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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Its land area of 108,889 km2 is divided
administratively into 22 departments and 331 municipalities, which in turn have
a total of 20,485 communities.
Demography:
In 2000, the country had an estimated population of 11,433,694, and the average
density was 102 inhabitants per km2. The indigenous population represents 48%
of the total. In 2000, the annual population growth rate was 2.9%. In terms
of age distribution, 44% of the total population were children and adolescents
under 15 years old and 5.3% were 60 or older. Life expectancy was 67.2 years
(64.7 years for men and 69.8 years for women). Agricultural activity accounted
for 26% of GDP and generated 60% of employment.
Economy: In 1998, Guatemalan economy grew
5%. In 1999 and 2000, GDP grew 3.6% and 3.3%, respectively, and per capita GDP
at 1995 prices was 0.9% and 0.8%, respectively. In 1998, the net tax burden
(not including returned tax credit) came to 8.9% of GDP. The internal debt as
a proportion of GDP was reduced from 10.6% in 1990 to 5.2% in 1998, and the
foreign debt went from 18% in 1990 to 10 % in 1998. Twenty percent of the households
received 63% of the income in the country, whereas 40% of households received
only 8%. In 1998, 91.3% of the indigenous population was living below the poverty
line. Open unemployment rose from 3.7% in 1995 to 5.6% in 1999. In 1999, the
illiteracy rate was 31.7% (39.2% for women and 26.3% for men). In 1999, the
birth rate was 34 per 1,000 population . A total of 53,486 deaths were registered
in 1999, for a mortality rate of 4.8 per 1,000 population . For both sexes,
the leading causes of mortality were pneumonia and diarrhea, which in 1999 represented
22.3% and 6.0% of all deaths, respectively. According to data from the National
Statistical Institute, the distribution of proportional mortality for the six
broad groups of causes in 1997 was as follows: communicable diseases, 13%; external
causes, 13%; diseases of the circulatory system, 12%; certain conditions originating
in the perinatal period, 8%; tumors, 7%; and all other causes, 47%. Physicians
certified 59.8% of all deaths. The underregistration is around 56%.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years):
In 1997 and 1999, the infant mortality rate was 37.7 per 1,000 live births,
and 40.5 per 1,000 live births. The rates for neonatal and postneonatal mortality
were 15.4 and 22.3 per 1,000 live births, respectively. The National Maternal
and Child Health Survey conducted in 1998-1999 (ENSMI 98-99) estimated infant
mortality at 45 per 1,000 live births. In 1999, acute respiratory infections
accounted for 40% of all deaths in children under 1 year, acute diarrheal
disease claimed 12%, and perinatal causes, 11%. The mortality rate in children
1-4 years old was 14 per 1,000; 9 per 1,000 in the cities and 20 per 1,000
in rural areas.
Schoolchildren (5-9 years): In
1999, a total of 1,027 deaths were registered in the 5-9 years age group,
for a rate of 0.6 per 1,000. Cases of acute diarrheal disease rose from 16,015
in 1997 to 43,119 in 1998 and 50,799 in 1999.
Adolescents (10-14 years and 15-19 years):
In 2000, Guatemala had a population of 2,752,924
adolescents, who comprised 24% of the national population. Rural areas comprised
51%. The fertility rate in girls aged 15-19 was 123 per 1,000. According to
data from the National Statistical Institute, in 1998 the leading cause of
death in youths aged 15-19 was gunshot wounds, followed by pneumonia and influenza
and intestinal infections.
Adults (20-59 years): In
1999, the population of adults between the ages of 20 and 59 numbered 4,116,147
and corresponded to 39.3% of the total. According to the findings of ENSMI
95, maternal mortality during 1990-1995 was estimated at 190 per 100,000 live
births. The Ministry's Health Management Information System gives maternal
mortality rates of 98 per 100,000 live births in 1997, 100.2 in 1998, and
94.9 in 1999. The use of family planning has been on the rise, from 31.4%
in 1995 to 38.2% in 1998 and 1999.
The Elderly (60 years and older): In 1999,
the proportion of the population aged 60 and older was estimated at 5.3%.
The leading reasons for consultation at the Ministry's health services were
preventable, communicable, and infectious diseases.
Workers' Health:National
Statistical Institute data for the period 1989-1999 indicate that women constitute
24% of the economically active. In the group of children and adolescents 7-14
years old, 34.1% were working. The Guatemalan Social Security Institute (IGSS)
covers only 17% of the national population. In 1998, there were 1,131 cases
of pesticide poisoning in six departments in the country, and in 1999 there
were 754.
The Disabled:
Disability is a legacy of the armed conflict and has especially affected those
who fought in the Army and the demobilized combatants of the Guatemalan National
Revolutionary Union as well as civilians from different parts of the country.
Indigenous Groups:
Guatemala is one of the Latin American countries with a high percentage of
indigenous population (48%). In 1998, illiteracy in the departments with 75%
to 100 % indigenous population was 52.2%. The 67.8% of the indigenous population
suffered from chronic malnutrition.
Analysis by type of health problem Natural Disasters:In
1999 and 2000, a series of tremors caused damage in 12 departments. In November
1998, Hurricane Mitch caused heavy damage in 14 of the country's 22 departments,
causing 106,000 people to be evacuated and taking the lives of 268. Heavy
rainfall in 2000, double the level in the winter of 1999, caused rivers to
rise and cause damage along the southern coast and in the west.
Vector-borne Diseases: In
1999, a total of 101,326 cases of malaria were reported and the annual parasite
index was 12.2 per 1,000 population . Of the confirmed cases, 92% were attributed
to Plasmodium vivax , 3.2% to P. falciparum , and 5.3% to 12 associated cases.
In 2000, there were 109,874 reported cases of malaria (95.9%, P. vivax ; 4%,
P. falciparum ; 0.1%, mixed). In 1999, a total of 3,617 cases of dengue were
reported (incidence: 931.7 per 100,000 population , recorded two cases of
hemorrhagic dengue and one death. In 2000, there were 10,083 reported cases,
9,006 of which were clinically diagnosed as classical dengue (1,035 of them
confirmed) and 42 were hemorrhagic dengue, leading to 9 deaths (case-fatality
rate was 21.4%).
Diseases preventable by immunization: The
last case of poliomyelitis was reported in 1991. Epidemiological surveillance
for the occurrence of acute flaccid paralysis continued during 1996-2000,
when the system reported 49, 77, 51, 56, and 87 cases in those five years;
none of them was confirmed to be polio. In 2000, the overall rate of acute
flaccid paralysis was 1.7 per 100,000 in the population under 15 years. In
1996, there were no reported cases of measles; one isolated case occurred
in 1997, but since then there have been no further cases. In the five years
1996-2000 there were reports of 128, 303, 171, 291, and 904 cases, respectively,
of unconfirmed measles. The numbers of reported cases of neonatal tetanus
in the four years 1996-1999 were 17, 7, 5, and 2, respectively. In 2000, there
were 6 cases and 3 deaths. Cases of pertussis increased during the period
1996-1999: 40 in 1996, 131 in 1997, 441 in 1998, 268 in 1999, and the age
group most affected is now 6-9-year-olds. The 194 reported cases in 2000 represented
28 % fewer than the year before. The last case of diphtheria was recorded
in 1997. In 2000, there were five reported cases of tuberculous meningitis,
one more than in 1999, with four deaths. all of areas which had over 90% BCG
coverage.
Intestinal infectious diseases: In
1999, there were a total of 385,633 cases of acute diarrheal disease (incidence:
3,470 per 100,000 population) and 3,244 deaths from this cause (29.2 per 100,000).
In 2000, morbidity was up 21.6% from that in 1999, with 468,981 reported cases
(4,220 per 100,000). . In 1999, children under 5 years old were most affected,
with 238,434 cases, or 61.8% of the total. Cholera cases doubled from 1,008
in 1997 to 2,077 in 1999. In 2000 the number dropped to 790. The case-fatality
rate has been declining: in 1999 there were 18 reported deaths, and in 2000
there were 6, with corresponding fatality rates of 0.9 and 0.8.
Chronic communicable diseases: In
1999, a total of 2,820 cases of tuberculosis were reported, 2,597 (87.1%)
of them pulmonary; of the latter number 2,264 were diagnosed by positive sputum
smear. Adults 25-34 years old were the group most affected, representing 21%
of all cases in 1999. In 2000, there were 2,274 registered cases of tuberculosis,
46.6% in women, and 324 of them in children under 10 years of age. In 2001,
only 27 cases of leprosy were registered at the national level, and the patients
were undergoing treatment.
Acute respiratory infections (ARIs): ARI's
are the leading cause of morbidity and mortality
in the country. In 1999, a total of 1,019,247 cases of ARI and 228,762 cases
of pneumonia were reported, with 11,082 deaths. Pneumonia was the leading
cause of mortality in infants under 1 year (10.6 per 1,000 population), while
63% of the cases and 50% of the deaths were in children under 5 years old.
Zoonoses:Two
cases of human rabies were reported in 1999 and six in 2000. A total of 13,207
persons were bitten by suspected rabid animals in 1999, and in 2000 the number
was 15,053. HIV/AIDS. The epidemic has been concentrated in urban populations
and groups traditionally regarded as being at high risk. As of 30 June 2001,
a total of 4,197 cases had been reported officially (35.9 per 100,000 population),
and underregistration is believed to be as high as 50%. Seventy-four percent
of the affected individuals are males; the 15–49 years age group is
most vulnerable, accounting for 87% of the cases. In 2000, the male-female
ratio was 2.1:1. As of 1999, there were 141 known cases of mother-to-child
transmission. A total of 266 cases of AIDS were reported in 1999 and 316 in
2000.
Nutritional and metabolic diseases: Forty-six
percent of children under 5 years old have some degree of chronic protein-energy
malnutrition. The prevalence of global malnutrition (as measured by weight-for-age)
is 24% in children under 5 years of age. The vitamin A deficiency (serum retinol
= 20 µ/dL) affected 15% of preschool children. Iron deficiency (Hb =12
g/dL) affected 35.4% of women of reproductive age, 39.1% of pregnant women,
and 34.9% of non-pregnant women. The prevalence of anemia (Hb = 11 g/dL) in
children 1–5 years old was 26%.
Malignant neoplasms: Cancers of the reproductive
system account for 42% of all neoplasms in both sexes. In 1999 there were
452 cases of cervical cancer and 240 deaths. Breast cancer is the third leading
cancer and the second most frequent site for women.
Accidents and violence: In 1999, a total
of 2,741 deaths were caused by accidents (5.1% of all deaths), with a rate
of 16 per 100,000 population. There were 384 suicides (0.7% of all deaths)
and 1,774 homicides (3.3%).
Emerging and re-emerging diseases: In
2000, five cases of leptospirosis were documented. In 2000, there were 126
cases of meningitis, 4 of them meningococcal.
RESPONSE OF THE HEALTH SYSTEM National
health policies and plans:The Constitution
of the Republic recognizes health as a fundamental right. The Peace Agreement
constitutes another public policy instrument that supports health sector reform
and extended coverage. The Health Code approved in November 1997 stipulates
that the Ministry of Public Health and Social Welfare is formally responsible
for leadership of the health sector. As defined in the Code, leadership includes
the guidance, regulation, surveillance, coordination, and evaluation of health
actions and institutions at the national level. This definition constitutes
the legal basis for a sectoral reform that has the capacity to transcend the
public institutions. The Code also obligates the Ministry to provide free health
care to persons without means. The instrument Health Policies 2000–2004
calls for development of the following: (a) integrated health care for families;
(b) health care for the Mayan, Garifuna, and Xinka peoples, with emphasis on
women; (c) health care for the migrant population and strengthening of integrated
health care for other groups; (d) broader basic health service coverage with
quality and sustainability; (e) basic and environmental sanitation; (f) access
to essential drugs and traditional medicine; (g) strategic distribution of human
resources; (h) institutional development, deconcentration, and decentralization;
(i) intra- and intersectoral coordination; (j) improvement and optimization
of external cooperation; and (k) expansion of health sector financing.
Health sector reform strategies and programs:
The objective of health sector reform is comprehensive
transformation of the social health production model, including improvement
of the efficiency and equity of service delivery. In addition, it has the following
specific objectives: (a) extension of basic health service coverage with emphasis
on the poorest segments of the population; (b) increased public expenditure
on health and mobilization of financial resources to ensure sustainability of
the sector; (c) redirection of resource allocation; (d) increased efficiency
of the public sector in the performance of its functions and the production
of services; and (e) generation of an organized social response, with a broad
base of social and community participation. Emphasis is placed on the organization
of publicly financed services to extend coverage to the rural population that
currently has no access to health care. In 1996, the population without health
service coverage was estimated at 46%; between 1997 and 2000, coverage was increased
to include an additional 35% of the total population. The strategy used was
based on a partnership between the Government, represented by the Ministry,
and nongovernmental organizations.
Organization
of regulatory actions: The regulatory role
of the Ministry in the private sector is especially important in ensuring the
quality control, efficacy, and safety of drugs and related products. The Department
for the Regulation and Control of Drugs and Related Products was created within
the Ministry to enable it to exercise control in this area, and the Department
is supported, in turn, by the National Health Laboratory, where physical, chemical,
and microbiological analyses are performed. The water supply coverage reached
92% of the population in urban areas and 54% in rural areas, while sanitation
coverage was 72% and 52%, respectively. In urban areas, 47% of the population
disposes of solid waste through collection services.
Organization
of individual health care services: In 1999,
the Ministry of Public Health and Social Welfare had 1,352 health establishments,
43 of which were hospitals (17 at the department level, 10 at the district level,
7 regional, 6 specialized, and 3 general hospitals that receive referrals).
There were 29 type A health centers, 234 type B health centers, 973 health posts,
48 peripheral emergency centers, and 15 maternity centers at the canton level.
The bed-population ratio was 1.0 per 1,000 in the country. IGSS has 24 hospitals,
30 consultation offices, 18 primary care posts, and 5 services attached to national
hospitals; 6 of the hospitals and 11 of the consultation offices are located
in the department of Guatemala. There are 2,447 available beds, for a ratio
of 1.4 per 1,000 beneficiaries. There is a 360-bed Public Psychiatric Hospital
in Guatemala City, and six other national hospitals have mental health units.
IGSS has a 30-bed psychiatric unit and is working on creating a mental health
program.
Health supplies:Drugs
are sold through a network of public and private pharmacies. There are 85 national
and 2 foreign laboratories that manufacture drugs. In 1999, the Ministry spent
US$ 17,073,649 on drugs, IGSS spent US$ 24,000,000, and the private sector spent
US$ 129,803,326. In 1997, a system was established for the joint negotiation
of drug purchase prices with participation by the Ministry, IGSS, and the Military
Medical Center.
Human resources: The
ratio of physicians to total population is 9 per 10,000. For every 3 physicians
there is only 1 professional nurse; for each professional nurse there are 14
nursing auxiliaries. Health human resources tend to be concentrated in urban
areas: the ratio of urban to rural physicians is 4:1, and for professional nurses
it is 3:2. Guatemala has 80 specialists in public health with a master’s
degree.
Health sector expenditure
and financing: In 1999, health expenditure
represented 2.8% of GDP. Households were the most important source of health
financing (42.9%), followed by the Government (27.3%), businesses (22%), and
external cooperation (7.8%). The annual amount spent on health came to US$ 630
million.
External technical cooperation
and financing:In the last five years, Guatemala’s
technical and financial cooperation amounted to US$ 2,386.6 million. Of this
total, 37.3% corresponded to nonreimbursable cooperation and 62.7% of it was
reimbursable. 75.2% was intended to support the peace process, 21.7% was for
other programs, and 3.1% was allocated for the Hurricane Mitch Reconstruction
and Transformation Program. The total amount disbursed during the five years
came to more than US$ 1,600 million, of which 55.3% corresponded to reimbursable
and 44.7% to nonreimbursable cooperation.
