Bridging the Maternal Care Gap: Mobile Antenatal Care in Rural and Indigenous Guatemalan Communities
Maternal health disparities are an endemic problem in Guatemala but are particularly pronounced between Indigenous and non-Indigenous women because of inequalities in access to health care, especially in rural regions. In 2013 the maternal mortality rate among Indigenous women was more than twice that of non-Indigenous women, despite government efforts to strengthen rural health access through the rural Coverage Extension Program, implemented in 1996. Beginning in 2014, the national government, in collaboration with international NGOs TulaSalud (Canada) and EHAS (Spain), introduced the Healthy Pregnancy Project (HPP), initially in the Alta Verapaz department (or region) and subsequently in San Marcos and most recently in Huehuetenango. It equips rural nurses with portable ultrasound kits that can be used in the country’s most difficult-to-reach areas. Nurses actively seek out Indigenous women and provide rudimentary maternal health care, including ultrasound diagnostic impressions. Scans are transmitted electronically to physicians who provide authoritative medical advice.
The HPP identifies potentially risky cases and refers women to more sophisticated care. Nurses are trained centrally, and arrange community visits to ensure rural Indigenous women who are otherwise less likely to access maternal health care receive the health services that they require. The project rolled out gradually across different departments (or administrative regions). Though initially an NGO-led project, it has been handed over to local governments to administer. Implementation by local governments is critical to ensuring local context and circumstances are reflected in the program. Its implementation of a common information technology platform has also ensured the program is able to reach communities that are hardest to reach.