MCSP Community Health Contributions Series: Guatemala

In Guatemala, MCSP was implemented from October 2016 to June 2019, focusing on reducing maternal and newborn mortality and rates of chronic malnutrition in five departments of the Western Highlands region. MCSP's overall goals in Guatemala were to provide technical assistance to the Ministry of Health (MSPAS) to increase coverage and utilization of evidence-based, sustainable, high-quality reproductive, maternal, newborn, child, and adolescent health and nutrition (RMNCAH/N) interventions at the household, community, and health facility levels. The project also aimed to strengthen and increase the quality of health care services provided in USAID priority municipalities in the Western Highlands. MCSP's community health strategy in Guatemala combined community service delivery with community capacity strengthening and community social and behavior change. The project worked at various levels within and outside the Guatemalan health system, strengthening horizontal and vertical linkages among actors to facilitate collaborative, mutually reinforcing actions to improve RMNCAH/N. Additionally, MCSP offered continuity for best practices and helped maintain their momentum and impact, as previous USAID-funded health projects in Guatemala came to an end in 2017. MCSP's community health approaches in Guatemala were based on three pillars: Service Delivery, Capacity Strengthening, and Social and Behavior Change. The project conducted a formative assessment, disseminated results, and facilitated the co-design of strategies to improve respectful care in three Quiché hospitals and six surrounding communities. The assessment found that verbal abuse was the most common type of disrespect mentioned, characterized by harsh words, shouting, humiliations, and offensive comments about sexual activities. To address the findings, MCSP led a collaborative process to convene actors from national, municipal, and community levels for a 1-day co-design workshop. The goals of the workshop were to establish a shared vision between communities and health care workers about respectful care, and to begin to develop and document action plans and strategies in response. During the workshop, key stakeholders developed work plans that outlined actionable solutions to reduce mistreatment and promote respectful care, assigning people responsible and timelines for implementation. In addition to respectful care, MCSP also worked on critical pathways for obstetric care during emergencies. The Critical Pathway, a model based on the four delays, is widely used to counter maternal deaths in the context of the Western Highlands. The strategy strengthens the emergency referral network at the community level and improves management and transfer of obstetric emergency cases between different levels of care. The pathway consists of linking families, community members, and service providers along an "emergency route" in response to complications during pregnancy or labor, and encourages mobilization of community leadership to prevent maternal and newborn mortality. MCSP's achievements in Guatemala include the development of a health campaign on respectful care, the design and implementation of the first professional Midwifery Technical Training Program in Guatemala, and the facilitation of a biministerial pilot youth champions initiative led by MSPAS and Guatemala's Food Programme. The project also certified 36 MSPAS facilitators in the newly adapted eLearning program, Diplomado Maternal and Child Nutrition within the First 1,000 Days, and collaborated with MSPAS to develop a mentorship training curriculum, certifying 90 clinical and managerial mentors in all six of the project's health area directorates.