Abstract
BackgroundThe 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. Currently at the midpoint of implementation and with external funding expected to phase out by 2020, SMI’s sustainability warrants evaluation. In this study, we examine if the major SMI components fit into the Dynamic Sustainability Framework to predict whether SMI benefits could be sustainable beyond the external funding and to identify threats to sustainability.MethodsThrough the 2016 Salud Mesoamérica Initiative Process Evaluation, we applied qualitative methods including document review, key informant interviews, focus group discussions, and a social network analysis to address our objective.ResultsSMI’s design continuously evolves and aligns with national needs and objectives. Partnerships, the regional approach, and the results-based aid model create a culture that prioritizes health care. SMI’s sector-wide approach and knowledge-sharing framework strengthen health systems. Evidence-based practice promotes policy dialogue and scale-up of interventions.ConclusionMost SMI elements fit within the Dynamic Sustainability Framework, suggesting a likelihood of sustainability after external funding ceases, and subsequent application of lessons learned by the global community. This includes a flexible design, partnerships and a culture of prioritizing healthcare, health systems strengthening mechanisms, policy changes, and scale-ups of interventions. However, threats to sustainability, including possible transient culture of prioritizing health care, dissipation of reputational risk and financial partnerships, and personnel turnover, need to be addressed.
Highlights
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
Four themes on sustainability emerged relating to the tenets of the Dynamic Sustainability Framework (DSF) (Table 1), with corresponding DSF tenets noted in brackets
We have shown that Salud Mesoamérica Initiative (SMI), an ongoing health intervention in Mesoamérica, presents a promising potential for sustainability due to many features that fit within the DSF and subsequent application of lessons learned by the global community
Summary
Limited financial growth of development assistance globally, with more focus on diseasespecific aid rather than sector-wide approaches [12], provides an opportunity to develop novel funding methods, improved donor-government and regional partnerships, robust health systems, and sustainable initiatives suitable for replication. The Salud Mesoamérica Initiative (SMI) is a public-private partnership dedicated to improving maternal and child health among the most underserved communities in seven Central American countries and the state of Chiapas in Mexico. SMI focuses on five public health domains: child health, vaccines, family planning, antenatal care, and peripartum care Within these domains, specific performance indicators, such as health facilities must have permanent supplies of five types of modern family planning methods or antenatal care by a qualified personnel must start before 12 weeks of gestation, are measured at the end of each operation. With SMI having been successful far in meeting its targets per the first operation findings, the sustainability of the initiative deserves investigation to ensure the gains acquired will continue once external funding ceases
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