Institution characteristics
Ninety-nine participating stakeholder institutions provided geographically localizable data on 5,861 nutrition-related activities. Organizational descriptive characteristics are summarized in Table 1. The majority of participating organizations were national non-governmental, community-based, or private sector organizations (59%), with bilateral aid, international non-governmental, religious, and academic organizations comprising the remainder. Overall, 42% of responding institution’s activities were distributed in the six departments prioritized by the Government of Guatemala for their high rates of malnutrition and poverty, whereas the majority (58%) were located in non-priority departments. Nearly half (45%) reported conducting both nutrition-sensitive and nutrition-specific activities, whereas 22% conducted only nutrition-specific and 33% only nutrition-sensitive activities. Eighty-one percent of institutions reported an active monitoring and evaluation program. The five most commonly mentioned program impact indicators included child growth (90%), breastfeeding and complementary feeding adequacy (65%), hygiene promotion (55%), micronutrient and food supplementation for women of childbearing age (25%), and prenatal care (23%).
Table 1
Key characteristics of institutions and nutrition-related activities in the national mapping effort.
|
Characteristic1
|
Percentage
|
|
Type of institution (n = 99)
Academic
National Religious
International Religious
Bilateral Aid Organization
International Nongovernmental Organization
National Nongovernmental Organization
Community Based Organization
Private Sector
|
3
5
7
13
13
27
15
17
|
|
Geographic distribution of institutions (n=99)
Alta Verapaz
Huehuetenango
Quiché
San Marcos
Sololá
Totonicapán
Other 16 departments not prioritized by the National Strategy
|
8
8
6
7
8
5
57
|
|
Yearly Institutional Budget (n=45)
US $1,000-$50,000
US $50,000-$100,000
More than US $100,000
|
38
11
51
|
|
Nutrition-specific vs. nutrition-sensitive activities (n=99)
Only nutrition-specific activities
Only nutrition-sensitive activities
Both nutrition-specific and nutrition-sensitive activities
|
22
33
45
|
|
Has monitoring and evaluation strategy for program activities (n=74)
|
81
|
|
Ethnicity of program beneficiaries (n=76)
Maya
Ladino/Mestizo
Not Tracked
|
67
12
21
|
| 1For each characteristic, the denominator of available responses is given in parentheses. |
Geographic distribution of institutions and activities
We compared the geographic distribution of nutrition activities and institutions to child stunting prevalence and national priority areas. Figure 1 depicts the distribution of nutrition stakeholder institutions and activities compared to stunting prevalence in children under 5 years by department. Misalignments between strategic priority and resource allocation were apparent. For example, the department of Totonicapán has the highest prevalence of child stunting in the nation but has notably fewer institutions and activities than other regions (Figure 1A-C, solid arrow). Similarly, Chimaltenango has an intermediate prevalence of stunting but the highest institutional concentration in the country (Figure 1A-C, dashed arrow). Finally, Escuintla has relatively low prevalence of stunting, but a disproportionately high concentration of nutrition activities (Figure 1A-C, arrowhead). A linear regression of the number of active, responding institutions versus departmental stunting prevalence (Figure 2) shows that in general, priority departments have more responding nutrition stakeholder institutions compared to most non-priority departments. However, consistent with Figure 1, there are examples of relative under-resourcing of some priority departments (e.g., Totonicapán) and potential over-resourcing of some non-priority departments (e.g., Chimaltenango).
Distribution of nutrition-sensitive, nutrition-specific, and priority area activities
Based on both international guidelines and the Guatemalan National Strategy, effective nutrition policy requires complementary implementation of both nutrition-sensitive and nutrition-specific interventions.(8–10) Figure 3 gives the distribution of nutrition-sensitive and nutrition-specific interventions by department. Variability in optimal implementation was observed. Some high-priority departments (Huehuetenango, Figure 3A-B, dashed arrow) showed good balance between nutrition-sensitive and nutrition-specific interventions. However, others (Sololá, Figure 3A-B, solid arrow) showed a marked mismatch in implementation of nutrition-sensitive vs. nutrition-specific interventions, with more emphasis on nutrition-specific activities. We also mapped the distribution of activities according to the National Strategy’s four priority areas (Figure 4).(8) Most notable in this visualization is the relative absence of primary care and health-sector strengthening activities in most of the priority departments other than Sololá (Fig. 4A) as well as the overall low number of education and behavior change activities at a national level (Fig. 4B).