The document summarizes a health system assessment conducted in Guatemala by a team of USC MPH students. Through stakeholder interviews and a literature review, the team performed a SWOT analysis of Guatemala's health system. Key strengths identified included the ability to identify health problems and solutions and efforts to improve health. Weaknesses included lack of resources, disparities, and inadequate implementation of education programs. Opportunities included forming stakeholder coalitions and investing in human potential. Threats included organizational, integration, and human resource issues. The team provided recommendations to strengthen the system by forming coalitions, integrating traditional healers, addressing provider paradigms, and developing sound health policies.

1. San Gabriel Valley and Metropolitan Service Planning Area Health Office (SPA 3 & 4)
ASSESSING THE PERFORMANCE OF THE
HEALTH SYSTEM IN GUATEMALA
Volume II: Slide Edition
Part II: Post-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

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2
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professional and academic manner to contribute with original unpublished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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i. EXECUTIVE SUMMARY 4
ii.ACKNOWLEDGEMENTS 6
I. GUATEMALA: A HEALTH SYSTEM IN TRANSITION
PART II: POST-TRIP REPORT
I. Analysis of the Guatemalan Health Care System 8
1.1 Stakeholder Anaylsis 9
1.2 SWOT Analysis 17
1.3 Recommendations for the future 25
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,
EXECUTIVE SUMMARY

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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 complete 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
EXECUTIVE SUMMARY

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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,
University of Southern
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
Leadership, University of
Southern California, Los
Angeles, CA
Wilson Ong, B.S. Biological
Science, University of
Southern California,
Los Angeles, CA. MPH,
Global Health Leadership,
University of Southern
California, Los Angeles, CA.
Lawrence Ham, B.S. Biology,
University of California,
Riverside, Riverside,
CA. MPH, Global Health
Leadership, University of
Southern California, Los
Angeles, CA.
Mana Pirnia, B.A. Psychology
University of California, Los
Angeles. MPH, Global Health
Leadership, University of
Southern California, Los
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
Leadership, University of
Southern California in Los
Angeles, CA
Amy Yeh, B.S., Biological
Sciences & B.A. Political
Science, University of
California, Irvine & M.A.,
Medical Sciences, Boston
University & MPH, Global
Health Leadership, University
of Southern California, Los
Angeles, CA
ACKNOWLEDGEMENTS

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1. ANALYSIS OF THE GUATEMALAN HEALTH CARE SYSTEM

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1.1 STAKEHOLDER ANALYSIS

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1.1 STAKEHOLDER ANALYSIS

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1.1 STAKEHOLDER ANALYSIS

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1.1 STAKEHOLDER ANALYSIS

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1.1 STAKEHOLDER ANALYSIS

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1.1 STAKEHOLDER ANALYSIS

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1.1 STAKEHOLDER ANALYSIS

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1.1 STAKEHOLDER ANALYSIS

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1.2 SWOT ANALYSIS

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1.2 SWOT ANALYSIS
1.2 SWOT ANALYSIS

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1.2 SWOT ANALYSIS

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1.2 SWOT ANALYSIS

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1.2 SWOT ANALYSIS

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1.2 SWOT ANALYSIS

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1.2 SWOT ANALYSIS

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1.2 SWOT ANALYSIS

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1.3 RECOMMENDATIONS TO STRENGTHEN THE GUATEMALAN HEALTH SYSTEM

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1.3 RECOMMENDATIONS TO STRENGTHEN THE GUATEMALAN HEALTH SYSTEM

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1.3 RECOMMENDATIONS TO STRENGTHEN THE GUATEMALAN HEALTH SYSTEM

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1.3 RECOMMENDATIONS TO STRENGTHEN THE GUATEMALAN HEALTH SYSTEM

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1.3 RECOMMENDATIONS TO STRENGTHEN THE GUATEMALAN HEALTH SYSTEM

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1.3 RECOMMENDATIONS TO STRENGTHEN THE GUATEMALAN HEALTH SYSTEM

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1.3 RECOMMENDATIONS TO STRENGTHEN THE GUATEMALAN HEALTH SYSTEM

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1.3 RECOMMENDATIONS TO STRENGTHEN THE GUATEMALAN HEALTH SYSTEM

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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
http://mph.usc.edu/ipr/
http://www.mrcalderon.com
© 2008 INSTITUTE FOR HEALTH PROMOTION &
DISEASE PREVENTION RESEARCH