Guatemalan health policy case: the need for a comprehensive policy towards development.

Osorio Figueroa, Cristian David (2018). 'Guatemalan health policy case: The need for a comprehensive policy towards development.' Paper presented at the annual conference of the HDCA, Buenos Aires, Argentina 2018.

Abstract

Guatemala represents one of the countries with the highest levels of inequality in Latin America.  An important socioeconomic lag, and an institutional structure that benefits the interests of the dominant social segment, creates a cycle that perpetuates the relative wealth accumulation among the wealthier echelons of Guatemalan society, and this is reflected in the social determinants of health and in the access to public services.

Furthermore, the country is going through a complex socio-epidemiological period with a high prevalence of infectious and chronic diseases and violence.  All these, worsen by the limited access to basic services that restricts the capabilities of a large segment of the population, with high territorial, gender, ethnic and functional diversity inequity.

The scope of this text is to present a theoretical and reflexive review, based on critical reading of the Guatemalan health situation and policy from the perspective of human development.  For this purpose, the following analysis categories were defined: real accessibility, financing, personnel training, and social participation, by gender and ethnicity.  Public documents and secondary sources from different reports available online were analyzed.

According to the human development´s point of view, inspired by the work of Amartya Sen, the interaction between the dynamic of operations such as living a healthy life and the required abilities to perform said operations, shapes the space for human progress.

Guatemala faces the challenge of ensuring the universal social protection coverage in front of its current poverty situation and constant segmentation mechanisms (such as by type of employment, by level of income or by place of domicile) that affects the access to health services.  Indeed, there is not a real access to said services in rural areas or zones that suffer high rates of violence; also, health services are mediated by the income of the family since the out-of-pocket financing prevails in the Guatemalan healthcare sector.

Currently, we can identify a lower access to services in Mayan and rural areas, and a limited approach to the maternal-infant group that leaves behind the access to women and children outside this group, to men and people with disabilities, or any other person that is not included in the gender binarism.  Even in urban areas, we can identify the absence of social inclusion policies of people living on the streets or a comprehensive care to other groups such as commercial sex workers, where the health care is limited to sexually transmitted infections.

The territorial inequity is also reflected in the uneven distribution of the human capital, mainly in the metropolitan area and seats of the provinces, where minimum cross-generational mobility opportunities are evident in the rural communities of Guatemala, with important gaps among men and women derived from training difficulty as a result of the restriction of capabilities of a wide segment of the population.

In this way, the inequality reduction should be constructed as a central goal of the Guatemalan public health policy, and be fought through explicit instruments such as distribution mechanisms of social justice with gender approach, intercultural pertinence, right to health, and including environmental issues as affirmative actions that could impact the social determination of health and that modifies the social agreements that impede a healthy life.

The pivotal role of health must be recognized and understood from its multi-view perception of health and its expression in an individual, familiar and community level.  And, the social protection, comprehensive policy-making and the provision of quality universal services integrated with other knowledge derived from various cultural matrixes and synthesis with a higher redistribution of the power of influence and pluralistic mechanisms of politic representation.

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