This article analyzes the role of government stewardship in the expansion of primary health care in post‐conflict Guatemala. By the time the Peace Accords were signed in 1996, the country's primary health care system was scarcely functioning with virtually no services available in rural indigenous areas. To address this gaping void/deficiency, the Ministry of Public Health and Social Assistance (MSPAS) embarked on a progressive expansion of primary services aimed at covering the majority of rural poor. Through a series of legal, policy, and program reforms up to 2014, the MSPAS dramatically expanded primary coverage and greatly improved basic health indicators for the entire population. To succeed in this effort, the MSPAS and its partners needed to simultaneously grow their stewardship capacity to oversee and develop the primary health system. On the basis of recent health systems strengthening literature, we propose a stewardship framework of 6 critical functions and use it to analyze the gains in government capacity that enabled the achievement of many of the country's primary health goals. Of the 6 stewardship functions, “building relationships, coalitions, and partnerships” especially with civil society organizations stands out as one of the keys to MSPAS success.

中文翻译：

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自1996年以来在危地马拉的政府管理和初级卫生保健

本文分析了冲突后危地马拉政府管理在扩大初级卫生保健中的作用。到1996年《和平协定》签署之时，该国的初级卫生保健系统几乎没有运转，农村土著地区几乎没有任何服务。为了解决这一悬而未决的缺陷/不足，公共卫生和社会援助部（MSPAS）开始逐步扩大主要服务范围，以覆盖大多数农村贫困人口。通过到2014年的一系列法律，政策和计划改革，MSPAS大大扩展了基本覆盖面，并大大改善了全民的基本健康指标。为了成功完成这项工作，MSPAS及其合作伙伴需要同时增强其监督和发展初级卫生系统的管理能力。在最近的卫生系统加强文献的基础上，我们提出了6个关键职能的管理框架，并用它来分析政府能力的增长，从而实现该国许多基本卫生目标。在6个管理职能中，“建立关系，联盟和伙伴关系”，特别是与民间社会组织的关系，是MSPAS成功的关键之一。