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SMI aims to reduce maternal and child health inequalities through a result-based financing model, where interventions are implemented in the areas representing the 20% poorest populations in each country and work to increase coverage of immunizations, reproductive services, maternal care, and child health services.  a doctor administers a finger prick blood test to a young girl

IHME is the independent evaluator of SMI. Our Institute works to capture changes in the key maternal and child health indicators targeted by SMI and assess the impact of interventions. Survey instruments are specifically tailored to each indicator and country, and the data IHME collects and analyzes, in collaboration with IDB, capture changes in the key maternal and child health indicators.

The initiative’s evaluation component include the following quantitative and qualitative models of data collection to comprehensively measure performance:

  • Household interviews: surveys in households capture use, access, expenditure, and perceived quality of key interventions for women of reproductive age and children under 5.
  • Biometric/anthropometric measurement: in select households, height, weight, and anemia measurements are taken, as well as dried blood spots for assessing effective coverage of measles vaccinations.
  • Health facility observation and interviews: surveyors record the availability of key interventions, supplies, equipment, infrastructure, staff, and good management practices.
  • Medical record reviews: information on record-keeping and quality of maternal and child health care, as measured against the norms in each country, is extracted from medical records.  
  • Qualitative methods: interviews and focus groups with key informants and community members, document review, and fact checking/fact-finding shed light on the processes and efficacy of SMI. 

Learn more about the qualitative process evaluation of SMI.

Survey instruments and protocols

Relevant survey instruments, protocols, and trainings used during the Salud Mesoamérica Initiative Evaluation can be found on the Global Health Data Exchange, along with data and materials from the baseline and first follow-up. 

Go to the GHDx
 

data collectors review survey information on a clipboard

Funding and partner organizations

The Salud Mesoamérica Initiative (SMI) is a public-private partnership between the Bill & Melinda Gates Foundation, the Carlos Slim Foundation, the governments of Canada and Spain, the Inter-American Development Bank (IDB), the countries of Central America and the state of Chiapas in Mexico.

The SMI Evaluation team harnesses the expertise of numerous distinguished organizations to carry out this work. Data is collected the following organizations across the nine participating countries:

  • El Colegio de la Frontera Sur (ECOSUR)
  • UNIMER
  • Fundación para la Educación y el Desarrollo Social (FES)
  • Instituto Nacional de Salud Pública (INSP)
  • University of Belize
  • University of Costa Rica

Results

Country profiles

Costa Rica

Guatemala

Mexico

Panama

Final reports

Costa Rica

Guatemala

Mexico

Panama

Presentations

DÍA 1 - ESPAÑOL | El Modelo de Financiamiento basado en Resultados para la Salud Global

DÍA 2 - ESPAÑOL | El Modelo de Financiamiento basado en Resultados para la Salud Global

Salud Mesoamérica 2015 Initiative: Data for Better Health

Scientific publications

Figure showing probability of delivering in health facility for Guatemala, Honduras, and Nicaragua
January 3, 2022
Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua
Research Article
We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery.
Chart of multidimensional care for neonatal asphyxia
December 1, 2021
Tackling equitable coverage and quality of care for neonates in hospitals: a pre-post assessment on asphyxia interventions in Mesoamerica
Research Article
Our objective was to assess the impact of the Salud Mesoamérica Initiative on neonatal asphyxia care in health centers and hospitals in the region.
March 16, 2020
Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries
Research Article
Haemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of oxytocin, before and after applying Salud Mesoamérica Initiative interventions in the poorest health facilities across Central America.
February 29, 2020
Assessing multidimensional care coverage for pre‐eclampsia in the era of universal health coverage: A pre–post evaluation of the Salud Mesoamérica Initiative
Research Article
Multidimensional care for pre‐eclampsia management increased across all facility types, countries, and severity of disease. The Salud Mesoamérica Initiative is a promising model for achieving such quality of care interventions in the era of universal health coverage.
February 12, 2019
Antenatal care as a means to increase participation in the continuum of maternal and child healthcare: an analysis of the poorest regions of four Mesoamérican countries
Research Article
Antenatal care (ANC) is a means to identify high-risk pregnancies and educate women so that they might experience a healthier delivery and outcome. The present analysis examines whether ANC uptake is associated with other maternal and child health behaviors in poor mothers in Guatemala, Honduras, Nicaragua, and Mexico (Chiapas).
October 16, 2018
Results-based aid with lasting effects: sustainability in the Salud Mesoamérica Initiative
Research Article
The Salud Mesoamérica Initiative is a public-private partnership aimed at reducing maternal and child morbidity and mortality for the poorest populations in Central America and the southernmost state of Mexico.
May 24, 2018
Appropriate and timely antibiotic administration for neonatal sepsis in Mesoamérica
Research Article
Neonatal sepsis is a leading cause of mortality among children under 5 in Latin America. This study examines the delivery of timely and appropriate antibiotics for neonatal sepsis among facilities participating in the Salud Mesoamérica Initiative project. 
April 16, 2018
Supply-side interventions to improve health: Findings from the Salud Mesoamérica Initiative
Research Article
Results-based aid (RBA) is increasingly used to incentivize action in health. In Mesoamerica, the region consisting of southern Mexico and Central America, the RBA project known as the Salud Mesoamérica Initiative (SMI) was designed to target disparities in maternal and child health, focusing on the poorest 20% of the population across the region.
October 27, 2017
Healthy competition drives success in results-based aid: Lessons from the Salud Mesoamérica Initiative
Research Article
The Salud Mesoamérica Initiative (SMI) is a three-operation strategy, and is a pioneer in the world of results-based aid (RBA) in terms of the success it has achieved in improving health system inputs following its initial operation. We investigated the influential aspects of SMI that could have contributed to its effectiveness in improving health systems, with the aim of providing international donors, bilateral organizations, philanthropies, and recipient countries with new perspectives that can help increase the effectiveness of future assistance for health, specifically in the arena of RBA.
October 17, 2017
Perceptions of and barriers to family planning services in the poorest regions of Chiapas, Mexico: a qualitative study of men, women, and adolescents
Research Article
In the poorest regions of Chiapas, Mexico, 50.2% of women in need of contraceptives do not use any modern method. A qualitative study was needed to design effective and culturally appropriate interventions.
March 15, 2017
Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study
Research Article
Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one.
January 23, 2017
Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries
Research Article
The purpose of this study was to identify factors associated with contraceptive use among women in need living in the poorest areas in five Mesoamerican countries: Guatemala, Honduras, Nicaragua, Panama and State of Chiapas (Mexico).
August 29, 2016
Alcohol abuse and other factors associated with risky sexual behaviors among adolescent students from the poorest areas in Costa Rica
Research Article
We applied the Integrative Model of Behavioral Prediction to analyze factors associated with risky sexual behaviors for adolescent students living in the poorest segments in Costa Rica.
August 19, 2016
Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries
Research Article
Poor women in the developing world have a heightened need for antenatal care (ANC) but are often the least likely to attend it. This study examines factors associated with the number and timing of ANC visits for poor women in Guatemala, Honduras, Mexico, Nicaragua, Panama, and El Salvador.
April 27, 2016
Institutional Delivery and Satisfaction among Indigenous and Poor Women in Guatemala, Mexico, and Panama
Research Article
Indigenous women in Mesoamerica experience disproportionately high maternal mortality rates and are less likely to have institutional deliveries. Identifying correlates of institutional delivery, and satisfaction with institutional deliveries, may help improve facility utilization and health outcomes in this population. We used baseline surveys from the Salud Mesoamérica Initiative to analyze data from 10,895 indigenous and non-indigenous women in Guatemala and Mexico (Chiapas State) and indigenous women in Panama. 
January 19, 2016
Diarrhea prevalence, care, and risk factors among poor children under 5 years of age in Mesoamerica
Research Article
Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011–2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. 
October 27, 2015
Missed opportunities for measles, mumps, and rubella (MMR) immunization in Mesoamerica: potential impact on coverage and days at risk
Research Article
Recent outbreaks of measles in the Americas have received news and popular attention, noting the importance of vaccination to population health. To estimate the potential increase in immunization coverage and reduction in days at risk if every opportunity to vaccinate a child was used, we analyzed vaccination histories of children 11–59 months of age from large household surveys in Mesoamerica.
July 14, 2015
Health and wealth in Mesoamerica: findings from Salud Mesomérica 2015
Research Article
Individual income and poverty are associated with poor health outcomes. The poor face unique challenges related to access, education, financial capacity, environmental effects, and other factors that threaten their health outcomes.
July 2, 2015
Comparative estimates of crude and effective coverage of measles immunization in low-resource settings: Findings from Salud Mesoamérica 2015
Research Article
Timely and accurate measurement of population protection against measles is critical for decision-making and prevention of outbreaks. However, little is known about how survey-based estimates of immunization (crude coverage) compare to the seroprevalence of antibodies (effective coverage), particularly in low-resource settings. In poor areas of Mexico and Nicaragua, we used household surveys to gather information on measles immunization from child health cards and caregiver recall. 
July 1, 2015
Breastfeeding practices among poor women in Mesoamerica
Research Article
We estimated the prevalence of ever breastfeeding, early initiation of breastfeeding, exclusive breastfeeding, and breastfeeding between 6 mo and 2 y of age using household survey data for the poorest quintile of families living in 6 Mesoamerican countries. We also assessed the predictors of breastfeeding behaviors to identify factors amenable to policy interventions.

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