The Lancet recently released a series of articles and commentaries on the topic of Universal Health Coverage in Latin America, written by notable researchers. While reading through some of the articles, I thought about how some of the key issues identified will play an important role in the learning experience of Peacework's upcoming trip to Guatemala.
Historically, the Latin American model for healthcare services has been divided into two socially distinct blocks: one for workers receiving social security benefits, and another provided by the Ministry of Health for the generally poorer and more vulnerable domestic workers. Most ironically, but perhaps also most expectedly, these domestic workers receive the lowest quality of healthcare services, as they face discrimination and higher payments at point of service. Such barriers render the access to healthcare socially and financially stressful. As such, there has been increasing support and promotion of the development of a universal healthcare system that enables equal access to healthcare.
However, this is where things get complicated. Equitable access to healthcare is impeded by gender inequities as well as racial and cultural discrimination. Guatemala, the destination of the upcoming Peacework trip, has one of the highest Gender Inequality Index values in Latin America (Figure 2, United Nations Development Programme). The Gender Inequality Index is based on measures of inequity between men and women for access to reproductive health, empowerment, and labour market.
What was especially interesting to me were the determinants of disparities in reproductive health. Calhuitz, the region in which Peacework’s project will mainly operate, has a maternal death rate more than 3 times greater than the national average. In a commentary written by Michelle Bachelet, the president of Chile, she identifies an example of progress in the equitable access to health care for women by pointing out that 18 Latin American countries (including Guatemala) provide at least 12 weeks of maternity leave for those with social security benefits, and "legal entitlement to maternity leave" for domestic workers. While this certainly is progress, a key point that Bachelet misses is that domestic workers are more likely to hold a relatively low socioeconomic status, live in areas with poor infrastructure, and be of discriminated social groups. Take for example the Chuj women of Calhuitz, who are discriminated against because of their race and have poor access to maternal healthcare services, resulting in dire maternal childbirth outcomes. These factors stand as roadblocks to the exercise of any poorly enforced and funded "legal entitlement" that women from a discriminated background may have.
Given these issues, there has been support for the development of a holistic and participatory approach to the development of a universal healthcare system in Latin America. This involves working with specific communities to identify and develop solutions for their specific needs, with an emphasis on active community participation and engagement. In addition, this promotes a multi-sector approach with consideration of education, infrastructure, social and gender justice, and other socioeconomic factors. This is the exact multidisciplinary and equitable approach that Peacework is striving to promote.
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