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Empowering communities through health system monitoring in Guatemala


Despite its middle-income status, Guatemala has some of the worst health outcomes in Latin America with more than half of its population living in poverty.  Indigenous populations in rural areas, who suffered the most during 36 years of civil war, have gained little from recent social reforms. 

To give these indigenous communities more input on decisions affecting their health services, a team of researchers, policymakers, and civil society organizations led by Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud designed and field tested a participatory health monitoring system in six rural municipalities. Developed between 2006 and 2010, the system has helped to change local power dynamics. National authorities and civil society organizations are now looking to apply its lessons in other municipalities.

“One of the main barriers (to reform),” says research leader Walter Flores, “is the hierarchies within the health system. There are deep hierarchies between those at the centre versus those working at the rural level. But the greatest hierarchy is between public officials and ordinary citizens.”

To address the lack of trust between citizens and health authorities, the monitoring system was guided by a multistakeholder steering committee, which included health workers and representatives from municipal government and community organizations. They worked together to evaluate healthcare facilities and families’ experiences with them.

Information was collected and analyzed four times a year, and the committee reported to the municipal development commission. Out of their discussions, action plans were developed. The steering committee then monitored whether decisions were carried out. Findings fed into successive cycles of assessment and fine tuning to ensure this joint action was improving equity and accountability.

In all six municipalities, the monitoring and advocacy initiatives achieved concrete improvements, such as the dismissal of subcontracted healthcare providers for poor performance and corruption; municipal coverage of ambulance fuel costs; improved water services for a district hospital; fewer absentee healthcare workers; and more follow up on complaints on discrimination.

For Walter Flores, one of the key lessons is the value of linking citizens and public authorities: “This type of trust is very important to rebuild the social fabric and strengthen democratic practices.”

As these results show, strengthening health information systems — and the capacities of those who run and use them — can strengthen democracy by making relevant data available and transparent to decision-makers and citizens alike. In this way, the systems provide accountability for both the state and the household. With a solid evidence base, and greater input from citizens, the health services delivered and used are more likely to reflect real needs.

Learn more about IDRC-supported research on health information system

"One of the main barriers (to reform) is the hierarchies within the health system. The greatest hierarchy is between public officials and ordinary citizens."

Research leader Walter Flores is the director of Centro de Estudios para la Equidad y Gobernanza en Sistemas de Salud in Guatemala.

Walter Flores