Linked & Mercy Corps Team on the Guatemala Sustainable Health Store Initiative

The Linked Foundation and Mercy Corps are developing a sustainable Community Pharmacy model for improving the health through increased access of health care products in rural Guatemala that is sustainable.

A Health Snapshot in Alta Verapaz

Most persons in the Alta Verapaz area are indigenous and non-Spanish speaking with extremely high illiteracy levels particularly among women (70%). Indigenous peoples make up 41% of the population of Guatemala, and there are evident differences in the health status of the indigenous and nonindigenous population. Infant mortality is higher among indigenous people (49 per 1,000 live births) than in the nonindigenous population (40 per 1,000), as is child mortality, 69 per 1,000 among indigenous people and 52 per 1,000 in the nonindigenous population, with virtually no change in this gap since 1995.

Most differences in the top causes of death (all ages) in Guatemala as a country vs the Alta Verapaz region can be attributed to a higher rate of poverty in Alta Verapaz and the relative isolation of rural areas. The poorest regions have the highest rates of malnutrition; 80% of children suffering from chronic malnutrition live below the poverty line. Most maternal deaths involve indigenous women as a result of their more precarious economic circumstances, higher fertility rates-two or three children more than nonindigenous mothers, and more limited access to health care. The incidence of chronic malnutrition among indigenous peoples (69.5%) is nearly double the figure for the nonindigenous population (35.7%).

Project Rationale

An earlier assessment of health care product availability in the Tucuru area of Alta Verapaz showed both a large unmet need, and several individual community attempts to address it. Some communities have botequines (very small home-based pharmacies) that provide basic pharmaceuticals on a fee for service basis, but few of these are sustainable and even fewer stock enough quanitity or variety to meet local needs or focus on major health issues. These initiatives are usually community-led, which is a strong indicator of the community's belief in the value these products can provide. However, few of these initiatives cross community boundaries and there have been no real efforts to collaborate, to become financially sustainable, or to reach large numbers of communities.

Our approach will focus on leveraging and improving what exists already - community efforts, health-focused NGOs and government organizations, peri-urban pharmacies, local drug manufacturers, and the local supply chain. Mercy Corps, for solving some of the hard issues around training, product offerings, financing, and sustainability, will serve as a catalyst for creating a program that can scale through collaborating with other social and government organizations. Working with what already exists will be especially important in the first year, as the team learns more about the on-the-ground challenges and the approaches that others are using. Approach during the second and third year will be on solving problems, ensuring sustainability, sharing learnings and finding local partners that have the potential to scale.