Welcome! If you haven’t checked out our previous blog: Why the Guatemalan Health Crisis Deserves our Attention, go give it a read!
Disclaimer: I do not pretend to be an expert on the intricacies of the Guatemalan political and social climate, the government policies or the legalities that surround the drug shortage, but I attempt to give insight as to some of the reasons behind it, in an effort to raise awareness to this issue.
Guatemala is a nation of picturesque greenery, rolling mountains, rich culture and tight communities. To visit Guatemala is to find your heart whisked away in the beauty of its landscapes and the strength and spirit of its people. I often remember the serenity of the mornings, the crisp air and the mountains towering all around. The feeling is indescribable, surrounded by so much history, beauty, and culture. However, like any other nation, Guatemala has its share of struggles and suffering. Among these, a debilitating drug shortage that tears through efforts to develop the health system and makes real progress difficult to grasp.
Although the largest and most populous country in Central America, Guatemala experiences some of the most dire healthcare conditions in the region. The large rural and indigenous population sees many disparities in medical care access, and bears much of the insufficiency due to isolation physically, financially and by language.
At 23.1 deaths per 1,000 live births, the infant mortality in Guatemala is the highest in Central America, while the life expectancy is the lowest (World Bank, 2019). For comparison, the infant mortality is 15.6 and 12.2 in neighbouring Honduras and Belize, respectively (World Bank, 2019). A high infant mortality indicates a high prevalence of communicable diseases, malnutrition and infection. Accordingly, 48% of Guatemalan children under five are stunted and chronically malnourished (MSPAS, 2010). Respiratory infections account for 14.1% of deaths in Guatemala, compared to an average of 5.3% across Latin America and the Caribbean (LAC) (IHME, 2013). Similarly, death due to diarrhea is over five times that of the LAC average.
Health outcomes in Guatemala are some of the worst in Latin America.
What are the reasons?
A brutal civil war raged in Guatemala from 1960 to 1996, and left behind a tattered and neglected health care system. Lasting effects of the violence and unrest continue to plague Guatemala, contributing to its trailing behind other countries in health care strategies and statistics. Although progress has since been made, the universal healthcare called for in the Guatemalan constitution is still a distant goal. This is due in part to lingering consequences of the war that impede the economy and make strong social services difficult to implement.
There is an extremely low government health care budget, and an even lower amount is actually received by facilities and able to be used in service of Guatemalan communities. This is due both to a weak tax system and to government instability. According to an article by the organization Mayan Families, 2016:
“In 2008, the Guatemalan government only spent about $97 per person on public healthcare. (In contrast, the United States spent $7,825.)”
Although Guatemala’s GDP is is one of the highest in Central America, only about 2.6% of it goes towards healthcare (Al Jazeera America, 2016). In addition Guatemala’s tax revenue is one of the lowest in Central America, limiting its ability to implement social services and develop its healthcare capacities.
The chronic lack of funding means there is a constant deficiency in the resources available to healthcare workers for their patients. Facilities are understaffed, under-equipped, and often without even basic medications. In many cases professionals are rendered completely unable to complete the work for which they have been trained. In one interview conducted as part of a study by USAID in 2016, it was reported that the medication budget assigned was 40% of what was needed. This means over half of the patients seen may not have been able to receive the treatment they required!
Government Corruption and Instability
There have been numerous cases of funds that were supposed to go towards healthcare, disappearing due to scandals surrounding government officials. These scandals not only physically deplete financial resources, they often lead to changes in administration as staff resign or are removed, and this causes disruption in ongoing plans for healthcare development.
Along the same lines, there have been frequent changes in president over the past several years, each bringing with them their own health ministers with their own ideas. This means that before an appointed health minister can successfully implement and execute a plan, there is a turnover in staff and the process is reverted back to the beginning.
While in Guatemala in 2015, we were told by the staff at the Cobán Hospital in Tactic, that the desperation created by all the above factors breeds tendency for theft. A lack of sturdy structures to store medication in makes it easy for thieves to break in and steal, whether in an attempt to save a loved one, or to sell for their own profit. Either way, this further depletes the already scant resources available for patients.
Guatemala has a comparatively young population that is rapidly growing. Its annual population growth rate is over double that of the average across LAC countries (World Bank 2015). This can be attributed to a high fertility rate and low prevalence of contraceptive knowledge, access and therefore, utilization. The rapidly expanding population places further strain on the already struggling healthcare system, rendering services unattainable to many.
The drug shortage is crippling, and has resulted in hospitals becoming a last resort for sick patients, a place for them to die rather than to be healed. I have attempted to demonstrate that the reasons for the shortage are extremely complex and will require work and change on many different levels from government, to legislation, to healthcare facilities themselves. But In the meantime, children are suffering, families are being destroyed and needless lives are being lost. So in the meantime, HLH is fighting in a simple way, to increase supply at the frontlines of this crisis.
We ask you to join us.
For more information, see the resources below:
The mission of HLH is to increase accessibility to medications and supplies for healthcare facilities in Guatemala. If you are interested in hearing more about the work we are doing, or in connecting with us, you can visit our website, check out our instagram or facebook, or sign up to receive our newletters. If you would like to support us in our work, please donate here.