The 130th Annual Meeting of APHA

Abstract #42371

Meredith P. Fort, International Health Program, University of Washington, School of Public Health, PO Box 357660, Seattle, WA 98195, 206-285-1840, mpfort@u.washington.edu

In December of 1996 the Guatemalan government and rebel groups signed a Peace Accords officially ending a more than 30-year civil war. As a part of the Accords, the government committed the Ministry of Health to increase government spending on health, encourage social participation, and improve health status. At the same time, the Inter-American Development Bank (IDB) put forth its agenda for change: modernization of the health sector to be financed by a loan.

Combining these two initiatives, in 1997 The Guatemalan government put into action a national health sector reform – the Comprehensive Health Care System (SIAS, the acronym in Spanish). In February of 1998 the Congress approved a new health code which set up the legal framework for privatization. The code permits the Ministry to contract private organizations for service provision, render services to third parties, and withhold proceeds from these sales.

Under SIAS the country is divided into jurisdictions of 10,000 inhabitants who are to be provided a basic package of services by an NGO. While the SIAS program has reached regions of Guatemala that were previously not covered, it has been criticized for its curative orientation and its one-size-fits all approach. According to the agency administering the IDB loan, 70% of the NGOs do not fulfill the requirements of the agreement they signed.

In my presentation I will evaluate the SIAS program, and analyze where the reform is predicted to go in the next four years, during the implementation of Phase 2: a $55 million IDB loan.

Learning Objectives: At the conclusion of the session, participants in this session will be able to

• Understand the role of lending agencies in health sector reform, using the Inter-American Development Bank (IDB) in Guatemala as a case study;
• Define public health concerns of the privatization of health services such as a lack of equitable coverage and a curative orientation; and
• Articulate opportunities for advocacy to promote public health within the health sector reform process.

Keywords: Public Health Policy, Developing Countries

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.