Americas > Central America > Guatemala > Guatemala Health Profile 2012

Guatemala: Guatemala Health Profile 2012

2012/03/13

Guatemala is a democratic republic consisting of 22 departments and which is in the process of restoring its social system after several decades of armed conflict. It is the most populous nation in Central America,whose population is largely poor, rural, young, and indigenous. Its crude birth rate is 33.8, with a total fertility rate of 4.2 (6.2 in indigenous families), the highest in the Region. It is a multiethnic, multicultural nation with 23 linguistic groups. The net schooling rate at the primary level was 92.3% between 2000-2004, with a literacy rate of 82.2% in the 15-24 age group. The income ratio between the highest and lowest 20% of the population was 20.5% between1984-2003, and the dependency ratio was 89.6 for 2006, the highest in the Hemisphere.

The cleavages within Guatemalan society are expressed in unequal access to basic health care services and education, and in life expectancies that vary substantially between social classes. Access to social insurance systems is segmented and varies widely by territory, social strata and economic sector. The social safety nets that were once pervasive, especially in the Indian village communities, were largely destroyed by 36 years of civil war. Equal opportunity does not exist; discrimination follows the fault lines of social cleavages.

Social safety nets

Although formally there is equality of opportunity, women and indigenous people are discriminated against. This is clear in the education sector, where indigenous women and girls are widely underrepresented. Racist prejudice against the indigenous population remains widespread. As a consequence, job opportunities and access to other public services is limited. HDI values and poverty rates vary significantly between Ladino and indigenous households, as they do between urban and rural areas, and males and females. President Colom has made the promotion of equal opportunity one of the pillars of his policy platform, but the success of implementation remains to be seen. Concerning violence against women, Congress approved a new “Law against Femicide and Other Forms of Violence against Women” in April of 2008. The law criminalizes gender-based physical, psychological, sexual and economic violence in the private and public spheres. It remains unclear if and how this is going to be implemented.

HEALTH & DEVELOPMENT
The country’s political and social model has not succeeded in eliminating exclusion, linked to the lack of sustainable growth and inadequate domestic redistribution. In the structural area, the main problems are the high concentration of land ownership; low taxation (around 9% of GDP); the high concentration of wealth; and difficulties in implementing more effective social policies. Guatemala’s public health expenditure is among the lowest in the Americas (around 1% of GDP); 20% of its population lacks regular access to health services; and the quality and effectiveness of public services are limited.
Social violence and lack of citizenship security have reached alarming levels. In the period 2003-2006 more than 2,000 women died violently. The United Nations System (UNS) keeps phase I of security, increasing it occasionally to phase II for certain areas of the country.

Data regarding the monitoring of the Millennium Development Goals (MDG) indicates only a remote possibility of achieving indicators 8, 10, and 16 and notes that 21.5% of the population lives on less than US$ 1 per day (2005), largely in rural and indigenous areas6. Approximately 49% of children under 5 suffer from chronic malnutrition (68% among indigenous children), and 30% of pregnant women have nutritional deficits. Food insecurity has worsened in recent years, and pockets of populations with acute and severe malnutrition have reappeared.
In 2004, infant mortality of 39 per 100 000 live births was reported, the third highest in the Americas, and under-5 mortality of 48 per ,000 live births, the fourth highest in the Americas. The estimated maternal mortality rate in 2000 was 153, with the figure for the indigenous population three times higher than for the non indigenous population. Guatemala has the third-lowest contraceptive use in the Americas. Some 75% of the population had access to an improved source of drinking water in 2002 (90% of the urban and 60% of the rural population), and the figure for improved sanitation facilities was 47% (77% urban and 17% rural) 6. The HIV/AIDS epidemic is growing and the male/female ratio is 1:1, with low antiretroviral (ARV) coverage. The estimated incidence of tuberculosis is 80 per 100 000, and the country reports 60% of the malaria cases in Central America.

Great strides have been made in vaccination coverage: there have been no cases of polio since 1990 or measles since 1997. Over 92% of infants are covered by the immunization program, which includes 10 vaccines. In recent years, progress has been made in controlling malaria, Chagas’ disease, and onchocerciasis.
Total health expenditure rose from 4.7% of GDP in 1999 to 5.4% in 2003, while government health expenditure fell from 48.3% to 39.7% in that same period and private expenditure increased from 51.7% to 60.3%.

OPPORTUNITIES

Peace agreements (basis for a national developmen agenda agreed on by the conflicting parties and a stepping stone to the MDGs and their targets)
Fifteen years of democratic opening. Ten years since the signing of the Peace Agreements
Political parties working together to establish mediumterm social programs
Ministry of Health with a proposal for National Health
Development Agenda (DNS), within the framework of the Sector-wide Approach to Health (SWAp)
Inequitable development and health model
Reducing discrimination and racism
Increasing tax revenues and improving the social redistribution of wealth
Increasing the budget allocated to the Ministry of Public Health (MSPAS)
Reducing the mainly rural and indigenous poverty level from 56%
Reducing the proportion of children under 5 with chronic malnutrition from 49%