Integration IndicatorGuatemala Decentralization and Integration in the Health Logistics System Thomas Bossert, Ph.D. Diana Bowser, M.P.H. Harvard School of Public Health Johnnie Amenyah Rebecca Copeland John Snow Inc./DELIVER Management and Technology in Health and Development Guatemala (GETSA)Guatemala: Decentralization and Integration in the Health Logistics System Thomas Bossert, Ph.D. Diana Bowser, M.P.H. Harvard School of Public Health Johnnie Amenyah Rebecca Copeland Management and Technology in Health and Development, Guatemala (GETSA) Harvard School of Public República de GuatemalaDELIVER DELIVER, a five-year worldwide technical assistance support contract, is funded by the Contraceptives and Logistics Management Division (CLM) in the Center for Population, Health and Nutrition of the Bureau for Global Programs, Field Support and Research of the U.S. Agency for International Development (USAID). Implemented by John Snow, Inc. (JSI), (contract no. HRN-C-00-00-00010-00), and subcontractors (Manoff Group, Program for Appropriate Technology in Health [PATH], Social Sectors Development Strategies, Inc., and Synaxis, Inc.), DELIVER strengthens the supply chains of health and family planning programs in developing countries to ensure the availability of critical health products for customers. DELIVER also provides technical management and analysis of USAID’s central commodity management information system (NEWVERN). This document does not necessarily represent the views or opinions of USAID. It may be reproduced if credit is given to DELIVER/John Snow, Inc. Recommended Citation Bossert, Thomas, Diana Bowser, Johnnie Amenyah, and Becky Copeland. 2003. Guatemala: Decentralization and Integration in the Health Logistics System. Arlington, Va.: John Snow, Inc./DELIVER for USAID. Abstract Decentralization has been one of the most far-reaching interventions in the health sector reform packages. Sectoral reform in Guatemala began in 1996 with the Health Services Improvement Program (HSIP), financed by ID and implemented by the Ministry of Health and Social Welfare (MSPAS). Among the goals of the reform were to expand health coverage with an emphasis on populations that lack access, increase the level of public expenditure, redirect resources based on efficiency and equity criteria, and generate an organized social response for mobilization and control of public resources. Another key objective was the development of a new health care model based on decentralization, provision of a basic services package and community participation. Using the decision space model, functions within the health logistics system were analyzed to measure the changes in performance indicators related to changes introduced by decentralization. The study's indicators for high decision space were related to better performance indicators for budgeting, needs quantification, procurement, and assignment of personnel to logistics tasks. These are major functions in a logistics system and, for effectiveness, it is important to be able to make adjustments to local conditions. Conversely, the findings also suggest that some functions may perform better if they remain more centralized. DELIVER John Snow, Inc. 1616 North Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: [email protected] Internet: deliver.jsi.com Harvard School of Public Health República de Guatemalav Contents Contents..................................................................................................................................................v Acknowledgements................................................................................................................................ix Acronyms and Spanish Translations .................................................................................................... vii Executive Summary ............................................................................................................................... 1 Guatemalan Health Logistics System................................................................................................ 1 Findings ............................................................................................................................................. 2 Table 1. Degree of Decentralization and Logistics System Performance ............................................ 2 Table 2. Degree of Integration and Logistics System Performance ..................................................... 3 1. Introduction...................................................................................................................................... 5 Conceptual Framework...................................................................................................................... 5 The Logistics Cycle ................................................................................................................................ 6 Objectives of the Study...................................................................................................................... 6 2. Background.................................................................................................................................... 11 Guatemalan Health Sector Reforms................................................................................................ 11 Health Services Delivery System..................................................................................................... 12 Commodity Distribution Systems................................................................................................ 13 3. Study Methodology........................................................................................................................ 11 Table 3. Summary of Survey Information Sources ............................................................................. 11 Table 4. Decentralization Study Sample—Guatemala, 2002 ............................................................. 12 4. Findings ......................................................................................................................................... 13 Analysis and Presentation ............................................................................................................... 13