Sustainability of the Healthy Municipalities Strategy in Guatemala

Abstract

Objective. Evaluate the sustainability of the Healthy Municipalities strategy in Guatemala in order to have solid evidence to support decision-making. Methods. A concurrent mixed-methods study was carried out in five phases: 1) theoretical-conceptual (based on a narrative review of the literature on sustainability, dimensions and categories were proposed for evaluation); 2) empirical (four municipalities were selected for convenience and 29 semi-structured interviews and four focus groups were conducted with key actors to explore sustainability; with this information, a score was assigned to each category and dimension); 3) analytical, by category and dimension (content analysis was performed for qualitative information, and totals and averages were calculated for quantitative information); 4) integrative (qualitative data were integrated into matrices by category and dimension, and quantitative data were supported by qualitative information); and 5) meta-inference (consideration was given to the context and its influence on the results). Results. Ninety-two (92) informants participated. In operational terms, progress was observed in the transfer and use of results, and in rotations in leadership. In the legal and political sphere, accountability and local planning were highlighted. In the economic sphere, progressive investment in health, water and sanitation was emphasized, as well as insufficient investment in social determinants of health. In the social sphere, few mechanisms were observed to promote and strengthen social participation. Conclusions. In the municipalities that participated in the study, a fair level of sustainability was observed in the Healthy Municipalities strategy.

The value and impact of embedded implementation research: insights from Latin America and the Caribbean

“…The embedded research studies in this supplement also reveal the critical importance of engaging communities and cultivating capacity to collaborate with other sectors to achieve health goals. Laureano-Eugenio et al reviewed Guatemala’s Healthy Municipalities strategy to improve its implementation; they documented potential for improvements in terms of promoting and strengthening social participation as well as insufficient investments in working on the social determinants of health ( 10 ). In another example, Sacoto et al studied an initiative focused on preventing non-communicable diseases in Ecuador; they found that insufficient institutionalization could limit the effort´s sustainability and that the initiative needs to improve its coordination with other sectors and actors ( 11 ).…”

La utilidad y el impacto de incorporar la investigación sobre implementación para mejorar la ejecución de los programas: perspectivas de América Latina y el Caribe

“…Los estudios sobre la incorporación de la investigación que se presentan en este suplemento también muestran la importancia fundamental de fomentar la participación de las comunidades y cultivar la capacidad de colaborar con otros sectores a fin de alcanzar los objetivos buscados en el ámbito de la salud. Laureano-Eugenio et al, al examinar la estrategia de Municipios Saludables de Guatemala para mejorar su ejecución, documentaron el potencial de mejorar en la promoción y el fortalecimiento de la participación social, así como la insuficiencia de las inversiones en la labor relacionada con los determinantes sociales de la salud ( 10 ). En otro ejemplo, Sacoto et al estudiaron una iniciativa para prevenir enfermedades no transmisibles en Ecuador y observaron que una institucionalización insuficiente podría limitar la sostenibilidad del esfuerzo y que era necesario mejorar la coordinación de la iniciativa con otros sectores y actores ( 11 ).…”

Desigualdades en la salud maternoinfantil de los migrantes: el caso de Haití y la República Dominicana

“…promoting and strengthening social participation as well as insufficient investments in working on the social determinants of health (10). In another example, Sacoto et al studied an initiative focused on preventing non-communicable diseases in Ecuador; they found that insufficient institutionalization could limit the effort´s sustainability and that the initiative needs to improve its coordination with other sectors and actors (11).…”