Recommendations for Sustainable Midwifery in Guatemala

Abstract

Guatemala plans to open its first government-sponsored professional midwifery school since 1960. During the new program's design stages, it is imperative to consider possible impediments to the program's sustainability. Schell's Sustainability Framework assesses internal and external domains to consider a program's capacity for sustainability. We conducted in-depth interviews with Guatemalan key decision makers and professional midwives (n = 7) and matched pertinent open codes from these interviews with Schell's Sustainability Framework's a priori domains. We analyzed the content of the coded segments, triangulating the findings with policy documents, peer-reviewed journal articles, and gray literature to identify facilitators and impediments to midwifery's sustainability. Recommendations follow. Our study revealed the following internal facilitators for sustainability: strategic planning, program adaptation, organizational capacity, and funding stability. External facilitators such as political support and funding sustainability were also present. The program's poor internal communications and weak external partnerships pose significant impediments to the program's sustainability. Program evaluation and public health impact were not discussed in the interviews, which merits further consideration. At the launch of this important midwifery program, program designers must heed recommendations informed by identified facilitators and impediments to increase midwifery's likelihood of success in Guatemala.