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Brochure of the Salud Mesoamerica 2015 initiative [ENG]
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In Mesoamerica, inequality measures six centimeters. That is the average difference in height between five-year-old children in the poorest 20 percent of the population and those in the wealthiest fifth.
““
Salud Mesoamérica 2015, a five-year
initiative, has been launched to close the
health equity gap in Central America and
the southern states of Mexico.
Between birth and age five, each
additional centimeter of height is
associated with higher cognitive skills,
stronger performance in school and,
eventually, a better chance to earn
decent wages. Amplified over the span
of a lifetime, those six centimeters can
become an abyss separating the poor
from the wealthy.
The height difference is due to
malnutrition, but it is also caused by the
absence or poor quality of basic health
services.
Most governments in Mesoamerica have
made important progress in providing
these services to their people. Indicators
such as life expectancy and infant
mortality have improved dramatically in
recent years. But these gains have yet to
reach the most marginalized populations,
with parts of Mesoamerica lagging
behind their peers in other regions.
4
Who are we?
Who are we? The Salud Mesoamérica 2015 (SM2015) Initiative is an innovative public-private
partnership between the Bill & Melinda Gates
Foundation, the Carlos Slim Health Institute (ICSS),
the Government of Spain, and the Inter-American
Development Bank (IDB) to reduce health equity
gaps affecting the extreme poor according to
priorities established by the countries in the region.
This is a five-year Initiative scheduled
for completion in 2015.
The Bill & Melinda Gates Foundation, the Carlos
Slim Health Institute, and the Government of
Spain are each contributing US$50 million for the
implementation of life-changing health solutions
aimed mainly at poor children and women in the
region. The US$150 million will finance projects in the
areas of reproductive health, maternal and neonatal
health, maternal and child nutrition, immunization,
and malaria and dengue.
The Initiative supports the efforts of the governments of this region to achieve the health Millennium Development Goals through investment in interventions of proven efficacy for the 20 percent poorest of the population
The IDB is the executing agency responsible for
designing projects jointly with ministries of health
which, in turn, allocate counterpart resources.
5
The Initiative envisages supporting enhancement
of information systems and strengthening of human
resources among health systems.
The Initiative will support information systems
and human resources strengthening within
health systems.
The Initiative works in close coordination with the
Mesoamerican Public Health System (SMSP) and
is a catalytic tool to achieve regional health goals
established by the SMSP and the Council of Central
American Health Ministers (COMISCA). A regional
vision and alignment with country health agendas
is critical to the Initiative’s success and its impact in
vulnerable communities.
ObjectivesWhat are the objectives of the Salud Mesoamérica 2015 Initiative? The work
of the Initiative will focus on reducing the
equity gap in coverage and quality of basic
health services for millions of people living
in poverty in the Mesoamerican region,
particularly women and children under five
years of age.
The Initiative supports regional govern-
ment efforts to meet the health Millennium
Development Goals through investment in
proven efficacy interventions for the poor-
est 20 percent of the population. Moreover,
the Initiative offers a unique opportunity to
promote and place the health equity issue
on the regional and national agenda.
The Initiative has these specific objectives:
• Increase the availability and
use of evidence to design and
implement pro-poor health policy.
• Build long-term political and
financial commitment to closing
the health equity gap.
• Increase the supply, quality, and
use of basic health services in
poor communities.
• Contribute to the elimination
of malaria and to the control of
dengue.
6
Why was the Salud Mesoamérica 2015 Initiative established? The Mesoamerican region consists of
the Central American countries (Belize, Costa Rica,
El Salvador, Guatemala, Honduras, Nicaragua and
Panama) and the nine southern states of Mexico,
and is among the most unequal regions in the
world. In spite of the progress made in health over
the past decade, the extreme poor continue to fare
substantially worse than their better-off peers
These socioeconomic inequalities are reflected in
rates of illness, injury, and health behaviors. Maternal
mortality rates in the Mesoamerican region are
among the highest in the American continent;
chronic malnutrition and anemia are very frequent;
timely immunization of children under two remains
a challenge; and infectious diseases like malaria
and dengue still affect the poor disproportionately.
Distribution of public expenditure in health for the
poorest does not commensurate with health needs.
These inequalities are unacceptable, yet mostly
preventable. The factors driving health equity gaps can be changed, provided that they are addressed in
an efficient and integrated manner.
Why was the2015 Initiative
established?
Salud Mesoamérica
8
maternal
Maternal and neonatal health
1 According to a 2006 study by the World Health Organization based on data from 2000.
• Maternal mortality ratios in the Mesoamerican region are among the highest on the American
continent, and are related to poor women’s limited
access to safe childbirth, pre- and postnatal
care, emergency obstetric care, and family
planning services.
• Only 48 out of 100 poor women receive care during pregnancy, compared to 99 out of 100
women in the 20 percent wealthiest segment of
the population, and 77 out of 100 women in the
average population.
• Only 50 out of 100 poor women receive qualified medical attention during childbirth, compared to
92 out of 100 women in the 20 percent wealthiest
segment of the population, and 67 out of 100
women in the average population.
• Eighty percent of all cases of infant mortality 1 occur during the first 28 days of life for the
newborn. Neonatal mortality is related to low
access to qualified medical attention during
childbirth and first days of life.
mortality
9
Maternal and neonatal health
• In Mesoamerica, poor children under the age of five have a mortality rate of 63.6 per 1,000 live births, compared to 33.3 on average at the
regional level. In other words, double the number
of children under five years of age in the poorest
20 percent of the population die, compared to
the regional average.
Only 50 out of 100 poor women receive qualified medical attention during childbirth
mortalityinfant
10
2 Regional data of this indicator do not include Guatemala.
• Approximately 2.5 million children under five years of age are affected by chronic malnutrition
in Mesoamerica.
• A poor child between the ages of four and five is six centimeters shorter on average than a child the same age from the wealthiest 20 percent of the population. In other words, a poor child is on
average 99 centimeters tall while a child of the
same age in the wealthiest quintile measures 105
centimeters. These inequalities are a direct cause
and consequence of the vicious circle of poverty
in the region. Each additional centimeter of height
is associated with higher cognitive skills and
school performance, and, later, higher income in
the labor market.
• In the region2, 32 out of every 100 poor children under the age of five suffer delays in growth,
compared to 4 out of every 100 children in the 20
percent wealthiest segment.
Nutrition
Aproximately 2.5 millon children under five years of age are affected by chronic malnutrition in Mesoamerica
• Since 1990, malaria incidence in Mesoamerica has decreased 82 percent, and, due to significant
increases in investment by governments and
donors, the illness is currently restricted to a
few geographic areas. Despite this progress, its
concentration in rural and remote areas results in a
high level of transmission among children under five
years of age and pregnant women in the poorest
20 percent of the population.
• Ninety-five percent of malaria cases in the region are related to Plasmodium vivax, the malaria
parasite species predominant in Mesoamerica. P.
Vivax rarely causes death, but a person living in an
area with moderate endemicity might suffer up to
30 symptomatic episodes of malaria in his or her
life. Moreover, there is a strong correlation between
the occurrence of malaria and the socioeconomic
characteristics of households and communities
in Mesoamerica.
• Dengue is an increasing public health problem in Latin America. Residents of poor neighborhoods
with no access to running water or sewage have a
high risk of contagion of dengue fever.
• In 2008, in Central America and Mexico, there were about 157,933 reported cases of dengue, of
which 9,347 were hemorrhagic dengue, the most
severe form, with 39 deaths due to the virus. The
high season for transmission of dengue coincides
with the rainy season, which starts in May and
continues until October or November.
• Only 57 percent of children are vaccinated in a timely manner in Mesoamerica.
• Complete and timely immunization of children
between 12 and 24 months old in the poorest 20
percent of the population ranges between 85 per-
cent in Belize and Honduras and 54 percent in El
Salvador and Guatemala.
ImmunizationMalaria
Dengue
What makes us different? Salud Mesoamérica
2015 is built on an operational model that acts on
both the supply and demand sides of basic health
services. Specific program components include:
using an innovative results-based financing model,
implementing evidence-based health policies, and
creating incentives to increase the use of quality
health services by the poorest in the population.
• The Initiative has an integrated approach; by
improving coverage and quality of health services,
promoting the use of health services and adoption
of healthier behaviors by poor households.
What are the expected results?
• A significant decrease in the
mortality rate of children under five
years of age.
• Reduction of chronic malnutrition
and micronutrient deficiency in
children under 24 months old and
among pregnant women.
• Increase in coverage and quality of
childhood vaccination in
poor communities.
• Increase in coverage and
quality of pre- and postnatal care
and improved access to family
planning.
• Use of evidence to design health
policies and programs geared
toward the extreme poor.
• Use of performance measures
and evaluation of all operations
financed by the Initiative.
• Elimination of malaria transmission
in low-risk communities;
and considerable reduction
in transmission in commu-
nities facing high risk.
• Reduction of dengue
vectors in the region; and,
also, more timely and effective
diagnosis, care, and notification of
dengue outbreaks.
different?Expected
results What makes us
13
• Results-Based Finance: funds from the Initiative,
allocated by country, will be supplemented
with national resources to develop operations.
If countries achieve agreed results in policy,
coverage and quality of health services, the
Initiative will reimburse half of government
contributions. To verify results achieved, rigorous,
independent evaluations will be conducted during
project implementation.
• The Initiative promotes national and regional policy dialogue aimed at improving access,
coverage, and quality of health services, such
as allocation and targeting of public resources
to guarantee health services to the poorest in
the region.
The resources are assigned by country based on poverty and inequality status
• Unlike other international programs, countries
participating in the Initiative do not compete for
resources because amounts are allocated per
country over a five-year period based on each
country’s poverty and inequality status. Moreover,
governments themselves determine priorities
and projects that will be financed within the
areas identified.
14
Partners
Carlos Slim Health Institute
The Carlos Slim Health Institute (ICSS) was created
in 2007 by the initiative of Mr. Carlos Slim Helú for
the development and funding of programs aimed at
contributing to solving the principal health problems
in Latin America and the Caribbean under an
innovative and human spirit and with a clear concern
for the neediest populations.
The goal of the Institute is to create and apply best
solutions, focusing on all aspects of health: from
pregnancy and childbirth to geriatric care; from
improvement in household environment to caring for
nature; from the physical and emotional well-being
of people to social factors; from the recognition of
individual efforts related to health to the recognition
of contributions by organizations and communities;
from personal self-care to large problems in the
Latin American region; from the dissemination
of traditional knowledge useful for health care to
the development of and introduction of the most
advanced technological solutions.
The Carlos Slim Institute works to generate health
solutions with a clear and promising goal: help people
live longer and better.
Spanish Cooperation (Government of Spain)
Spanish Cooperation aims to contribute substantial progress toward sustainable human development, eradication of poverty, and a full enjoyment of rights. The Principles of Paris Declaration and Accra Agenda for Action provide a framework for its work that uses different instruments, including a more active and efficient multilateralism.
The horizontal priorities of Spanish Cooperation are social inclusion and the fight against poverty, promotion of human rights and democratic governance, integration of gender in development, improvement of environmental sustainability, and respect for cultural diversity.
Health is one of the main priority sectors of Spanish Cooperation development policy. Health is considered a fundamental right and necessary condition to achieve the enjoyment of all other rights. Without an adequate health policy, it is impossible to reach a well-balanced and long-lasting development that allows women and men to achieve their individual goals. Health is a public good and, as such, its management is a key component of public responsibility.
The Salud Mesoamérica 2015 program involves participation of the Ministry of Economy and Finance, the Ministry of Foreign Affairs and Cooperation, and
the Spanish Agency for International Development
Cooperation.
Initiative
Inter-American Development Bank
The Inter-American Development Bank (IDB) is the
main source of multilateral financing and expertise
for economic, social, and institutional development
in Latin America and the Caribbean, with a mandate
to achieve measurable results, increased integrity,
transparency, and accountability.
The IDB partners with countries to combat poverty
and promote social equity through programs tailored
to local conditions. Working with governments as
well as with the private sector, the Bank seeks to
achieve sustainable economic growth, increase
competitiveness, modernize public institutions, and
foster free trade and regional integration.
Established in 1959, the IDB has fifty years of
experience in the region. Since then, the Bank
consolidated as a group creating the Inter-American
Investment Corporation (IIC) and the Multilateral
Investment Fund (MIF).
Bill & Melinda Gates Foundation
Guided by the belief that every life has equal value,
the Bill & Melinda Gates Foundation works to help all
people lead healthy, productive lives. In developing
countries, it focuses on improving people’s health
and giving them the chance to lift themselves out
of hunger and extreme poverty.
In the United States, it seeks to ensure that all
people—especially those with the fewest
resources—have access to the opportunities they
need to succeed in school and life. Based in Seattle,
Washington, the foundation is led by CEO Jeff
Raikes and Co-chair William H. Gates Sr., under
the direction of Bill and Melinda Gates and
Warren Buffett.
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