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Guatemala
>> Regional Overview >> Guatemala Overview Activity Data Sheet
PROGRAM: Guatemala
TITLE AND NUMBER: Better Health for Rural Women and Children, 520-003
PLANNED FY 2001 OBLIGATION AND ACCOUNT: $5,737,000 (DA); $5,226,000 (CSD)
PROPOSED FY 2002 OBLIGATION AND ACCOUNT: $7,000,000 (DA); $5,750,000 (CSD)
STATUS: Continuing
INITIAL OBLIGATION: FY 1997 ESTIMATED COMPLETION DATE: FY 2003Summary: Despite a 43% reduction since 1987, Guatemala still has the highest infant mortality rate in Central America and one of the highest in the hemisphere. The high maternal mortality ratio, especially among indigenous groups, reflects women's inadequate access to reproductive health services. This objective seeks to improve the health status of Guatemalan women and children at the national level and to diminish the disparity in health indicators between rural Mayan families and the rest of the country. By targeting assistance in seven predominantly indigenous departments, the purpose of the objective is to reduce the infant mortality rate (IMR) by 20% from 51/1000 to 41/1000 live births and to decrease the total fertility rate (TFR) from 5.1 to 4.8 births during the 1995-2002 period. Since the IMR and TFR are 14% and 24% higher, respectively, among Mayans than the national averages for these indicators, USAID is developing new approaches to improve the quality and accessibility of maternal-child health (MCH) services in indigenous communities. An important element of these new models is the reduction of cultural confrontation between indigenous and western health systems. USAID supports both the Guatemalan Government and local nongovernment organizations (NGOs) in their efforts to improve health practices. The direct beneficiaries of USAID assistance include men and women of reproductive age and children under five years of age who are gaining access to preventive and curative MCH services, including reproductive health.
Key Results: (1) Increased use of MCH services by enhancing demand for health care and improving the quality of care provided at health facilities and by community health workers; (2) Better management of MCH programs of both the public sector and local NGOs by improving logistics systems to guarantee well stocked rural health facilities, and by strengthening financial and administrative systems; and (3) Stronger Guatemalan commitment to integrated women's health by engaging local NGOs in family planning programs and helping policy makers use reliable demographic and health data to define policies that will permit more Guatemalan couples to elect the number and spacing of their children.
Performance and Prospects: The Government of Guatemala's Health Sector Reform Initiative, that began under the former government in 1996, emphasizes coverage of health services in the poorest and most remote regions of Guatemala through public-private partnerships. This initiative continues under the new administration. During 2000, for the first time, the Guatemalan Government made reproductive health a top priority and the Ministry of Health launched a national Reproductive Health Program. As a result, the program accomplishments exceeded expectations in reproductive health, historically the most challenging part of the program. With Development Assistance funds, record growth was achieved in "new family planning users" and "couple years of protection" (CYPs), both of which greatly exceeded targets. Coverage of health services has greatly increased, especially in the poorest and most remote rural areas of Guatemala. Countrywide, about 3 million inhabitants that previously did not have access to health care services are being served by NGOs contracted by the Guatemala's Ministry of Health (MOH). Activities financed under the objective are specifically designed to address the factors that give rise to the urban-rural differentials in terms of use of family planning methods, vaccination coverage, prenatal care, intra- and post-partum care, maternal mortality, and infant mortality. These include increasing the geographic and linguistic accessibility of services; improving health providers' technical competence, interpersonal communication skills and cross-cultural understanding; and strengthening behavior-change efforts and referral systems.
The Pan American Health Organization (PAHO) is providing support to local and central levels of the MOH to increase immunization coverage. With CSD funds, USAID assisted the Government of Guatemala in launching the Integrated Management of Childhood Illnesses (IMCI) program. The results of USAID assistance have been excellent, as demonstrated by comparing the 1995 and 1999 national health survey results: the infant mortality rate dropped from 51 to 45 per 1,000 live births; the contraceptive prevalence rate grew from 31% to 38%; and, the percent of children between 12 and 23 months who were immunized grew from 43% to 60%. As a result, new more ambitious targets have been set for 2002. Survey data will be available again in 2003. The target for "met need for essential obstetric care" was reached in 2000. "Absence of contraceptive stock-outs" an indicator for better management of MCH services had a mixed performance. The Family Welfare Association met the 2000 target, but our two public sector partners fell short. A number of corrective measures are in place to ensure strengthening of public sector management capacity. The integrated women's health advocacy indicators greatly exceeded expectations and contributed to the improved policy environment score (PES) up from 45 in 1997 to 52 in 2000.
In FY 2001, USAID intends to obligate a total of $10,963,000 ($5,737,000 DA/$5,226,000 CSD) in order to reach the following goals: 1) more rural families use quality MCH services ($3,767,210 DA/$3,598,860 CSD); 2) government and NGO-based public health programs are better managed ($1,326,120 DA/$1,561,480 CSD, including $499,000 for HIV/AIDS surveillance); and, 3) better definition of policy and use of data by GOG support integrated women's health ($643,670 DA/$66,660 CSD).
In FY 2002, USAID intends to obligate a total of $12,750,000 ($7,000,000 DA/$5,750,000 CSD) in order to achieve the following results: 1) increased access to better quality MCH services and improved household health practices, especially in rural indigenous areas ($5,152,300 DA/$3,973,460 CSD); 2) better managed public health services ($1,407,700 DA/$1,729,130 CSD, including $500,000 for HIV/AIDS surveillance); and 3) stronger Guatemalan commitment to integrated women's health ($440,000 DA/$47,410 CSD).
Possible Adjustments to Plans: In 2001 USAID will design a new HIV/AIDS activity to establish a national HIV/AIDS surveillance system in order to measure the overall effect on the epidemic of national prevention and mitigation programs.
Other Donor Programs: The Inter-American Development Bank (IDB) is financing a two-phased health sector reform loan to improve access to basic health services in rural areas and to improve hospital efficiency. USAID coordinates closely with the IDB and the Ministry of Health in the design of community health reforms and provides technical assistance for the implementation of reforms at the local level, especially in the predominantly indigenous areas of the western highlands. USAID and the Pan American Health Organization (PAHO) enjoy a productive working relationship, especially in the area of childhood immunization. Plans are underway for a joint USAID-PAHO initiative to continue improving immunization coverage. USAID continues its lead role in the area of reproductive health with other donors such as the European Union and United Nations Population Fund (UNFPA) gradually delivering increased support to reduce maternal mortality and improve reproductive health in the country. USAID is the major donor, providing approximately half of all donor support in the health sector.
Principal Contractors, Grantees, or Agencies: Current long-term grantees include the Ministry of Health, the Social Security Institute, the Family Welfare Association (APROFAM) and a local pharmaceutical distributor (IPROFASA). Long-term U.S. grantees include the University Research Corporation, Project Concern International, the Population Council, Management Sciences for Health. Current long-term U.S. partners operating under USAID Global Bureau projects include the Johns Hopkins Program for International Education in Reproductive Health (Maternal Neonatal Health Project), John Snow Incorporated (Family Planning Logistics Management Project), the Futures Group International (Policy Project) and the Population Council (Frontiers Project).
FY 2002 Performance Table
Guatemala 520-003
Performance Measures:
Indicator FY97
(Actual)FY98
(Actual)FY99
(Actual)FY00
(Actual)FY00
(Plan)FY01
(Plan)FY02
(Plan)Indicator 1: Percent of Children Under Five Years Treated for Pneumonia (B - 1995) 41% NA 37% NA NA NA 0.45 Indicator 2: Percent of Children Under Five Using Oral Rehydration Therapy or Increased Liquid Intake During Diarrheal Disease (B - 1995) 51% NA 59% NA NA NA 0.65 Indicator 3: Percent of Children 12-23 Months Fully Immunized (B - 1995) 43% NA 60%* NA NA NA 0.7 Indicator 4: Contraceptive Prevalence Rate (B - 1995) 31% NA 38% NA NA NA 0.41 Indicator 5: Total Fertility Rate (B - 1995) 5.1 NA 5 NA NA NA 4.8 Indicator 6: Infant Mortality Rate per 1,000 live biths (B - 1995) 51 NA 45 NA NA NA 41 Indicator 7: Couple Years of Protection (CYP)** 62.1 64.7 79.1 93.3 89 94 97 Indicator Information:
Indicator Level (S)or(IR) Unit of Measure Source Indicator Description Indicator 1: IR Percent INE, Macro & CDC Note: All data, except CYPs, are from national family health surveys in 1995 and 1999. For children under five years of age, the percent of cases of cough and rapid breathing in the two-week period prior to the survey that are treated by a health provider. Indicator 2: IR Percent INE, Macro & CDC Note: All data, except CYPs, are from national family health surveys in 1995 and 1999. For children under five years, the percent of diarrheal episodes occurring in the two-week period preceding the survey that are treated with oral rehydration therapy or increased fluid intake Indicator 3: S Percent INE, Macro & CDC. Note: All data, except CYPs, are from national family health surveys in 1995 and 1999. Percent o children aged 12-23 months who have received all of the following vaccinations: DPT3, Polio3, BCG and measles. * Ministry of Health data for 2000 show great progress under this indicator, but because of reliability issues, we will continue to report on survey findings, which as noted above, will be available in 2002. Note: All data, except CYPs, are from national family health surveys in 1995 and 1999. Indicator 4: IR Percent INE, Macro & CDC Note: All data, except CYPs, are from national family health surveys in 1995 and 1999. Percent of women aged 15-49 who are using (or whose partner is using) a contraceptive method at a particular point in time. Reported for women who are either married or in sexual union. Note: All data, except CYPs, are from national family health surveys in 1995 and 1999. Indicator 5: S Average number of births per woman SINE, Macro & CDC Note: All data, except CYPs, are from national family health surveys in 1995 and 1999. Average number of children that would be born to a woman during her lifetime if she were to past through all her childbearing years conforming to a current schedule of age-specific fertility rates. Note: All data, except CYPs, are from national family health surveys in 1995 and 1999. Indicator 6: IR Infant deaths per 1,000 live births INE, Macro & CDC. Number of deaths of infants under 1 year of age per 1,000 live births (direct estimate). Note: All data, except CYPs, are from national family health surveys in 1995 and 1999. Indicator 7: S CYPs per calendar year SPartners' logistics management information systems (APROFAM, Ministry of Health, Social Security Institute, IPROFASA and other USAID-supported NGOs). Note: All data, except CYPs, are from national family health surveys in 1995 and 1999.
This indicator measures the estimated protection (in terms of couples protected for one year) from pregnancy provided by family planning methods based upon the volume of contraceptives sold or distributed. In 2000 CYPs were recalculated for 1997 onwards using standard conversion factors as follows: 1 IUD = 3.5 CYP; sterilization (male or female) = 11 CYP (Guatemala); 15 cycles of oral contraceptives = 1 CYP; 120 condoms/VFTs = 1 CYP; 4 Depo-Provera injections = 1 CYP; 1 trained NFP user = 2 CYP; 4 LAM users = 1 CYP. The 1999 actual figure was revised upward based on final data from partners. As a result, 2001 and 2002 targets were increased. ** In 2000 CYP figures from 1997 onwards were recalculated using standard conversion factors recommended by USAID/Washington. The 2001 and 2002 targets have been revised upwards based on excellent performance in 2000. U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 19,944 DA 9,728 DA 10,216 DA 17,082 CSD 4,797 CSD 12,285 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Fiscal Year 2000 4,500 DA 5,931 DA 5,275 CSD 6,779 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 0 DFA Through September 30, 2000 24,444 DA 15,659 DA 8,785 DA 22,357 CSD 11,576 CSD 10,781 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA Prior Year Unobligated Funds 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 5,737 DA 5,226 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 5,737 DA 5,226 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 7,000 DA 7,000 DA 44,181 DA 5,750 CSD 6,613 CSD 39,946 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 0 DFA
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Last Updated on: May 29, 2002 |
