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

Bernardo Hernández ,Alexandra Schaefer,Emily Linebarger,Diego Ríos‐Zertuche ,Erin B Palmisano,Emma Iriarte,Benito Salvatierra,Charbel El Bcheraoui,M Thom ,Giovanni Flores ,Kitty S Harris ,Joseph N Camarda ,Pedro Bernal-Lara,Casey K Johanns,María Paola Zúñiga-Brenes ,Aruna M Kamath ,Julio César Mateus ,Isabel Cristina Casas ,Danny V Colombara ,Rebecca M Cogen ,Ali H Mokdad

doi:10.1186/s12884-021-04279-2

Abstract

BackgroundThe Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. 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.MethodsWe used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother’s locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women’s characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country.ResultsEquipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (β = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (β = − 0.130, 95% CI -0.23, − 0.03) more than in the comparison group.ConclusionsResults indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities’ capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.

Highlights

The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism
Our analysis on institutional delivery is based on 8754 births in the inclusion time frame for which data for the nearest facility are included in the study
Our study finds no significant impact of the intervention on the capacity of facilities to provide delivery care as measured by our capacity score, we find an improvement in specific aspects of equipment and staffing in intervention facilities, documented in previous studies [32], which suggests that SMI has helped countries to improve the capacity of their health facilities

Summary

Introduction

The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. The Salud Mesoamérica Initiative (SMI) is a publicprivate collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica since 2011 through a comprehensive health care strategy to improve access to, use of, and quality of maternal, reproductive, neonatal, and pediatric health services. It is coordinated by the Inter-American Development Bank, and, through a results-based aid mechanism, works with countries in the region to reduce health disparities in geographic areas with the highest proportion of the population living in poverty [9]. The main barriers to access to institutional delivery include economic and geographic barriers to travel to health facilities, including roads and transportation networks and availability of public or private transportation; lack of proper infrastructure and human resources in health facilities; negative perceptions about the health services; and cultural and religious barriers [10,11,12]

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