Improved Health Infrastructure Governance Offers Hope of Clean Water and Sanitation for Hundreds of Thousands of Guatemalans
On June 3, 2021, the Guatemalan Ministry of Health approved a proposal presented by its Integral Health Care Directorate (SIAS) to streamline the management of water, sanitation, and hygiene (WASH) infrastructure projects in the country. When this proposal is executed later this year, a total of over 400,000 Guatemalans from 22 different communities will have better access to potable drinking water.
The need for an improved approach for implementing WASH projects in Guatemala is immense. Nearly 4 million Guatemalans do not have access to safe drinking water, due in part to the time it takes to approve the execution of WASH infrastructure projects. In response, Guatemala’s Minister of Health created a working group to identify flaws in the system. This group is made up of advisers to the Vice Minister of Hospitals, delegates of the Health Areas Directorate of Central Guatemala, and authorities from SIAS’ legal, financial, and human resources departments. The Health and Education Policy Plus (HEP+) project —HP+’s program in Guatemala—also joined the working group to assess the flow of the current WASH project approval process and identify new mechanisms through which to streamline project authorization.
HEP+’s analysis revealed that the centralized nature of WASH project technical evaluations is the source of the slow approval process. SIAS is the only institution in the country authorized to conduct these reviews and therefore has created a bottleneck. In July 2021, 29 WASH projects were pending approval by SIAS. Without system improvement, the expected wait time for these projects’ approval is three to six months—making it impossible for projects to be implemented within their originally established timeframe.
To address the backlog, HEP+ and SIAS conducted a needs assessment and developed a plan to decentralize the approval processes. The plan recommends that WASH offices be integrated into Guatemala's 29 health area directorates and that each office include an environmental engineer/sanitarian, a lawyer, and rural health and sanitation technical experts. Decentralizing the process in this manner will allow the newly established WASH offices to more efficiently and effectively evaluate the technical and legal aspects of WASH project proposals located in their health area and to better provide project stakeholders with the necessary support to prepare for project implementation.
HEP+ also proposed the creation of a national water and sanitation office at SIAS to oversee and provide support to Health Area Directorate offices, including verifying compliance with technical and administrative standards and training office staff.
Hope for Better Health Outcomes
The approval of the management proposal signals significant progress in improving the efficiency of public resource management in Guatemala—WASH improvement project approval is now expected to take only 7 to 15 days. This improved efficiency is an important step that will strengthen measures to prevent chronic malnutrition and water- and food-borne disease.