Data was needed on Salud Mesoamerica Initiative’s impact on child and maternal health inequalities.

Maternal and child health inequalities persist in Mesoamerica, particularly among the poorest 20 percent of the population. Limited access to quality health care services—including reproductive services, maternal and child health care, and immunizations—contributes to poor health outcomes in these vulnerable communities.

To address these challenges, strengthen overall health systems, and improve the quality and use of reproductive, maternal, neonatal, and child health, the Salud Mesoamerica Initiative (Iniciativa Salud Mesoamérica, SMI) employed a regional, 10-year public-private partnership to establish a results-based financing model that provided initial funding for evidence-based health care interventions. This partnership brought together governments, private foundations, the Inter-American Development Bank (IDB), and other donors to support interventions in Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and Chiapas, Mexico. After the program ended in 2022, the IDB pursued a rigorous evaluation of the project’s effectiveness and sustainability.

NORC is using mixed methods to assess the effectiveness and sustainability of SMI interventions.

The IDB asked NORC to undertake a final summative evaluation of SMI. Our evaluation analyzes quantitative data previously collected by the Institute for Health Metrics and Evaluation (IHME) with new qualitative data collected by us. To calculate pre- and post-intervention changes, we use quantitative data from households and health facilities in all eight countries. We estimate program causal impact by comparing data from intervention areas to non-intervention areas in Nicaragua, Honduras, Guatemala, and Chiapas, Mexico. We are collecting qualitative data in Belize, El Salvador, and Honduras via: 

• 69 key informant interviews with representatives from Ministries of Finance and Health, the IDB, donors, local health departments, hospitals and health center staff 
• 27 focus groups with community health workers, midwives, mothers, and their partners or family members. 

Our comprehensive approach also includes a context-mechanism-outcome framework to examine what works, for whom, and in what circumstances. This framework emphasizes the context of implementation and specific interventions that aim to influence mechanisms of maternal, neonatal, and child health (MNCH) to achieve intended outcomes.