Inequalities in health outcomes, access, and quality of medical care remain entrenched in much of Mesoamerica, the region consisting of southern Mexico and Central America. While the region has experienced significant improvements in general health status over the past decade, inequalities in maternal, child, and neonatal mortality remain between and within countries. In many areas, vulnerable groups such as poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. The Salud Mesoamérica 2015 Initiative was set up to address these health inequalities in eight countries: El Salvador, Guatemala, Honduras, Nicaragua, Belize, Costa Rica, Panama, and Chiapas, Mexico.
The initiative seeks to help Mesoamerican governments achieve the health-related Millennium Development Goals and reduce health disparities in the region. The initiative invests in projects with evidence-based effectiveness in the areas of reproductive health, maternal and neonatal health, and child health, including immunization and nutrition. It also plans to deliver integrated supply- and demand-side interventions by using results-based financing, implementing evidence-based health policies and interventions, and creating incentives to increase the use and quality of health services for the poorest quintile of the population.
The Salud Mesoamérica 2015 Initiative is a public-private partnership among the Bill & Melinda Gates Foundation, the Carlos Slim Health Institute, Spain’s Cooperation Agency for International Development, the Inter-American Development Bank (IDB), and the countries in the Mesoamerican region. The initiative is administered by IDB.
IHME was selected to provide technical assistance under the Monitoring, Learning, and Evaluation (MLE) component of the Salud Mesoamérica 2015 Initiative. MLE monitors progress and generates knowledge and evidence about how results are achieved and is thus a critical component of program implementation. IHME is engaged in the following activities:
1. Provide technical assistance
IHME advises on the selection of performance indicators and performance targets to measure achievement at the national level. Key indicators include coverage of contraceptives, antenatal and postnatal care access for women and newborns, access to skilled birth attendants in an institutional setting, coverage of MMR vaccination in children ages 1 to 3, and quality assessments of several medical interventions related to delivery, antenatal and postnatal care, and immunization. Experts at IHME advise on how to define and measure each indicator, and IHME researchers help set performance targets by using existing data to analyze national and regional trends in coverage and outcomes before commencement of the baseline surveys. IHME experts also advise on sampling and study design.
2. Develop surveys and other instruments
To adequately measure health system performance and assess the impact of the Salud Mesoamérica 2015 Initiative, surveys specifically tailored to each indicator and country have been designed. Surveys are conducted in households and facilities in each country. The household surveys ask questions about use, access, and perceived quality of key interventions for women of reproductive age, newborns, and children under 5 years of age. The facility surveys ask questions about availability of key interventions at selected facilities.
In addition, trained field staff collect biometric data from households and review medical records. Blood samples from young children are used to measure coverage of MMR vaccination, height and weight measurements are used to assess prevalence of stunting in young children, and hemoglobin is measured in women and children to track prevalence of anemia. Data from medical facilities are used to measure indicators of facility capabilities and quality of care.
Combined, these four modes of data collection allow IHME researchers to measure and track use and access to key interventions, outcomes, and inputs and quality of care provided at facilities.
3. Monitor data collection
Data are collected at four points during the Salud Mesoamérica 2015 Initiative: at baseline, 18 months after baseline, 36 months after baseline, and 54 months after baseline. Collecting data at four intervals allows researchers to track performance at each phase and over the five-year duration of the initiative as well as provides opportunities for mid-course adjustments, if necessary. At each phase of the initiative, data collection activities are monitored to ensure high data quality and inform the results-based financing framework.
4. Analyze data and disseminate results
IHME researchers analyze survey data to measure and track performance of indicators at each of the four time intervals and reports results to IDB’s Coordination Unit. These results, in turn, will inform IDB’s negotiations with national governments and ongoing management of the Salud Mesoamérica 2015 Initiative. Another dimension of data analysis will allow researchers to test the impact of the initiative and specific components of it by comparing trends in intervention groups and control groups.
The direct impact of the Salud Mesoamérica 2015 Initiative is a greater understanding of the magnitude and nature of disparities in use, access, and quality of care in Mesoamerica. Armed with this improved information, governments can enact measures to promote use, improve access and quality of care, and reduce inequalities. The Salud Mesoamérica 2015 Initiative framework and instruments could be applicable to other countries or interventions.
The data and results generated from the Salud Mesoamérica 2015 Initiative will improve the capacity of national governments to develop regular, timely systems for collecting data on population health. In addition, these results will allow IDB, policymakers, and other stakeholders to assess the impact of the results-based financing framework and effectiveness of setting targets to measure the long-term performance of health systems.
The project’s goal is to reduce inequalities in access to high-quality health care and outcomes in poor, rural, and indigenous populations in Mesoamerica.