Focus on:
Standards-Based Management
and Recognition
Improving Maternal and Neonatal Health Care Services in Guatemala
Guatemala has one of the highest rates of maternal mortality in Latin America. This
rate is particularly startling, considering that the major causes of maternal death in the country
are preventable. The Guatemalan Peace Accords of 1996 called for the reduction of maternal mortality
as a key measure of the country’s socio economic success. To this end, in 2000, the Ministry of
Health (MoH) and Jhpiego’s Maternal and Neonatal Health (MNH) Program, in collaboration with the
Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, instituted
CaliRed, a quality improvement initiative for maternal and newborn health. The purpose of the
program was to improve the quality, performance and utilization of maternal and neonatal health
services, including normal care and management of complications, provided by skilled providers
in a network of health facilities.
CaliRed was formalized by the MoH in 2001 as a national strategy for improving
the quality of maternal and newborn health care. The program initially covered eight health areas
of the MoH and 30 municipalities with a total of 154 facilities and 99 communities. The facilities
included 10 hospitals, 44 health centers, 97 health posts and three maternities.
Using national norms and international evidence-based standards, program partners
developed a technical assessment tool and established criteria for measuring quality at the
facilities through the Standards-Based Management and Recognition (SBM-R) process, a practical
management approach for improving the performance and quality of health services. Seven key
technical areas were identified to assess performance, including emergency care during pregnancy;
labor, childbirth, postpartum, and newborn care; support services; infection prevention;
information, education and communication and demand promotion; human resources, materials and
logistics; and management systems. Jhpiego and partners trained MoH personnel to serve on
quality teams to conduct baseline assessments of quality at the facilities, identify gaps
in quality, analyze their causes and determine the interventions needed to ensure improvements
at each facility.
The CaliRed initiative achieved impressive implementation results during its
first six to nine months. Once the quality assessment teams conducted the baseline assessments
at the facilities, staff became motivated to introduce corrective measures to reduce the identified
gaps. Health care personnel incorporated improved clinical practices, cultural practices and
support functions. The facilities increased the level at which they met performance standards from
an average of 18 percent to an average of 51 percent. The teams noted achievements in all technical
areas. Moreover, important changes in evidence-based practices led to other tangible improvements
such as reduced patient stay at participating facilities, fewer blood transfusions and associated
cost savings.
A multidisciplinary assessment team composed of representatives from the MoH,
professional associations, civil society and universities was established to assess the facilities
for accreditation as quality sites. When the health care facilities met 70% of the performance
standards, they received recognition in the form of ceremonies, plaques and letters of commendation.
The opportunity for “cross-visits” to other, already accredited, sites was an additional incentive.
When the facilities met 85% of standards, they received accreditation.
The sustainability and scale up of the SBM-R methodology to improve maternal and
neonatal health care services in Guatemala has been remarkable, and is among the program's most
significant results. The program was expanded to a total of 222 facilities—15 hospitals, 66 health
centers and 141 health posts, covering nearly one-third of all public sector health care facilities
in the country. Through the SBM-R process, the MoH, health care personnel and communities are
working together to improve performance and quality in essential maternal and newborn health care,
especially in traditionally underserved rural areas.
SBM-R is still used today in Guatemala in some of the health districts, and is
being implemented by the USAID bilateral, "Calidad en Salud II." The approach is also being
implemented by the second largest health provider in the country, the Guatemalan Social Security
Institute, in two provinces and a maternity hospital in Guatemala City. SBM-R has been expanded
to other technical areas in addition to maternal and newborn health. The ongoing use of the SBM-R
approach in Guatemala demonstrates its longevity and sustainability as an effective management
tool to improve the quality of health care services in the country.
More Information
Additional information about Jhpiego's work in standards-based
management and recognition is available on under
What We Do and Media Center.
For additional resources on SBM-R, browse the
Human Resources for Health
and Information Sheets
sections of our Publications Catalog, or
contact us.
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