"Health is a business for everyone and is not a right to anyone:" Neoliberal health care provision in rural Guatemala

Abstract

Guatemala caught the attention of the international community as it emerged from its civil war. The stabilization offered by the Peace Accords of 1996 allowed the World Bank and the Inter-American Development Bank to urge the Guatemalan government to reduce health disparities. These organizations used their economic power as leverage to promote neoliberal reforms in health care, focusing on decentralization and privatization. In this thesis, I explore the intended and unintended consequences of these reforms as perceived by health care providers practicing in four rural communities in the state of Suchitepéquez. I focus on the perspectives of health care workers because they play a significant role in the delivery of health services. They translate health policy into health practice; yet, few studies attempt to understand how policies affect their professional and social lives. I assess the challenges faced by governmental and private health care providers as they attempt to mediate between national policies and the needs of rural communities. I examine how decentralization and privatization have undermined the motivation of rural health care workers and subverted their trust in each other. I argue that health provision in rural Guatemala is fragmented, underfunded, and uncoordinated; health care workers are dispirited, mistrustful of each other, and torn between profiteering, attracting "clients," and serving "patients." I conclude that neoliberal restructuring has failed to significantly diminish health care disparities and significantly improve health care access; in reality, it has widened the gap between rural communities and their urban counterparts. Neoliberal health care reforms in Guatemala equated to cuts in state services, poorer regulation efforts, gains for private providers, and poor health care for the most vulnerable communities.