Using an activity-based costing (ABC) approach, it became apparent that only one-third of what was required for national nutrition services was funded in 2013, and greater investment in maternal and child nutrition services is imperative to achieve national objectives. A report and executive summary provide details on the exercise, and a manual on the ABC approach provides guidance on how to use and apply the ABC methodology for costing nutrition interventions.

Website (English)

Guatemala Health System Assessment 2015

Guatemala’s public health system benefits from a well-established regulatory framework, many years of institutional history, dedicated and experienced health sector workers, and an absence of dependence on external sources for financial support. Furthermore, the Peace Accords of 1996 established the basis for the future development of the system for the benefit all Guatemalans. Nevertheless, and in spite of its solid institutional legacy, during recent decades a number of problems have developed which have compromised the public health sector’s effectiveness. The result is a system which is fragmented, inefficient and fails to provide an equal level of health services to all Guatemalans. The country’s recent political instability has only brought these problems into sharper focus. Strengthening Guatemala’s health system requires a thorough understanding of the system’s unique strengths and weaknesses. At the request of the USAID/Guatemala Mission, the Health Finance and Governance (HFG) project conducted a Health System Assessment (HSA) in Guatemala. The primary objective of the HSA was to map the health system’s strengths and weaknesses and to prepare a set of written recommendations intended to guide health system strengthening efforts in the country.

Full report (English)

Executive Summary (English)

Full report (Spanish)

Executive Summary (Spanish)

Guatemala Private Health Sector Assessment of Family Planning, Antenatal Care and Delivery Services

The Strengthening Health Outcomes through the Private Sector (SHOPS) project conducted a private sector assessment (PSA) in Guatemala at the request of USAID/Guatemala in order to identify the strengths and weaknesses of the private health sector and solicit recommendations from private sector stakeholders to strengthen health system efforts in the country. The findings and recommendations of the PSA will serve as a resource for public sector, private sector, and international stakeholders as they work to improve health outcomes in Guatemala. The PSA focused on the private sector’s current role in family planning and maternal health services and identified ways to mobilize untapped private sector resources to increase supply and demand of services.

Full report (English)

Full report (Spanish)

Executive Summary (Spanish)

Guatemala Experiences in Bulk Purchasing of Medications

Guatemala experiences in bulk purchasing of medications. This document presents an analysis of the acquisition system for medications and other medical supplies by the Public Sector in Guatemala. It also describes the challenges and opportunities that this purchase model presents as well as its benefits for scale economies.

Full report (Spanish)

Related Links

Fanta III Food and Nutrition Technical Assistance

Frontlines: Nutrition and Family Planning Intersect for a Healthier Guatemala

Frontlines: Our Neighbors, Ourselves: Guatemala’s Chronic Malnutrition Crosses Borders

'Invisible' crisis scars children for life

Una crisis 'invisible' deja a los niños guatemaltecos con cicatrices de por vida

From nurse to nurse: let’s help women build stronger families

1,000 Days of Nutrition in Guatemala

Meet The 15-Year-Old From Rural Guatemala Who Addressed The U.N.

Girl, 15, addresses UN commission