Bottlenecks and barriers to effective coverage of early childhood health and development interventions in Guatemala: A scoping review

Abstract

Objectives. To identify bottlenecks and barriers to effective coverage by Early Childhood Health and Development (ECHD) interventions in Guatemala. Methods. A scoping review of more than 100 peer-reviewed articles, grey literature, and other academic publications was conducted. Articles published from 2005-2019 were considered. Results were analyzed using the Tanahashi model of effective coverage that categorizes coverage by five domains: availability, accessibility, acceptability, contact, and effective coverage. Results. A total of 103 articles were identified, addressing 337 bottlenecks and barriers to effective coverage by ECHD interventions in Guatemala. Most occurred along the acceptability dimension (35.9%). The findings revealed four opportunity spaces: (i) strong political interest and commitment (opportunity for leadership); (ii) vibrant community health networks (opportunity for leverage); (iii) availability of promising evidence-based projects and interventions (opportunity for scale-up); and (iv) strong agency presence (opportunity for collaboration). Conclusions. Most bottlenecks and barriers to ECHD interventions in Guatemala occur around acceptability, followed by accessibility and availability. There is considerable potential for national leadership, leverage, scale-up, and collaboration of ongoing efforts in the country. These results may be used to inform future research and policymaking. The Tanahashi approach is an effective lens of analysis that can be applied to other countries, geographic areas, and contexts in future studies.

Principles Based Budgeting: Resources for Revisioning Academic Planning

“…Factors influencing service coverage depend on the availability of a service to the stakeholders who should benefit from it (Marra & Espinosa, 2020). Understanding service coverage involves assessing a variety of factors, such as availability of resources (commodities, facilities, personnel), people's attitudes to the service (acceptance, social norms, religion), as well as the actual quality/success of the service (Stewart et al, 2009).…”

“…A coverage measure is then defined for each stage (usually through a ratio between the number of people for whom the service condition is met and the target population). Evaluation of coverage is based on five measurements that help to mitigate bottlenecks in resource allocation (Marra & Espinosa, 2020). Availability Coverage refers to the amount of service that can be made available to the target group as determined by the bottleneck of essential resources required to provide the service.…”

“…Availability Coverage refers to the amount of service that can be made available to the target group as determined by the bottleneck of essential resources required to provide the service. Accessibility Coverage is the amount of service made accessible to the target group, which mitigates bottlenecks of geographical and financial accessibility (Marra & Espinosa, 2020). Acceptability Coverage refers to acceptance of any service by the target group(s) through reducing barriers of religious, cultural, economic, or other inhibiting factors.…”