Making the post-MDG global health goals relevant for highly inequitable societies: findings from a consultation with marginalized populations in Guatemala

International Journal for Equity in Health

Walter Flores¹  Fernando José Jerez¹  Silvia Sánchez¹  Ana Lorena Ruano¹ 

[1] Centro de Estudios para la Gobernanza en los Sistemas de Salud, Guatemala City, Guatemala

关键词: Sustainable development goals;    Millennium development goals;    Go4Health;    Community consultations;    Community participation;    Guatemala;   

Others  :  1137642
DOI  :  10.1186/1475-9276-13-57

 received in 2014-03-13, accepted in 2014-06-10,  发布年份 2014

【 摘 要 】

Introduction

The United Nations presented a set of Millennium Development Goals that aimed to improve social and economic development and eradicate poverty by 2015. Most low and middle-income countries will not meet these goals and today there is a need to set new development agenda, especially when it comes to health. The paper presents the findings from a community consultation process carried out within the Goals and Governance for Global Health (GO4Health) research consortium in Guatemala, which aims to identify community needs and expectations around public policies and health services.

Methods

Through a participative and open consultation process with experts, civil society organizations and members of the research team, the municipalities of Tectitan and Santa Maria Nebaj were selected. A community consultation process was undertaken with community members and community leaders. Group discussions and in-depth interviews were conducted and later analyzed using thematic analysis, a qualitative method that can be used to analyze data in a way that allows for the identification of recurrent patterns that can be grouped into categories and themes, was used.

Findings

Following the Go4Health framework’s domains for understanding health-related needs, the five themes identified were health, social determinants of health, essential health needs and their provision, roles and responsibilities of relevant stakeholders and community participation in decision-making. Participants reported high levels of discrimination related to ethnicity, to being poor and to living in rural areas. Ethnicity played a major role in how community members feel they are cared for in the health system.

Conclusion

Achieving health goals in a context of deep-rooted inequality and marginalization requires going beyond the simple expansion of health services and working with developing trusting relationships between health service providers and community members. Involving community members in decision-making processes that shape policies will contribute to a larger process of community empowerment and democratization. Still, findings from the region show that tackling these issues may prove complicated and require going beyond the health system, as this lack of trust and discrimination has permeated to all public policies that deal with indigenous and rural populations.

【 授权许可】

   
2014 Ruano et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kenny C, Glassman A: What will follow the millennium development goals? the high level panel’s ambitious recommendations on health deserve support. Br Med J 2013, 347.
• [2]Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder AA, Pielemeier NR, Mills A, Evans T: Overcoming helath-systems contraints to achieve the Millennium Development Goals. Lancet 2004, 364:900-906.
• [3]Friedman A, Jahn A, Ooms G, Sridhar D, Waris A: Realizing the Right to Health for Everyone: The Health Goal for Humanity. Copenhagen: Go4Health research consortium; 2013.
• [4]Fridman E, Flores W, Brolan C, Hill P, Hussein S, Mulumba M, Latif L, Eggermong N, Gostin L: Community Engagment: engaging communities in the post 2015 global health agenda is a necessary for human rights and social legitimacy. In Global Development Goals. Edited by UNA-UK. London: UNA UK; 2013.
• [5]UN: The Millennium Development Goals Report. New York: United Nations; 2013.
• [6]Popay J, Escorel S, Herández M, Johnston H, Mathieson J, Rispel L: Understanding and Tackling Social Exclusion: Final Report to the WHO Commission on Social Determinants of Health. Lancaster: WHO; 2008.
• [7]Ruano AL, SanSebastián M, Hurtig AK: The process of social participation in primary health care: the case of Palencia, Guatemala. Health Expect 2011.
• [8]UNDP: Acting on the future: breaking the intergenerational transmission of inequality. New York: United Nations Development Program; 2010.
• [9]Behrman J, Baviria A, Székely M: Social Exclusion in Latin America: Introduction and Overview. Washington DC: Inter-American Development Bank; 2002.
• [10]Flores W, McCoy D: Making Progress -Slow, but With Grounds for Some Optimism. Maternal and Child Health and Equity in Guatemala: An Analysis of the Clinical Health System and Underlying Reasons, With Recommendations for National and International Stakeholders. 2004. [Background paper for the MDG taskforce on maternal and child health. Ministerio de Salud de Guatemala. Guatemala.]
• [11]INE: Características de la población y de los locales de habitación censados. Guatemala: Institutio Nacional de Estadística; 2003.
• [12]INE: Mapas de pobreza en Guatemala: un auxiliar para entender el flagelo de la pobreza en el país. Guatemala: Instituto Nacional de Estadística; 2003.
• [13]INE: ENCOVI. Guatemala: Institution Nacional de Estadística; 2011.
• [14]WB: Equity and Development. Washington DC: World Bank; 2006.
• [15]Flores W: Elementos fundamentales del sistema de salud, dinámica de su estructura, funcionamiento y desempeño. Guatemala: Programa de las Naciones Unidas para el Desarrollo; 2007.
• [16]Flores W, Ruano AL, Phé-Funchal D: Social participation within a context of political violence: implications for the promotion and exercise of the right to health in Guatemala. Health Hum Rights 2009, 11(1):37-48.
• [17]PNUD: Guatemala: diversidad étnico-cultural. Guatemala: Programa de las Naciones Unidas para el Desarrollo; 2005.
• [18]SEGEPLAN: Plan de desarrollo de Tectitán, Huehuetenango. Guatemala: SEGEPLAN; 2010.
• [19]COMUDE NEBAJ Q, SEGEPLAN: Plan de desarrollo de Nebaj, Quiché. Guatemala: SEGEPLAN; 2010.
• [20]Cresswell JW: Qualitative Inquiry and Research Design: Choosing Among Five Perspectives. London: Sage; 2007.
• [21]Fereday J, Muir-Cochrane E: Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods 2006, 5(1):1-11.
• [22]Nabel J: Race, Ethnicity and Sexuality: Intimate Intersections, Forbiden Frontiers. NY: Oxford University Press; 2003.
• [23]Beauchamp T: Principles of Biomedical Ethics. 1989 edition. New York: Oxford University Press; 1989.
• [24]Scheyvens R, Scheyvens H, WE M: Development Fieldwork: A Practical Guide. London: Sage; 2003.
• [25]Ruano AL, Dahlblom K, Hurtig AK, SanSebastián M: If no-one else stands up, you have to: a story of community participation and water in rural Guatemala. Global Health Action 2011, 4:2011.
• [26]Ruano AL, Hernández A, Dahlblom K, Hurtig AK, SanSebastián M: ‘It’s the sense of responsibility that keeps you going’: stories and experiences of participation from rural community health workers in Guatemala. Arch Public Health 2012, 70(1):18. BioMed Central Full Text
• [27]Nordenfelt L: The concepts of health and illness revisited. Med Health Care Philos 2006, 2007(10):5-10.
• [28]WHO/UNICEF: Declaration of Alma-Ata. WHO Chron 1978, 32(11):428-430.
• [29]Ruano AL: The role of social participation in municipal-level health systems: the case of Palencia, Guatemala. Umeå, Sweden: Umeå University; 2012.
• [30]Pelcastre-Villafuerte B, Ruiz M, Meneses S, Amaya C, Márquez M, Taboada A, Careaga K: Community-based health care for indigenous women in Mexico: a qualitative evaluation. Int J Equity Health 2014., 13(2)
• [31]Boulware LE, Cooper L, Ratner L, LaVeist T, Powe NR: Race and trust in the health care system. Public Health Rep 2003, 118(July-August 2003):265-358.
• [32]Gilson L: Trust and the development of health care as a social institution. Soc Sci Med 2003, 56(2003):1453-1468.
• [33]Garcia-Subirats I, Vargas I, Mogollon Perez A, de Paepe P, Ferreira da Silva M, Unger J, Borrell C, Vásquez M: Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil. Int J Equity Health 2014., 13(10)
• [34]Ley de consejos de desarrollo urbano y rural. 2002.