With HEP+ support, inter-institutional agreements that pave the way for the transfer of health functions to local health areas were signed on July 18 between Guatemala’s central government ministries and six municipalities. These agreements allow for improved coordination between central and local authorities and support capacity strengthening at the municipal level, empowering local health area directorates and municipal health districts to plan, operate, and monitor newly delegated responsibilities. With this increased monitoring at the local level, authorities can better monitor health outcomes according to the epidemiological profile of each municipality and thus, support the reduction of morbidity and mortality indicators. The newly delegated comprehensive healthcare approach is also anticipated to improve water and sanitation services for communities. HEP+ supported the Presidential Secretariat for Executive Coordination with designing a framework and methodology to collect input from stakeholders at all levels on the competencies to be delegated and provided input on the inter-institutional agreements.
Health and Education Policy Plus (HEP+) in Guatemala marked its completion featuring advancements in health reform and civil society leadership with a hybrid event on June 14. Derek Sedlacek, USAID Guatemala Director of the Health and Education Office, highlighted the collaborative nature of HP+’s work: The results achieved respond to the priorities identified collaboratively with the Guatemalan government and the Ministry of Health.…We are sure that all of the positive achievements from this [project] period will be maximized to continue improving health outcome indicators for the Guatemalan population, especially in rural areas. Two breakout sessions presented themes of civil society engagement and governance and health sector reform, with a focus on the project’s response to COVID-19. During the civil society breakout session, representatives from ALIANMISAR, the Men’s Network, and OSAR described their strengthened capacity as a result of partnering with HEP+ and how this had supported their health service provision, quality monitoring, and advocacy. Both sessions emphasized that the project’s achievements were possible because of collaboration, trust, and partnerships struck between the project and its key partners—the Guatemalan government and civil society organizations.
The Guatemalan Registry of Legal Entities on April 5, 2022, authorized the formal registration of three HEP+ civil society partners as nongovernmental organizations (NGOs). With NGO status, the National Alliance of Indigenous Women’s Organizations for Reproductive Health (ALIANMISAR), Network of Men for Health, Education, and Nutrition (REDHOSEN), and Young Artists for Social Justice (JAxJS) can gain stronger financial security through more fundraising channels. This will contribute to the sustainability of their networks and their work to continue advocating for improved access to health, education, and nutrition services in their communities. HEP+ has provided capacity development and financial support for the advocacy activities of its civil society partners for years, and over the past year has helped the organizations navigate the NGO-registration application process. You can read more about HEP+’s efforts to strengthen CSO capacity. in our brief.
Following years of advocacy by the National Alliance of Indigenous Women’s Organizations for Reproductive Health, Nutrition, and Education (ALIANMISAR) through letters and petitions to congressional committees, the Guatemalan Congress approved Law Initiative 6026 in March 2022. The law declares May 19 “National Day for the Dignity of Comadronas” (midwives) and allocates an annual payment of GTQ 3,000 (approximately USD 380) to each of the 23,000 nationally registered traditional midwives in the country. Approval of the law is a major step in symbolically and financially recognizing the important and demanding work of midwives, who provide maternal and neonatal health services in Guatemala. This law will be enacted as a part of the 2022 budget and is a result of the capacity strengthening HEP+ provides its civil society partners in the areas of political dialogue and advocacy.
HEP+ support came to fruition with the publication of two Guatemalan Ministry of Health (MSPAS) agreements that create new offices to support water, sanitation, and hygiene. In 2021, HEP+ provided technical assistance to an MSPAS team that assessed the flow of the water and sanitation project approval process and identified solutions through which to streamline project authorization. Following the assessment, HEP+ assisted MSPAS’s Integral Health Care Directorate with the technical, legal, and financial validation of two proposals before they were presented to MSPAS authorities. One establishes a Coordination Unit for Healthcare and Environment within MSPAS’s Integral Health Care Directorate. The other creates health authorization offices in each of the 29 health area directorates with the aim of streamlining the management of water, sanitation, and hygiene infrastructure projects in the country. With the creation of these new offices, approximately 400,000 Guatemalans from 22 different communities will have better access to potable drinking water and will benefit from future sanitation projects.
To capture and share the positive impact of health policy implementation, HP+ uses storytelling featuring local partners through film. On January 25, HP+ hosted a virtual watch party that featured a short film—“Why Policy Matters: Strengthening Family Planning Services for Guatemala's Indigenous People”—about Guatemala's National Contraceptive Security Commission (CNAA) and a network of local, multisector subcommittees helping to improve access to family planning services and commodities, especially to meet need among rural and Indigenous communities. The discussion featured representatives from the Reproductive Health Program of the Ministry of Health, the CNAA’s Observatory on Reproductive Health, and a community-based logistics coordinator for medicine. Similarly, on January 13, HP+ held a watch party for "Messages of Hope: Reaching Boys and Men with HIV and AIDS Information," followed by an interactive panel discussion with representatives from Malawi’s National AIDS Commission, the Evangelical Christian and Qadria Muslim associations, and the Chikwawa District Health Office. The short film documents how the Faith and Community Initiative in eight Malawi districts worked with religious leaders to engage previously hard-to-reach men and boys. The religious leaders incorporated “Messages of Hope”—accurate HIV messages that correspond with religious texts from the Bible or Qu'ran—into their sermons and day-to-day community engagement work. This effort is helping dispel myths and misconceptions about HIV, fight stigma, and increase willingness to access HIV services and treatment. View the full Why Policy Matters series.
At the end of December 2021, the government of Guatemala issued a ministerial decree to create the Special Unit for Medical Emergencies (SUME), which will serve as a 911-like service to assist Guatemalans in medical emergencies. HEP+ worked with the Vice Minister of Hospitals and other departments within the Guatemalan Ministry of Health (MSPAS) to ensure the legal, technical, financial, and administrative elements for creating this unit were established and integrated efficiently. SUME will be available nationwide and contribute to MSPAS efficiency and service quality for COVID-19 patients during the pandemic, as well as support Guatemalans with other medical emergencies. This month, MSPAS will develop a timeline for SUME implementation and a manual to guide SUME operations and functions.
At the request of USAID, HEP+ presented to USAID Washington and members of the Bureau for Latin America and the Caribbean on November 23, 2021, on the case for health sector decentralization in Guatemala and the flagship decentralization successes of the project. Some of these decentralization successes include the enactment of the National Decentralization Agenda, 10 prioritized ministries producing their own decentralization plans, assessing municipal capacity to take on decentralization responsibilities through HEP+-developed information systems, and leading capacity development to support municipal ability to take on new responsibilities. Between 2016 and 2018, the number of municipalities deemed capable of implementing the newly delegated functions doubled to 14. Health sector decentralization is a priority for HEP+ and the Guatemalan Ministry of Health. In 2022 the project will be prioritizing further legal reform, the continuation of municipal capacity development, and a “territorial ordainment” tool that will help the project prioritize municipalities for decentralization.
Herminia Reyes, Country Director for HP+ in Guatemala, discussed effective citizen participation approaches aimed at improving transparency and accountability in Guatemala at a December 7, 2021, virtual panel co-hosted by the PACE project, HP+, and USAID’s Office of Population and Reproductive Health (PRH) and the Center for Democracy, Human Rights, and Governance (DRG). The event—"Family Planning and Effective, Inclusive, and Accountable Governance"—highlighted the multisectoral benefits of investment in family planning and how it can support the long-term realization of effective governance and resilience. Reyes was joined by PACE’s Kenya Deputy Director, Chrysantus Shem, who provided a case study and Elizabeth Leahy Madsen who spoke about a new analysis showing the link between mature age structure, effective governance, and political stability. The panel was moderated by Lillian Benjamin of PRH and featured comments from David Jacobstein of the DRG Center. The webinar panel was held in the lead up to the Global Summit on Democracy, convened by the Biden Administration.
From November 16 to 18, 2021, HEP+ delivered a workshop to 21 participants to foster joint accountability among government and civil society on commitments outlined under Guatemala’s Law for Healthy Motherhood. This dynamic workshop gave civil society and government stakeholders the opportunity to discuss the accountability mechanisms and joint commitments related to improving maternal health in Guatemala, promoting transparency, and strengthening governance around adolescent pregnancy. Workshop participants prepared action plans to address adolescent pregnancy, which will begin with conducting qualitative research to learn more about gaps and opportunities for strengthening programs and approaches to prevent adolescent pregnancy. Applying what was taught at the workshop, participants plan to analyze the relevant health system actors, their accountability roles in the area of adolescent pregnancy, and the accountability relationships between relevant parties at the national and subnational levels. The networks will present results in March 2022.
In September 2021, Guatemala’s Ministry of Health (MSPAS) adopted the Home Management of COVID-19 Patients: A Practical Guide for Healthcare Personnel as national guidance. HEP+ is using the guide—which was adapted from HP+’s 2020 COVID-19 Home-Based Quality Care guide—to train MSPAS healthcare workers on how to provide home-based care. Since September 30, 2021, 133 healthcare providers from Alta Verapaz, Quiché, San Marcos, and Metropolitan areas were trained; the next training will be held in Huehuetenango. The guide will be shared with those who have been trained, who will then share the information with health personnel in their health areas who did not receive the HEP+ training. While written for healthcare workers, the guide is equally useful for personal use or when caring for a household member with COVID-19.
In August 2021, the National Alliance of Indigenous Women's Organizations for Reproductive Health (ALIANMISAR) and the Human Rights Ombudsman's Office (PDH) completed their most recent indicator data collection and health clinic monitoring using the V1000D monitoring tool. Previously, HEP+ supported the development of the tool—which houses indicators related to health services, products, and human resources—and has strengthened the capacity of ALIANMISAR to conduct data analysis and advocacy. The monitoring exercise revealed an undersupply of family planning methods, ferrous sulfate, and rotavirus and pneumococcal vaccines as most doctors were busy attending to COVID-19 patients, limiting their availability to provide other essential health services. ALIANMISAR presented department-level findings to relevant health area directorates to make the case for solutions to health service issues. PDH will compile and share findings and recommendations at the national level.
As a result of data collected and analyzed by HEP+, the Guatemalan Ministry of Health (MSPAS) authorized the COVID-19 vaccination for everyone 18 years and over in specific rural areas, as opposed to following vaccination administration by age groups. MSPAS also adopted a community engagement plan to better promote vaccination in rural communities. HEP+ conducted evaluations of two rural communities in Quiché and explained to the government the challenges of reaching the most remote communities while following the current national vaccination plan. HEP+ also collaborated with community leaders and municipal authorities to develop a strategy to promote vaccination in the rural community of Ixcán in Quiché. Since this engagement, Ixcán has experienced an increase in the number of people vaccinated and the percentage of the population fully vaccinated exceeds the department average of 10.3%. HEP+ is using the same approach of community evaluation, vaccination plan modification, and community engagement with the local health area directorates in the departments of Ixil, San Marcos, and Alta Verapaz, and aims to continue implementing the strategy at the national level.
Through a local civil society organization (CSO) partner, HEP+ successfully delivered 12 trainings to leaders from partner civil society organizations in Guatemala. Representatives from National Alliance of Indigenous Women’s Organizations for Reproductive Health (ALIANMISAR), the National Network of Men, and Young Artists for Social Justice (JAxJS) received trainings on project and financial management, fundraising, proposal development, marketing, and conducting social audits. The 12 sessions were attended by 1,863 participants from the various networks, and the average increase in knowledge as demonstrated by pre- and post-tests was 34 percent. HEP+’s collaborative partner was the Consultora Multi-Profesional S.A., which also provided mentorship opportunities for 70 network leaders with the aim of developing their skills through practical exercises in each of the training topic areas. Following these trainings, civil society groups are more empowered to sustain their gains in skills and knowledge and to hold authorities to account. For example, after the trainings, three civil society networks of Totonicapán organized a meeting with their Health Area Directorate in June to learn about the 2020-2021 budget execution of the Crecer Sano program, which aims to combat chronic malnutrition. The civil society groups of Totonicapán will be conducting new budget analyses with the information gathered during the meeting and will develop strategies to make better use of the program's financial resources.
Frontline healthcare workers at Guatemala’s Ministry of Public Health and Social Assistance (MSPAS) recently completed an HEP+-created series of training sessions on COVID-19 care. “Improving the Quality and Hospital Care of Patients with COVID-19” covered epidemiology and management of COVID-19, COVID-19 therapy and therapeutic options, intubation, mechanical ventilation, nosocomial infections, anesthesia and management of delirium, ventilator weaning, and other topics. Thirty-nine doctors and 42 respiratory therapists and nursing staff completed the 26 hours of theoretical and practical training in June. A second training series in July and August covered mental health for health workers, the use of antibiotics in the patient with COVID-19, post-COVID-19 syndrome, and fungal infections in a COVID-19 patient. Health workers who have completed the course will train the staff under their charge on the same material. Thus far, a total number of 1,421 attendees have attended these additional sessions in July and August. HEP+ will provide technical assistance to update the infection prevention and control manuals in the coming weeks.
Guatemala and Malawi recently launched two university courses on policy modeling, data utilization, and demography and development created with HP+ support. Public Health and Demography, Reproductive Health and Nutrition at the School of Medicine of the Universidad San Carlos de Guatemala is an initiative of the Technical and Academic Commission led by USAC faculty in the School of Medicine, of which HEP+ has been a part since February 2021. HEP+ led the course's development by coordinating workshops and course approval and developed the course documentation and modules. Classes include Introduction to Public Health, Public Policy Framework, Demography and Development, and Reproductive Health and Development. In Malawi, HP+ developed the Policy Modeling curriculum at the University of Malawi’s Chancellor College alongside professors in the college’s Department of Population Studies, contributing models for policy planning such as Spectrum, DemDiv, and ImpactNow. The course, which was developed in 2019 and approved in 2021, will be mandatory for fourth-year demography students. In both courses, students will gain knowledge and skills in analyzing and communicating complex data for decision making, set policy goals, and use model results for policy analysis, implementation, and planning. These activities will prepare students to be effective public health policy influencers and practitioners.
Traditional Guatemalan midwives—comadronas—recently received property from San Juan Ostuncalco for the creation of their own clinic. HEP+ supported the Observatory on Reproductive Health (OSAR)—Guatemala’s reproductive health watchdog—in the development of a proposal to the San Juan Ostuncalco Municipal Council for clinic space to provide medical services and store equipment. After the June handover of the property, clinic construction can begin. The clinic will be attended by 93 comadronas and remain open 24 hours a day. It is expected to serve 40 percent of the young children and pregnant women in San Juan Ostuncalco.
Building digital solutions for health was the focus of a recent online policy forum convened by the Health and Education Policy Plus project (HEP+) in Guatemala. HEP+, with the Ministry of Health and Social Assistance (MSPAS) and the Office of Human Rights (PDH), delved into the importance of increasing information-sharing through digital platforms. The July 27 forum featured opening remarks by Yma Alfaro of USAID and Herminia Reyes, HEP+ Guatemala’s country director, which led into descriptions of three data dashboards that monitor health and education indicators. The panel discussion that followed focused on the experience of MSPAS and PDH in working with the HEP+ technical team and how HEP+ support helped bring solutions to the population. Claudia Maselli of PDH emphasized that “the support of USAID, HEP+, and Palladium has been hugely beneficial to the institution. This partnership and leadership [with HEP+ have] enabled us to build these tools that monitor and publish the results of our work. The technical assistance has been very valuable for our entire team.” The online policy forum was held in Spanish with live English interpretation.
The School of Medicine of the Universidad San Carlos de Guatemala recently established a course titled "Public Health and Demography, Reproductive Health and Nutrition," with Health Policy Plus deputy director and family planning expert Jay Gribble delivering the launch keynote address. At the June 11 event, Gribble stressed the importance of focusing on the need for multisectoral approaches, systems interventions, and integrated methodologies to promote local development. In a blog post building on the speech—The Data Imperative in Guatemala's COVID-19 Recovery—Gribble and Robin Brazier, assistant country activity manager for Health and Education Policy Plus (HEP+) in Guatemala, shared their perspectives on the critical role data can play in improving public health and local development, particularly in the context of a global pandemic. In the post, they discuss how, as the COVID-19 pandemic continues in Guatemala, a focus on improved data collection and systems, data use, and data triangulation across sectors is imperative for decisionmakers to best address the pandemic’s impact across other health areas.
In June, HEP+ completed a series of training sessions for frontline health care workers at Guatemala’s Ministry of Health (MSPAS). HEP+ designed the content for and delivered the course, “Improving the Quality and Hospital Care of Patients with COVID-19.” The series covered topics such as epidemiology and management of COVID-19, COVID-19 therapy and therapeutic options, intubation, mechanical ventilation, nosocomial infections, anesthesia and management of delirium, and ventilator weaning. Eighty-one healthcare providers (39 doctors and 42 respiratory therapists and nursing staff) completed the 26 hours of theoretical and practical training. To continue the knowledge transfer within hospitals, those health workers who have completed the course will train the staff under their charge on the topics about which they have learned. HEP+ will provide technical assistance to update the infection prevention and control manuals in the coming weeks. A second training series is being conducted in July and August 2021, which will cover mental health for health workers, rational use of antibiotics in the patient with COVID-19, post-COVID-19 syndrome, and fungal infections in a COVID-19 patient.
Guatemala has streamlined the approval process for water and sanitation projects for 19,000 people in 22 communities, reducing the time needed for approval of water project from six months to one to two weeks. HEP+ provided technical assistance to the Ministry of Health and Welfare’s Integral Health Care Directorate, supporting the development of the streamlining proposal and its presentation to the ministry. The approved proposal also includes the creation of a National Water and Sanitation Office at the directorate, which will supervise the work carried out by other water and sanitation offices in the country.
With the support of HEP+, the Nutrition Institute of Central America and Panama (INCAP) has made significant progress in collecting baseline data for Guatemala’s Great National Crusade for Nutrition (GCNN), which aims to reduce malnutrition in the country. As of May 25, INCAP had visited 536 homes in Chimaltenango, Sacatepéquez, and the department of Guatemala as a part of an effort to identify municipalities most in need. Once baseline data collection is complete, the information will be used to monitor and evaluate the GCNN’s efforts, help the Guatemalan government better identify local health needs, and inform nutrition intervention delivery. In addition to preventing chronic malnutrition and anemia, the national strategy aims to reduce maternal and infant mortality and morbidity, promote food security and nutrition, strengthen food services, and prevent and infectious diseases. HEP+ support of the GCNN initiative includes creating systems for technical and operational analyses, a budget based on programmatic categories, and a strategy to define the resources and activities needed to strengthen the GCNN.
Prominent civil society organizations in Guatemala have come together to raise the profile of family planning and its role in men’s lives. Guatemala’s Network of Indigenous Women for Reproductive Health, the Young Artists for Social Justice of San Marcos, and the Network of Men for Health, Education, and Nutrition held an online conversation May 15 on “Family Planning and New Masculinities” to commemorate the International Day of Families. HEP+ supports gatherings such as this by facilitating partnerships between participating organizations. This discussion among network representatives promoted the importance and benefits of family planning, as well as the important role men have in family planning. This conversation is part of a broader HEP+ effort to build community understanding of and support for sexual and reproductive rights and to emphasize men’s responsibility in supporting their families.
HEP+ Guatemala held a virtual conference on May 6 for more than 480 healthcare and hospital workers about therapeutic options to treat COVID-19. It was the first in a series of 27 training sessions to develop capacities among frontline healthcare workers to improve quality of care for COVID-19 patients in Guatemala. Conference keynote speaker Dr. William Checkley, associate professor of medicine at Johns Hopkins University, shared resources to improve clinical practice in the care of COVID-19 patients. The session also featured remarks from Dr. Francisco Coma, vice-minister of hospitals for Guatemala’s Ministry of Public Health and Social Assistance; Dr. Yma Alfaro of USAID/Guatemala; and Herminia Reyes, country director for HEP+ Guatemala. The session improved understanding of current, evidence-based options available to treat patients diagnosed with COVID-19 and promoted the exchange of experiences, challenges, and improvements in patient care.
HEP+ is actively supporting the Guatemalan Ministry of Health and Social Assistance in rolling out the country’s second phase of its vaccination plan. HEP+ is coordinating efforts among government agencies, private sector representatives, and other implementing partners to set up in-person registration stands at accessible points and help deploy vaccination posts based on population density. HEP+’s activities have resulted in the installation of 547 vaccination centers and 49 registration stations for people without an internet connection. HEP+ also supported the ministry with the IT support necessary to launch its COVID-19 Vaccine Website, where Guatemalans can register online for COVID-19 vaccinations. With these activities, Guatemala expects to speed up the second vaccination phase, forestall crowds at vaccination sites, and increase the number of vaccinated people in the country. As of May 10, more than 131,000 people 70 years of age and older had registered on the website. Guatemala hopes to vaccinate 620,000 people over the age of 70 as part of phase two of its vaccination plan.
In its efforts to improve its family planning programs, Guatemala is moving ahead with addressing guidelines outlined in the country’s National Family Planning Strategy. With technical and financial support from HEP+, the Department of Guatemala last month formally established a Subcommittee on Contraceptive Security. Subcommittee members will develop their 2021-2022 work plan by August of this year and plan to address the guidelines outlined in the National Family Planning Strategy. Goals include strengthening family planning services, implementing comprehensive sex education in schools, and guaranteeing the supply of contraceptive methods in all health services. The Department of Guatemala is the largest of the county’s 22 geographic divisions and membership in the subcommittee includes representatives from the region's four health area directorates, which cover 20 percent of the country's total population. The subcommittee also will have representation from key nongovernmental organizations: the Asociación Pro Bienestar de la Familia de Guatemala, the Guatemalan Social Security Institute, the Organization for Women's Health & Development, the Reproductive Health Watchdog, and the Presidential Secretariat for Women. The establishment of the subcommittee is part of HEP+’s larger efforts to support the National Contraceptive Security Commission and the Ministry of Health and Social Assistance’s National Reproductive Health Program.
A participant at a recent HEP+ organized forum on female empowerment said that opposition from her own family is one of the obstacles women face in contributing to Guatemala’s civil society organizations. “[My family] told me that women only had to dedicate ourselves to having children, but I said no, that we also have to take advantage of the time we have and empower more women and support them,” said Amanda Baltazar, leader in a network in San Marcos. Amanda’s remarks were made at a virtual forum on March 12, one of two supported by HEP+ as part of International Women’s Day activities organized by REDMISAR, the JAxJS Network, and the Network of Men for Health, Education, and Nutrition of San Marcos. Participants in the discussion, "The Power of Women in Society,” described some of the challenges and opportunities that have motivated them to grow personally and professionally. The second forum, "Empowered Women," was organized by the Metropolitan JAxJS Network. Guest speakers shared their personal and professional challenges and explained how they have overcome them.
Guatemala's government last month launched a technical working group charged with streamlining public services related to education, health, citizen security, infrastructure, and the environment with an emphasis on the country’s inland regions. The group, the Decentralization Process Bureau (METPRODES) is the initiative of Guatemala President Alejandro Giammattei and Presidential Secretary for Executive Coordination (SCEP) Álvaro Díaz. The plan for decentralization will allow ministries to transfer functions and resources to the local level, improving quality of, and increasing access to, public services across communities. HEP+ has worked closely with the SCEP since 2016 to launch and implement the national strategy for decentralization and will continue to do so in support of METPRODES.
HEP+ Guatemala and one of its long-standing civil society partners are among the co-authors on a recent article on the importance of encouraging partnerships during challenging times such as the COVID-19 pandemic. The paper draws on a 12-country study series on multisectoral collaboration for health and sustainable development in the context of the health and rights of women, children, and adolescents to incorporate sectoral analysis into multisectoral research methods, develop a core set of research questions, and identify shared indicators of success and failure across sectors. The article, “Specific Considerations for “Research on the Effectiveness of Multisectoral Collaboration: Methods and Lessons from 12 Country Case Studies,” appeared in BMC Globalization and Health. Among its co-authors are Susana Palma from HEP+ and Silvia Xinico from HEP+ the partner National Alliance of Indigenous Women’s Organizations for Reproductive Health.
With the help of HEP+, the Guatemalan government is on track for a successful distribution of 400,000 doses of the COVID-19 vaccine from Astra Zeneca. After four months of HEP+ support, the Guatemalan government unveiled the National Vaccination Plan Against COVID-19 on February 9, will receive the vaccine in late February, and plans to begin distribution in the beginning of March. The vaccination process will cover several months and reach, in order, 1) health care workers, 2) those 70 and older, 3) people with pre-existing medical conditions, 4) other. HEP+ will continue to support the Ministry of Health for the full rollout.
HEP+ is training local leaders and experts in Guatemala on how to plan for and deliver services related to COVID-19. The training is designed to help participants work with local authorities in planning for both COVD-19 care and prevention services. So far, 130 area chiefs, epidemiologists, statisticians, and heads of service provision from five health areas have taken the course. In addition to these three trainings, reaching leaders from Escuintla, Santa Rosa, Retalhuleu, Suchitepéquez and Sacatepéquez health areas, HP+ is planning an additional three sessions. At the conclusion of the in-person training, HP+ will index the material and make it available throughout the country, giving health experts quicker access to this information to better respond to the ongoing pandemic.
HP+ supported the Guatemala Ministry of Health (MSPAS) in improving the quality, efficiency, and management of public spending through the development a Spending Quality Tool. The tool helps to automate reporting on the use of the health budget. It creates automated dashboards that monitor advances by unit, center, or cost, and type of purchase, among other classifiers, and generates reports. The tool replaces a manual reporting system, helping the MSPAS present financial results faster and saving on personnel costs. Delivery of the tool represents the first stage of HP+’s work; in the upcoming months, HP+ will develop another programming and planning module with budget planning and procurement scheduling functions.
HP+ has helped coordinate the donation of 50 ventilators, facilitated by USAID, to the Guatemalan Ministry of Health. In early December, HP+ provided more than 100 medical and paramedical personnel from five Guatemalan hospitals in-person training in the use of ventilators. Equipped with improved treatment protocols and patient care options, healthcare workers will be able to immediately use the ventilators to treat COVID-19 patients. They will also be able to provide other necessary therapies for adults and children in need of ventilator support. In upcoming weeks, HP+ will provide training for two additional hospitals and will continue to provide technical assistance to ensure adequate use and handling of the equipment.
Health Policy Plus (HP+) marked World Contraception Day this year with a focus on the positive, a welcome distraction from the COVID-19 pandemic, by asking our colleagues and partners, “what about contraception puts a smile on your face?” With a reflection by family planning and reproductive health lead, Jay Gribble, and a photo collage featuring messages from around the world, HP+ demonstrates many reasons to smile as voluntary contraception and method choice continue to improves the lives of women and men, their families, and communities.
Last month, more than 2,300 public and private sector health professionals in Guatemala participated in five hours of live training on COVID-19. The two sessions—broadcast on YouTube—featured presentations from top local experts and interactive questions from viewers. Since airing, more than 18,000 additional views have been recorded. In coordination with key health sector stakeholders, HEP+ facilitated and moderated the sessions and solicited participant input for future trainings. With a solid foundation of knowledge on the basics of COVID-19, health professionals nationwide will be able to improve practices in service delivery to support Guatemala’s pandemic response.
Two civil society networks supported by HEP+ in Guatemala—Young Artists for Social Justice (JAxJS) and the Sexual and Reproductive Health Watchdog’s Youth Branch (OSAR Youth)—are disseminating key messages to contain the spread of COVID-19 through social media and radio. Local members of JAxJS have produced songs and poetry on preventing contagion, which target young Guatemalans, that receive an average of 7,000 daily views. OSAR Youth has disseminated key messages on the importance of continuing to provide reproductive health services and prevent teenage pregnancies. These civil society partners continue their advocacy efforts amidst the pandemic to maintain FP/RH, human rights, and policy development for disenfranchised populations on the government's policy agenda.
On December 19, the Pharmaceutical and Other Health Technologies Policy was approved by ministerial decree in the presence of authorities from the Ministry of Public Health (MSPAS), the Guatemalan Institute of Social Security (IGSS), over 70 health sector public officials, and representatives of international cooperation agencies. The event where the policy was approved was led by the Minister of Health. The policy represents a strategic mechanism that guides, directs, and implements comprehensive actions with national reach. It strengthens health sector governance by establishing criteria and strategies to define roles and responsibilities in the management of medicines and other health technologies. It also unifies guidelines for health and public sector institutions to guarantee access to medicines to all Guatemalans. During the event, IGSS committed to adhere to the policy and collaborate with MSPAS to achieve its full implementation. The MSPAS Logistics Management Unit Director acknowledged the technical assistance received by the Pan American Health Organization, World Health Organization, and USAID/HEP+ during the design, development, validation, and approval process of the policy.
Read Local News Coverage:
In Guatemala, HEP+ has been supporting the National Network on Indigenous Women Rights, or REDNAMI, to strengthen advocacy and policy dialogue strategies and promote the long-term sustainability of civil society networks in Guatemala. On November 18, in observance of the International Day of Non-Violence against Women, REDNAMI held an event to discuss sexual and reproductive violence against indigenous women in Guatemala, advocating for government commitment to honoring human rights and minimizing violence against girls, adolescents, and adult women, and increasing funding for health and education—specifically targeting prevention of adolescent pregnancy, maternal death, and chronic malnutrition. Silvia Xinico, Coordinator of the National Alliance of Indigenous Women’s Organizations for Reproductive Health, Nutrition, and Education, served as moderator of the event, and emphasized the importance of including indigenous women’s issues in national policy.
Guatemala’s government leadership extolled the country’s progress and ongoing commitment to decentralization at the first-ever congressional session on decentralization and at a related meeting held days apart in early October. With acknowledgement of the USAID-funded Health and Education Policy Plus (HEP+) for its support of the government’s efforts, outgoing President Jimmy Morales and incoming political leaders both reiterated their commitment to decentralization of primary health care and education to the municipal level and the expected positive impact on health, education, and economic development of Guatemalans at all levels of society. Guatemala’s commitment to decentralizing primary health service delivery and education is enshrined in legal and regulatory statutes but implementation had lagged for several years. The congressional gathering comes at a time of political transition and was remarkable for the commitment to continue the effort by both outgoing and incoming leaders. The progress in implementing the country’s decentralization policy is at a pivotal time and comes after many years of effort by USAID and HEP+ to develop guidelines for implementation; support for civil society networks that demand accountability and monitor implementation; and for the development of an information system that supports decentralization. The SIPRODES information system, developed with support from HEP+, is an important data visualization tool that tracks the capacity and readiness of each municipality to take on newly devolved responsibilities; identifies and highlights areas for capacity development within the municipality; and establishes a communication path from the municipalities to the central government to signal readiness and evaluate how the municipalities are doing.
The National Reproductive Health Program, as coordinator of the National Contraceptive Assurance Commission, held the Contraceptive Assurance Sub-Committees Meeting on August 8 and 9, to implement Ministry of Health and Social Welfare guidelines requiring that each health area form its own contraceptive assurance subcommittee. The sub-committees, integrated with the support of HEP+, submitted their findings and challenges and exchanged experiences with representatives of the health areas and other organizations that will be part of future sub-committees. USAID representative Vikki Stein, who attended the meeting, said "I want to specially recognize the Ministry of Health as the governing entity, because it has taken a very important decision to extend the sub-committees to all health areas. This action is helping improve the lives of women by preventing maternal and infant mortality."
The Indigenous Women’s National Alliance for Reproductive Health, Education, and Nutrition (ALIANMISAR)—a Guatemalan civil society network supported by USAID through HEP+—signed a letter of understanding on July 2, with Acción Ciudadana (“Citizen Action”) with the aim of contributing to establishing the conditions and guidelines of cooperation for the promotion of transparency, anti-corruption legal assistance, training, and prioritization of social auditing. Acción Ciudadana is an entity that aims to promote the establishment of transparency mechanisms and processes to contribute to the achievement of a strong culture of democracy and the rule of law. In the future, Acción Ciudadana will conduct face-to-face activities for technical support in social auditing and cooperation through ALIANMISAR’s many activities, contributing to long-term sustainability.
HEP + supported the municipalities of Sacapulas (Quiché) and San Rafael Pie de la Cuesta (San Marcos), to develop and formalize the Food Security and Nutrition (SAN) Policies of each municipality, based on the "Guide to Elaborate the Municipal Investment Plan" also developed by HEP+. These municipal policies are based on four pillars: 1) Food consumption, 2) Biological use of food, 3) Availability and access to food, and 4) Institutional strengthening, and are in alignment with Guatemala’s National Development Plan, K’atun 2032. These policies make it possible to allocate municipal resources transparently and manage resources with other organizations that work on food security and nutrition. The municipality of San Rafael Pie de la Cuesta has already allocated funds in its annual budget to operationalize said policy. The implementation of these policies at the municipal level will aim to improve food and nutrition conditions and reduce chronic malnutrition in the municipality. HEP+ monitors the implementation of these policies and advocates with other municipalities to develop similar policies.
February 1 marked the first meeting of the year of Guatemala’s National Council of Rural and Urban Development (CONADUR). Representatives from the Ministry of Health, the Ministry of Finance, the Executive Coordination Secretariat of the President's Office, and the General Planning Office submitted proposals and progress updates related to the country’s ongoing process of government decentralization—an initiative supported by HEP+. As a result of the meeting, presided over by Guatemalan President Jimmy Morales, the council approved a regulatory framework for the administration of financial resources, planning, and implementation processes of programs and projects that will facilitate and increase transparency. HEP+ will continue to support the decentralization process by providing technical assistance to the Guatemalan government and other stakeholders.
The Office of the Human Rights Ombudsman (PDH) in Guatemala announced a commitment to expand its strategic alliance with ALIANMISAR, a local civil society organization, to assume the responsibility of monitoring the educational quality in the five education departments prioritized USAID and expand the program to schools in all 22 departments of the country starting on February 1, 2019. This commitment is a direct result of HP+’s efforts to build capacity within civil society networks and track progress on the program’s influence on the educational system; in the years since the program’s monitoring began in 2013, these networks have leveraged over US$3.8 million to improve 138 schools. Based on these positive responses to these results, the PDH and ALIANMISAR designed six questionnaires aimed at students, parents, teachers, and directors to collect demographic and institution-specific data that will provide a baseline for future educational interventions in the region. Additionally, the PDH has developed an online app to track and review the answers provided in these questionnaires, highlighting the visibility and accessibility of the data. The strategic alliance marks an important milestone for HP+’s efforts to achieve sustainable results that will have lasting effects in Guatemala as the PDH will accompany civil society networks to advocate for positive changes in the quality of educational services and will actively monitor future cases of human rights violations reported by students and educators.
In recent weeks, Guatemala’s Ministry of Education (MINEDUC) officially established the National Workforce Training System (SINAFOL) for school and extracurricular education systems. SINAFOL—a system that has been supported by HEP+ for over a year—is the structure that manages and coordinates the government, private sector, and social agents to define and implement policies and strategies that guide education and technical occupational training in the country. It incorporates standardization processes, training, evaluation and certification of labor skills, entrepreneurship, and citizenship in a permanent learning context. In addition to establishing the system in early November by ministerial degree, on January 3, MINEDUC published two additional decrees to (1) support the creation of six new careers in order to expand opportunities for young people in the education system, and (2) create a system of skill certification. HEP+ will continue to support the operation of SINAFOL and the skill certification system in coming months. Read the press coverage.
The HEP+ team in Guatemala continues their work to support the government’s health sector reform and to put in place a strong, decentralized system of governance and public service provision. In September, President Jimmy Morales reaffirmed his commitments to decentralization at a meeting of the National Urban and Rural Development Council and announced the launch of the HEP+-supported National Decentralization Agenda. Members of the HEP+/HP+ team were on hand to capture the President’s remarks and authored a blog, asking: Will decentralization achieve Guatemala’s promise of accountable, inclusive democracy?
With the support of the USAID-funded HP+ Guatemala (HEP+) and the successful advocacy of local networks since 2015, the Congress of Guatemala on August 17, 2017, approved a revision to the civil code to prohibit the marriage of minors, with no exceptions. A previous 2015 law established 18 years as the legal age of marriage, but judges could rule on exceptions, leading to marriage for 4,743 minors (13 and 17 years old) between 2015 and 2016. The revised civil code eliminates the loophole. Local organizations, including the National Alliance of Indigenous Women's Organizations for Reproductive Health (ALIANMISAR) and the National Men's Network (la Red Nacional de Hombres), with support from HEP+, used multi-faceted advocacy strategies to bring an end to child marriage. The elimination of the exception in the civil code means a brighter future for girls in Guatemala as it breaks the vicious cycle of "children raising children." The advocacy groups working closely with HEP+ continue to conduct outreach to local judges to monitor enforcement. Check our news article for links to local coverage.
With the support of the USAID-funded HP+ Guatemala (HEP+) and the successful advocacy of local networks, the Congress of Guatemala on August 17th approved a revision to the civil code to prohibit the marriage of minors, with no exceptions. A previous 2015 law established 18 years as the legal age of marriage, but judges could rule on exceptions, leading to marriage for 4,743 minors (13 and 17 years old) between 2015 and 2016. The revised civil code eliminates the loophole. Local organizations National Alliance of Organizations for Reproductive Health of Indigenous Women of Guatemala (ALIANMISAR) and the National Network of Men (la Red Nacional de Hombres), with support from HEP+, used multi-faceted advocacy strategies to bring an end to child marriage. The elimination of the exception in the civil code means a brighter future for girls in Guatemala as it breaks the vicious cycle of “children raising children.” The advocacy groups will continue to conduct outreach to local judges to monitor enforcement.
Read related news stories:
Since October 2016, the USAID-funded Health and Education Policy Plus (HEP+) has supported Guatemala’s Secretary of Executive Coordination of the President (SCEP) to promote decentralization in the national policy agenda. With HEP+ support, a National Decentralization Plan was approved by President Jimmy Morales in February 2017. On July 21, 2017, with President Morales in attendance, SCEP signed agreements with the Municipal Association of Los Altos in the Quetzaltenango Department to launch pilot decentralization programs in three municipalities. HEP+ will continue to support the implementation of these pilots through technical support for a National Decentralization Agenda (to be launched in September 2017) and the creation of operational and monitoring and evaluation plans. A local radio station covered the launch event twitter: https://twitter.com/RadioPuntoGT/status/888398025747509248
Representatives from Guatemala’s Ministry of Education (MINEDUC) launched EscuelAPP, a new mobile application designed to enhance civil society’s role in holding the national government accountable for high-quality education. The application was developed by the USAID-funded Health and Education Policy Plus (HEP+) and is linked to a database created and maintained by HEP+ and its predecessor policy projects. EscuelAPP is available to the general public and to local and national MINEDUC staff. It offers easy, real-time access to school-level information on teachers, school performance, and delivery of benefits. Ministry staff and civil society use the app to monitor performance and change and make comparisons across schools and communities.