Guatemala
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.
Guatemala is commonly 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. 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 seven different administrations during our time in Guatemala: Presidents Portillo, Berger, Colom, Molina, Morales, Giammattei and Bernardo Arévalo who assumed office in January 2024. We have been able to work effectively with each administration, and we expect it to be no different with President Arévalo.
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.
