Maternal mortality is disproportionately prevalent in low-income countries. Of the 295,000 women who died of complications from pregnancy or childbirth worldwide in 2017, 94 per cent lived in low-income and resource-limited settings. Guatemala’s Alta Verapaz region, where 78 per cent of the population lives in rural areas and 48 per cent live in extreme poverty, reported a maternal mortality rate of 273 in 2012. The EHAS Foundation (Hispanic American Health Link) is combating the issue of maternal mortality in rural Guatemala with the Healthy Pregnancy Project (HPP), a portable prenatal care kit that is designed specifically for use in remote areas. EHAS trains and equips local health personnel with a backpack that includes a computer, a portable ultrasound scanner – powered by a foldable solar panel – and, blood and urine analysis systems that use immediate test strips. Local health personnel organize days in their respective communities where women can come and be tested for possible pregnancy-related complications. Test results and ultrasound images are examined by local health personnel for any possible complications and health risks.
The Hard to Reach
Pregnant women in rural Guatemala lacking access to health care services.
In addition to its overall success in mitigating systemic barriers contributing to regional inequity, the Healthy Pregnancy Project (HPP) showcases important strategies that should be considered in other healthcare intervention contexts. Overall, its success in reaching difficult-to-reach populations included the following strategies.
- A strong NGO partnership network centred on one local partner is critical to the success of health interventions like the HPP. The importance of the TulaSalud-EHAS relationship to the HPP’s success demonstrates the need for strong local-international NGO alliances in implementing projects that depend on government support and familiarity with the local context.
- One of TulaSalud and EHAS’s key objectives for the HPP was to eventually transfer the program’s operational responsibilities to the government. In the long term, transferring programs to government control has both risks and benefits. However, government administration facilitates a project’s scale-up, which can result in institutional change and help a project become more entrenched in the public care system.
- The HPP’s scale-up in Guatemala reflected its staged rollout strategy. The HPP successfully scaled up its implementation from just one department to three, with plans to expand further to other departments, and even other countries. NGOs should strive to strike a similar balance between widespread rollout and fine-tuning their project to the local context to ensure that it remains effective and appropriate.
- Cultural competency embedded within a community-led approach contributed to an efficient, impactful and sustainable healthcare intervention. The HPP utilized local staff to build trust and overcome barriers in reaching rural and Indigenous populations across Guatemala.
- A key factor for the HPP’s success was its strategic use of technology, such as implementing a telecommunications platform in the portable kits that leverages the availability of cellphones and wireless service in remote areas, in addition to introducing new software innovations for data gathering and information management.
This research was made possible through the Reach Alliance, a partnership between the University of Toronto’s Munk School of Global Affairs & Public Policy and the Mastercard Center for Inclusive Growth. Research was also funded by the Ralph and Roz Halbert Professorship of Innovation at the Munk School of Global Affairs & Public Policy. We express our gratitude and appreciation to those we met and interviewed. We are also grateful to support staff, including translators, who helped make our research possible.
This research was vetted and received approval from the Ethics Review Board at the University of Toronto. Research was conducted remotely during the COVID-19 pandemic.