Geneva Health Forum Archive

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Strengthening Health Systems and Democracy through the Empowerment of Rural Indigenous People in Guatemala

Author(s) Walter Flores1, Ismael Gomez2
Affiliation(s) 1Executive office, Center for the Study of Equity and Governance in Health Systems, Guatemala City, Guatemala, 2Field implementation, Center for the Study of Equity and Governance in Health Systems, Guatemala, Guatemala.
Country - ies of focus Guatemala
Relevant to the conference tracks Advocacy and Communication
Summary Based on both human rights and health systems frameworks, a coalition of CSOs have been implementing a participatory approach to empower rural indigenous citizens to monitor public policies and health care services, demand actions to improve equitable resource allocation and shift power relations at the municipal level. The premise of this work is that strengthening health systems must be part of a larger effort to redress historical discrimination of population groups. In addition, the political empowerment of indigenous populations is a key condition to an equitable and responsive health system. After 5 years the approach has shown important positive results.
What challenges does your project address and why is it of importance? Many health inequities are the expression of inequities of power in society. A history of discrimination, exploitation and 36 years of armed conflict in Guatemala has created unequal power relationships that place rural indigenous population at great disadvantage, suffering worse health outcomes than non-indigenous populations and facing many access barriers to existing services.
How have you addressed these challenges? Do you see a solution? Following a human rights framework, a coalition of civil society organizations led by Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud (CEGSS), have been implementing a participatory-action research approach aimed to empower rural indigenous citizens to monitor public policies and health care services, demand actions to improve equitable resource allocation and a shift power relations at the  municipal level. The premise of this work is the understanding that in a context such as Guatemala, strengthening health systems must be part of a larger effort to redress historical discrimination. In addition, the political empowerment of indigenous population is a key condition to an equitable and responsive health system. The process includes the monitoring of health polices and services by community based indigenous organizations. The key characteristics are the following:
• Based on both a human rights framework and health systems strengthening.
• Citizens’ health boards carry-out the following activities:
– Surveying existing services to assess compliance with national standards (drugs availability, medical equipment, human resources)
– Document cases of families suffering hardship due to unmet healthcare needs
– Studying barriers to access (transport, discrimination, resource allocation)
– Submit a report to authorities
– Implement strategic advocacy to demand changes
How do you know whether you have made a difference? Through ethnographic research and in-depth case studies, we have documented that our approach has had a positive impact in improving the availability of services at municipal level. It has also improved the level of trust between community based organizations and health authorities. Community leaders that have been part of this process also report “empowerment” and a motivation to expand their work. The health system is strengthened by improving resource allocation to benefit highly marginalized rural areas at the same time that health personnel develop skills to negotiate and respond to the user of services need. Overall, this approach is also strengthening democracy and promoting the social inclusion of indigenous populations.
Have you or the project mobilized others and if so, who, why and how? Skills and knowledge to implement the approach have been transferred to other NGOs that work in different regions of the country. In addition, due to the relevance of the approach, we have managed to raise funding to expand the approach to 20 new rural indigenous municipalities of Guatemala.
We are also participating actively in several international networks (COPASAH: www.copasah.net) in which we are transferring our skills, knowledge and tools and also learning from other colleagues that participate in the networks.
When your donor funding runs out how will your idea continue to live? A central component of our approach is the capacity-building of indigenous community leaders engaged in accountability and equity work. Up to June 2013, more than 400 community leaders from 15 different rural municipalities have been trained on community monitoring and social accountability of public polices and services. We are also transferring the skills to other civil society organizations present in these 15 municipalities. Since those organizations already have a presence in those municipalities and do not receive financial support from us, it is expected that they will continue to provide technical assistance to the community leaders once the skills and knowledge transfer process is completed. We are also active members of COPASAH (www.copasah.net) and TALEARN (http://www.transparency-initiative.org/news/talearners-safe-space). In both networks we are contributing to field building, hence the skills and knowledge shared in these two networks will remain with all the other member organizations