Evaluation of a demonstration primary health care project in rural Guatemala: the influence of predisposing, enabling and need factors on immunization coverage, equitable use of health care services and application of treatment guidelines

In high- and low-resource settings, care is often provided inequitably, with more and higher-quality services being offered to those who need them less. We evaluated the influence of predisposing, enabling and need characteristics on immunization coverage and use of health services in a population-based primary health care model called the Inclusive Health Model in rural Guatemala. We also analyzed providers' application of treatment guidelines for children with pneumonia. A longitudinal cohort design was used from 2006 to 2009 to analyze data from the model's two demonstration sites. We found a significant positive association between families' health risk level and their use of health care services, with the model providing more services to those with greater need. Services are not provided differentially for those families with a higher or lower wealth level or selected sociodemographic characteristics. Distance from a clinic is significantly associated with lower service use, but this constraint decreases with time. Implementation of treatment guidelines does not vary with different provider characteristics. The Inclusive Health Care model's aim of offering care equitably to families living in its catchment area is reflected in these findings. This study offers an approach and conceptual model for tracking equity in service delivery that may be applicable in other settings.