San Cristóbal, Totonicapán, in western Guatemala has a population of approximately 30,000 residents, 90 percent of whom are indigenous K’iché. Some 30 percent are illiterate; 80 percent are poor, 40 percent extremely so. In 2000, the rate of infant mortality was 55 for every 1000 live births, compared to a rate of 45 nationally. Indigenous women were three times more likely to die in childbirth than other Guatemalan women.
In 2001, Asociación Consejo de Mujeres Mayas de Desarrollo Integral (CMM), a grassroots organization managed for and by indigenous women received $190,025 from the IAF to organize a network of volunteers to address health issues in nine villages around San Cristóbal. Approximately 19,000 residents were expected to benefit.
The IAF is a pioneering donor to grassroots organizations providing health services to indigenous Guatemalans. The results include dramatically better survival rates of women and children in poor communities. Guatemala’s rates of infant and maternal mortality are among the highest in the Western Hemisphere and, as indicated above, the statistics especially grim for indigenous citizens. CMM proposed to address these problems by providing training for 30 midwives in pre- and post-natal care and 145 other community volunteers to address the leading causes of childhood mortality and other health issues. The project included inoculations, preventive health classes and a nutrition program. A cadre of 30 pharmacy managers also trained by CMM would offer safe, reliable access to medication in the participating communities.
In 2010, a team of evaluators from the IAF visited San Cristóbal to assess whether conditions had improved and health services were maintained after IAF funding ceased in 2006. Among the most noteworthy findings are the following:
- Volunteer trainers increased from 45 in 2001 to 145 in 2006. In 2010, 155 volunteers conducted sessions on preventive health measures.
- There were no trained midwives in 2001. By 2006, 37 had been trained and there were 39 active midwifes in 2010.
- Midwives now charge the same fee for delivering boys and girls. Before CMM intervened, delivery of a boy cost more because males were valued more.
- Comites Comunitarios de Desarrollo (health committees) link each community to government services and health authorities.
- The 1,222 home gardens planted to address chronic malnutrition in small children and inadequate nutrition in women represented a five-fold increase over the original goal set.
- CMM’s improved ability to leverage resources is reflected in an increase in its annual budget from $143,000 in 2001 to $227,000 in 2010.
Improvements in the health of residents of the nine communities can be attributed to CMM’s work. Women and their families adopted practices conducive to good health thanks to workshops organized by CMM’s volunteers. Local physicians who had previously ignored referrals by midwives, began to take these health workers seriously and admit their patients for treatment. The IAF’s funding helped CMM develop and earn credibility as an organization.
Examples of CMM’s effectiveness:
- The maternal death rate decreased from 7 per 1,000 births in 2001 to none in 2006 and in 2010.
- Infant mortality decreased from 45 per 1,000 births in 2001 to 37 in 2006 and 27 in 2010.
- Midwives have gained professional recognition among physicians. Guatemala’s ministry of health has contracted CMM to provide health services and hired several of its volunteers.
- Home gardens supply foods essential to a balanced diet conducive to the development and health of children.
Midwives learned when to refer difficult cases to the nearest hospital and when to dispense iron supplements, folic acid and tetanus shots. They also adopted basic practices, such as wearing gloves during a delivery, which prevents infection and improves survival rates.
Rural pharmacies, or botiquines, are functioning where none existed before. They are managed by volunteers who dispense over-the-counter medications, provide first-aid and hold discussions on preventive health measures. However, four of the 18 launched with IAF funding had closed by 2006 because of low profit margins.
The health committees, which include women and men, continue to meet regularly to discuss health issues affecting residents and coordinate activities with other health-care providers.
CMM’s ties to the communities resulted in trust, collaboration and networking that contributed to their success. The volunteers combine both standard medical practies and K’iche traditions consistent with the expectation of those seeking their help. This encourages residents to seek out medical care rather than going without.
Benefits of the pharmacies included convenient access to medication in the communities served. Through CMM’s training, the managers in the volunteer network became well-versed in preventive measures. However, CMM’s policy of providing medication at low prices puts the long-term economic viability of the pharmacies at risk.
CMM’s focus on training and organizational development was crucial to the grantee’s success. Through its network of competent volunteers, CMM continues to monitor conditions and offer education and training. Its long-term sustainability will depend on effective leadership, donated labor and time, and CMM’s ability to diversify its sources of funding beyond the contract’s it now receives from Guatemala’s government.