228422 Assessment of Coverage, Quality, and Equitable Utilization of a Primary Health Care program in Guatemala

Tuesday, November 9, 2010 : 3:24 PM - 3:42 PM

Meredith Fort, MPH, PhC , Department of Health Services, School of Public Health, University of Washington, Seattle, WA
Juan Carlos Verdugo, MD, MPH , Instituto de Salud Incluyente, San Lucas, Guatemala
Lidia Morales, MD, MA , Instituto de Salud Incluyente, San Lucas, Guatemala
Carmen Arriaga, MD , Instituto de Salud Incluyente, San Lucas, Guatemala
Anabella Perez, MD , Instituto de Salud Incluyente, San Lucas, Guatemala
Zully Hernandez, MD, MPH , Instituto de Salud Incluyente, San Lucas, Guatemala
Francisco Zamora, MD, MPH , Instituto de Salud Incluyente, San Lucas, 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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Public health or related public policy

Learning Objectives:
1) Describe the experience of the Inclusive Health Model in Guatemala 2) Analyze the model´s coverage, quality, utilization, and public health impact 3) Assess potential for expansion of the service delivery model

Keywords: International Public Health, Community Health Programs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The proposed abstract is the topic of my dissertation for the PhD in Health Services at the University of Washington. I have presented oral presentations on numerous occassions at APHA. I also helped develop an APHA MCH-International Health learning institute session in 2007 where I was a presenter.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.