HISTORY, A DETERMINANT OF HEALTH: Current Initiatives in Indigenous Guatemala

Welcome to May everybody!

For the last couple of months, we have been exploring how past experiences and events can impact the health of those in the present. We’ve taken some time to focus on Guatemala, explore the evolution of her health care system, and dive into its impact on her Indigenous populations. To wrap up our focus on Indigenous Guatemala, we are going to learn about one of the largest and long-running community initiatives that have made a national impact in improving healthcare delivery for Indigenous Guatemalan women.

In our first blog that focused on Indigenous Guatemala, we learned that in 1989, after almost 36 years of violence, the Guatemalan government formed the National Reconciliation Commission (CNR) in an effort to restore stability to the nation and give its citizens a platform to report the atrocities they had faced during the revolutions. By the end of 1996, 11 peace accords had been formed, and efforts were made to rectify divisions in the government. Plans within these accords were set to address social and structural issues and mandate a 50% increase in the public health budget. This increase in financial support aimed to eradicate polio and measles, prevent ill health, and decrease maternal and infant mortality. The National Alliance of Indigenous Women’s Organizations for Reproductive Health, Nutrition, and Education (ALIANMISAR) is one of the many networks that formed years after these accords to further address these public health issues.

What is ALIANMISAR ?

ALIANMISAR was first formed in 2006 by a network of indigenous women who recognized that there was a lack of cultural acceptability and a gap in the quality of healthcare being provided to their demographic. The network has collaborated with different sectors of the government, and various community-based organizations to form monitoring systems that evaluate the care being provided to Indigenous women at a range of public health services. These systems include interviews with service care providers, regular inspections of health facilities, and the tracking of quality in health equipment, supplies, and medicines. Over the years, these systems have led to crucial changes in health policies and legislations, and have collectively improved various aspects of Guatemala’s health infrastructure and its delivery of healthcare to Indigenous women.

Why MONITORING ?

As Guatemala slowly recovered from decades of armed conflict, the inequities between its Indigenous and non-Indigenous populations became very obvious. What was even more striking was how much bigger the gaps were for its Indigenous women, especially when it came to maternal care. It was estimated in 2000, that the national maternal mortality rate in Guatemala was 70 per 100,000 live births, with the rate more than doubling for Indigenous women. In an initial effort to approach this problem, ALIANMISAR introduced various monitoring systems to gather evidence of these inequities, gain knowledge on where these inequities were occurring, and develop initiatives that would allow for permanent change.

One of the first systems that ALIANMISAR implemented was service user monitoring. This system monitors the performance of health providers and the ability of patients to access their care. The implementation of this system has led to increases in quality of care and has helped indigenous women learn how to better utilize the services available to them. In addition to this, this system of monitoring keeps all government sectors involved accountable and ensures that the “health and human rights of Indigenous people” are upheld.

Why the need for COLLABORATION?

Over the years, ALIANMISAR has collaborated with various groups. From field offices in the Human Rights Ombudsman to the USAID-funded Health and Education Policy Project, the National Food Security and Nutrition Council, municipal governments, and the Ministry of Health. Their collaboration with these different stakeholders has granted the network many opportunities to explore all the inequities that surround maternal mortality. It has created spaces that allow for effective advocacy while targeting health services that contribute to rising inequities. From reproductive health services to nutrition, and immunization services, ALIANMISAR’s diverse collaborations have allowed access to the monitoring of various sectors of care that contribute to the health and well-being of Indigenous Guatemalan women.

ALIANMISAR’s collaboration with governmental bodies like the Ministry of Health has also been critical in directing political dialogue that advocates for systemic change, community initiatives, and modification of laws and policies. It has also given rise to the importance of “cultural appropriateness” and care that is tailored to Indigenous women and their communities.

Current CHALLENGES & LIMITATIONS

• Despite their long list of collaborations, ALIANMISAR is highly dependent on short-term grants and donor support. This is often not enough to cover all the areas where ALIANMISAR’s monitoring systems are present and can sometimes lead to reduced monitoring in various areas.
• The network of Indigenous women who keep ALIANMISAR going are volunteers. They do not get paid and are sometimes reliant on personal resources. This has resulted in a “high turnover of volunteers” and has presented other challenges that some may view as “inconsistent with the principles of equity and gender equity“.

Even with all these challenges, ALIANMISAR’s impact has not been stifled and the network’s achievements grow every year. As one of Guatemala’s longest-running community-led national alliances, ALIANMISAR has made a positive change in the delivery of healthcare for Guatemalan Indigenous women and continues to give hope for a better system that all of Guatemala can rely on.

For more information on ALIANMISAR and their work in Guatemala, please visit their website at http://www.alianmisar.org/.

Together we can make an impact on the health of the nations and the generations to come.

The mission of WHEF is to increase accessibility to medications and supplies for healthcare facilities in Guatemala and Grenada. If you are interested in hearing more about the work we are doing, or in connecting with us, you can visit our website, check out our instagram or facebook, or sign up to receive our newletters. If you would like to support us in our work, please donate here.

The mission of WHEF is to increase accessibility to medications and supplies for healthcare facilities in Guatemala and Grenada. If you are interested in hearing more about the work we are doing, or in connecting with us, you can visit our website, check out our instagram or facebook, or sign up to receive our newletters. If you would like to support us in our work, please donate here.