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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 COVID-19 vaccination rollout strategy in Burkina Faso has been challenged by the proliferation of misinformation spread through the community, including through social media and other local media, which can lead to vaccine hesitancy. To address the situation, HP+, in concert with the Communications Unit of the Ministry of Health, first identified rumors and misinformation. The project then identified themes and developed messages with key responses stratified by audience (healthcare workers and the general population). Evidence-based information to address rumors and increase vaccination coverage has been disseminated through training and advocacy briefings with government, healthcare workers, civil society, bloggers, influencers, and local radio.
A March 3, 2022, article in the Zodiak, “HP+ Ends 5-Year Journey with Praises,” reports on the project’s achievements and closure in the district of Mangochi, where it provided technical and financial support around implementation of the country’s youth-friendly health services strategy. Support included orienting community groups and developing action plans to improve youth access to and uptake of health services. Later, activities evolved to include entrepreneurship training and supporting youth clubs as they grew, generated resources, secured funding, and formed the first ever youth-led cooperative in the district. As their businesses have grown, the youth clubs have continued to invest a portion of their profits into making youth-friendly health services accessible to their peers. “Since we were trained as a group, now our total assets are valued at over K5 million and, as individuals, we have progressed so well that some of us have built better houses,” said Gift Unyolo, Chairperson for Alinafe Youth Club in Nankumba Traditional Authority. The leader of Nankumba hailed HP+ for its achievements and said, given a chance to talk to the donors, he would lobby for more funding as the project has left a notable impact in the area.
To ensure standards are met to access and effectively implement PEPFAR’s “Game Changer Funds,” HP+ West Africa supported training of 16 participants from two networks of civil society organizations (CSO)—CUPIDON and CORAB—working in HIV and community surveillance in Togo and Burkina Faso. Support included the design of a competency-based training package consisting of nine modules focused on strengthening organizational capacities for governance and management, community and associative leadership, networking, project management and resource mobilization, monitoring and evaluation, and documentation of results. These skills aim to strengthen the organizations’ ability to effectively implement and monitor PEPFAR activities and country-level HIV policies and strategies. During the workshop, the CSOs developed a joint workplan to support one another. Remarking on the workshop, the president of CORAB stated, “During nearly 20 years of experience, this is the first time I have seen this dynamic of exchange and knowledge transfer. I would like to thank HP+ through [sic] USAID for this great initiative…these skills should eventually allow us to professionalize so that we can increase the mobilization of resources at the level of our associations.”
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.
The Burkina Faso national government, local officials, and community leaders recently agreed to a plan to coordinate family planning activities in two eastern communes. The signed partnership agreement, facilitated by HP+, enabled an annual allocation of FCFA 2 million (approximately US$3,600) for community leaders in Fada/Dori and Kaya communes to continue conducting awareness-raising activities on local radio, in health facilities, and during cross-generation dialogue. Parties to the agreement are the Ministry of Health, the East Region municipality of Fada, health districts, and the local community leaders’ union (Union des Religieux et Coutumiers du Burkina pour la Santé et le Développement or URCB/SD). The agreement is just one effort in Burkina Faso to promote family planning as a way to lower birth rates and infant mortality. Through the Sahel project, HP+ collaborated with URCB/SD to map community influencers and potential family planning spokespersons in three regions. A total of 720 local leaders were identified and trained in family planning promotion. Afterward, they held sessions on community radio and organized awareness sessions in health and social promotion centers. The messages were developed by the leaders and linked family planning advocacy to holy texts and cultural values. In each region, the leaders held an intergenerational dialogue on sexual and reproductive health with more than 30 participants including other traditional leaders, religious leaders, women, youth, teachers, and parents. Finally, leaders held advocacy meetings with local elected officials and health officials, where they shared community feedback from their family planning awareness-raising experiences and discussed ways to sustain the interventions, which were appreciated by their constituencies.
In a historic accomplishment, Malawi youth clubs supported by HP+ have banded together to form the first youth-led and youth-centered cooperative in Mangochi District. The cooperative will continue the individual businesses established by the clubs—beekeeping and the sale of honey—and the businesses’ support of local family planning initiatives. Such initiatives include revamping youth corners, buying bicycles and motorbikes to ferry youth to and from facilities, and supporting youth-friendly health services/family planning coordinators to conduct limited outreach. Members also hope to establish a facility separate from the hospital space where they now hold their regular meetings. The Thema Honey Youth Producers and Marketing Cooperative Society is one of only 12 in the district. To establish the cooperative, the individual clubs completed a required training facilitated by a multisectoral government team from central, district, and community levels and with financial and technical assistance provided by HP+. After the training, members applied to the Ministry of Trade and Industry for certification. Once certified, the cooperative will be eligible to access better markets for their honey as well as other government initiatives and opportunities.
After receiving an entrepreneurial training delivered jointly by HP+ and Feed the Future’s Agriculture Diversification Activity, participants from Nankumba Traditional Authority in the Mangochi district of Malawi used the curriculum and their own resources to orient other youth clubs on the topic. This raises the total number of youth clubs conducting social enterprises (such as bee keeping, maize farming, and goat farming) from the initial 15 clubs, two years ago when the training was first provided, to 29. Since a proportion of the profits from these businesses are invested in youth-friendly health services (YFHS), an increase in the number of clubs translates to an increase in YFHS investments. The vision of these clubs is to construct a youth resource center in their community through collective contributions, beyond the other investments currently being made. The youth resource center will serve as a separate space where FP information and some services can be provided, as the YFHS facility where youth currently access services is located within the local hospital and is quite small.
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.
Civil society organizations in West Africa are reporting progress in reducing stigma toward persons living with HIV and increasing access to HIV care after receiving organizational support and training from HP+. During fiscal years 2020 and 2021, HP+ supported the development of data collection tools and trained data collectors to use the tools to ensure PEPFAR-funded facilities provided a supportive environment for quality and barrier-free HIV services in 17 facilities in Burkina Faso and 25 in Togo. In initial feedback received so far, the trained organizations have seen a reduction in reports of stigma and an increase in access, specifically fewer instances of informal fees and earlier access to antiretroviral therapy. HP+ will continue to support the organizations in their efforts to secure funding and expand their monitoring objectives to better quantify the impact of HP+’s technical assistance.
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.
HP+ is working to advance implementation of a transformative reproductive health and family planning law in Madagascar by providing advocacy training to representatives of civil society organizations and government ministries. Twenty-eight participants from 17 civil society organizations and government ministries—including youth and women's organizations and three ministries (health, youth, and population)—attended an HP+-hosted advocacy training from February 24–26, 2021. Using the Advance Family Planning SMART approach, participants developed work plans, budgets, and SMART objectives. Examples of objectives include incorporating a budget line for state participation in contraceptive purchasing and conducting a situational analysis and consultation with persons with disabilities regarding access to reproductive health and family planning services. During the next 12 months, HP+ will continue to provide support and monitor the SMART objectives and advocacy plans developed and adopted during the training.
In the first collaboration of its kind, Mali’s workers’ unions and civil society came together recently to support Universal Health Coverage Day December 22. The event in the capital city of Bamako was supported by technical assistance from HP+. It brought together various stakeholders to demand government action on its universal health coverage (UHC) strategy. The Council of Ministers endorsed the universal health insurance plan and national fund for universal health insurance in 2018 as part of Mali’s UHC strategy, but implementation remains slow. To ignite implementation of the plan in 2021, HP+ partnered with the Civil Society Platform for UHC, a civil society group under the Global Financing Facility, to mobilize key stakeholders to push the government to adopt the necessary regulations to fully operationalize the insurance coverage. With support from HP+, the Civil Society Platform developed a UHC call to action and the workers’ unions agreed to sign. Full implementation of plan will contribute to improved health outcomes for Malians.
HP+ worked with the FP2020 Secretariat to develop new guidance on establishing strong “mutual accountability” approaches. The new guidance provides a “how-to” for governments to meaningfully engage civil society throughout the commitment process and how government and civil society can hold each other accountable for meeting 2030 commitments to family planning. The FP2020 Secretariat is rolling out the new guidance, and it will be officially launched in the coming weeks. The accountability guidance builds on HP+’s extensive experience supporting accountability for FP2020 commitments. It promotes including civil society throughout the commitment process—commitment-making, implementation, and tracking—and includes examples derived from an HP+ global review of existing social accountability mechanisms. FP2020 will disseminate this guidance through its country focal persons and other venues. Both the guidance and examples are available online.
In Malawi, youth clubs are thriving, enabling young people to continue to access youth-friendly health services (YFHS) during the COVID-19 pandemic. The 45 youth clubs in Mangochi, trained by HP+ and the USAID AgDiv Project in June 2019 on enterprise and entrepreneurship, have been mentored by an HP+-trained multisectoral ministry team and youth champion during the pandemic. They have invested approximately MWK 459,000 (US$611) in their respective centers, supporting the provision of YFHS and information on COVID-19 to youth throughout the region.
HP+ recently launched revamped message boards in the Family Planning Financing Roadmap website’s Community of Practice to support the sharing of information and resources about family planning financing among decision-makers, policy-makers, and advocates. The Family Planning Financing Roadmap is an online resource, which enables stakeholders to explore specific family planning financing options based on country context. The message boards and other learning materials are expected to help stakeholders identify sustainable ways for countries to fund their family planning initiatives and underpin their long-term health and development goals.
In Madagascar, HP+ has been supporting journalist trainees to provide information and news about family planning/reproductive health (FP/RH). Twenty news articles have since been produced that reach local, regional, and national audiences. Last November, 11 journalists were trained by HP+ on the fundamentals of FP/RH, the FP/RH law, and issues related to population and development. The following January, with HP+ support, nine of the trainees conducted field investigations to raise public awareness of early pregnancy, break taboos on contraception, and disseminate the FP/RH law. In July 2020, HP+ supported the development of a yearlong editorial calendar and dissemination strategy to support these efforts.
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.
In December 2019, Burkina Faso’s Ministry of Health launched a monitoring and evaluation (M&E) plan to measure its progress on increasing contraceptive access. The finalization and implementation of the Costed Implementation Plan M&E plan is an important milestone showcasing the country’s commitment to increasing modern contraceptive prevalence, which at 30.7 percent, is the highest in the West Africa region. The M&E plan was developed following the formation of a multisectoral steering committee and thematic groups comprised of public, private sector and civil society representatives who advocated for a tool to track progress, a model for the region. Read our news story for more details.
Cambodia took a major policy implementation step in its national HIV/AIDS response this month when the Prime Minister approved a resolution directing operational funding for the response and other key advancements, notably the eligibility of all people living with HIV to receive a Health Equity Card and recognition of the important role played by civil society organizations. The resolution also guides the Ministry of Health to amend policies for health center and hospitals to use their own funds for HIV/AIDS activities, in addition to Ministry’s national budget. This achievement represents the culmination of an extensive effort by HP+ Cambodia and its health advisors, who are embedded at the National AIDS Authority (NAA), to advance health financing policy implementation for people living with HIV. This effort included sensitization and capacity building with the NAA leadership and ongoing support for the entire policy advocacy process including the drafting of the board resolutions and proposal to the Prime Minister’s office. Moving forward, the Prime Minister’s directive calls for the Supreme National Economic Council to further study the fiscal space to ensure implementation of the commitments and to sustainably mainstream the HIV/AIDS response through strengthened human resources, procurement, supply chain management, and health information systems. HP+ will continue to support the NAA in implementation of the new guidance.
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.
Nigeria’s Abia State launched its social health insurance scheme on September 26, 2019, taking a major step forward in ensuring its citizens gain access to equitable, affordable, and quality health services. The launch comes after a year’s long engagement by Health Policy Plus (HP+), which provided technical support to the health insurance scheme that includes defining and costing of health benefit package, developing the mechanism for claims management and provider payments, and strengthening of the organizational capacity of the agency’s governing board, management, and staff. The launch event was attended by HP+ project director Suneeta Sharma and HP+ Nigeria deputy country director Gani Alabi and several high-level government officials, including the deputy Governor of Abia state, Dr Udeh Oko Chukwu and representative of Senator Orji Uzor Kalu, former governor of Abia state, who committed to enrolling vulnerable populations from his constituency through his eponymous foundation. The chairman of the House of Assembly’s committee on health also demonstrated political will reinforcing the legislatures’ commitment to policies and frameworks for universal access. The governor’s representative announced that disbursement of funds through the Basic Health Care Provision Fund would begin on October 1, flowing to the 292 accredited ward-level primary health centers. The event demonstrated community leadership and the importance of traditional leaders in overseeing the success of the health scheme at the local level. Moving forward, payroll deductions of formal sector employees will begin in October.
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Government and civil society health leaders from nine Francophone countries of West Africa called for the integration of community health workers into their nations’ health systems at a ground-breaking meeting in Lomé, Togo. The three-day workshop, held from September 16 – 19, gathered health officials and implementing partners, and local community health workers, who shared their perspectives. Senior officials from Togo’s Ministry of Health, WAHO and WHO’s West Africa office, along with U.S. Ambassador, Eric Stromayer joined a high-level opening ceremony. Eleonore Rabelahasa, the Senior Health Systems Strengthening and Policy Advisor in USAID’s regional health office, also participated in the three-day workshop. Five Togolese CHWs, who deliver a range of family planning, malaria and health consultations interventions, discussed the challenges and opportunities they face as front-line health workers and their perspectives to improve their capacity to improve equitable access to health services. The delegates developed action plans for each country with a goal to convene key stakeholders and put in place a plan of action by June 30, 2020.
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.
HP+ worked with Uganda-based Samasha Medical Foundation to scale-up its Motion Tracker—a locally-produced, civil society led tool that strengthens accountability and helps countries make progress toward their FP2020 commitments. HP+ supported its scale up from Uganda to Tanzania and Zambia, which resulted in broader community and stakeholder involvement and stronger FP2020 commitments in both countries that can be tracked and monitored. HP+’s work with Samasha helped cement the Motion Tracker as a sustainable, locally-grown approach to strengthening self-reliance and joint accountability, with Samasha receiving additional funding from the World Health Organization and the New Venture Fund to continue their work in Uganda, Zambia, and Tanzania, and further expand to Nigeria.
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 2017 and 2018, HP+ began developing tools and approaches to advance public financing for non-governmental organizations working in HIV and other health related areas. HP+ supported the Global Fund for AIDS, Tuberculosis and Malaria (the Global Fund) efforts to prioritize public financing to civil society organizations (CSOs) and non-governmental organizations (NGOs) as a critical factor in all countries’ paths to sustaining and financing their HIV, TB and Malaria programs. This included support to develop the social contracting diagnostic tool, and setting standards for analyzing the legal/regulatory factors inhibiting or enabling this government health system reform. The tools and approaches are now being used around the world by the Global Fund, HP+, and other technical assistance providers to support the uptake of social contracting. HP+ developed a policy brief to summarize the importance of advancing public financing for NGOs/CSOs/private sector as critical to HIV services and epidemic control. The brief outlines the key competencies and capacities needed to advance social contracting into government health systems. In Guyana, HP+ worked with government and other country stakeholders to identify the legal and regulatory barriers for public financing of CSO-led HIV services. In Kyrgyzstan, HP+ supported the Ministry of Health to develop regulations and protocols to implement public financing contracts to non-governmental organizations. In 2018, the government allocated funding to the mechanism.
The Ministry of Public Health has announced it will more than triple its budget to procure contraceptives in 2019. The budget item jump, from 62 million FCFA in 2018 to 200 million FCFA in 2019 comes as result of USAID-supported advocacy by family planning groups and support from Health Policy Plus (HP+), and promises to vastly increase the country’s capacity to provide voluntary family planning to meet demand. HP+ assisted Nigeren family planning advocates in forming The Network of Champions in Advocacy for Adequate Health Financing (RCPFAS) and, with the Directorate of Maternal and Child Health, provided guidance to its members to make the case for the increase, which meets a pledge made by the government at the Family Planning Summit in London in 2017. HP+ also helped organized a series of meetings with civil society and key Ministry of Health and Ministry of Finance decision makers to secure the commitment and the sign off by the Secretary General Ranaou Abache on November 22, 2018. Read more in our news story.
USAID and PEPFAR, through HP+ is providing technical support to Guyana’s national AIDS program secretariat to plan for the country’s transition from external to domestic financing of HIV programs and services. This support includes the development mechanisms the government can use to directly support civil society through new “social contracting” measures. A meeting held in mid-November resulted in consensus among nearly 50 civil society, private sector, and government stakeholders and donors to move forward with a social contracting model. In addition to implementation of the model, HP+ will provide additional support to Guyana’s mobilization of domestic resources for HIV programs, including developing costing of civil society-led services and programs and technical assistance to Guyana’s high-level HIV Transition and Sustainability Steering Committee.
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.
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