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Strengthening the Network of MNCHN Services

In Santo Tomás Milpas Altas, Guatemala, WINGS Family Planning Educator Evelyn registers women to receive the long-term contraceptive methods of their choice, which were predominantly Jadelle implants. © 2015 Anna Zatonow/WINGS Guatemala, Courtesy of Photoshare


With a goal of reducing chronic and acute malnutrition and maternal and child morbidity and mortality, the Government of Guatemala defined the Pacto Hambre Cero or Zero Hunger Pact as a national priority, with the 1,000 Days Strategy at its core. This strategy consists of interventions in nutrition and health that target children before conception. In support of the Ministry of Health’s efforts, the USAID | TRAction and USAID | Nutri-Salud projects engaged in a technical cooperation approach that embedded knowledge generation activities into traditional technical assistance to better inform and improve interventions. These technical cooperation activities aim to strengthen the network of maternal and child health and nutrition (MNCHN) services by largely focusing on supply-side issues.

Technical assistance focused on improving service quality and organization of MNCHN services. Activities focused on properly implementing training and referral improvements to all levels of MNCHN services, beginning with community and primary level of services up to the third level of services (hospitals). Activities included:

  • Updating staff training and monitoring of hospitals, health centers, and health posts in nutrition counseling, including exclusive breastfeeding, immunizations, recognition of danger signs in children, to mothers/caretakers with children in the first two years of age
  • Updating staff training to include integrated activities for maternal health and nutrition
  • Supporting the facilitation of updated staff training and implementation of norms
  • Supporting health personnel and academic centers in the development of municipal and community surveillance system prototypes

TRAction supplemented technical assistance activities with the completion of an implementation assessment to understand how to increase utilization of the improved network of MNCHN services. Through the assessment, TRAction systematically analyzed the deterrents to skilled care utilization, which include factors related to cultural birth preferences, geographic and financial access, perceptions of the formal/informal health system, and quality of care. 


Guatemala: Ixil Health Area, Quiche Department

The Ixil Health Area in the Department of Quiche was selected as the site for the implementation assessment because it has great need for a more efficient and effective health system and has some of the poorest education, economic and health indicators in Guatemala. Maternal mortality is estimated at 277 deaths per 100,000 births (national average being 153); infant mortality rates reach 66 deaths per 100,000 live births (national average being 471) and 82% of residents live on less than two dollars a day (52% nationwide). Furthermore, the chronic malnutrition rate for Quiche is 72.2%, while 1% of it is acute malnutrition (compared with a national average of 49.8% chronic malnutrition with 1% of it being acute).


Technical Assistance:

  • Reduce chronic and acute malnutrition and maternal mortality in the Western Highlands of Guatemala through the implementation of an integrated network of MNCHN services

Implementation Evaluation:

  • Identify factors which influence maternal and child health care seeking behavior
  • Understand the experiences of women who seek maternal and child health care in both formal and informal settings
  • Explore key factors that are helping or hindering the implementation of the integrated network of MNCHN services
  • Respectful Maternal CareThe project has a particular focus on measuring Respectful Maternal Care (RMC) within the project because few women in Ixil deliver in a facility (approximately 10%).  This is an opportunity to learn what is ‘different’ about the ten percent of women who deliver in facilities and how disrespect and abuse plays into the decision related to where women seek care for delivery. Moreover, experiences of non-facility childbirth and perspectives of traditional birth attendants will also be included in the implementation assessment to understand what drives decisions to deliver outside of a facility.

To learn more about TRAction Project efforts on Respectful Maternal Care, click here.


Technical Assistance: Some of the preventive and clinical packages that were implemented in the Ixil and Quiche Health Areas were: updating staff training in integrated activities for maternal health and monitoring of hospitals, health centers, and health posts in nutrition counseling to mothers as well as caretakers; complementary supplementation with micronutrients, immunizations; recognition of danger signs in children; provide technical assistance to health personnel and academic centers for the development of municipal and community surveillance system prototypes.    

Implementation Evaluation: TRAction completed an implementation evaluation that informed the processes and design of the integrated network of services, which includes understanding utilization of services provided by the integrated network and informal health area. The study helped identify key factors that affect care-seeking behavior and demand for services.  It also focused on cultural appropriateness, preferences, and experiences of disrespect and abuse while receiving care. The results found have provided lessons that will inform the strengthening of the integrated network of health services and its responsiveness to the population. This will also improve access and utilization of essential maternal, child and nutrition services among a population group that is traditionally excluded. 

Click here to read the preliminary report on this study's findings. The report is in Spanish. 


Principal Investigator: Hernan Delgado, URC
In collaboration with ​Cooperativa Agricola Integral Todos Nebajenses (COTONEB)


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