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Guatemala Health System Assessment 2015

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Guatemala Health System Assessment 2015 GUATEMALA HEALTH SYSTEM ASSESSMENT 2015 August 2015 This publication was produced for review by the United States Agency for International Development. It was prepared by Carlos Avila, Rhea Bright, Jose Carlos Gutierrez, Kenneth Hoadley, Coite Manuel, and Natalia Romero and edited by Michael P. Rodriguez for the Health Finance and Governance Project. The Health Finance and Governance Project USAID’s Health Finance and Governance (HFG) project will help to improve health in developing countries by expanding people’s access to health care. Led by Abt Associates, the project team will work with partner countries to increase their domestic resources for health, manage those precious resources more effectively, and make wise purchasing decisions. As a result, this five-year, $209 million global project will increase the use of both primary and priority health services, including HIV/AIDS, tuberculosis, malaria, and reproductive health services. Designed to fundamentally strengthen health systems, HFG will support countries as they navigate the economic transitions needed to achieve universal health care. August 2015 Cooperative Agreement No: AID-OAA-A-12-00080 Submitted to: Scott Stewart, AOR Office of Health Systems Bureau for Global Health Recommended Citation: Avila, Carlos, Rhea Bright, Jose Gutierrez, Kenneth Hoadley, Coite Manuel, Natalia Romero, and Michael P. Rodriguez. Guatemala Health System Assessment, August 2015. Bethesda, MD: Health Finance & Governance Project, Abt Associates Inc. Abt Associates Inc. | 4550 Montgomery Avenue, Suite 800 North | Bethesda, Maryland 20814 T: 301.347.5000 | F: 301.652.3916 | www.abtassociates.com Avenir Health | Broad Branch Associates | Development Alternatives Inc. (DAI) | Johns Hopkins Bloomberg School of Public Health (JHSPH) | Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG) GUATEMALA HEALTH SYSTEM ASSESSMENT 2015 DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government. CONTENTS Acronyms.................................................................................................................. v Acknowledgments .................................................................................................. ix Executive Summary ................................................................................................ 1 1. METHODOLOGY ............................................................................................... 1 1.1 Framework for the Health Systems Assessment Approach .................................... 1 1.2 HSA Process.......................................................................................................................... 1 2. GENERAL OVERVIEW ...................................................................................... 3 2.1 Demographic Trends .......................................................................................................... 5 2.2 Epidemiological Profile ....................................................................................................... 6 2.3 Reproductive Health and Family Planning ..................................................................... 7 2.4 Maternal Mortality ............................................................................................................... 8 2.5 Child Health .......................................................................................................................... 9 2.6 Nutrition .............................................................................................................................. 10 2.7 HIV/AIDS .............................................................................................................................. 11 2.8 Health System Overview ................................................................................................. 11 3. GOVERNANCE ...................................................................................... 15 3.1 Overview of Governance ................................................................................................ 15 3.2 Policy, Legislation, and Regulatory Framework ......................................................... 17 3.3 Citizen Voice, Responsiveness, and Transparency ................................................... 23 3.4 Findings and Recommendations..................................................................................... 27 4. HEALTH FINANCE .......................................................................................... 31 4.1 Overview of Health Financing ........................................................................................ 31 4.2 Resource Flows and Management ................................................................................. 35 4.3 Resource Mobilization ...................................................................................................... 38 4.4 Resource Allocation .......................................................................................................... 42 4.5 Purchasing ............................................................................................................................ 47 4.6 Resource Pooling ............................................................................................................... 50 4.7 Findings and Recommendations..................................................................................... 51 5. SERVICE DELIVERY ......................................................................................... 55 5.1 Overview of Service Delivery ........................................................................................ 55 5.2 Organization of Health Service Delivery Networks ................................................ 55 5.3 Access to Health Services ............................................................................................... 65 5.4 Utilization and Demand for Health Services .............................................................. 70 5.5 Quality of Health Services ............................................................................................... 73 5.6 Findings and Recommendations..................................................................................... 74 6. HUMAN RESOURCES ..................................................................................... 77 6.1 Overview of Human Resources for Health ................................................................ 77 6.2 Current HRH Situation .................................................................................................... 78 6.3 Action Areas ....................................................................................................................... 80 6.4 Findings and Recommendations..................................................................................... 87 i 7. HEALTH INFORMATION SYSTEMS ............................................................ 89 7.1 Overview of HIS in MSPAS ............................................................................................. 89 7.2 Information Platforms ....................................................................................................... 90 7.3 Regulation and Resources ............................................................................................... 99 7.4 Data Collection and Analysis ....................................................................................... 102 7.5 Use of Information for Decision-Making .................................................................. 105 7.6 Findings and Recommendations.................................................................................. 106 8. MEDICAL PRODUCTS AND SUPPLY CHAIN ......................................... 109 8.1 Overview of Medical Products.................................................................................... 109 8.2 Pharmaceutical Policy, Laws, and Regulations ........................................................ 112 8.3 Selection of Pharmaceuticals ....................................................................................... 114 8.4 Procurement .................................................................................................................... 115 8.5 Storage and Distribution............................................................................................... 118 8.6 Availability and Access to Quality Products ............................................................ 120 8.7 Financing of Health Commodities .............................................................................. 124 8.8 Findings and Recommendations.................................................................................. 125 REFERENCES ...................................................................................................... 129 List of Tables Table 2.1. Population indicators in Guatemala and the LAC region (2013) .......................... 5 Table 2.2. Top ten causes of DALYs lost in Guatemala (2010) ................................................ 7 Table 2.3. Maternal mortality ratio by mother’s region of residence, 2013 .......................... 8 Table 2.4. Insurance coverage levels ............................................................................................... 12 Table 2.5. Source of immunization for children
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