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Scaling-Up Management for Results Strategy

Photo of Child outside home in Guatemala, Photoshare


The objective of the Management for Results (MfR) Strategy is to link human, financial, and technological resource management to development goals and objectives. This includes employing policies, strategies, resources and processes to improve decision-making, transparency, and accountability. In a cooperative effort between the Ministry of Health and Ministry of Finance, the implementation of the MfR Strategy is an opportunity to improve health service provision, in alignment with the Zero Hunger Pact, which aims to reduce maternal mortality and chronic malnutrition among children under five. TRAction provided technical assistance to support the implementation of the Strategy.

In addition to the technical support, TRAction assessed the strategy's implementation through the use of an implementation evaluation.  Experience suggests that implementing the MfR Strategy in the public sector has proven to be a challenge for several countries in Latin America. Therefore, the implementation evaluation (also commonly referred to as a ‘process evaluation’) was useful in capturing information about program performance and documenting lessons learned.  This knowledge was then incorporated into further implementation of MfR activities in Guatemala and shared with key stakeholders through the development of a dissemination plan.


Guatemala: The MfR Strategy was implemented in priority Area Directorates covering the 166 municipalities with the highest prevalence of childhood malnutrition, according to the last census of school children height carried out in 2008. The Area Directorates were: Quiche, Ixil, Huehuetenango, San Marcos, Totonicapán, Sololá, Quetzaltenango, Chimaltenango, Chiquimula, Alta Verapaz and Baja Verapaz. However, the implementation evaluation concentrated on the Central Level of the Ministry, as this is where the Strategy originates, and on the Ixil Health Area.


The specific MfR Strategy objectives for each element of the project are described below.

Technical Assistance:

  1. Establish a strategic plan that clearly defines the results to be achieved in a given health budget.
  2. Allocate financial and budgetary resources to ensure required inputs for the delivery of products and services to the population.
  3. Define mechanisms and indicators (output, outcomes, input, etc.) for monitoring budget execution and establishing which available financial and budgetary resources determine positive improvements.

Implementation Evaluation:

  1. Document strategy implementation and determine fidelity.
  2. Explore how key contextual factors affected implementation of the strategy.
  3. Document overall lessons learned and implications for future strategy efforts.


The evaluation focused on Central-Level and the Ixil and San Marcos Health Areas.  Interviewees included MSPAS staff in Area Directorates and Municipal Health Districts; MINFIN staff, and SEGEPLAN staff.  Mixed methods were used, including  a review of implementation documents and records, key-informant interviews, group discussions and field visits.


Lessons learned in regard to the perception of the MfR strategy were:
  • The strategy was perceived as a very important process to create policies, processes, transparency, and accountability for the benefit of the population.
  • The considerable efforts by MINFIN and SEGEPLAN to lead and operate strategy implementation, as well as efforts by MSPAS to implement it have been recognized.
Lessons learned in regard to improvement opportunities for implementation were:
  • Training was insufficient to prepare key MSPAS staff and is considered a constraining factor to implementation of the strategy within the Operational Programming process.
  • MfR implementation was spontaneous.  A guiding document was needed to determine the technical scope, the results, and the definition of a plan to implement the strategy in the country.
  • Improvement is needed in the transfer of information, availability of equipment, and ease of connectivity to Cost Centers and to MSPAS, which operate the system.
  • Implementation of the MfR has focused on monitoring and evaluating MSPAS’ fiscal and budget executions, overlooking essential MSPAS functions which provide quality services to the population.
Lessons learned in regard to challenges at the institutional level were:
  • Governing bodies and MSPAS must have the same vision of the MfR Strategy’s objectives and implementation stages, instead of differing perceptions.
  • Staff turnover at the various MSPAS levels weakens the MfR strategy.
In accordance to the results and lessons learned, the following recommendations were developed to optimize the MfR Strategy:
  • Based on critical and operational processes, an inter-institutional, three-pronged approach is needed to provide practical solutions to process and system constraints.
  • Support should be provided to Key Strategy 7 of the MSPAS Strategic Plan pertaining to implementation of a Quality Management System, whose technical aspects are closely related to the critical processes contained in the MfR Agreement.  Emphasis should be placed on ensuring that MfR Strategy implementation strengthens quality service-provision processes to the population, and not only budget-management processes.
  • Coordination, internal management, and counterpart-definition mechanisms should be redefined.
  • The institution should perform an internal review within the framework of MfR implementation and its coordination mechanism with its Institutional Work Technical Group.
  • A comprehensive and overall analysis of the MfR Strategy and its programming and budget processes should be performed to define an implementation plan.

Click here to read the preliminary report on the study's findings. This is a Spanish-language report. 


Principal Investigator: Rodrigo Bustamante, URC

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