USAID Health Care Improvement Project (HCI) | Guatemala


HCI Guatemala 1) provided technical assistance to the Ministry of Health (MOH) to improve quality in maternal, neonatal, and child health and nutrition; family planning; and prevention of sexually transmitted diseases 2) supported the establishment of a quality management assurance system in the MOH using ISO 9001: 2008 standards to strengthen MOH financial, administrative, and health care processes. By establishing a Quality Management and Assessment System (QMAS), the MOH, with HCI support, showed improvements in client satisfaction and service quality and established a Quality Unit exemplifying MOH commitment to creating a culture of quality. 3) supported the MOH to improve the quality of health service delivery and effect behavior change under the Government of Guatemala's Conditional Cash Transfer Program (CCTP). 

HCI Guatemala introduced a health delivery model that integrated maternal and neonatal health care, linking users (e.g., pregnant women and traditional birth attendants) in rural areas with health services delivery units (e.g. health posts and hospitals). The Promotion of Essential Obstetric and Neonatal Care (ProCONE) was first introduced in the health area of San Marcos and has shown significant results in improving the quality of basic maternal and neonatal care. As a complement to the ProCONE strategy for improving service quality, the project also assisted the MOH in the implementation of a Maternal Mortality Surveillance System. HCI has assisted in the improvement of its webpage where health managers have access to some detailed information and data via the internet, especially related to the QMAS. 

Furthermore, the project supported the MOH in meeting an ever-increasing demand for family planning services, helping build an infrastructure of skilled personnel in family planning counseling and contraceptive technology. It also supported the MOH in nutrition and health care for children under two years by supporting compliance with cost-effective practices at the community and health service levels, such as growth promotion and through the Baby-Friendly Hospitals Initiative.

All activities were supported by social and behavior change communications to improve the behavior of health workers and the general population and to promote community participation in health and nutrition. This work will continue under the TRAction project and Nutri-Salud project.

Key Activities

  • Promoted and improved the quality of community, basic, and complicated essential obstetric and neonatal care and integrated family planning into the complete package of maternal and neonatal care
  • Improved the quality of essential nutrition for children under age two through interventions such as supplementation with vitamins and minerals; growth monitoring; counseling mothers on breastfeeding, complementary feeding, feeding of the sick child; and vaccination and hygiene
  • Helped establish a Quality Assurance Unit within the MOH that supports a culture of quality
  • Designed, tested, implemented, monitored, and evaluated social and behavior change communication interventions on the various health and nutrition components
  • Conducted operations research to help improve different aspects of the project and technical assistance to the MOH (e.g., institutionalization, spread of best interventions, support strategies for QI teams, and incentives for health workers)
  • Supported the expansion of ISO certification for maternal and neonatal care processes in six health centers, for integrated HIV/ STI care processes in two health centers, and budgetary processes at the MOH central level.


  • ProCONE was been expanded from 22 facilities in San Marcos to more than 300 health services delivery units in 9 of the country’s 29 health areas
  • At 67 facilities, the percentage of deliveries where providers complied with the standard for the active management of the third stage of labor rose from 37% to over 90%.
  • The recognition of danger signs by women increased from 24% to 67%, and the percentage of pregnant women with a family emergency plan from 18% to 49%.
  • The San Pedro Sacatepéquez Health Center received ISO 9001: 2008 certification in basic maternal and newborn care services in August 2010.  The MOH central level received ISO 9001: 2008 certification in budgetary, and financial processes in October 2010.
  • Quality Management Systems expanded through certification of additional health centers: two HIV/STI clinics and six basic maternal and neonatal service centers.
  • CCTP Health Centers receiving support from HCI improved the quality of some services provided to children under 5 years of age, compared with CCTP Health Centers without HCI support; among these services were: vitamin A, ferrous sulfate and folic acid administration, weigh and plot weight-for-age on graph, evaluate feeding problems and  classify growth
2008 to 2013
US Agency for International Development (USAID)
Regions/ Countries