Government stewardship and primary health care in Guatemala since 1996
| Published date | 01 February 2019 |
| Author | Harry E. Cross,Juan Dent,Marisela De La Cruz |
| DOI | http://doi.org/10.1002/pad.1827 |
| Date | 01 February 2019 |
SPECIAL ISSUE ARTICLE
Government stewardship and primary health care in Guatemala
since 1996
Harry E. Cross
1
|Marisela De La Cruz
2
|Juan Dent
1
1
Palladium, Washington, D.C., USA
2
Palladium, Guatemala City, Guatemala
Correspondence
H. E. Cross, Palladium, 1331 Pennsylvania
Avenue NW, Suite 600, Washington, DC
20004, USA.
Email: harry.cross@thepalladiumgroup.com
Funding information
United States Agency for International Devel-
opment, Grant/Award Number: Cooperative
Agreement AID‐OAA‐A‐10‐00067
Summary
This article analyzes the role of government stewardship in the expansion of primary
health care in post‐conflict Guatemala. By the time the Peace Accords were signed in
1996, the country's primary health care system was scarcely functioning with virtually
no services available in rural indigenous areas. To address this gaping void/deficiency,
the Ministryof Public Health and Social Assistance (MSPAS) embarked ona progressive
expansion of primary services aimed at covering the majority of rural poor. Through a
seriesof legal, policy, and programreforms up to 2014, theMSPAS dramaticallyexpanded
primary coverage and greatly improved basic health indicatorsfor the entire population.
To succeedin this effort,the MSPAS and its partnersneeded to simultaneously growtheir
stewardshipcapacity to oversee and develop the primaryhealth system. On the basis of
recenthealth systems strengthening literature, we proposea stewardship framework of 6
critical functions and use it to analyze the gains in government capacity that enabled
the achievement of many of the country's primary health goals. Of the 6 stewardship
functions,“building relationships, coalitions,and partnerships”especiallywith civil socie ty
organizations stands out as one of the keys to MSPAS success.
KEYWORDS
accountability, civil society organizations, governance,Guatemala, health stewardship, laws,
policies, primary health
1|INTRODUCTION
The 1996 Peace Accords began the arduous process of rebuilding
Guatemala's social infrastructure, fostering a more inclusive and
democratic society, and addressing pervasive social inequities. In the
two decades since, the country has made steady but slow social and
economic progress despite periods of political turmoil. But poverty
and inequalities, especially among indigenous people, are still widespread.
By 2014, 60% of the population still lived below the national poverty
line of about US$3.50 daily with the majority of them concentrated
among indigenous people (Instituto Nacional de Estadística [INE],
2016). Guatemala's efforts to reduce poverty and inequality have been
hindered by a weak and at times dysfunctional state apparatus. The
World Bank, through its Worldwide Governance Indicators, tracks
countries' global rank across six governance measures. The scores for
Guatemala during 1996–2015 were among the lowest in Latin America
(World Bank, 2017). Low governance scores reflect the government's
shaky capacity to carry out basic functions like revenue collection and
the provision of basic public services. As a result, social spending in
Guatemala is among the lowest in Latin America with just 2% of 2015
gross domestic product allocated to public health (Comisión Económica
para América Latina y el Caribe [CEPAL], 2016; World Bank, 2016).
Despite the relative lack of socioeconomic progress and a weak
governance environment, Guatemala nevertheless witnessed major
------------------------------------------------------- -- --- -- -- --- -- --- -- -- --- -- --- -- -- --- -- --- -- -- --- -- --- -- --- -- -- --- -- --- -- -
This is an open access article under the terms of the Creative Commons Attribution License, which permit s use, distribution and reproduction in any medium, provided
the original work is properly cited.
© 2018 The Authors Public Administration and Development Published by John Wiley & Sons Ltd.
Received: 6 December 2017 Revised: 14 March 2018 Accepted: 11 May 2018
DOI: 10.1002/pad.1827
Public Admin Dev. 2019;39:11–22. wileyonlinelibrary.com/journal/pad 11
To continue reading
Request your trial