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. 2022 Jan 3;22(1):5.
doi: 10.1186/s12884-021-04279-2.

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

Bernardo Hernandez  1 , Katie Panhorst Harris  2 , Casey K Johanns  2 , Erin B Palmisano  2 , Rebecca Cogen  2 , Maximilian G Thom  2 , Emily Linebarger  2 , Charbel El Bcheraoui  3 , Aruna M Kamath  4 , Joseph Camarda  2 , Diego Rios-Zertuche  5 , María Paola Zúñiga-Brenes  6 , Pedro Bernal-Lara  5 , Danny Colombara  7 , Alexandra Schaefer  8 , Benito Salvatierra  9 , Julio César Mateus  10 , Isabel Casas  10 , Giovanni Flores  11 , Emma Iriarte  5 , Ali H Mokdad  12
Affiliations

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

Bernardo Hernandez et al. BMC Pregnancy Childbirth. .

Abstract

Background: 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. 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.

Methods: We 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.

Results: Equipment, 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.

Conclusions: Results 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.

Keywords: Evaluation; Low-income countries; Maternal and child health.

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Conflict of interest statement

Authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Sample composition
Fig. 2
Fig. 2
Probability of delivering in a health facility predicted from multivariate difference-in-difference models at baseline and follow-up in intervention and comparison groups, overall and by country
Fig. 3
Fig. 3
Probability of choosing a more distant facility for delivery predicted from multivariate difference-in-difference models at baseline and follow-up in intervention and comparison groups, overall and by country
See this image and copyright information in PMC

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