title: Implementation and progress of an inclusive primary health care model in Guatemala: coverage, quality, and utilization.
abstract: OBJECTIVE
  To describe a primary health care model designed specifically for Guatemala that has been implemented in two demonstration sites since 2004 and present results of a process evaluation of utilization, service coverage, and quality of care from 2005 to 2009.
  
  
  METHODS
  Coverage, utilization, and quality were assessed by using an automated database linking census and clinical records and were reported over time. Key maternal and child health coverage measures were compared with national-level measures.
  
  
  RESULTS
  The postnatal coverage achieved by the Modelo Incluyente de Salud of nearly 100.0% at both sites contrasts with the national average of 25.6%. Vaccination coverage for children aged 12-23 months in the Modelo Incluyente de Salud reached 95.6% at site 1 (Bocacosta, Sololá) and 92.7% at site 2 (San Juan Ostuncalco), compared with the national average of 71.2%. Adherence to national treatment guidelines increased significantly at both sites with a marked increase between 2006 and 2007. Utilization increased significantly at both sites, with only 7.5% of families at site 1 and 11.2% of families at site 2 not using services by the end of the 5-year period.
  
  
  CONCLUSIONS
  Coverage, quality of care, and utilization measures increased significantly during the 5-year period when the service delivery model was implemented. This finding suggests a strong possibility that the model may have a benefit for health outcomes as well as for process measures. The Modelo Incluyente de Salud will be financially sustained by the Ministry of Health and extended to at least three additional sites. The model provides important lessons for primary care programs internationally.
authors: Health Services, University of Washington, Seattle, United States of America.
authors: Meredith P
authors: MP
authors: Fort
authors: David E
authors: DE
authors: Grembowski
authors: Juan C
authors: JC
authors: Verdugo
authors: Lidia C
authors: LC
authors: Morales
authors: Carmen A
authors: CA
authors: Arriaga
authors: Mary A
authors: MA
authors: Mercer
authors: Stephen S
authors: SS
authors: Lim
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards / Q000706:statistics & numerical data; D006166:Guatemala; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D008962:Models, Theoretical; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D055815:Young Adult