An Evaluation of Health Beliefs and Participation in the Inclusive Primary Healthcare System (INS) in Guatemala

The Instancia Nacional de Salud (INS) is a grassroots proposal for an alternative primary healthcare system for Guatemala. Current project implementation is in 40 communities in 2 regions of Guatemala; the present investigation is situated in K'iche' Mayan communities of the Boca Costa de Sololá. The INS approach integrates individual, family, and community health programs ranging in activities from staffed community clinics to social organizing. The participation prevalence for families with young children in the Boca Costa de Sololá coverage area is 87-96%. Why the few remaining households choose not to utilize INS clinic services may illuminate final barriers of access to care, after removing economic, cultural, racial, and linguistic barriers. Initial logistic regression of the census database revealed that after controlling for all other variables (sector, political affiliation as measured by municipal alliance, mother's religion, language spoken, educational level, latrine or boiled water at risk and socioeconomic status) that only distance, head-of-household's religion, and having a child ≤ 5 were predictive of clinic usage in the 1230 families examined. After selecting households with children ≤ 5 in which no member had ever reported a clinic visit, the actual number of non-participant households was 44/1230. Thirty-two households of non-participants, in 5 communities, were successfully interviewed in order to determine their illness explanatory models, impressions of the clinic, staff, and other INS services, and why they chose not to participate. Fifty matched participant “controls” were also interviewed. There was no difference in likelihood, severity, or duration of recent illness among the groups. Nor did use of home remedies, traditional healers, or over-the-counter drugs predict decreased clinic usage. In fact, of the mothers who brought their sick children to the clinic for the current illness, two-thirds used other medicines either before or after the visit, 22% used home remedies, and 17% also went to a traditional healer. The only significant predictors of clinic use, by chi-square, were that mothers in the non-participant group were less likely to fear their child's death and were more likely to be single female heads of household. Further investigation to explain the constraints or liberties of mothers living alone might reveal novel determinants of differential healthcare access.