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Mesoamerican Motherhood: A Look Back

By - Oct 15 2015

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To get an idea of Mesoamerican motherhood, we want to paint you a picture of where these mothers live. As the Economist wrote in a recent piece, Mesoamerica is a land of contrasts, where just a short flight from “the skyscrapers on the esplanade in a Mesoamerican metropolis…indigenous communities are so poor and malnourished that their young children can die for lack of a boat fare to get to the nearest health clinic.” It is a land where, despite economic growth and a swelling middle class, 1.8 million women and children across 121 of the sub-region’s municipalities live in extreme poverty, and where the symptoms of this extreme poverty translate into subpar—even dangerous—conditions for expecting mothers and their babies-to-be.

For an idea of these conditions, one need only look at the numbers: only 1 of every 2 pregnant women in the poorest 20% gives birth assisted by skilled personnel, while twice as many children under five die compared to the regional average. Those who survive face great obstacles to their health and growth, with five year olds in this demographic an average of 6 centimeters shorter than those in the wealthiest 20%. In this setting, where poverty compounds all development challenges, improving the lives of mothers, young children, and their communities required an innovative and targeted approach; one with key objectives, financial incentives, and firm deadline for progress.

Enter Salud Mesoamérica, an innovative public-private partnership which sought to reduce health equity gaps in Mesoamerica faced by the poorest 20% of the Mesoamerican population. Thanks to critical funding from the Carlos Slim Foundation, the Bill & Melinda Gates Foundation, the Government of Spain, and the Inter-American Development Bank, the initiative set out to back the efforts of Mesoamerican governments in reaching the health Millennium Development Goals with a particular focus on women and children under five years of age. Implementing tried and tested solutions to expand and enhance the quality of basic public health services, Salud Mesoamérica worked—at its core—to make Mesoamerican motherhood better across the board, focusing in the areas of reproductive, maternal, neonatal and child health care, maternal and child nutrition, and immunization.

Working in Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Mexican state Chiapas, Salud Mesoaméricaoperated on a few basic concepts that distinguish it from other projects. Its funds, for instance, can finance only evidence-based, cost-effective child and maternal health interventions. Governments and partners of the initiative bear equal responsibility for the cost, sharing on average 50% of all costs incurred. All results are verified by an independent third party through both household and health facility surveys. And lastly, countries who meet 80% of the targets of their performance indicators reap the benefits of this partnership’s innovative results-based financing model, receiving 50% of their original investment to use freely within the health sector.

Kicking off in 2010, the initiative teamed up with governments and health ministries to set specific targets and indicators for malnutrition, vaccination, and maternal and infant mortality and morbidity. With 2015 as its deadline, Salud Mesoamérica’s regional goals included reducing infant mortality by 15%, providing health services to 260,000 poor children, expanding vaccination coverage, and increasing by 50% births attended by skilled personnel to reduce deaths of mothers and newborns. But with only 50 of 100 poor women cared for by skilled personnel during childbirth (compared to 92 of 100 women in the wealthiest 20%), and mortality rates of children under five double those seen at regional levels, the initiative’s partners had their work cut out for them. How did they fare? The results are in.

Across the board, progress is visible. All countries have reflected a sizeable expansion of essential health care in a short period of time, with 69% of the negotiated targets met in 8 countries. Costa Rica, El Salvador, Honduras, Nicaragua, and Panama passed targets with flying colors. Elsewhere, results remain impressive, with all countries experiencing a change of mindset in which results-oriented health efforts are perceived as new and catalytic, where new evidence based strategies are emerging left and right, and where health supply systems are further strengthened every day. All countries are currently in the second phase of the program, working hard to reach health coverage and quality targets.

Though Salud Mesoamérica will continue working to expand access to health and though there is still much work to do, there is much to celebrate as well. As 2015 winds down, take a moment to reflect on the progress made thus far. Mesoamerican motherhood is better because of it.

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An example of success in El Salvador

 

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