2.GHLR.GuatemalaAssessment.SlideEdition1

ASSESSING THE PERFORMANCE OF THE
HEALTH SYSTEM IN GUATEMALA
Volume II: Slide Edition
Part I: Pre-trip report
June 2008
Institute for Health Promotion and Disease Prevention Research
CASE STUDY
Institute for Health Promotion and Disease Prevention Research
GLOBAL HEALTH LEADERSHIP REPORTSBEST PRACTICE SOLUTIONS TO ENHANCE THE PERFORMANCE OF HEALTH SYSTEMS
M. RICARDO CALDERÓN, SERIES EDITOR

Assessing the Performance of the Health System In Guatemala: Volume II.1 Slide Edition June 2008
2
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At a Glance
The GLOBAL HEALTH LEADERSHIP REPORTS series was created by Professor M.
Ricardo Calderón during his tenure at the Institute for Health Promotion and
Disease Prevention Research (IPR) of the University of Southern California’s Keck
School of Medicine (USC). It was designed to provide a forum for faculty and
students of the USC Master of Public Health (MPH) Program to share lessons
learned and best practice solutions to enhance the performance of health
systems around the world. Traditionally and due to scholarly purposes, the
research, training and service of university faculty and students is published in a
variety of peer reviewed and professional journals. While this is the acceptable
professional and academic manner to contribute with original unpublished
research, social science analyses, scholarly essays, critical commentaries and
letters to the editors, there is an extensive body of practical information and
valuable knowledge that is either not submitted for publication or that takes
too long to be published. This lack of information exchange reflects a missed
opportunity to strengthen, expand and diversify knowledge learning and
capacity development in order to trouble-shoot, problem-solve, make informed
choices, prioritize investments, implement evidence-based practices or lead
innovation and change in the healthcare and public health industries.
The Global Health Leadership Reports series was created to fill some of these
gaps in information dissemination and exchange. More importantly, it was
designed for the timely integration of research findings and best practice
solutions into program development, implementation and evaluation. It
was also created to continue to enhance the performance of health systems
and population health outcomes. This is accomplished through electronic
publications that can be easily distributed by e-mail, posted on websites, or
transmitted via internet around the world. This is also done by capitalizing
upon the research efforts and practical solutions developed by faculty and
graduate students during their teaching and learning experience, graduate
education, classroom debates, and group discussions, including a variety of
projects that are implemented by talented, creative and innovative faculty and
students.
We trust that the reader will be open to our publication rationale and
approach, and will contribute to further disseminate reliable information
for the effective development of community and global health programs,
plans and policies. We hope that the Global Health Leadership Reports will
stimulate discussion and reflection, propel continued dialogue, and encourage
the pioneering of new combinations of innovative approaches and practical
solutions to enhance the performance of health systems and improve
the health status and wellbeing of individuals, families and communities
worldwide. We also hope to contribute to fulfill the vision to create healthy
people living in healthy environments locally and globally. People living longer,
quality lives in a world with less pain and suffering, less injuries and disease,
less health inequities and disparities, and a world where our minds and bodies
perform at optimum levels.
INSTITUTE FOR HEALTH PROMOTION &
DISEASE PREVENTION RESEARCH
Keck School of Medicine
University of Southern California (USC)
1000 South Freemont Avenue, Unit 8
Alhambra, California 91803
The Global Health Leadership Reports is a publication
of the USC Institute for Health Promotion and Disease
Prevention Research (IPR). The opinions expressed herein
are those of the editor and author(s) and do not neces-
sarily reflect the views of the University of Southern
California. Excerpts from these publications may be freely
reproduced acknowledging Global Health Leadership
Reports as the source.
Internet: http://mph.usc.edu/ipr/
http://www.mrcalderon.com
GLOBAL HEALTH LEADERSHIP TEAM
SERIES EDITOR:
M. Ricardo Calderón, M.D., M.P.H.
Senior Administrative Director,
International Training Programs;
Associate Professor, Preventive Medicine;
Founding Director, Master of Public Health (MPH) in
Global Health Leadership Track; and
Regional Director, Latin America and the Caribbean,
USC-IPR, and
Area Director & Health Officer
County of Los Angeles Department of Public Health
MANUSCRIPT AUTHORS
Andrea Cooper, Pharm.D., M.P.H.
Robyn Eakle, B.A., M.P.H.
Nik Gorman, B.A., M.P.H.
Lawrence Ham, B.S., M.P.H.
Jae Hyun, B.S., M.P.H.
Katrina Kane, B.A., M.P.H.
Saieh Khademi, B.A., M.P.H.
Liyan Moghadam, B.S., M.P.H.
Wilson Ong, B.S., M.P.H.
Mana Pirnia, B.A., M.P.H.
Brian Sandoval, B.S., M.P.H.
Amy Yeh, B.S., M.A., M.P.H.
ENGLISH/SPANISH TRANSLATORS
Roberto D. Valladares, B.S., B.S.
Cándida E. Valladares, B.S., B.A.
INFORMATION DISSEMINATION INITIATIVE
Carina Lopez, M.P.H.
Program Manager

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EXECUTIVE SUMMARY 4
ACKNOWLEDGEMENTS 6
GUATEMALA: A HEALTH SYSTEM IN TRANSITION
PART I: PRE-TRIP REPORT
1. Government and Demographics 9

2. Stewardship 18

3. Health Care System 22
4. Health Indicators & Public Health Statistics 29
5. Environmental Issues 32
6. Health Care Expenditures 41
7. Human Resources 44
8. Health Care Facilities 48
9. Service Delivery 54
10. Regional Care/Indigenous People 70
11. Creative Use of SWOTs 75
12. Recommendations 77
TABLE OF CONTENTS
Table of Contents

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EXECUTIVE SUMMARY
A twelve-member team of Master of Public Health (MPH) students of the University of Southern California
(USC), along with two pre-medical students and English/Spanish translators from Westmont College,
conducted an assessment of the health system in Guatemala during summer 2007. The assessment was
designed, organized and directed by the USC Founding Director of the MPH Global Health Leadership Track.
It was created as the culminating USC MPH Public Health Practicum, a field internship experience aimed
to apply the scientific intelligence and leadership skills acquired by students in the MPH program to a real
life setting. It was also developed in preparation for the work that students will perform in institutions,
communities and countries when they graduate and join the public health workforce at local, national or
international level.
The practicum placed special emphasis on teamwork, collaboration, partnerships and leading change
efforts to improve institutional performance and population health outcomes. The total internship program
lasted ten weeks –Literature Review: 5 weeks; Guatemala Site Visit: 3 weeks; Report Writing: 2 weeks—
and students played roles as USC “interns and researchers” as well as “evaluators and consultants” in
Guatemala. The host institution in Guatemala was the MPH program at the Universidad de San Carlos
de Guatemala (USAC) whose faculty and students contributed considerably to the development of the
practicum and resulting health system assessment. The design of this “real life experience” was based
on the Strategic and Implementation Planning Approach conducted by Family Health International (FHI)
in the 1990s during the implementation of the largest HIV/AIDS Prevention and Control Project in the
world –The United States Agency for International Development (USAID) AIDSCAP Project, 1992 - 1997.
That is, a 3-week field assignment to develop a strategic or an implementation plan ending with a formal
presentation to the respective USAID Mission and country counterparts including a written, draft document
left in-country. This was preceded by preparation time and was followed by final report writing time along
with respective FHI, USAID and country approvals.
The USC MPH students conducted an extensive literature review to become knowledgeable about the
society and health system of Guatemala. Upon arrival on-site, a powerpoint presentation was given to
the USC Internship Program Director and MPH professors at USAC. This was followed by an intensive
3-week period comprising indepth interviews with country counterparts from the public, private and
non-profit sectors as well as representatives from international technical cooperation and donor agencies.
Opportunities were also provided for cultural immersion to understand the social, cultural, political and
economic environments in Guatemala. At the end of the field experience, a USAC/USC Technical and
Scientific Session was convened at the Metropolitan University Center. This two-hour session was attended
by close to 100 national and international stakeholders. The presentation discussed the Guatemalan Health
System and the Critical Importance of Global Health Training. A question and answer period followed the
presentation acknowledging the outstanding work and contributions of the USC students and enriching the
technical content of the discussion.
The purpose of this publication is to make available to students and faculty in the U.S. and Guatemala, and
to the local and international population, health and development community, the practicum rationale and
strategic approach and findings and recommendations of the assessment. This was done through a SWOT
Analysis resulting in the following thematic and topical issues:
STRENGTHS: capacity to identify health problems and solutions, work efforts to improve health,
awareness of the need for education, availability of traditional healers,
WEAKNESSES: systemic ideologies, data management, lack of resources, stewardship and political
insecurity, education implementation, population disparities,
ASSESSING THE PERFORMANCE OF A HEALTH SYSTEM IN GUATEMALA: VOLUME II.1 SLIDE EDITION

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OPPORTUNITIES: form stakeholder coalitions, integrate traditional healers, change provider paradigms,
bridge alliances, invest in human potential, develop a sound health policy, and
THREATS: organizational issues, integration issues, human resources issues, communication challenges,
investment issues, and lack of enforcement of health related laws.
In addition, readers are referred to a companion publication, “Assessing the Performance of the Health
System in Guatemala, Volume I, Narrative Report”, for a narrative description of the public health practicum
and health system assessment.
We trust that the reader, including local and international public, private and non-profit organizations
working to improve the health status and well-being of individuals, families and communities in Guatemala,
will benefit from the strengths and accomplishments and the concerns and recommendations outlined
in this report. We acknowledge the contributions of the USAC faculty and students and all stakeholders
interviewed, and congratulate and thank the USC students for their interest and willingness to contribute
to the Guatemalan society with this report. We also hope that global health leadership training continues to
expand the opportunities to engage faculty, students and population health and development practitioners
from industrialized and developing countries to enhance the performance of health systems.
M. RICARDO CALDERÓN, M.D., M.P.H.
Los Angeles, CA
June 2008
ASSESSING THE PERFORMANCE OF A HEALTH SYSTEM IN GUATEMALA: VOLUME II.1 SLIDE EDITION

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Andrea Cooper, PharmD,
University of Southern
California, Los Angeles, CA
& BCPS.
Nik Gorman, B.A. Psychology,
Lewis and Clark College,
Portland, OR. MPH, Biostatistics
and Epidemiology, University
of Southern California , Los
Angeles, CA.
Jae Hyun, B.S. Physiology,
University of California, Los
Angeles. MPH, Biostatistics and
Epidemiology, University of
Southern California, Los Angeles,
CA.
Katrina Kane, B.A. Kinesiology
and Applied Physiology,
University of Colorado, Boulder,
CO. MPH, Global Health
Leadership, University of
Southern California, Los Angeles,
CA.
Saieh Khademi, B.A. Political
Science, University of
California, Los Angeles. MPH,
Health Promotion, University
of Southern California, Los
Angeles, CA.
Liyan Moghadam, B.S.
Physiological Sciences, B.S.
Biochemistry, University of
Arizona, Tucson, AZ. MPH
Global Health Leadership,
California, Los Angeles, CA.
ACKNOWLEDGEMENTS

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Robyn Eakle, B.A. French
Literature and Comparative
Literature, University of
Washington, Seattle, WA.
MPH, Global Health
Southern California, Los
Angeles, CA
Wilson Ong, B.S. Biological
Southern California,
Los Angeles, CA. MPH,
Global Health Leadership,
California, Los Angeles, CA.
Lawrence Ham, B.S. Biology,
University of California,
Riverside, Riverside,
CA. MPH, Global Health
Angeles, CA.
Mana Pirnia, B.A. Psychology
University of California, Los
Angeles. MPH, Global Health
Angeles, CA.
Roberto Daniel Valladares
Calderón, B.S.Chemistry
& B.S. Biology, Westmont
College, Santa Barbara, CA.
Cándida Elizabeth Valladares
Calderón, B.S. Chemistry & B.A.
Biology, Westmont College,
Santa Barbara, CA.
Brian Sandoval, B.S.
Physiology, California State
University, Long Beach
& MPH, Global Health
Southern California in Los
Angeles, CA
Amy Yeh, B.S., Biological
Sciences & B.A. Political
California, Irvine & M.A.,
Medical Sciences, Boston
University & MPH, Global
Health Leadership, University
of Southern California, Los
Angeles, CA
ACKNOWLEDGEMENTS

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PROGRAM APPROACHES AND ACCOMPLISHMENTS
Demographics
• Mestizos/Ladinos/Europeans 59.4%
• Amercan Indians 40.5%
– K'iche 9.1%,
– Kaqchikel 8.4%,
– Mam 7.9%,
– Q'eqchi 6.3%,
– other Mayan 8.6%,
– indigenous non-Mayan 0.2%
– other 0.1%
1. GOVERNMENT AND DEMOGRAPHICS

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Government - Timeline
• 1996 - Alvaro Arzu elected president, purged
senior military officers, & signed peace
agreement with rebels, ending 36 years of civil
war.
• 2000 - Alfonso Portillo sworn in as president
after winning 1999 elections
• 2003 December - Conservative businessman
Oscar Berger wins presidential election
• 2004 May - Former military leader Efrain Rios
Montt placed under house arrest
Government - Cont
• Presidential representative democratic
republic
• 1985 Constitution ensures separation of
powers among the executive, legislative, &
judicial

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Government - Cont
• Executive Branch
– President and VP directly elected
– Head of state & government
– Limited to one term
• Currently serving
– President: Óscar José Rafael Berger
Perdomo (GANA)
– Vice President: Eduardo Stein Barillas
Government - Cont
• Legislative Branch
– Congress of the Republic (Congreso de la
República)
– 158 members - elected to 4 year terms
– Selected on the basis of
• Departmental constituencies
• Nationwide proportional representation

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Government - Cont
• Judicial Branch
– Constitutional Court (Corte de Constitucionalidad
• Highest court
• 5 judges serving 5 year terms
• Each serves as president for 1 year
• Each is elected through a different mechanism
– Supreme Court of Justice (Corte Suprema de Justicia)
• 13 judges serving 5 year terms
• Elect their own president annually
• supervises trial judges around the country
– Trial judges
• Elected to 5 year positions
Religion
• Predominant religion: Roman Catholic
– Latin Rite Catholicism
– Marked by syncretism - incorporating traditional
Mayan beliefs and customs
• Protestant
– 40-33% of the population
– Primarily Evangelical and Pentecostal
• Traditional Mayan Religion
– 1% of the population
– Practice has been encouraged by Peace Accords
• Protection offered
• Altars established at all Mayan ruin site

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Languages
• Official language: Spanish
– However, 23 total National Languages
– 1996 Peace Accords
• Translation of official documents & voting materials to
indigenous languages
• Spanish spoken by: 60% of population
– Other 40% primarily Native American
– > 20 distinct languages
– Ex: Quiché, Cakchiquel, Kekchi, Mam, Garifuna, &
Xinca
Languages by Region
• 21 Mayan languages
• Several non-Mayan
Indigenous
languages

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Education Indicators
1 % GDP spent on education 2.6
2 Compulsory education, years 8
3 Primary school enrollment % 95M
91F
4 Primary school completion % 63.3
5 Secondary school completion % 10.1
6 Literacy rate: % of total population 63M
49F
Education - Continued
• PRONADE (1992)
– Improved enrollment rates in remote areas
– Nationwide program reaching:
• > 4,100 communities
• > 445,000 children
– As of 2005, all but one department had
reached goal of 70% attendance

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Key Economic Indicators
1 Total labor force in millions 3.84
2 Unemployment rate 7.5%
3 GDP total in B US$ 2005
GDP per capita in US$ P.P.P.
$62.8
$4,155
4 Inflation rate, annual, 2003 5.5%
5 GDP - real growth rate, 2003 2.1%
6 Debt - external in billions $5.0
7 Economic aide received, 2000 $250m
8 % population living in poverty 56

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Key Health Economic Indicators
1 WHO HCS ranking 78th
2 Health spending % total GDP 5.7
3 Total health: % Gov’t expenditure
Total health: % Private expenditure
41
59
4 Government health spending as % of
total gov’t spending
18.8
5 % of gov’t health spending for Social
Security
49.4
6 % Private health spending: Out of
Pocket
90.5
7 % Private health spending: prepaid
plans
4.2
Human Development Index
• LONG AND
HEALTHY LIFE
(LE@B)
• KNOWLEDGE (ALR
& school
enrollment)
• DECENT
STANDARD OF
LIVING (GDP per
capita in purchasing
power parity (PPP))
HDI Score: .673 -- HDI Ranking: 117th

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Stewardship
1. One of four Health System vital functions
- involves setting and enforcing rules and
providing strategic direction
2. Government has ultimate responsibility for HS
performance
3. HS performance dependent on income,
expenditure, design, management and
financing.
2. STEWARDSHIP

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Ministerio de Salud Pública y
Asistencia Social
• Constitution recognizes health as a public right
• Health Code approved in Nov 2007 stipulates
the Ministry of Public Health and Social
Assistance to be formally responsible for
leadership of the health sector.
• Regulatory role limited to within the Ministry
with regard to budgetary limits
Ministry of Public Health
• Together with the IGSS makes up the public
sector dealing with health in the country
• In charge of over 1352 health
establishments
• Further divided into sub-national
administrative units (Area Authorities) with a
decentralized budget
• Principal providers of direct services to
uninsured
2. STEWARDSHIP

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Finances
• Foreign Investments
• Public Spending (steadily increasing in the
1990s)
• In 1996 a larger proportion of budget
diverted away from hospital networks and
into primary healthcare… but
• HR still concentrated in hospitals
• Allocation not performance based
• Attempts at a National Health Account
Health System Weaknesses
• Moonlighting
• Poor Planning and Lack of Accreditation
system
• Few standard protocols
• No commitment to universally guaranteed
services
• Sustainability
• Provider not separated from the purchaser
2. STEWARDSHIP

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Stewardship tasks
• Defining the vision and direction of health
policy
• Exerting influence through regulation and
advocacy
• Collection and using information
2. STEWARDSHIP

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Health System History
• The Peace Accord signed in Dec. 1996
• Health policy falls under government program
for economic modernization
• 8% national funds allocated to municipials
• 1996-2000 Social Development Plan
• Government devised a set of health policies
• Prevention became a main focus of reform
3. HEALTH CARE SYSTEM

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Previous Goals
• 7 goals from the 2000 plan:
-reorganization
-integration
-modernization of health dept
-increased coverage and improved quality of basic
health services w/ emphasis on the prevention and
control of priority problems
-improved management of hospitals
-promotion of general health and healthy
environment
-improved quality of drinking water and extended
coverage of basic sanitation in rural areas
-social participation and oversight
-coordination of international technical cooperation
Health System Breakdown
• MSPAS 25%; IGSS, 17%; Military Health Service,
2.5%; nongovernmental organizations, 4%; and
the private sector, 10%.
• < 60% of the population has the benefit of some
form of health coverage
• Government changed the traditional care model
through
• Comprehensive Health Care System (SIAS) was
designed and implemented

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General Organization of Health
System
• Guatemala: 8 regions, 22 departments,
municipalities (331 in total)
• Each municipality is autonomous and has its
own elected mayor
• Some ministries (including the Ministry of
Health) have decentralized their budget
execution to sub-national administrative units
called Area Authorities (@ least 1/dept)
Three Sectors of Health Care
• Public:
(1) The Ministry of Public Health & Social Welfare
(MSPAS); The Drug Access Program (PROAM)
(2)The Guatemalan Social Security Institute (IGSS)
• Private: (3) Both nonprofit and for-profit

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Public Sector
• MSPAS:
• executive branch agency
that steers the health
sector
• one of the principal
providers of direct
services to the uninsured
• IGSS:
• autonomous
• financed by mandatory
contributions from
workers and employers
• It covers formal workers
in the capital and along
the southern coast
• two main categories:
health services and social
security
Private Sectors
• Non-profit:
• 1,100 NGO’s; 82%
national, and 18%
engage in health
activities.
• NGO’s important
partners in the effort to
expand the coverage of
basic primary care
services.
• Financing comes from
the MSPAS.
• For-profit
• Private hospitals,
physicians, clinics,
laboratories, and
pharmacies, primarily in
the capital and major
cities.
• Limited coverage.
• MSPAS & the Health Code
• Wealthier: private clinics
and hospitals; lower-
income groups to
pharmacies

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Health Code
• Provides 5 domains of government
oversight:
– management
– regulation
– surveillance
– Coordination
– evaluation of health activities and institutions
Traditional Medicine
• Traditional medicine comes from Mayan
culture
– Found mainly in rural areas among the indigenous
population
– Conducted by comadronas (midwives)
– Comadronas play key role in deliveries and primary
obstetric care

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Traditional Medicine (con’t)
• Monthly meetings allow health
care providers to learn from
each other’s practice and values
• There lies a lack of trust
between the comadronas and
the western health care
providers
Comadronas
• Comadronas face various barriers when trying to
combine their services with the western health care
system.
– difficulty with the cultural content of training programs
– stigmatization in mainstream hospitals
– lack of opportunity to interact with physicians or nurses.
– insufficient financial resources
– lack of coordination between government and NGO staff in
the training and support
• This marginalization can suppress the integrity of the
Mayan health care services.

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Health Issues
• Infant Mortality Rate
– 39 per 100,000 live births
– Third highest in Americas
• Low life expectancies at birth
due to communicable diseases:
– Diarrhea
– Pneumonia
– Cholera
– Malnutrition
– Tuberculosis
4. HEALTH INDICATORS & PUBLIC HEATLH STATISTICS

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Public Health
• Health Information Management System
(SIGSA)
• Implemented in 1996 by the Ministry of Public
Health and Social Assistance
• Based on the policy of expanded coverage
• incorporates information as part of the
Comprehensive Health Care System.
• Includes modules on health statistics, finance,
planning, supplies, human resources, and
hospital management.
Public Health & Surveillance
• Vital registration of deaths covers
approximately 86% of population
• System for Epidemiological Surveillance of
Maternal Deaths
• Implemented in Guatemala City in 1991
• In Huehuetenango & Baja Verapaz in 1995

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Environmental Overview
• 20% of land is nationally protected
• Protection and supervision provided by
Comite Nacional de Areas Protegidas,
Insituto Nacional de Bosques, and Ministry
of Environment and National Resources
• Deforestation is still a growing issue
5. ENVIRONMENTAL ISSUES

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Environment
• Environmental degradation leads to:
-Deforestation
-Soil Erosion
-Loss of Biodiversity
-Pollution
Effects of Deforestation
• Exploitation of agro-exports (i.e. Bananas)
changes tropical forests
• As a result there is a climate change that
occurs
• Examples:
– Pet En region receives insufficient rainfall due
to improper harvesting methods
– Karst region has limited water due to a
number of geological accidents

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Environmental Issues
• Earthquakes
• Windstorms
• Floods
• Volcanoes
• Drought
• Epidemics
• Extreme Temperatures
• Wild Fires

35
Sanitation
• Access to improved water is 92%
• Access to sanitation facilities is 81%
• Yet access is greater in urban versus rural
areas
• Collection of water from rooftops into
containers perpetuates water borne illness
thus contributing to infant mortality rate
• Maintenance of water facilities is thus
essential

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Sanitation
• Effective programs to improve latrines and
sanitary education are needed in rural areas
• Key Elements to Success:
1.Controlling their own resources
2.Organizing community participation to meet goals
3.Allowing rural population to connect with the land
4.Allowing villagers to devise solutions when
confronting common problems
– Previous programs failed because culture and
environmental factors were not taken into
consideration

37
Transportation Infrastructure
• Major Highways include:
– Pan American Highway
– Pacific Highway
– Atlantic Highway
• In 2004, 41.6% of roadways were paved
with asphalt
• Tropical Storm Stan (2005) damaged
existing transportation networks
Transportation Issues
• Rural roadways are limited and at times
impassible
• Greater distance to water sources becomes
hazardous due to perilous transportation
routes
• Exports from the major ports use outdated
handling procedures. This increases prices
and causes lengthy delays.

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6. HEATLH CARE EXPENDITURES

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Health Economic Indicators
1 Total labor force in millions 3.84
2 Unemployment rate 7.5%
3 GDP total in B US$ 2005
GDP per capita in US$ P.P.P.
$62.8
$4,155
4 Inflation rate, annual, 2003 5.5%
5 GDP - real growth rate, 2003 2.1%
6 Debt - external in billions $5.0
7 Economic aide received, 2000 $250m
8 % population living in poverty 56

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Health Workers in Guatemala
• PAHO- 1993
– 51,000 persons working in the health sector
• 26% - community volunteers
• 17% - private sector
• 57% - public sector
– 19,385 Ministry of Public Health and Social Assistance
employess
• 12.4% - professionals
• 8.8% - technicians
• 26.5% - administrative and miscellaneous duties
7. HUMAN RESOURCES

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Health Workers in Guatemala
Physicians
• Medical practice is not regulated by the
government
• Association of Physicians and Surgeons
– Bound by law to:
• Ensure and uphold ethical and responsible practice by its
members
• Stimulate improvement and excellence in everything related
to the medical profession
– The Health Code states that only licensed association
members may practice the profession
7. HUMAN RESOURCES

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7. HUMAN RESOURCES

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7. HUMAN RESOURCES

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8. HEALTH CARE FACILITIES

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References
• Nigenda G, Mora-Flores G, Aldama-López S, Orozco-Núñez. La
práctica de la medicina tradicional en América Latina y el Caribe: el
dilema entre regulación y tolerancia. Salud Publica Mex 2001;43:41-
51.
• www.paho.org/english/sha/prflgut.htm
• http://go.worldbank.org/895XOA32K0
• Center for Reproductive Law and Policy, 2001

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Service Delivery
9. SERVICE DELIVERY

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10. REGIONAL CARE/INDIGENOUS PEOPLE

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SWOT
• Strengths: attributes of the organization
that are helpful to achieving the objective.
• Weaknesses: attributes of the organization
that are harmful to achieving the objective.
• Opportunities: external conditions that are
helpful to achieving the objective.
• Threats: external conditions that are
harmful to achieving the objective.
11. CREATIVE USE SWOT’S

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Creative Use of SWOTs
1. How can we Use each Strength?
2. How can we Stop each Weakness?
3. How can we Exploit each Opportunity?
4. How can we Defend against each
Threat?
11. CREATIVE USE SWOT’S

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Recommendations for
Improvement (HS)
• Allow for more equality in service for traditional
medicine like western medicine
• Increase allopathic and traditional medicine
cultural competency
• Increase the indigenous culture’s independence
and autonomy that other health systems receive
• Increase data collection on indigenous people
and traditional medicine.
12. RECOMMENDATIONS

78
INSTITUTE FOR HEALTH PROMOTION &
Keck School of Medicine
University of Southern California (USC)
1000 South Freemont Avenue, Unit 8
Alhambra, California 91803
http://mph.usc.edu/ipr/
http://www.mrcalderon.com
© 2008 INSTITUTE FOR HEALTH PROMOTION &

2.GHLR.GuatemalaAssessment.SlideEdition1

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