A Fragmented System: A Look Into Guatemala's Healthcare Gap
The Land of Eternal Spring in Trouble
Guatemala, the land of eternal spring, is the largest economy in Central America, with almost three times the GDP of neighboring countries like Honduras and Nicaragua. Despite having a calculated GDP of nearly 86 million and being considered an upper middle-income country, Guatemala's political instability, social inequality, and limits on public investment have left the beautifully diverse nation in trouble. There are many components why Guatemala currently ranks 77th globally regarding the quality of life. However, it is Guatemala's inability to develop a sound healthcare system and combat its citizens' declining health that has contributed to the stagnation of the country's success and productivity. For instance, in the absence of healthcare infrastructure, Guatemalans see their productivity affected by the consequences of ill health, overspending on health services, loss of available work/school days, and loss of wages due to illness.
Despite having a large population, more than half of Guatemalan citizens live in chronic poverty, leaving them vulnerable to subpar healthcare services and a lack of providers. The effects of this misuse of resources are deeply felt in the country's rural areas, where most of the indigenous Mayan population, nearly 50% of Guatemala's total population, resides.
The COVID-19 pandemic explicitly showcased these disparities when misinformation due to language barriers, lack of leadership, and mistrust of the government left rural communities vulnerable to the often fatal virus.
The Guatemalan government did little to cater to the needs of the Mayan communities. As Maria Martin, an expert on Latino issues and Latin America, states, the hesitancy towards the vaccine and other COVID-19 treatments arose in rural communities as “Spanish isn’t widely spoken, and many people are illiterate, without television or computers, which is how the government was disseminating health information.”
Furthermore, the instability and lack of communication of the government and the involvement of other religious and political organizations that directed Mayan communities to “not get vaccinated or wear masks” are also at fault, as stated by Alicia Samuc—a public health nurse in Santiago, Guatemala.
Although the Ministry of Health recorded no official data on the impact of SARS-CoV-2 on Indigenous communities, "it can be assumed they were heavily impacted" as "almost three-quarters of human resources in the area of health" are located where only 13% of the indigenous population lives. Furthermore, as the Guatemalan government acquired vaccines, the rollout was mainly conducted in "urban areas like Guatemala City," and the patients were "university educated and identified ethnically as Ladino-that is, not Indigenous."
With such apparent healthcare disparities, how can Guatemala begin to close its healthcare gap? The "land of eternal spring" may have to assess its healthcare system's failed structure, careless underfunding, and rampant inequity to begin a path toward progress.
The Private v. Public Sector: Creating the Gap
Guatemala currently has a fragmented system, making it extremely difficult to provide care to all its citizens. The nation's healthcare system is divided between the public and the private sector. The public sector includes the Ministry of Public Health and Social Assistance (MSPAS), The Guatemalan Institute of Social Security (IGSS), and the Military Health Services. These institutions are the primary providers of coverage for more than two-quarters of the Guatemalan population. However, the IGSS and Military Health Services solely serve beneficiaries and affiliates enrolled in their programs—primarily based on their job title or military status. This leaves communities who do not fit the enrollment criteria, like informal workers from rural areas, with no coverage and subject to the minimal services offered by MSPAS. Furthermore, more serious medical treatment and services are usually not covered by the public sector, leaving Guatemalans to opt for private services.
The private sector is divided into two categories: the for-profit sector, similar to the one in the United States, financed through out-of-pocket payments and private insurance, and the nonprofit sector, which runs on donations and volunteer engagement. Nevertheless, private insurance is a luxury in a country with a poverty rate of 47% and 58% of indigenous children affected by chronic malnutrition. Therefore, these services are used mainly by the middle and upper-class communities where, unsurprisingly, most of the healthcare services are centralized.
Corruption Is Affecting Guatemalan Health
Even though the failure of the Guatemalan healthcare system could be attributed to its current structure and mode of operation, the same can be said for many different countries across the globe. As Elizabeth McGlynn stated, "extensive research…yields no conclusive findings that one system is better or worse than others," when it comes to healthcare. Nonetheless, in Guatemala's case, corruption and the government's mishandling of the healthcare budget—which is around 271 dollars per capita—has led the country to its current situation.
Guatemala's current health expenditure is around 6% of the GDP, and it's expected to grow due to the Covid-19 pandemic. However, despite this accomplishment, there has been evidence that corruption is actively deteriorating an already fragmented system.
The United Nations for Project Services reported that significant cases of corruption "were affecting medicine procurement in Guatemala's IGSS" in which "certain suppliers were found to be unfairly benefiting from government procurement" while thousands of Guatemalans were uninsured and at risk.
Similarly, in 2021, President Alejandro Giammattei found himself in a precarious position as it was reported that after paying 80 million for Sputnik vaccines, the country had only received a fraction of the ones purchased. The Minister of Health, Amelia Flores, was denounced for her involvement, but there were no other significant repercussions for the government. In fact, since Giammattei's term started, he has had to name three different ministers—Hugo Monroy, Maria Amelia Flores, and Francisco Coma—all connected to dubious handling of health affairs.
Disparities of Care: A Symptom of Discrimination
Despite the structural and administrative problems the Guatemalan healthcare system suffers from, the disparities of care are mainly a symptom of the rampant discrimination of the indigenous communities. As the UN's Committee on Elimination of Racial Discrimination reported, "indigenous peoples had been the most affected and had suffered severe human rights violations." Despite the government taking responsibility for such usurpations, the consequences of "brutal and bloody internal armed conflict" allowed for "deep-rooted inequalities" to remain in the fabric of Guatemala's internal affairs. In fact, the life expectancy of indigenous peoples in Guatemala is 13 years shorter than non-indigenous citizens.
Indigenous communities in Guatemala have one of the highest infant mortality rates in Latin America and an alarming rate of maternal mortality at 73 per 1,000 live births. As Victoria Cumes, coordinator of Nuestra Voz rights group remarks, "we are discriminated against one, because we are poor, second, because we are indigenous, and because we are women."
The Ministry of Health has put into place initiatives to highlight the needs of indigenous communities over the last two decades. However, they are often not successful or carried out to fruition. In some rural regions, the health investment is as little as 140 US dollars, it is simply not enough to care for such a large population of Guatemalan citizens.
Therefore, as Guatemala hopes to advance toward a more productive and unified country, extensive change is needed. Keeping all its citizens healthy must be a priority for the government. This can only happen by assessing the current system's failures and developing a more culturally competent, transparent, and inclusive healthcare system.