Improving Health and Nutrition for Indigenous Communities in Guatemala

The Challenge: Chronic Malnutrition in Indigenous Communities

Guatemala has one of the highest rates of chronic malnutrition in the world, with 47 percent of children under five suffering from stunting. Indigenous communities, which make up nearly half of the population, face even greater challenges due to poverty, geographic isolation, and limited access to healthcare. Many children and mothers in these areas cannot access essential health services, contributing to high rates of maternal mortality and preventable diseases. Recognizing these urgent needs, the Crecer Sano Project was launched in 2017 to address the root causes of malnutrition and improve health outcomes, with a special focus on the first 1,000 days of life.

The Approach: Building Stronger Foundations for Health and Nutrition

At the core of the Crecer Sano Project is the belief that access to quality healthcare, clean water, and education is essential for breaking the cycle of malnutrition. The Project takes a multi-sectoral approach, financing activities across four key areas:

First, the Project focuses on healthcare infrastructure at the primary level of care, expanding access to essential services in remote areas. With these new health posts and renovated centers, families in vulnerable regions will have better access to care without the burden of traveling long distances. Each health post offers services such as growth monitoring, prenatal care, and chronic disease prevention and management, reducing the pressure on national hospitals.

In addition to healthcare infrastructure, the Project improves water access and sanitation. Clean water is critical for preventing diarrheal diseases, which contribute to malnutrition.  More than 30,000 families have received water filters through the program, ensuring safer drinking water for households.

“The provision of filters is very important for the community because it helps us protect life—we can now drink clean water.”” — Juan Alberto Choy, Vice President of COCODE, Alta Verapaz

The Project also recognizes the crucial role indigenous midwives (comadronas) play in community health, emphasizing behavior change beginning with activities at the health facility and ultimately reaching the community level. This includes integrating the comadronas’ ancestral knowledge and traditional practices with modern maternal care in training materials to promote healthy breastfeeding practices, ensuring that their communities receive culturally appropriate and effective care. These efforts help ensure children receive essential nutrients during the first 1,000 days, a critical period for growth and development.

“It brings me great joy to be part of the Crecer Sano Project. I am a grandmother and midwife, and I gained much knowledge and experience from the breastfeeding workshop. Now I can tell many mothers to breastfeed, so we no longer have malnourished babies in our community.” — Anastasia Tecún, Midwife, Chichicastenango

To sustain these efforts, mobile healthcare brigades travel to remote communities, ensuring that even the most isolated families receive care. Mobile healthcare teams are currently active, providing essential services such as vaccinations and prenatal care. The Project also played a key role in Guatemala’s COVID-19 response, supplying medical equipment and expanding healthcare capacity during the pandemic to ensure communities continued receiving vital services.

Results to Date: Transforming Health and Nutrition Outcomes

The Project has made significant progress across 139 municipalities in seven departments with the highest concentrations of indigenous populations, particularly in Quiché, San Marcos, Alta Verapaz, and Chiquimula:

• Healthcare Infrastructure: 17 new health posts have been completed and equipped, of which 13 have now been inaugurated. By the end of 2024, 31 new posts and 81 renovated centers are expected to be inaugurated. This expansion has already made a difference: two health posts inaugurated by President Bernardo Arévalo on September 4, 2024 in Semejá II and Chugüexá II now serve over 5,800 people in Chichicastenango.

“We are very grateful now that we have a new health post. People won’t need to walk far anymore, and for pregnant women, it will be much easier to access services.” — Vilma Ventura, Nurse, Chichicastenango

“We are very happy with how the Health Post turned out; it wasn’t like this before. It had leaks and was in bad condition. Now they have changed doors, windows, and the roof; it looks very nice, and they are providing very good service.” - Domingo Caal, Indigenous Mayor of San Juan Chactelá, Uspantán, El Quiché.

• Water and Sanitation: More than 31,000 families received water filters to improve their access to safe drinking water and contribute to preventing diarrheal diseases, a leading cause of malnutrition in children.

“The filters arrived at the perfect time because there are no water systems here. Families collect rainwater, and in the summer, they rely on sources that have been found to be contaminated. The filters will help reduce diarrheal diseases, especially among children.” — Brenda Tzib, Rural Health Technician, Alta Verapaz

• Nutrition and Maternal Health: 4,500 Indigenous midwives have been trained to guide mothers in immediate attachment and exclusively breastfeeding their children, respecting midwives as traditional therapists and important community leaders. Additionally, 238,000 nutrition kits have been distributed to families with children under two, supporting healthy development during the first 1,000 days.
• COVID-19 Response: Mobile healthcare brigades delivered essential care to 488 remote communities between February and May 2023, ensuring families can access services without traveling long distances.

Why Crecer Sano Matters

The Crecer Sano Project is more than just a health initiative—it is a lifeline for Guatemala’s indigenous communities, particularly highlighting the indispensable contributions of comadronas in enhancing maternal and child health. With the support of the World Bank and GFF, Guatemala is building a healthier, more inclusive future, ensuring that all families have access to the care and resources they need to thrive.

“This health post is just the beginning. The historical debt owed to families in villages and rural areas is enormous, but we are working so that with healthcare... we can all live well, and no one is left behind.”— President Bernardo Arévalo