Beginning in 1997, the government of Guatemala extended coverage of a package of basic health services to 3 million people living in rural, impoverished, and primarily indigenous communities through three different delivery models: contracting of nongovernmental organizations (NGOs) to directly provide services (direct model), contracting of NGOs to act as financial managers for the Ministerio de Salud y Assistencia (Ministry of Health and Social Protection [MSPAS]) health service providers (mixed model), and strengthening of health posts operated by the MSPAS (traditional model). This chapter presents the results of household and provider surveys carried out in 2001. The household survey found that women and children in catchment areas served by the mixed model had significantly better results for many key health indicators when compared to the traditional model. Results for those served by the direct model were similar to the traditional model although these communities had only recently begun to receive services and were located much farther from health facilities. Users tended to report greater satisfaction with the new models. The provider survey found that the NGO-based models are generally more productive than the traditional model; however, they are more costly, and results on economic efficiency were mixed. We conclude that mixed and direct provider models are good alternatives to traditional health services for providing basic services in Guatemala. Contracting basic health care may be an effective strategy to reduce health inequities in other country contexts where access to health services is inadequate.