The Access and Utilization of Public Health Centers in Guatemala City
JAMES L. MULVIHILL
Guatemala is typical of most Latin American states in its long-standing commitment to low-cost public health services. Until the 1940s, such services were usually affiliated with religious organizations. After that time, the government took responsibility for providing such care. In 1975 an innovative national health plan stressed preventive health care, early recognition and treatment of disease, along with support for improvements in housing, sanitation, and health education.
The local entry point to this health care system is the primary health care center. This center is charged with treating common illnesses and referring patients requiring more specialized care to larger, more centralized facilities. As a result of this health plan, the Guatemalan government encouraged several studies of the location and utilization of the various levels of its public health care system. This chapter summarizes the findings of two previous studies of Guatemalan health locations in both rural and urban environments. The study then analyses public health center utilization within Guatemala City. The key finding of these studies is that "access" does not simply mean providing health centers. There are questions concerning the position of individuals within their physical and social environments, and the attitudes they hold of public versus other health care types that must also be answered.
An extensive study was performed in three rural, mountainous provinces of Guatemala. 1 The study found that the government's campaign to establish wide-