Physical access and utilization of health services in rural Guatemala

It is frequently stated—and more frequently assumed—that the dispersed settlement of a rural population results in isolation and a substantial physical separation from modern-sector health services. This study shows that for three large departments in western Guatemala—Sololá, Tolonicapán, and San Marcos—the vast majority of persons have reasonably good physical access to health services, even taking bad roads and slow travel times into account. Furthermore, the Ministry of Health has strategically located its facilities in congruence with rural market centers, and virtually the entire population visits these market centers with great regularity. Analysis of 1800 actual patient visits, however, shows that Ministry facilities have minuscule geographic drawing power, that is, the vast majority of patients come only very short distances. The question is raised: Why? Although no definitive answer is provided here, the most plausible explanation is simply that the health posts—which are understaffed by poorly trained personnel and badly under-equipped—do not cure very well, and thus people are not highly motivated to use them. Improving levels of utilization depends on improving the quality of delivered services, not building more health posts or overcoming supposed ‘cultural barriers’.