Improving maternal-infant health and reducing malnutrition of children under the age of two in Guatemala

Impact Evaluation Plan (PR-3549) (Only in Spanish)

The objective of the program “Improved Access and Quality of Health and Nutrition Services" during Phase I, is to improve access, use and quality of primary and secondary health and nutrition services, to help improve maternal and child health and reduce chronic malnutrition in children under two years of age.        

The program will focus on at least 77 of the 147 Guatemalan municipalities (municipios) that currently have priority status under the conditional cash transfer program.  The main program activities would include expanding coverage and strengthening the delivery model of the preventive nutrition program Comprehensive Community-based Care for Women and Children (AINM-C). Coverage Expansion Program would be created in each jurisdiction and would be comprised of a team of three educators to focus on key activities, such as individual counseling and home visits to children who fail to gain weight or attend weighing sessions.

Coverage of basic primary healthcare services will also be expanded and their quality improved through the use of Mobile Medical Groups (MMGs) which are mobile teams that travel at least once a month to isolated rural communities to provide basic health and nutrition services. The MMGs also include two educators who carry out preventive nutrition activities.

The indicators of interest for both interventions are:  weight and height; anemia; and knowledge and adoption of practices (exclusive breastfeeding, supplemental feeding, micronutrients, immunization, hygiene, care of sick children, general childcare, seeking timely healthcare, family planning). The indicators for the MMG model include immunization, prenatal care and postnatal care.

The program impact evaluation strategy will focus on strengthening the AINM-C and expanding the MMGs. In the first case a random allocation design will be used. This will enable half of the jurisdictions covered by each provider to be served at the start of the program (after establishing the baseline) and the other half to be covered in the fourth year of implementation. Through this simple scheme, it will be possible to estimate the impact of the intervention (comparing changes in indicators in both groups at the end of the third year as a result of strengthening the AINM-C teams) and major inputs will be available to improve the design and implementation of the program.

In the case of the MMGs, 47 municipalities will be served during Phase I and the remaining 30 during Phase II. As the priority status of the municipalities was assigned according to their levels of poverty, in this case a random selection cannot be applied. Therefore the design of the evaluation is non-experimental, but extremely rigorous, with the criteria for setting up the comparison group defined beforehand (statistical pairing will be based on data from the 2002 Population Census and the census of the Mi Familia Progresa program) as well as the impact measurement strategy (comparing changes in indicators in beneficiary and non-beneficiary communities). A baseline covering all the municipalities will be established as well, and another survey will be conducted at the end of Phase I.