to reduce health equity gaps

public-private partnershipAn innovative

in Mesoamerica

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.

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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.

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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.

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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

inequalities in Mesoamerica

Dataon health

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

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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

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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

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• 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.

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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.

www.saludmesoamerica2015.org