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Guatemala has the fourth highest rate of chronic malnutrition in the world, and the third highest maternal mortality rate in Latin America. The majority of the poverty, malnutrition, and maternal/infant deaths are concentrated among the indigenous population of the rural western highlands, where health services are thinly spread. This is the region where I performed my summer fieldwork with the organization Nutri-salud.
Nutri-salud is a project that aims to strengthen the quality and increase the coverage of community level health services. There are three main components to the project: reducing chronic malnutrition by improving the nutritional status of women of reproductive age and children under five, improving maternal/neonatal/infant health through better access to and improved quality of essential services, and through facilitating community mobilization and engagement to seek solutions to health problems.
I was assigned to the community mobilization component of the project to monitor the activation of Community Health Commissions (CHCs) in the Ixil region. CHCs are grassroots groups in charge of the community’s health and health care. Since February of 2013, Nutri-salud has been training health care facilitators and supporting those individuals as they train the CHCs to recognize “danger signs” in pregnant women and infants, and develop a plan of action to be implemented in case of a health emergency with the aim of reducing maternal and infant mortality. To evaluate the success of the CHCs’ activation, I attended trainings given by health care facilitators to the CHCs, and interviewed members of the CHCs to evaluate how much of the material taught at trainings they had learned and implemented.
Based on what I saw in the trainings, heard in the interviews, and read in reviews of the training materials and other related literature, I recommended revisions to the training materials, adjustments to the implementation of the trainings, and created new materials to be used in training the facilitators and for the facilitators to use training the CHCs. Additionally, I developed an interactive dramatization for the fully trained CHCs to practice the emergency plans in a simulation-type situation. These revisions and new materials can be used in all regions that Nutri-salud services, in addition to the Ixil region.
Before arriving in Guatemala, I knew little about the on-the-ground distribution of health care in rural areas. It was exciting to participate in Nutri-salud and the Ministry of Health’s collaborative attempt to reduce maternal and infant deaths in rural areas through community engagement. By taking responsibility for the health of their communities, active, well-trained CHCs have the potential to reduce the maternal and infant mortality rate in the western highlands and improve the general health situations of their communities as well.