The government of Guatemala released its long awaited plan for revamping the rural primary health care system. The proposal is outlined in detail in a document entitled ‘Fortalecimiento del Primer Nivel de Atencion’, which roughly translates as ‘Strengthening the First Level of Care’. TulaSalud’s work is in precisely this domain, so we analyzed the report with great interest. We were gratified (and relieved) to see a very thoughtful and progressive document, which for us amounts to a very strong endorsement of the programs we have fostered in the department (province) of Alta Verapaz. The document specifically addressed the future of the PEC (the acronym for the spanish equivalent of Extension of Coverage Program). The PEC arose out of the Civil War Peace Accords in 1996. It was acknowledged at that time that large areas of the countryside lay beyond the coverage of the formal public health systems. Under the PEC local NGOs were contracted to extend that coverage to the unserviced areas via traveling health teams. TulaSalud and DASAV (the public health administration in Alta Verapaz) have recognized the inadequacy of the traveling team model of primary care, and worked over the years to supplement with solutions rooted in the communities. Here are some of the elements of the proposal that we were excited to see:
- Emphasis away from traveling teams and toward permanent resources in communities.
- Establishment of 2220 local community-based health centers (Centros de Convergencia) each staffed during working hours by an auxiliary nurse (in the north, that would typically be a graduate of our CAEC program). 380 Centros de Convergencia are currently up and running in Alta Verapaz.
- Improve the cultural relevance, by means of training and contracting of persons selected by the communities of the same ethno-linguistic regions, in order to facilitate the provision of services in the user’s own language, with cultural relevance and collaboration with traditional therapists.
- Train and hire auxiliary nurses specializing in maternal, neonatal and infant care to improve the availability of qualified personnel in communities, not only in provision of preventive services and maternal-infant care, but also for the coordination of emergency maternal-infant plans, preparation of emergency transports and accompanying emergency cases referred to other levels of care.
- Equip and supply Centros de Convergencia for the provision of integrated services for the care of women of fertile age, during adolescence, adult life, pre-conception orientation, pregnancy, birth, as well as detection of other health problems of women.
- Reduce indices of chronic and acute malnutrition by implementing the Hunger Zero and Thousand Day Window programs in the management framework.
- Strengthening information systems, supervision and logistics for the delivery of services at the primary level in the community.
- Increase the budget for primary health care.