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Cultural Competences Help to Improve Healthcare among Indigenous Populations

Author(s): F. G. Arevalo1
Affiliation(s): 1Sociology, Universidad de San Carlos de Guatemala, Guatemala
Keywords: Maternal and neonatal health, indigenous health

Every three minutes, a neonatal death occurs in Latin America. The poorer urban and rural populations are the most affected and within them, in Guatemala, the indigenous population has also the lowest levels of access to basic infrastructure and insufficient coverage to essential maternal and neonatal health services. For instance, in Guatemala, the national neonatal mortality rate is 23 per 1,000 live births but in indigenous communities, the rate can reach up to 39, almost 60% higher. This paper will present a Case Study and Analysis of a new approach for health services provision, focused on Maternal and Newborn Care, developed for rural and indigenous areas of Guatemala. The approach is based in the incorporation, within a Basic Health Team, of an auxiliary nurse, called Mayan Obstetrical Nurse (MON), as a specialized health worker, in charge of neonatal health, within the maternal, newborn and child health (MNCH) continuum of care.


The purpose of this paper is to describe the process followed to design, implement and evaluate the incorporation, of the MON within a Basic Health Team, in rural and indigenous populations of Guatemala, where health service provision is provided by a programme called Extension of Coverage Programme (ECP) through a team, composed by 1 physician, 1 educator and at least one community health worker. Guatemalan Ministry of Health (MOH) provides services to approximately 4.2 million of inhabitants with this modality, sub contracting local NGOs, selected in an open and competitive process, with participation of local authorities and civil society representatives. However, even though, ECP has been working in the country for almost ten years, some indicators as Neonatal and Post Partum care, as well as Maternal Mortality have not been improved substantially.
Given this situation, two years ago the Ministry of Health, with the support of the International Cooperation, developed a curriculum of a new cadre, which was going to be focused to specifically address maternal and neonatal service provision. Beside of detect and refer complications, train and supervise traditional birth attendants, among other activities, some specific characteristics were defined: All participants should be Mayan, must have previous training, of at least 1 year as auxiliary nurse, some experience in maternal and neonatal care, be proficient in the language spoken in communities to serve, and reside in the area of work. MON was in charge of the National School of Nurses, and supported with scholarships granted by USAID.


MON experience is an innovative project in Latin American region, in particular for those countries with predominance of indigenous populations. After almost two years of the incorporation of the MON in health teams, there is solid evidence of improvements in some key maternal-child indicators, but also, there is solid evidence of improvement in the quality of services. In this point is necessary to stress that the majority of health personnel in Guatemala do not speak other languages but Spanish. Among the most remarkable results, there was an important increment for family planning information and use of methods for birth spacing. Post partum and neonatal early detection and care were substantially incremented and by the end of 2,007, more than 100 references were made, for mothers and newborns detected in danger of death.

Lessons learned:

The experience or MON produced several lessons, in relation with health workers and training centres. Cultural competences have showed to be extremely important in order to improve access and quality of health services. It is possible to develop acceptable levels of competence for community health workers to address critical public health issues, as maternal and neonatal death. With relatively small resources, Ministries of Health can be able to train, hire or certify qualified personnel to address key maternal and child health issues.

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