Salud Mesoamérica Initiative (SMI)

Capturing changes in maternal and child health indicators, we assessed programs aiming to reduce inequalities in Central America and Mexico.

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.


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)
  • Fundación para la Educación y el Desarrollo Social (FES)
  • Instituto Nacional de Salud Pública (INSP)
  • University of Belize
  • University of Costa Rica



Regional reports

Final reports

Costa Rica




Country profiles

Costa Rica




Survey instruments and protocols

Data, survey instruments, and supporting documentation for all rounds of the Salud Mesomaerican Initiative evaluation are available on the GHDx.

Go to the GHDx

Selected 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 Initiative: Select results from the baseline measurement


Salud Mesoamérica Initiative: Select results from the first operation measurement


Salud Mesoamérica Initiative: Select results from the second operation measurement

Salud Mesoamérica Initiative: Select results from the third operation measurement

Salud Mesoamérica Process Evaluation: Evidence on Culture Change in Health Systems

Salud Mesoamérica Initiative: Mixed-Methods Evaluation Plan




Scientific publications

Scientific Publication

Impact of the Salud Mesoamerica Initiative on delivery care choices in Guatemala, Honduras, and Nicaragua

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.

Scientific Publication

Access and use of oxytocin for postpartum haemorrhage prevention: a pre-post study targeting the poorest in six Mesoamerican countries

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.

Scientific Publication

Assessing multidimensional care coverage for pre‐eclampsia in the era of universal health coverage: A pre–post evaluation of the Salud Mesoamérica Initiative

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.

Scientific Publication

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

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).

Scientific Publication

Results-based aid with lasting effects: sustainability in the Salud Mesoamérica Initiative

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.

Scientific Publication

Appropriate and timely antibiotic administration for neonatal sepsis in Mesoamérica

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.