Where We Work


The people of Guatemala have endured a difficult history; most recently, a brutal civil war that raged over most of the second half of the twentieth century and left much of the country’s health system, and other social services, in disarray. Despite signing the 1996 Peace Accords, followed by a decade of reasonable political stability and moderate economic growth, Guatemala remains at or near the bottom of Latin America’s development indicators, including those related to poverty, inequality, violence, health, corruption, and human rights. These threats are often experienced at a greater severity for women, Indigenous peoples, or rural populations.

Map of Guatemala
Map of Guatemala

Guatemala is best understood as a country divided in two; one Guatemala is urban, non-Indigenous, educated, wealthy, and formally employed, the other Guatemala is rural, Indigenous, less educated, impoverished, and living on subsistence farming. This pattern remains consistent for indicators of health, with the later Guatemala contending with higher levels of poor health outcomes, such as child malnutrition, adolescent pregnancy, maternal and infant death, and many other non-communicable diseases. The north and northwest regions of the country are the most severely disadvantaged, having the highest percentages of rural and Indigenous communities.

Nonetheless, our experiences working in Guatemala over the last decade have been uniformly positive. At all levels of the health system, we find professionals and community health workers who are as capable and dedicated as their counterparts in Canada or anywhere else in the world. We are inspired by the leadership and energy we see throughout the system, and remain encouraged to provide support when and wherever we can.

Guatemala is divided into 22 departments (or provinces in the Canadian context). TulaHealth concentrated its first efforts in the department of Alta Verapaz, and since then, has extended that work to several other departments that face similar challenges. These include Huehuetenango, El Quiché, and Sololá. The four departments of Alta Verapaz, El Quiché, Huehuetenango, and Sololá have a population of more than 3.4 million people, which are characterized by large multilingual Indigenous, rural, and impoverished populations and poor health indicators.

There have been six different administrations during our time in Guatemala: Presidents Portillo, Berger, Colom, Molina, Morales, and Alejandro Giammattei who assumed office in January 2020. We have been able to work effectively with each administration, and we expect it to be no different with President Giammattei.

Country facts and stats

  • Total Population - 17.6 million
  • Rural Population - 49%
  • Poverty (less than US$5.5 per person per day) - 49%
  • Extreme Poverty (less than US$1.9 per person per day) - 9%
  • Population Aged 0-14 - 34%
  • Population Aged 10-24 - 32%
  • Indigenous Population (24 ethnic groups) - 40%
  • Chronic Malnutrition (% of children under 5) - 47%
  • Maternal Mortality Ratio - 88 deaths per 100,000 live births
  • Maternal Mortality Ratio (Indigenous Women) - 163 deaths per 100,000 live births
  • Births Attended by Skilled Health Personnel - 63%
  • Adolescent Birth Rate Aged 15 to 19 - 92 per 1,000 women
  • Secondary School Enrolment - Female: 46% Male: 48%
  • Child Marriage by Age 18 - 30%
  • Human Development Index (HDI) - 126 of 189 countries

National Health System

Guatemala’s health system is characterized by multiple public and private institutions, which operate largely independently. We concern ourselves only with parts of the health system that affect the rural poor.

Health service delivery in Guatemala is operated, governed, and paid for by the Ministry of Health, or Ministerio de Salud Publico y Asistencia Social (MSPAS). Health services are most frequently delivered at local health centers or health posts, or centros de salud and puestos de salud, which are scattered throughout Guatemala’s remote landscapes.

Despite being the primary entry point for community health care delivery, health posts often contend with lack of basic infrastructure and health personnel and medication shortages. These inconsistencies limit the Ministry of Health’s capacity to provide adequate health services, and foster public distrust in the public health system.

  • Current Health Expenditure (% of GDP) - 5.8%
  • Current Health Expenditure per Capita - USD$241
  • Out-of-Pocket Health Expenditure - 53%
  • Physicians - 0.36 per 1,000 people
  • Nurses and Midwives - 0.95 per 1,000 people