Latin America and the Caribbean (LAC) Regional Network Initiative

Based at the Federal University of Pelotas in Brazil, the International Center for Equity in Health (ICEH) was a key partner in Countdown 2015 and continues to lead the Equity research for Countdown globally, in-country and now regionally as the lead and coordinating institution of the LAC Regional Network Initiative.

The main goals of the LAC regional network are:

  • Capacity building towards monitoring, with a focus on equity, and including coverage, policies, programs and financing, with priority given to high burden countries.
  • Coordinating country case studies, with priority given to high burden countries.
  • Coordinating thematic studies on issues recognized as especially relevant for the region, or lacking in the literature.
  • Offering technical support to research colleagues across the region that want to do their own studies or monitoring exercises
  • Creating long lasting collaborations between the participants of the capacity building activities and the monitoring and evaluation studies

LAC Regional Network Activities

Measuring Inequalities in Coverage of Reproductive, Maternal, Newborn and Child Health Interventions

The LAC regional network carried out a first workshop in Medellín, Colombia, 18-22 October. The Facultad de Salud Pública, Universidad de Antioquia, offered the venue and local support for the workshop that focused on two main areas: coverage and equity, starting with basic definitions of RMNCH intervention coverage, including data sources and statistical aspects of survey analyses and moving into understanding, defining and measuring health inequalities.

The workshop included 19 participants from 10 LAC countries: Bolivia, Colombia, Ecuador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama and Peru. Additionally, two participants from Mozambique and special participants representing UNICEF Panama and UCL joined the workshop. The workshop was facilitated by faculty from Universidad Peruana Cayetano Heredia (Lima, Peru), Pan American Health Organization (Washington, DC), UNICEF headquarters (New York) and ICEH (Pelotas, Brazil).

Regional Workshop on Ethnic Inequalities in RMNCH in Latin America and Launch of the Countdown Haiti Case Study

The LAC regional network hosted a second workshop at ICEH from May 15-19, 2017 focused on ethnic inequalities in reproductive, maternal and neonatal and child health (RMNCH) interventions in Latin America. The workshop overlapped with a working group meeting aimed at designing a country case study in Haiti for the Countdown to 2030.

The workshop had four objectives:

  • To review and summarize that state of knowledge about ethnic group inequalities in the region, regarding the health of women and children.
  • To analyze existing data from national surveys (such as DHS, MICS and RHS) to measure ethnic inequalities in RMNCH intervention coverage in the region.
  • To set up a network of collaborating institutions to produce multi-country analyses of ethnic inequalities in RMNCH.
  • To start a Countdown case-study in Haiti.

The workshop was attended by 24 participants from 17 countries (Haiti, Guatemala, Chile, Brazil, Suriname, Bolivia, Colombia, Nicaragua, Costa Rica, Peru, Honduras, Ecuador, Argentina, Dominican Republic, Paraguay, Guyana, and Mexico), plus 22 staff members and students from the ICEH. The full meeting report is available here.

Multi-country Secondary Analysis of Ethnic Disparities

As a result of the two workshops described above, the LAC regional network has initiated two studies. The first is a multi-country study on RMNCAH comparing ethnic groups in LAC, with focus on indigenous and Afro descendant populations. The percentage of indigenous populations in LAC varies widely, from very small (e.g. Brazil, El Salvador) to nearly half the population (e.g. Bolivia, Guatemala). The study involves secondary analysis from 16 countries (Belize, Bolivia, Colombia, Costa Rica, Dominican Republic, Ecuador, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname and Uruguay) and is anticipated for completion by early 2019.   The research questions that the analysis will address are as follows:

  • How are the ethnic groups of each country characterized?
  • How are ethnic groups distributed in terms of region, area of residence (urban and rural), maternal schooling and wealth?
  • What is the coverage of RMNCH interventions by ethnic group?
  • What is the prevalence of undernutrition and breastfeeding patterns by ethnic group?
  • To what extent do differences in terms of area of residence, education and wealth account for ethnic inequalities? Which of the above factors have greater explanatory power?

In-depth Case Study on Haiti

The poorest country in LAC, recently hit by multiple crises, Haiti will be the focus of the second study to be conducted through the LAC regional network. A country-case study on the Haitian health situation with emphasis in RMNCAH interventions and other relevant health issues such as natural disasters and cholera, the study is planned with a 2-year timeframe culminating in dissemination activities taking place in May 2019.

The overarching objective of the Haiti case study is to explore the reasons for progress in selected indicators of RMNCH in Haiti since 1994, including the role of social determinants such as antipoverty strategies, health system reforms, health sector financing, health policy adoption, implementation of specific public health RMNCH interventions, international assistance, and NGOs.   The specific objectives of the study are enumerated below (the full Haiti case study workplan is available upon request).

  1. To describe trends in
    1. RMNCH coverage in Haiti from 1994 to present at both national and departmental levels;
    2. Neonatal, infant and under five mortalities, stunting and total and adolescent fertility rates;
  2. To document inequalities for the indicators listed in objective (1) at both national and departmental levels;
  3. To document changes in social, political and economic determinants of health in Haiti for the same period;
  4. To document implementation of policies and programs
    1. Inside the health sector, including their financing, policies and human resources (e.g. malaria, HIV and tuberculosis);
    2. Outside the health sector, relevant to RMNCH, such as female education, access to improved water and sanitation, access to basic infrastructure, poverty reduction strategies, women’s empowerment;
  5. To assess the association between RMNCH interventions coverage and impact indicators, considering contextual factors such as GDP, human resources, health care facility availability;
  6. To explore the role of factors such as natural disasters (cyclones, earthquakes), epidemics, governance and external help on RMNCH;
  7. To document trends of domestic health financing and in Official Development Assistance (ODA);
  8. To derive lessons to guide policy actions for further improvement of RMNCH by 2030.