Assessment of Coverage, Quality, and Equitable Utilization of a Primary Health Care program in Guatemala

Starting in 2004, a team of national, civil society-based public health practitioners initiated the implementation of the “Inclusive Health Model”, a primary health care model designed specifically for Guatemala. The model is implemented by bilingual, community health agents (community auxiliary nurses) in coordination with a support, supervision, and referral team. The model integrates 18 Ministry of Health (MOH) vertical programs into three operational (individual, family, and community) programs. The model's three guiding principles: gender equity, inter-cultural equity, and the right to health aim to reach traditionally excluded groups, in particular rural Mayan populations. The model is being implemented in two demonstration sites in coordination with MOH districts serving nearly 20,000 people. Methods: Coverage, utilization, and quality are assessed using an automated database linking census and clinical records. Coverage measures are compared with a nationally-representative survey. Equitable utilization is assessed using patient and provider characteristics. Quality of care is assessed by application of national treatment guidelines in clinic visits. Results: Comparing the first and fourth years of implementation (2005 and 2008), complete vaccination coverage for children 12-23 months increased from 44.8-92.0% and 48.1-91.2% in the two sites. This compares to 70.7%, for the Southwest region (preliminary report, 2008/9 National Maternal and Child Health/CDC survey). Post-partum/newborn controls reached coverage of 95% in 2007 compared to the regional average of 20.4% (2008/9 survey). Utilization and quality results will also be presented. Implications: The Inclusive Health Model is being considered for expansion by the MOH and provides important lessons for programs internationally.