Improving the Health of Guatemala's Most
Vulnerable Population: Migrant and Resident
Women and Children in the Boca Costa Region
of Southwestern Guatemala
Cooperative Agreement No.: FAO-A-00-97-00030-00
September 30, 2001 to September 29, 2005
FINAL EVALUATION REPORT
 September 12, 2005
Project Location: Boca Costa Region, Guatemala
Submitted to:
USAID/GHB/HIDN 
Child Survival and Health Grants Program
Room 3.7.75, Ronald Reagan Building
1300 Pennsylvania Avenue
Washington, DC 20523-3700
Submitted by:
Project HOPE – The People-to-People Health Foundation, Inc.
Millwood, Virginia 22646
Tel: (540) 837-2100
Fax: (540) 837-1813
Report prepared by:
Judiann McNulty, DrPH, Evaluation Team Leader
Contributions by Anabela Aragon and Brenda Yves, Project Staff
KPC report prepared by:
Juan Carlos Alegre, Project HOPE M&E Specialist
Statistical analysis by Marco Cifuentes
HQ Contact person: Field Contact Persons:
Bonnie Kittle, Víctor Calderón, M.D. (Guatemala City)
Director, Health of Women & Children Anabela Aragón, M.D. (Quetzaltenango)
TABLE OF CONTENTS
A. Summary................................................................................................................................... 4
The main accomplishments of the program ................................................................... 5
Highlights from the comparison of the baseline and final KPC surveys...................... 6
Priority conclusions of this evaluation............................................................................. 7
Recommendations:............................................................................................................ 8
B. Assessment of Results and Impact of the Program.............................................................. 9
Progress report by intervention area.............................................................................. 11
Results: Cross-cutting approaches................................................................................. 18
Program Management.................................................................................................... 26
Conclusions and Recommendations ......................................................................................... 33
ANNEXES................................................................................................................................... 37
A. Evaluation Team Members and their titles
B. Evaluation Assessment methodology
C. List of persons interviewed and contacted
D. Description of Guatemalan Health Delivery System
E. Final KPC Report
F. Project Data Sheet Form - updated version
LIST OF ACRONYMS
AIDS Acquired Immuno-deficiency Disease Syndrome
AINM-C Integrated Maternal and Child Health Attention - Community level
BCC Behavior Change Communication
BHU Basic Health Units
CBDA Community-Based Distributing Agent
CS Child Survival
CSHGP Child Survival and Health Grants Program
CSTS+ Child Survival Technical Support Project
DIP Detailed Implementation Plan
ECP Expanded Coverage Project of the MSPAS (formerly called SIAS)
HIV Human Immuno-deficiency Virus
IEC Information, Education and Communication
IGSS Guatemala Institute of Social Security
ILO International Labor Organization
IMCI Integrated Management of Childhood Illness
IPPF International Planned Parenthood Foundation
KPC Knowledge, Practices and Coverage
LQAS Lot Quality Assurance Sampling
M&E Monitoring and Evaluation
MSPAS Ministry of Health, also MOH
ORS/T Oral Rehydration Salts/Therapy
PDA Personal Digital Assistant
RH Reproductive Health
RHP Rural Health Promoter
STI Sexually Transmitted Infections
TBA Traditional Birth Attendant
TT Tetanus Toxoid
USAID United States Agency for International Development
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A. Summary
In 2001, Project HOPE was awarded a four-year extension to expand its CS-XIII project aimed at 
improving the health of women and children migrating to or residing in or near (and dependant 
upon) coffee plantations in the Boca Costa region of southwestern Guatemala which is a piedmont 
area about 20 miles wide by 100 miles long above the Pacific coast. The target population consists 
of 330,000 beneficiaries, including 162,304 children under age five and 171,959 women of
reproductive age. The project provided benefits to migrants and residents in the target area through 
capacity building of Ministry of Health (MSPAS), Guatemala Institute of Social Security (IGSS), and 
3 local NGOs involved in the national Expanded Coverage of health services program (ECP) in the 
target area. These three NGOs include ADISS, The Red Cross and the Funrural or Funcafe which 
is the development organization linked with ANACAFE, the coffee growers' national association. 
(See Annex D for an explanation of the Guatemala health system and administrative divisions.)
The project worked with partner technical staff and a nucleus of Master Trainers in 4 Health Areas, 
equivalent to geographic Departments: San Marcos, Quetzaltenango, Retalhuleu and Suchitepequez. 
In the Department of Suchitepequez, the project also worked with the IGSS which has a community 
outreach program. The project assisted these partners in replicating training programs associated 
with several national health strategies: clinical and community Integrated Management of
Childhood Illness (IMCI) and Essential Maternal and Newborn Care (AMNE) for health staff and 
community volunteers through all health units in 29 municipalities1
. These trainings reached 964 
Rural Health Promoters (RHPs), 783 Traditional Birth Attendants (TBAs), and 60 Community 
Based Distribution Agents of family planning methods. In this way the extension project has 
continued to support increased access to primary health care while expanding to include a focus on 
integrated reproductive health and on strengthening capacity-building for sustainability of heath 
attention for migrants. During the first two years, the project also targeted four municipalities in the 
Highlands of San Marcos from which many migrants originate. Through the MSPAS and with 
involvement of municipal governments, the project trained 30 health workers in IMCI and 30 Rural 
Health Promoters in C-IMCI and trained 150 RHPs and 175 TBAs in preventive health and health 
promotion.
In the Boca Costa, the project instigated and helped to establish Basic Health Units (BHUs) within 
or next to coffee plantations with owner and administrator moral and financial support, and 
facilitated training of Rural Health Promoters (RHPs) to operate them. All but 35 of the BHUs 
operate under the auspices and supervision of the Ministry of Health and Social Assistance (MSPAS) 
district. The remaining 35 BHUs have been absorbed by NGOs contracted by the Extended 
Coverage Project (ECP). Despite the fact that many plantations have closed production or 
drastically reduced personnel due to the dramatic drop in coffee prices between 2000 and 2004, the 
project has worked with a total of 183 of the proposed 200 coffee plantations (this target was 
revised in 2002 in the 1st annual report submitted to USAID’s CSHGP). In each coffee plantation 
there is one BHU. Out of the 164 active BHUs, 108 are located within coffee plantations; and the 
others are located in adjacent communities. All of these BHUs are managed by trained RHPs, who 
provide medicines appropriate for IMCI/AINM-C services, including antibiotics. The project 
 
1 The DIP mentions 30 municipalities; but Santiago Atitlan became covered by an organization contracted under the 
ECP shortly after the DIP was prepared and hence, was dropped. The project intervention in the highlands from which 
migrants originate was active in 4 of the 5 municipalities cited in the DIP during the first two yeas.
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motivated MSPAS local health personnel and, in Suchitepequez, IGSS health personnel, to provide 
periodic health campaign outreach services on plantations, especially between October and February 
of every year when migrants are present for the coffee harvesting season.
Besides MSPAS and IGSS partners, the project collaborated closely with JHPIEGO to extend the 
Maternal and Neonatal Care (MNC) approach, and with local NGOs (ADISS, The Red Cross, the 
Suchitepequez branch of FUNCAFE which is the development organization of ANACAFE, the 
coffee grower's national association) to extend coverage of primary health care services to rural areas 
in accordance with national strategies for Integrated Systems of Health Attention (SIAS). 
The project’s level of effort is divided as follows: 5% immunization, 10% nutrition and 5% 
breastfeeding, 3% Vitamin A and 2% micronutrients, 15% acute respiratory infections, 10% control 
of diarrheic disease, 5% malaria, 20% maternal and newborn care, 15% child spacing and 10% 
HIV/AIDS.
The main accomplishments of the program
The principal accomplishment of the project, considering the context, is the attitude changes 
regarding migrants among Ministry of Health (MSPAS) staff and plantation owners and managers. 
When this project was designed nearly ten years ago, no one amongst the health workers, the 
MSPAS hierarchy, or the plantations took into account that the migrant families had health needs 
and rights which weren’t being met. During this final evaluation, MSPAS staff at all levels and 
plantation managers acknowledged that this had been the case. The current norms, activities and 
plans of the MSPAS specifically for attending migrant health needs and, the commitment of the 
plantations in supporting the Basic Health Units (BHUs) is testament to a major attitude shift. The 
attitude change is not wholly due to the influence of this CS project, however. A cholera outbreak 
on the plantations of Quetzaltenango further spurred MSPAS interest in migrant health. The 
plantation owners have begun to see the migrant work force disappear due to migration out of the 
country, former migrant families’ reluctance to pull their children out of school to migrate, and 
because the extremely low wages offered in recent years during the “coffee crisis” forced former 
migrants to seek other means to augment their income. Facing a good harvest and rising prices 
now, some plantation owners feel pressed to improve living and working conditions in order to 
compete for the decreasing pool of migrant coffee pickers and to gain accreditation for entry into
special marketing programs such as Fair Trade. The project has taken advantage of both the cholera 
outbreak and the labor concerns of plantation owners to promote the need to improve health 
services and conditions for migrants.
As the second major accomplishment, the project has succeeded in greatly improving access to basic 
health services for the residents and migrants on and near the coffee plantations of the Boca Costa 
of southwestern Guatemala. This was accomplished through the establishment and continuation of 
152 Basic Health Units (BHUs) on or near the coffee plantations in the three Departments of San 
Marcos, Quetzaltenango, and Suchitepequez as well as in one municipality of Retalhuleu
Department. The final evaluation team believes the potential for sustainability of the BHUs is good 
due to the fact that the project-trained promoters are motivated to continue indefinitely, half of the 
plantations are providing material support and all BHUs are linked either to the MSPAS health 
centers, to the Guatemalan Social Security Institute (IGSS) or to one of the NGOs which have
6
contracts with the MSPAS to provide rural health services. The level of supervision being provided 
to the BHUs is commendable.
Additionally, as a third major accomplishment of the extension phase, the project has facilitated the 
training of 904 health workers of the MSPAS, the IGSS of Suchitepequez, and the NGOs Funcafe, 
ADISS, and the Guatemalan Red Cross in greatly improved and standardized care through
institutionalization of Essential Maternal and Newborn Care (AMNE), Integrated Management of 
Childhood Illness (IMCI) and 183 community health promoters/workers known as promoters in
Community IMCI (C-IMCI). As a part of the capacity-building component, teams of Master 
Trainers with impressive skills in adult learning have been established in each of the three MSPAS 
Areas and in IGSS Suchitepequez. Each of these teams has trained additional health workers 
beyond the project intervention municipalities. (For an explanation of the Guatemalan health 
delivery system, please see Annex D.) 
Highlights from the comparison of the baseline and final KPC surveys
The improvements in coverage, health behaviors and knowledge among the Boca Costa residents 
are impressive. Nearly all targets, although set quite high in the DIP, were met or exceeded. The 
percentage of children completely immunized nearly doubled while the percentage of women who 
received two doses of Tetanus Toxoid (TT) quadrupled as did the percentage of women who had 
three or more prenatal visits. Significantly more mothers initiated breastfeeding in the first hour 
after birth and the percentage of those offering exclusive breastfeeding to their infant under six 
months of age increased from 79 to 87 percent. Three times as many mothers now recognize 
symptoms which indicate the need to take a sick child to medical care and more mothers could 
name danger signs during pregnancy and post-partum. At the mid-term only 8.4% of women could 
name two symptoms of sexually transmitted illness (STI) but this jumped to 62.5% by the end of the 
project. Knowledge of ways to prevent HIV increased from 17% at baseline to nearly 80%. 
While a quantitative final KPC survey of migrants only was not possible due to the seasonal absence 
of the migrant workers on the plantations, a mini-survey was conducted with a convenience sample 
of 68 migrant families in their communities of origin (nine families had actually just arrived on one 
plantation). Knowledge and behaviors among the migrants seriously lag behind those of residents. 
For example, 47 out of the 68 migrant women interviewed answered that nothing could be done to 
prevent HIV or did not know. Only five of the sixty-eight migrant mothers recognized symptoms 
of pneumonia while 38% of the resident mothers did. On the other hand, prenatal care coverage 
with a minimum of one visit was higher among migrants than among residents. 
The health facilities and BHUs in the target Areas have begun to track coverage, morbidity and 
mortality separately for migrants. This data is being included in the national HIS, which now 
includes a column specifically to identify migrants. Some health districts have altered their hours of 
operation to be available in the evening for migrants, but more could be done on this as well as 
promotion of services to the migrants. All health Area offices reported they are now providing 
additional medicines to the health districts to cover the increased case loads (of migrants) during the 
coffee harvest season. District health directors confirmed that supplies are stable and sufficient.
Based on the interviews with Area and district health teams, with plantation administrators and with 
RHPs, the potential for sustainability seems quite good. More than 50% of plantations are paying a 
salary to the RHP and/or supplying medicines for the BHU. The Area health offices have 
7
established norms and have plans in effect to continue immunization visits to the plantations, and to 
support the RHPs and BHUs. RHPs are receiving monthly supervision and regular in-service 
training. Three other Health Areas in Guatemala which have large seasonal influxes of migrants 
have expressed interest in replication. The National Coordinator for Migrants from the central 
MSPAS, who has been deeply involved in this project, will play a key supportive role in any 
replication in other Areas.
Priority conclusions of this evaluation
Positive Outcomes:
· Direct coordination established between and has become routine between the MSPAS, and 
IGSS at the national, Area, and local levels. On-going coordination now exists between 
these institutions and the National Association of Coffee Producers (ANACAFE) as well as 
with plantation administrators and owners at the local level.
· Involvement of plantation owners and administrators in support of health services and 
education for migrant workers, and of a growing number in improving living conditions for 
migrants on the plantations. Such improvements have occurred on about 20% of target 
plantations during the life of the project and it is hoped that this initiative will spread to 
other plantations in the near future, spurred by the rising price of coffee, labor shortage, and 
a desire to compete in the world market through mechanisms such as Fair Trade.
· Implementation of 152 Basic Health Units with very good potential for sustainability to 
serve migrants and residents dependent on coffee plantations. This has significantly 
improved access to health care for these families. 
· Operationalization of the national policy for health care for migrant populations which was 
established during Phase I of the project. This has been accomplished by each of the three 
Area Health Offices and by IGSS Suchitepequez with the support of Project HOPE.
· Implementation of norms for providing health care to migrants, including collecting and 
using data on migrants. Each Area Health Office and each target district how have 
operating plans and procurement allotments which take into account the migrant population.
· Institutionalization of IMCI and AMNE in the target districts of the three Departments and 
in San Felipe. This has resulted in significant improvement in quality of care through 
application of standardized procedures and improved provider/patient communication 
skills.
· Formation of teams of Master Trainers in each Health Area and in IGSS, who will continue 
to provide high quality training and follow-up to health personnel and RHPs.
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Weaknesses:
· As found during the mid-term evaluation, the weak part of the program, particularly for 
migrants, is the behavior change communication strategy which was not successful in 
reaching the migrants with urgently needed health information and support necessary to 
change behaviors. The initial proposal for CS XIII laid out some potential strategies for 
reaching migrants in their communities of origin but these strategies were only tacitly 
implemented, if at all. 
· While the project did some impressive monitoring of certain aspects of the project, including 
periodic LQAS surveys of residents, synthesis of migrant coverage data, BHU use, etc., there 
is a lack of pre and post evaluation of health worker skills. Assessments of BHUs and the 
application of IMCI were conducted in 2003 and again in 2004. However, it would have 
been useful to have repeated both prior to the final evaluation. The project did not follow 
the suggested monitoring plan laid out in the DIP which might have enabled them to better 
discern the lack of behavior change among migrants early on in the extension project.
· The DIP for this CSXVII project did not include indicators for measuring attitude changes 
resulting in policy and practice changes among health personnel and plantation management, 
or behavior change indicators for migrants, even though the project specifically targeted 
migrant health as its primary purpose. The evaluation team acknowledged that measuring 
behavior change on a transient population is not easy, but that more effort should have been 
made.
· The RHPs were trained in AINM-C, but, without scales, cannot implement the approach. 
Some plantations have purchased scales, but neither the project nor the MSPAS had funds 
to supply the needed scales for most of the RHPs. 
Recommendations:
1. For the Ministry of Health Area Offices and IGSS Suchitepequez:
a. Sustain the BHUs through maintenance of current levels of supervision and supplies and 
annual assessment of RHP skills. 
b. Seek outside funding and lobby the central MOH for funding to continue training of district 
staff, TBAs and RHPs.
c. Maintain communication and coordination with currently supportive plantations and work to 
engage others.
2. For Project HOPE:
The quality of this project, including management and technical capacity, has been exceptional, 
and Project HOPE headquarters should proactively seek additional funding to replicate this 
project in other areas of the country. Alternatively HOPE could implement similar capacity￾building activities for the MSPAS or ECSP contractors in these departments or others in other
technical areas such as HIV/AIDs, family planning or, in the Highlands, Infant and Young 
Child Feeding.
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B. Assessment of Results and Impact of the Program
1. Results: Summary Chart for KPC Surveys of Residents of the Boca Costa
Baseline
(2001)
Final
(2005)
Indicators For Resident Women Target
% %
Comment
1. Percentage of children 12 to 23 months 
completely immunized.
70%
42.1 80.8
Nearly doubled 
2. Percentage of children 6 to 23 months that 
have received a dose of Vitamin A in the 6 
months previous.
50% 15.7 68.7
Greatly exceeded
3. Percentage of children that received breast 
milk within first hours after birth. 75% 62.5 75.0
Met target
4. Percentage of children 0 to 6 months 
exclusively breast fed. 70% 79.2 87.3
Significantly 
exceeded
5. Percentage of children under age 2 
malnourished (< -2 sd weight/age).
Decrease 
by 10% 24.6 20.2
Some 
improvement
6. Percentage of mothers or child caretakers that 
can name at least two danger signs that indicate a 
child should be seen by a trained health care 
provider.
Increase 
by 50% 34.4 90.9
Greatly 
exceeded 
7. Percentage of mothers that offered equal or 
more breast milk, liquids and/or food during the 
child's last episode of diarrhea.
Increase 
by 60% 34.9 84.3
Exceeded target
8. Percentage of mothers or child caretakers that 
sought help from a trained health care provider 
during child's last episode of diarrhea. 34.9 44.4 84.3
Nearly doubled
9. Percentage of mothers that can mention at 
least two health messages they have heard on the 
radio in the previous month. 60% 6.1 53.4
10. Percentage of mothers that received at least 
two doses of tetanus toxoid before the birth of 
their last child. 60% 22.6 49.4
Much improved, 
but fell short of 
target 
11. Percentage of mothers that received at least 3 
prenatal care visits from a health professional 
during their last pregnancy. (not including TBAs.)
50% 11.1 35.2
Improved but 
fell short of 
target. 
12. Percentage of mothers able to report at least 
two maternal danger signs during pregnancy or 
post-partum period.
50% 12.3 46.0
Significant 
increase, but 
short of target
13. Percentage of mothers with at least one post￾partum visit after their last pregnancy. (TBA 
visits not counted.)
40% 13.2 26.0
Improved. 
14. Percentage of non-pregnant women that do 
not desire to have children in the next two years 
that are using family planning methods. 40% 15.1 52.8
Significantly 
increased
15. Percentage of mothers that recognize at least 
two signs and symptoms of Sexually Transmitted 
Disease (STD) in men or women.
50% 0.0 62.5 Exceeded
16. Percentage of mothers of children 0 to 23 
months old that can identify at least two ways to 
avoid HIV infection.
70% 17.3 79.5 Exceeded
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2. Results: Technical Approach
a. Project Overview
The overall goal of this extension project was to provide better health in a sustainable manner for 
women and children residing in or migrating to coffee plantations in three departments and one 
additional municipality of Guatemala’s Boca Costa Region. This has involved achieving tripartite 
collaboration among employers, government, and NGOs. In terms of strategic approach, the focus 
has been exclusively on building the capacity of the project’s local public and private partners by 
strengthening the activities they are currently engaged in or have been designated to be engaged in –
planning, service delivery, training and supervision, logistics and outreach along with collaboration
with the plantations and their communities. Project HOPE did not engage in the delivery of health 
care services to residents or migrants in the target area nor in direct health education or training.
The project provided capacity-building support to its partner agencies for the following
interventions: Immunization (5% level of effort), nutrition and breastfeeding (20%), acute
respiratory infection (15%), diarrhea (10%), malaria (5%), maternal and newborn care (20%), child 
spacing (15%), and HIV/AIDS/STIs (10%). The project provided technical, management, financial, 
research, monitoring, and evaluation support to its local partners, the MSPAS, IGSS, and three 
NGOs, who were directly responsible for carrying out the interventions. 
Through the project, these partners have built professional relationships with 94 coffee plantations 
which have resulted in improved access to the plantations to: 
a. conduct periodic immunization and Vitamin A supplementation campaigns;
b. establish, supply, and monitor Basic Health Units; staffed by RHPs
c. conduct inspections of sanitary and living conditions for migrant workers;
d. implement health education activities.
In addition, the project targeted four municipalities in the Highlands of San Marcos Department 
from which many migrants come. The project used match funding from the International Labor 
Organization (ILO) to assist the San Marcos Area Health Office to train and supervise existing 
RHPs in health promotion, and funded training in IMCI and AMNE for health personnel from 
those districts. These activities took place during the first two years of the project and the results 
were reported in the mid-term evaluation. 
In an attempt to reach migrants from other Departments with minimal health education, the project 
taped and disseminated messages via 50 radio stations, in Spanish, Ki’che and Mam languages. The 
project also shared supplies of the educational materials produced for use by RHPs with the
Area Health Offices in the Departments of Hueheutenango and Quiche. 
The extension project focused on forming and strengthening the training teams in each Health Area 
and IGSS, particularly in the use of adult learning methods to improve the quality of training and in 
follow-up supervision. Through the training teams, virtually all employees in the targets area (from 
health facilities to health posts to regional hospitals) were trained in IMCI, AMNE, and AINM-C.
Particularly notable, is the fact that the project introduced IMCI to IGSS, which had not previously 
considered adopting the approach. The IGSS hospital in Suchitepequez is also applying AMNE. 
There is potential for IGSS to scale up these approaches in other parts of the country.
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Outputs of CS XVII Extension Phase
Health Area No. of Active 
RHPs
Total No. UBS
Functioning
Highland
Communities
Plantations
Involved
San Marcos 182 106 69 37
Quetzaltenango 18 18 NA 18
Suchitepequez 39 40 NA 39
Totals 239 152 69 94
Training Outputs of CSXIII and CSXVII
Topic CSXIII CSXVII Highlands of 
San Marcos
Totals
(accum￾ulative)
Clinical IMCI 136 494 30 660
IMCI/AINM-C in health facilities 238 377 30 645
AMNE, Family Planning, STIs/HIV/AIDS - 410 30 440
Community IMCI and AINM-C for RHPS 150 183 - 333
Promotion and prevention for RHPs 650 964 150 1764
MNC, FP, STIs/HIV/AIDS for TBAs 679 783 175 1637
TOTALS 1853 3211 415 5479
b. Progress report by intervention area 
 
It should be noted that Project HOPE’s role in interventions was that of capacity building of partner 
service delivery. Project HOPE facilitated establishment of the BHUs and training of RHPs in C￾IMCI to improve coverage, promoted policy changes affecting migrant services at the district and 
Area levels, promoted formation of and trained MSPAS and IGSS training teams in IMCI, 
Integrated Maternal and Child Attention (AINM-C) and in Essential Maternal and Newborn Care 
(AMNE), funded cascade training and follow-up, and coordinated communication between MSPAS, 
IGSS, the NGOs, and the plantation administrators. Project HOPE provided educational materials
and paid for development of radio spots, but did not engage in any direct community education. As 
match, Project HOPE supplied some essential medicines and Vitamin A, but devoted efforts to 
assuring that the MSPAS now has plans and systems to permanently supply the districts, and 
through them, the BHUs.
NOTE: All indicators from the DIP presented in the following discussion on interventions were 
written for resident women living permanently on or near the coffee plantations. The DIP did not 
include any indicators for migrant women, even though they are a primary target of the project. The 
results from a mini-KPC survey of a convenience sample of migrant women (see Annex B) are
presented for comparison in some key areas.
IMMUNIZATIONS – 5% of effort
Indicator Baseline Final
Percentage of children 12 to 23 months completely immunized. 42.1 80.8
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The project succeeded in motivating the MSPAS personnel and, in Suchitepequez, the IGSS staff, to 
undertake regular immunization campaigns on the targeted plantations, including one campaign on 
each plantation in their jurisdiction during the harvest season when migrants are there. In many 
cases, the plantation administrators provided transportation or fuel for the immunization teams to 
come. In Suchitepequez, the MSPAS provided the vaccine and logistics while the IGSS doctors and 
nurses went to the plantations. This represents a level of coordination that was unimaginable prior 
to this project. 
These campaigns and implementation of clinical IMCI, which includes checking the child’s 
immunization status, are the factors which enabled the project to achieve complete coverage. 
Another factor affecting this indicator is the strategy the project employed prior to the final KPC 
survey of alerting all community members (via community leaders and RHPs) to have their 
children’s immunization cards available in case they were among the households selected for the 
survey. This resulted in 98.8% of families having the card on hand at the time of the interview.
Conclusion/Lesson Learned: Increasing the level of collaboration between the health delivery 
system and the plantations is an effective way to implement periodic immunization campaigns
thereby significantly increasing vaccination coverage on plantations that could be scaled up with 
other plantations and in other Health Areas. 
NUTRITION, BREASTFEEDING and MICRONUTRIENTS – 20%
 Indicators Baseline Final
Percentage of children 6 to 23 months that have received a dose of Vitamin 
A in the 6 months previous. 15.7 68.7
Percentage of children that received breast milk within first hours after birth.
62.5 75.0
Percentage of children 0 to 6 months exclusively breast fed.
79.2 87.3
Percentage of children under age 2 malnourished (< -2 z weight/age).
24.6 20.2
The dramatic increase in Vitamin A distribution is due to the same campaigns on the plantations 
employed to increase immunization coverage, and to Vitamin A supplied by Project HOPE to the 
MSPAS. Also, the MSPAS has made a more concerted effort from the national level down in recent 
years to rejuvenate the Vitamin A supplementation program. The increases in immediate initiation 
and in exclusive breastfeeding are commendable considering that there was no specific activity 
targeting these behaviors other than the education and counseling from the health workers and 
RHPs trained in IMCI and AINM-C. 
After the project extension was approved and before the DIP was written, the government 
approved a new program for community level called Integrated Maternal and Child Attention at the 
Community Level (AINM-C). This uses growth monitoring and nutrition counseling as the entry 
point for caregiver education, leading into the other maternal and child health counseling. Project 
HOPE supported the training of all the RHPs in AINM-C, but did not have the budget to provide 
Salter scales. Some few plantations went ahead and purchased scales, and the BHUs which have 
been absorbed by the ECP now have scales. 
13
There was no improvement in nutritional status possibly due to factors beyond the project. 
Economic, and hence, food security of resident families has been affected throughout the life of the 
project by the low coffee prices, which resulted in less work and layoffs. 
Additionally, when the percent of children with inadequate weight for age is relatively low to begin 
with, as it was in this case, reducing malnutrition significantly requires very concerted efforts 
targeting individual families with counseling and support. Therefore, an on-going growth
monitoring is essential to detect each malnourished child. This is a premise of AINM-C.
Finding: 
While resources were invested in training RHPs in AINM-C, very few have been able to apply the 
training due to the lack of scales. There is no plan, yet, for the MSPAS to acquire the needed scales. 
Behavior change was achieved in nutrition-related practices including early initiation and exclusive 
breastfeeding, and feeding frequency. Nutritional status did not change significantly among resident 
children. 
Lesson learned: 
When a detailed budget is developed, great care should be taken to make sure that all of the 
materials and supplies essential to each intervention are budgeted for. 
PNEUMONIA – 15%
Indicator Baseline Final
Percentage of mothers or caregivers who can name at least two danger 
signs that indicate a child should be seen by a trained health care worker. 34.4 90.9
The indicator above refers to signs of any child illness. Due to the way this question is now 
formulated in the KPC 2000+, it is difficult to relate the response specifically to pneumonia, which 
takes the most lives. In looking at the detailed frequencies on the final KPC, only 39% of mothers 
mentioned difficult or rapid breathing (signs of pneumonia) as signs that the child needs medical 
care. Mothers are most likely to mention that the child has a fever or that the child is not eating or 
drinking. For some reason, the project did not choose to measure the number of mothers who 
sought care when their children had signs of pneumonia as an indicator, a key health behavior for 
child survival. Seventy-five percent of the mothers whose children had signs of pneumonia in the 
two weeks prior to the final KPC survey had sought medical care, most going directly to health 
centers. This increased significantly from 41% at baseline.
The field investigations revealed that the medical personnel and promoters (13/15) are well-trained 
to use the respiratory timers they received as a part of IMCI training. They expressed strong 
appreciation for their new skills in diagnosing pneumonia. Furthermore, eleven of the fifteen 
promoters interviewed were able to correctly explain how to administer the antibiotic. They have 
been trained to give the first dose and make referrals to the health facility. District health records 
and promoters’ monthly reports show that the referral system is working well. Twelve of the fifteen 
BHUs, that received unannounced visits during the final evaluation, had supplies of essential 
antibiotics for children and reported no recent stock-outs during the past two months. The other
three had some, but not all, required medicines.
14
The districts convene monthly meetings of the RHPs to which the RHPs must bring their 
completed report forms. Those attending with completed forms are re-supplied with medicines. 
This has served well to get the RHPs to attend the meetings which include case reviews, and 
additional training on themes important to the season. The three BHUs visited by the evaluation 
team that reported shortages of essential drugs were ones where the RHP had missed one or more 
meetings or a monthly meeting had been postponed.
Findings:
· Although not a project indicator, the increase in care-seeking when a child has signs of 
pneumonia is significant and points to some effectiveness of community education or one-on￾on counseling by health personnel and RHPs and/or increased confidence in health facilities.
· Final evaluation team observations of approximately ten percent of the promoters trained in C￾IMCI documented correct use of the timer, knowledge of respiration rates and correct dosage of 
antibiotics to prescribe.
Lessons Learned:
- Linking RHP attendance at monthly meetings is an effective strategy to avoid stock-outs and 
motivate regular attendance. 
- The reformulation of the standardized KPC survey does not permit the accurate measure of 
knowledge of danger signs as it relates to pneumonia. 
DIARREAL DISEASES – 10%
Indicators Baseline Final
Percentage of mothers that offered equal or more breast milk, liquids 
and/or food during the child's last episode of diarrhea.
34.9 84.3
Percentage of mothers or child caretakers that sought help from a 
trained health care provider during child's last episode of diarrhea.
44.4 93.7
As with pneumonia, this intervention was addressed by IMCI and C-IMCI training for health 
personnel and for RHPs respectively. According to the final KPC, care-seeking behavior had greatly 
improved with 93% of resident mothers seeking care for a child with diarrhea. Sixty-three percent 
sought care at the BHU and sixty-five percent gave their sick child ORS. However, 75% of mothers 
reported giving their sick child medicine to treat the diarrhea. 
Forty-three out of the sixty-eight migrants interviewed also said they give medicine to children with 
diarrhea while only 14 mentioned giving any oral rehydration solution. 
Findings:
· Care-seeking behavior for diarrhea greatly increased and caregivers are using ORS. (a conclusion 
would be something like; the approach used to address diarrhea case management was effective.) 
· Most care-givers are seeking care for diarrhea at the UBS.
· Too many mothers are still treating diarrhea with medicines.
15
MALARIA/DENGUE -5%
The project did not establish any indicators for malaria, possibly because the only activity was 
strengthening health worker skills to diagnose and treat malaria through the IMCI training. The 
KPC survey included a question about symptom recognition to which 64% of mothers know any 
signs of malaria. To a question the project added to the KPC asking for signs of dengue fever, 
seventy-two percent of mothers were able to mention some signs of dengue, which is seasonally 
endemic in the Boca Costa and more common than malaria, particularly among children.
RHPs were trained to recognize these illnesses as a part of their C-IMCI training and to make 
referrals. Evaluation team reviews of their records showed that they are making appropriate 
referrals. RHPs were also trained to promote the use of locally available mosquito nets. The final 
survey showed little change from the baseline survey (thirty-two percent).) Forty percent of the 
households report having one or more nets, and in all these homes, the child sleeps under the net. 
In 63% of the households having one or more nets, the mother also sleeps under the net. 
As a result of the greatly enhanced coordination between plantations and health services, many 
plantations are now inviting the Vector Control officer of the health district to come and fumigate 
on the plantation prior to the arrival of the migrants. This use of residual spray for mosquitoes is 
fully in line with MSPAS policy and is likely preventing vector borne illnesses. There is,
unfortunately, no way to document this possible impact.
Findings:
· The RHPs trained during the project are able to recognize malaria or dengue and make referrals.
· Vector control officers are now allowed to spray on the plantations near migrant living quarters.
MATERNAL NEWBORN CARE – 20%
Indicators Target Baseline Final 
Percentage of mothers that received at least two doses of 
tetanus toxoid before the birth of their last child.
60% 22.6 49.4
Percentage of mothers that received at least 3 prenatal 
care visits during their last pregnancy. 50% 11.1 35.2
Percentage of mothers able to report at least two 
maternal danger signs during pregnancy or post-partum 
period.
50% 12.3 46.0
Percentage of mothers with at least one post-partum 
visit after their last pregnancy. 40% 13.2 26.0
The DIP targets for the maternal health indicators were set quite high considering the very low 
levels in the baseline, so it is not surprising that none were wholly achieved. In rural Guatemala, this 
is only the second generation of women who have had access to maternal care from health 
professionals. Women’s confidence in, and comfort with, traditional birth attendants remains high. 
The project collaborated closely with the USAID-funded Maternal Newborn Project which was 
implemented in Guatemala by JHPIEGO. Project staff members were trained by JHPIEGO, which 
provided the project with the training curriculum for Essential Maternal and Newborn Care
16
(AMNE), now a national protocol. The project trained an AMNE training team in each Area and 
one for IGSS, and through them, trained 410 health professionals and 783 traditional birth
attendants. In addition to training, project staff helped the partner institutions implement a 
supervision system which enables the health personnel to maintain close working relationships with 
the TBAs, strengthening timely referrals for complications and for prenatal care. 
The project assisted the partners to conduct a skills assessment of the trained TBAs. The 
assessment showed a big gap between knowledge and practice, and resulted in revamping the 
training to emphasize recognition of danger signs and making timely referrals; rather than the many 
topics formerly taught. IGSS, which previous to this project had never worked with TBAs, took on 
TBA training and support as a part of their new community outreach program in Suchitepequez. 
They coordinate closely with the MSAP health facilities in this endeavor. IGSS took the training a 
step further, bringing TBAs into the maternity ward to observe and practice.
The DIP did not include an indicator for measuring knowledge among mothers of neonatal danger 
signs, and hence, this was not emphasized in the health messages. Considering that approximately 
half of infant mortality occurs in the neonatal period and that more than half of deliveries occur at 
home with unskilled attendants, this was an unfortunate oversight. 
Evaluation team members questioned TBAs, some RHPs, and plantation staff about the availability 
of emergency transport. Plantations generally provide transport for their residents and migrants 
when the need arises. For communities off the plantations, emergency transport is a serious 
concern, which the project did not address, even though the lack of emergency transport and 
distances to health facilities were spelled out in the DIP. Project staff did not have the experience 
or training in community mobilization necessary to undertake building the capacity of the MSPAS 
staff and promoters in order for them to undertake this. The headquarters technical staff did not 
have this expertise either.
Findings:
· Insufficient attention may have been given to educating families and TBAs on newborn danger 
signs.
Conclusion:
· The project had time to implement a limited community mobilization effort to have
communities develop emergency transport plans which would enhance the survival chances of 
both mothers and newborns in time of emergency. Project staff would have needed some 
additional technical assistance to enable them to promote community mobilization. A
suggestion has been made to the partners to pursue the idea of community plans for emergency 
transport. 
Lesson Learned: 
· When the baseline data survey confirms that a behavior is quite low, be careful not to set overly 
ambitious results objectives. 
· Future projects that focus on maternal & newborn care should contain an indicator regarding 
appropriate care of the neonate. 
17
CHILD SPACING – 15%
Indicator Baseline Final
Percentage of non-pregnant women who do not desire to have 
children in the next two years or are not sure that are using family 
planning methods. 15.1 52.8
Besides promotion of child spacing through the RHPs and TBAs, the project trained 60 community￾based distribution agents in the Department of Suchitepequez, who are linked to the national IPPF 
affiliate known as APROFAM. They are trained to provide counseling and to promote family 
planning besides selling contraceptives. They are functioning independently to sell methods with a 
slight profit margin. Health personnel and TBAs received refresher training on family planning and 
materials to use for education and promotion. They make referrals to the health centers.
While the increases in family planning use among residents are significant, the migrants have not 
been reached. Among the 68 migrant women interviewed, 23 could not name a single family 
planning method. Only 13 of the 68 are currently using any family planning method. (See the 
Behavior Change section below for analysis of the educational efforts with migrants.)
Conclusion: 
· Family planning promotion through community health workers was effective with residents.
Lesson learned:
· A specific strategy was needed to reach migrants with family planning promotion.
STI/HIV/AIDS – 10%
Indicators Baseline Final 
Percentage of mothers that recognize at least two signs and 
symptoms of Sexually Transmitted Disease (STD) in men or 
women.
0.0 62.5
Percentage of mothers of children 0 to 23 months old that can 
identify at least two ways to avoid HIV infection. 17.3 79.5
The STI/HIV/AIDS intervention consisted of raising awareness through IEC activities carried out 
by the RHPs and TBAs and radio spots. TBAs and the health staff of partner institutions received 
training on self-protection and prevention. It must be noted that the government and NGOs all 
over the country are conducting awareness campaigns, largely via mass media, about HIV/AIDS 
which may be as responsible for the improvements in knowledge as any of the project effort.
During the final evaluation, many RHPs mentioned their personal concern for educating their 
neighbors about HIV/AIDS and how to prevent it. TBAs and health workers also expressed 
gratitude for training in self-protection as they go about their work.
Conclusion:
· While there were significant improvements in knowledge related to HIV/AIDS, this is a 
probable cumulative effect of project efforts combined with national media campaigns.
18
c. New tools and approaches that the program used
This project was among the “pioneers” in using Personal Digital Assistants (PDAs) to collect KPC 
survey data. Project staff were trained to use the PDAs for the mid-term survey and later used 
them for Year 4 LQAS monitoring and again for the final survey. Both the project and MSPAS staff 
who participated in data collection had an easy time learning to use the PDAs. This included a long￾time project driver who has never used a computer or other digital device. While the use of the 
PDAs may have facilitated data collection and eliminated the time required for data entry, project 
staff had concerns about possible errors in transfer of data to other programs for analysis. Project 
HOPE will have to evaluate the outcome of the PDA use across other projects before definitely 
adopting the methodology. 
3. Cross-cutting approaches 
a. Community Mobilization
The project design did not include community mobilization. As mentioned above under the 
maternal-newborn intervention, a limited community mobilization effort to assure emergency
transport plans for off-plantation communities might have contributed to reducing maternal and 
newborn mortality. 
There was mobilization of plantation owners and administrators to participate in the project. As 
evidenced by the participation of so many plantations, and the requests of others to participate, this 
was obviously effective. The approach included sharing health data with the Associations of 
Plantation Administrators in each Department and, then, convening regular meetings between the 
administrators and district health leadership to plan BHUs, campaigns and other activities. There is 
obviously demand from them to continue as 63% of the plantations have committed to continued 
funding for the RHPs and/or medicines. A small but significant number of plantations are making 
serious improvements in the living conditions of migrant workers and more can be expected to do 
so if coffee prices continue to regain strength and the labor shortage continues.
Conclusion: The mobilization of plantation owners was effective.
b. Communication for Behavior Change
The rather traditional approach of using prepared flip charts to teach mothers groups coupled with 
emphasis on individual counseling during health contacts appears to have been sufficient to bring 
about a number of important behavior changes among residents, as shown by the KPC results 
presented earlier in this document. Most of the targets for behavior change were met. The 
project participated in the national-level inter-agency task force to define health messages, and 
acquired additional private funding to develop educational materials. The project had outside 
technical assistance to conduct operations research and then use the results to develop attractive
“mother reminder materials”. The project, however, did not have a behavior change strategy 
which targeted specific families with specific messages according to their needs, nor identified 
secondary recipients for learning activities. 
19
Since the communities on and near the plantations are generally quite small, RHPs have frequent 
contact with mothers as neighbors and relatives, and said that most message dissemination was 
through informal channels. Plantation administrators were helpful in giving workers time off to 
attend more formal educational sessions. During the evaluation, many community members 
mentioned that one way they support the RHP is by attending the health education sessions.
Improved counseling skills of health workers through IMCI and AINM-C training were noted by 
mothers during the client satisfaction surveys the project conducted. The project placed special 
emphasis on applying principles of adult learning during both training and community education.
The final evaluation team assessed the capacity of the RHPs to use the educational materials and 
found it to be satisfactory. It will be up to the RHPs, supported by the district health personnel, to 
continue to reinforce the behavior changes amongst the mothers. Since the RHPs enjoy good 
support from the health districts or ECP-implementing NGOs, it is likely this reinforcement will 
continue and that the work of the RHPs will be sustained. Furthermore, since all messages and 
behaviors are related to national initiatives, residents will receive reinforcement via radio, billboards, 
and posters in the health centers.
The best measure of the effectiveness of the behavior change approach is the comparison of results 
of the baseline and final KPC surveys. The effectiveness of the limited BCC interventions for 
migrants (radio spots and counseling at health contacts while on the plantations) was measured by a 
LQAS sample during the mid-term evaluation and the mini-KPC conducted as part of the final 
evaluation (see Annex B). The results of this survey of a convenience sample showed that migrants 
are not being reached with health messages. 
Knowledge and Behavior of Migrants According to Two Separate Surveys
KPC Questions LQAS 2003* Convenience Sample 2005**
Huehuetenango Total
No knowledge of danger signs during pregnancy 43.0% 27/41 37/68
Recognition of signs of pneumonia in child 0 2/41 5/68
Care seeking for child with pneumonia signs 54.5% 6/9 10/16
Have heard of HIV/AIDS 32.9% 7/41 17/68
Know at least one way to prevent HIV/AIDS 23.7% 1/41 12/68
No knowledge of family planning methods 48.7% 16/41 23/68
Currently using a modern FP method 8.5% 11/41 13/68
Have recently heard radio spots on health 1/75 24/41 36/68
*Survey of migrant women on plantations. ** Survey of women mostly in communities of origin.
During the initial phase, the project attempted to conduct the standard health education sessions for 
groups of migrants using the “flip chart talk” method. This was not at all successful for many 
reasons. First of all, the priority of all migrant adults is to work as much as possible while on the 
plantations, since the earnings are their only cash income for the year. Since they are paid by the 
amount picked, they did not want to take time off to go to a health education session. Secondly, the 
migrants on a single plantation may come from various areas of the country and speak entirely 
distinct languages from each other and from the RHPs or health workers. Print messages are of
little use as migrant women are among the most uneducated in the country according the project 
surveys and the national demographic surveys. (See project proposals for data.) Faced with these 
20
realities, the project and MSPAS staff abandoned attempts at health education for migrants on the 
plantations.
Despite the fact that the CSXIII project struggled without success to reach and impact the migrant 
population, the DIP for the extension project did not include any innovative approach to achieve 
this, other than directly targeting 4 Highland municipalities of San Marcos, during the first two years 
of the current project. Project staff needed outside technical support from headquarters or a 
consultant to “think out of the box” and come up with alternative ways to disseminate health 
messages to migrants on the plantations. 
The proposal for the CSXIII project had proposed coordinating closely with the NGOs working in 
communities of migrant’s origin and with the MSPAS in those Departments. Aside from the 
provision of educational materials to the Area Health Offices in Quiche and Huehuetenango, this 
did not happen in either the original project or the extension. During the final evaluation, the team 
learned that it is quite possible to identify specific communities of origin. When requested, the 
plantation administrators were able to verbally name the municipalities from which their migrants 
normally come and some administrators produced lists of contractors with names of specific aldeas. 
This enabled evaluation team members to travel directly to those communities of origin to interview 
the migrants. If the project had identified the communities of origin in this manner from the outset, 
they could have then worked with the MSPAS or NGOs in those particular areas to target potential 
migrants in their own languages and context with important BCC activities.
The project missed an opportunity to evaluate the sustainability of behavior change. They had 
conducted a baseline KPC survey in the Highland communities and a final survey in 2003 after the 
two years of intervention ended. If funding had been available, it would have been interesting to 
have conducted the survey again as part of this final evaluation to assess maintenance of behavior 
change two years after. (Activities have been continued by the MSPAS and RHPs.)
Findings: 
a. The behavior change education for residents was quite effective based on KPC results.
b. Migrants still lack essential health information and care-seeking or preventive behaviors. 
Lesson learned: 
1. It would have been possible and desirable to track migrants back to communities of origin and 
then, work more closely with NGOs and MSPAS in those municipalities to assure effective BCC 
outreach and monitoring there, rather than on the plantations where they are dedicated to 
picking coffee.
2. In projects implemented in phases, subsequent phases should be used to assess the effectiveness 
of activities/initiatives carried out during earlier phases and improve on them.
21
c. Capacity Building Approach
i. Strengthening the PVO Organization
Project HOPE has learned many lessons from the Guatemala Child Survival Project (GCS) and this 
has strengthened the agency’s capacity in several ways. For example through the GCSP, HOPE
deepened their understanding of how to partner with the private sector and this in turned spawned
other projects in other countries where the one of the partners was from the private sector. The 
GCSP helped HOPE focus more effectively on sustainability the agency to adopt a more mentoring 
role in this project such that local organizations, including the coffee plantation owners and 
insurance agency, would be obliged and aided in taking responsibility for health provision to 
plantation workers – both migrant and local. Some of these lessons learned have been shared 
during HOPE’s 2005 leadership conference and there are plans to share these lessons more widely 
with the CORE community via vclass in early December 2005. 
Project HOPE Guatemala received technical support from PACT to undertake an internal
assessment using a tool called Evaluation of Organizational Capacity (ECO). The process included 
self-analysis of many different aspects of HOPE/Guatemala, and all Project HOPE/Guatemala 
employees were actively involved. This led to strong identification of the employees with Project 
HOPE Guatemala, and to development of a four-year strategic plan to strengthen certain aspects of 
the organization such as administration, accounting, personnel policies, performance appraisals and 
job descriptions, and adult learning methodology. Project staff and management feel they have fully 
met or exceeded the planned improvements. 
Project HOPE headquarters has built capacity in monitoring and evaluation through the application 
of LQAS sampling and the use of PDAs for data collection, using this project as a laboratory. 
Conclusion:
· ECO appears to have been a very effective tool for helping Project HOPE Guatemala assess 
and improve internal systems.
ii. Strengthening Local Partner Organizations and Health Facilities Strengthening
The capacity building efforts of this project focused on the MSPAS health districts, IGSS
Suchitepequez, and the NGO partners, and consisted not only of the training in and
institutionalization of IMCI and AMNE (see below), but also in training and mentoring in
supportive supervision, monitoring and evaluation, and strengthening of reporting, administration, 
and logistics. While the improved capacity in health worker performance is documented through 
the monitoring system, there were no pre and post assessments of capacity in the other areas.
The project conducted performance assessments, client satisfaction surveys, and a health facility 
assessments of the BHUs during 2003 and early 2004, all of which resulted in identifying weaknesses 
and taking corrective actions through improved supervision, adjustment of training methods or 
content, additional refresher training, and taking RHPs to the health centers to work alongside the 
nurses and physicians to improve skills.
22
To help strengthen FUNCAFE, the partner which is ANACAFE’s development arm responsible for 
health care delivery on a number of plantations, Project HOPE tried to replicate the ECO process 
but the FUNCAFE leadership was not comfortable with the self-analysis methodology and the 
process was discontinued. 
During the final evaluation, partner staff were asked which capacity-building activities were most 
useful and have had immediate application in their routine work. They identified learning LQAS, 
use of PDAs for data collection, and skills in supervision as elements of the capacity building which 
are most useful.
Lesson learned:
The project could not measure improved capacity in the partners due to lack of a pre and post 
assessment. The DIP should have included a plan for this.
iii. Strengthening Health Worker Performance
The approach for strengthening health worker performance through training in standardized
protocols and procedures (described below under training) was very effective. The training was 
accompanied by monitoring, actually performance-based supervision. Project HOPE introduced 
the supervision tools (created and tested by JHPIEGO and PAHO with the MSPAS) and mentored 
supervisory staff of the partners in their use. Project HOPE accompanied the training teams/master 
trainers on initial supervision visits, but quickly phased this completely over to the trainers. The 
results of the monitoring visits were tracked by both Project HOPE staff and the partner training 
teams. Reinforcement of skills was provided by the partner training teams, as needed through in￾service training and supervision. 
Project HOPE had support of JHPIEGO staff, particularly in San Marcos Regional Hospital and 
the IGSS Hospital in Mazatenango, to implement the supervision/monitoring system for AMNE. 
In both, they implemented a baseline assessment of skills prior to the training, and a follow-up 
assessment some months later to observe improvements in the target health facilities. JHPIEGO 
developed a very detailed tool for this purpose.
During the final evaluation, district and Area health staff expressed their confidence in being able to 
continue the level of supervision implemented under the project. Supervision at the health centers 
and hospitals has been strengthened by the tools, and will continue. The Master Trainers assumed 
this responsibility for a time immediately post-training, but once district staff learned to use the 
monitoring tools, the Master Trainers turned over the responsibility to the district and Area health 
staff.
District health staff are currently making supervision visits once a month to the RHPs and also 
convening a monthly meeting at the health center will them. Transportation for supervision does 
not seem to be an issue as the district staff have access to some motorcycles or vehicles or can 
frequently ride with the vehicle going out to do immunizations. None of the health staff interviewed 
felt that lack of transportation would be a barrier to continued monthly supervision.
The monitoring tools are sensitive enough to measure changes in performance over time. The 
project also verified skills application by conducting separate performance assessments of both 
23
health workers and RHPs. MSPAS staff were pleased to learn how to do this and are currently 
continuing such assessments. One was underway in IGSS during the final evaluation visit.
Finding: 
Health worker and RHP performance has been enhanced through quality training and follow-up 
monitoring and assessments, the use of which appears to have become internalized in the Area and 
District health services.
 iv. Training
The cascade training strategy led by the Master Training Teams was very effective. Project HOPE 
began to form the training teams during the first phase of the project and they became a major focus 
of the extension project. Each Area (four) now has a training team made up of 10-12 persons, 
including personnel from the Area Health Office and districts. IGSS has separate teams for IMCI 
and for AMNE made up of hospital and regional management staff. The members of the training 
teams are called Master Trainers. Each team has operating rules which specify their role: detection 
of training needs, training of health workers in initiatives of the central MSPAS, coordination of 
training with partner institutions, performance monitoring and supervision, and provision of 
reinforcement of skills application. 
 The trainers are still motivated and could cite examples of how adoption of adult learning strategies 
has greatly improved training outcomes. Project HOPE staff followed the training down the 
cascade to assure continued quality and found that quality was maintained even under difficult 
circumstances. 
Project staff had considerable support from the Project HOPE Regional Health Educator, based in 
Lima, Peru, who was largely responsible for the emphasis on adult learning. The project also 
benefited from highly evolved and tested training curriculums developed at the national level for 
IMCI, AINM-C, and AMNE. 
The training objectives (see table in Section B Results above) were largely met, except in the case of 
TBAs where the target was set unrealistically high. In addition, the training teams have taken the 
training program to other districts outside the project target area. The universal application of the 
IMCI algorithm and the AMNE protocols is evidence of the effectiveness of the training. 
The confidence the training inspired in health workers is notable. Staff at all levels feel they now 
have the capacity to not only implement the new skills in care provision, but also to train and 
support others.
The institutionalization of the Master Training teams and district-level trainers bodes well for 
sustainability of the training approach. The teams do need to do additional planning regarding 
training new personnel and to replacing training team members when one retires or leaves the area. 
Unfortunately, funding for future training and refresher training remains elusive. So far, it is not 
included in Health Area budgets, which are limited due to decisions made at the central level by the 
Ministry of Finance. The Area Office of Quetzaltenango has taken the step of approaching the 
24
Social Investment Fund (of the government) for the needed funding. If they are successful, this may 
be an option for the other Areas to pursue. 
Findings and conclusions:
1. The quality of training and the cascade approach has been very effective.
2. The training teams have been institutionalized and are motivated.
3. Funding for future training is a serious limiting factor for sustainability.
d. Sustainability Strategy
The chart below shows the sustainability indicators found in the DIP and what has been
accomplished.
Accomplishment of Sustainability Objectives
Objectives Indicators Accomplishment
Health areas / municipal 
health councils have 
strengthened service delivery 
policies for migrants.
Additional human/material resources 
allocated by all three health Areas and at 
least 20 municipalities for migrant 
activities. 
Written policy statement at each health 
area.
This was accomplished at both the 
Area and District levels within the 
MSPAS, largely through the 
efforts of the National 
Coordinator for Migrant Health 
and project advocacy.
Revolving drug funds 
operating on low-access 
plantation and municipalities
Number of new revolving drug funds 
(RDF) providing essential drugs.
This idea was dropped at the mid￾term due to improved supply from 
MSPAS and lack of a source of 
drugs for the RDF.
Health areas/districts /IGSS 
allocate sufficient resources 
to training, supervision, and 
follow-up of health facility 
staff and community agents.
12 -20 trainers available in each health area;
Resources allocated to achieve targets of 
training plans.
Training targets were met, but 
funding came from Project 
HOPE. Areas and districts do not 
have future funding for training.
Data inform decision-making 
at all levels 
Review of health data integral component 
of all routine meetings.
Data is available, but use is still 
less than hoped for.
Plantation BHU data 
integrated into and used in 
MOH HIS.
MOH at health area/municipal/health 
facility level can provide data-based 
information about work of community 
agents.
BHU data is fully incorporated by 
all districts.
HU promoter supervision/ 
refresher meetings 
conducted monthly at closest 
MOH facility.
At least 80% of promoters supervised 
monthly at health facility.
Reports and interviews showed 
that this is happening in 90% of 
districts.
MOH health campaigns and 
preventive activities on 
plantations during harvest.
All larger plantations receive at least one 
MOH health campaign for immunizations 
and Vitamin A per harvest season.
Campaigns are taking place as 
scheduled with plans to continue 
indefinitely.
Plantation HUs have 
continuous supply of 
essential drugs and supplies.
90% of HUs report no stockouts during 
the harvest season.
RHPs reported few stockouts last 
season. 17 out of 19 promoters
visited had sufficient supplies.
Plantation owners and 
municipal directors meet at 
least quarterly to address 
8 plantation owner networks meeting 
quarterly with municipal level MOH/IGSS 
staff.
Meetings are held less frequently, 
but the administrators and district 
staff have frequent contact.
25
plantation health issues.
Plantations include cost of 
maintaining promoter and 
HU in annual budget
60% of plantations can report line item for 
health activities at final evaluation.
Plantation networks provide guidance on 
level of contribution to health.
Sixty-three percent of plantations 
visited during the final evaluation 
have funds to contribute to BHU 
and RHP.
Increase demand for HU and 
health facility services.
80% of resident mothers and 60% of 
migrant mothers have sought care or 
participated in health education activities at 
the HU.
This was not measured by the 
final KPC.
Implement 100 new HU in 
plantations
20 new units in year 1; 30 in year 2; 40 in 
year 3 and 10 in year 4
A total of 152 Health Units are 
functioning.
 Health councils at 
department and municipality 
level, promoting health 
services for migrants.
3 department health councils; 15 
municipality health councils, planning 
health activities for migrant and resident 
workers
The Area Health Councils are 
functioning, but municipal health 
councils were not a success. Only 
3 of them remain functional.
The project had a solid plan from the beginning of CS XIII, which continued in this extension 
phase, to undertake all activities through the partners, hence did not create independent activities to 
be phased over. The project did fund training activities and production of materials, and, as always, 
the government’s ability to find other funding to continue this level of effort is questionable. This 
limitation can only be addressed by bi-lateral donors working with the Ministry of Finance and 
central MSPAS to re-order priorities. 
The Area Health offices do not feel they need continued technical or management assistance for this 
particular initiative. They expressed confidence in their ability to continue to implement IMCI, 
AMNE, and support to the BHUs, RHPs, and TBAs. 
Conclusions:
· The BHUs, having support of the MSPAS, NGOs, and plantations, have excellent prospects 
for sustainability.
· The current level of monitoring and supervision of RHPs is very adequate to sustain good 
performance and to encourage volunteers to continue.
· The intensity of training will not be sustained unless the Area Health offices obtain outside 
funding or there is a major change in funding for the central level MSPAS. 
26
C. Program Management
1. Planning
The DIP planning process included workshops with stakeholders in each of the Health Areas 
and preparation of the DIP in-country, both of which resulted in a very practical DIP work plan 
and a sense of program ownership by the project partners. Partners, at the time of the final 
evaluation, felt responsible for the project outcomes. 
As mentioned previously, the DIP’s monitoring and evaluation plan was weak; specifically the 
lack of indicators to measure behavior change among migrants and to measure attitude changes 
among health providers. Furthermore, there were no plans for pre and post assessment of 
health facilities and health worker skills. Project staff were not aware of these deficits until the 
final evaluation process when they became aware of the lack of data to show outcomes. 
2. Staff Training
The following chart shows the training of project staff. The improvements in project 
administration, ability to conduct two KPC surveys and annual monitoring using LQAS and 
PDAs, and the impressive application of adult learning theory in training curriculums are all 
evidence of how well the staff has applied their new skills within the project and shared them 
with partners. It appears that adequate resources were devoted to staff training, and it is 
commendable that Project HOPE has experimented with the use of technology like V-Class to 
reduce the cost of training as well as enable staff to learn from other staff in the Latin America 
region.
Since nearly all program staff entered this phase of the project with 4 years of experience in 
project implementation, they had clear ideas of what additional training was needed and those 
needs seem to have been met.
Staff Training Activities
Staff Period Topic
Dr. Anabela Aragon, Project 
Coordinator
Sept. 2002
Sept. 2003
Leadership Week at HOPE center.
Delia Urrutia, Administrator August 2003 Exchange visit to HOPE Honduras: 
Strengthening administrative systems
Lic. Giovanni Rodriguez, Project 
Health Educator
August 2003 Exchange visit to HOPE Peru: Workshop 
with HOPE Regional Health Educator
Lic. Julieta Afre, Project Investigator October 2003 CORE Group regional workshop in KPC 
methodology using EPI-INFO for 
Windows
Dr. V. Calderon, Director; Karina 
Galvez, Project Nurse Health 
Educator
March 2002 CORE Group regional workshop in 
Nicaragua: Advances in IMCI
Dr. Enrique Ventura, Project 
Supervisor; Brenda Yes, Project Nurse 
October 2003 ECO technical support workshop in 
Nicaragua
27
Health Educator
9 HOPE Staff March 2002 Develop Clinical Skills course AMNL 
HOPE MSP y JHPIEGO
2 Doctor 1 nurse June 2002
MSP May 2002
Training Session AIEPI, HOPE Personnel 
13 HOPE Staff March 2002 Training session about Situational ward
5 HOPE Staff March 2002 Workshop of Transfer Methodology of 
ECO
PACT. Washington
12 HOPE Staff
AIEPI - AMNE
February 2003 Community IMCI/AINM-C and Maternal 
Newborn Care
Project Health Educator and Trainers March 2003 and
Monthly session 
by V-Class
Creating Training Plans – by Marta Arce 
Health Educator for 
Project HOPE 
Reproductive Health Team
Child Survival Team 
April 2003 Follow-up and supervision of 
IMCI/AINM-C
HOPE Health Education Trainer January 2004 Workshop Methodology of Adult 
Education
Project HOPE and partner staff July 2003 Workshop: Use of PDAS, KPC and LQAS 
Methodology by V-CLASS from HOPE 
Nicaragua and Juan Carlos Alegre , HQ 
M&E specialist
One project staff member Workshop 
of EPI-INFO 
October 2003 Workshop on EPI-INFO by CORE
12 HOPE Staff February 2004 Workshop on Dealing with HIV/AIDS 
stigma by HOPE Honduras staff
Project HOPE March 2004 Workshop on HIV/AIDS by MSPAS 
National Program of HIV/AIDS
In the past year, refresher courses in technical areas have been provided to staff in-house by the 
appropriate technical staff specialist (i.e. child survival, maternal and neonatal care, or adult 
education). This was done on a monthly basis and is considered by field staff to be a very 
appropriate and useful activity. 
Project HOPE has undertaken a regional focus to improve staff training facilitation skills and IEC 
capacities. A regional health educator has been employed (based in Lima, Peru) and has provided 
training and follow-up with Project HOPE staff in Guatemala several times during the life of the 
project. All staff can clearly describe new attitudes and skills they have acquired through this 
training and consider this to be an excellent source of technical assistance to further their 
transformation from direct implementation to a capacity building focus.
A project health educator was hired in December 2002 and has focused to-date on assisting field 
staff in more carefully organizing and preparing for training activities. Recently, a tool was 
developed jointly by staff and is being used to observe and assess trainings and provide immediate 
feedback. 
28
3. Supervision of Program Staff
Project staff felt that they received adequate and timely supervision. The project manager is 
supervised by the country director. In turn, she supervises the field supervisor to whom the field 
staff reported. The field supervisor spent at least one day per month accompanying each of the field 
staff and also reviewed their paperwork, providing immediate feedback and suggestions for
improvement. The quality of their work and the evident job satisfaction resulting in nearly 100% 
retention of staff during eight years, are testimony to good supervision. Each of the field staff 
explicitly stated this during the final evaluation. Because Project HOPE’s involvement is ending and 
staff are not continuing with HOPE, there is no need for maintenance of the supervision.
The concepts of performance-based and frequent supervision have been passed on to the partners, 
particularly the MSPAS. Project HOPE staff spent much of the second half of the project modeling 
good supervision and mentoring the MSPAS staff in monitoring/supervision. The MSPAS and 
NGOs have been maintaining monthly supervision of RHPs for two years.
4. Human Resources and Staff Management
For Project HOPE, there was very minimal field staff turnover during the eight years of project. 
Only two of the technical positions had to be replaced when physicians left to pursue private
practice. This is an impressive achievement and is testimony to good supervision and management, 
the excellent morale and team spirit among staff. While impossible to document, such low staff 
turn-over and commitment to the project and organization has contributed to the project’s success, 
particularly the relationship-building and training capacity. 
As the project draws to a close, some of the project staff have been moved to Project HOPE’s 
micro credit program and others are being absorbed by the partner NGO ADISS. Still others are 
currently seeking new positions, with strong letters of reference from Project HOPE.
The MSPAS and ECSP partners have the necessary personnel and personnel policies in place to 
continue the expanded services to residents and migrants of the Boca Costa. Project HOPE is not 
continuing involvement.
5. Financial Management 
The project staff stated satisfaction with theirlocal financial management system and its adequacy to 
monitor spending, for timely transactions, and to produce reports. During the life of the project, 
there was considerable turn-over in the Finance Department of HOPE HQ which resulted in slow 
or inaccurate reports of the state of the HQ portion of the budget and match accounting. The latter 
resulted in an overspending of field funds because the final year budget of the field staff was 
predicated on more match funding than was actually available. This confusion ultimately resulted in 
Project HOPE HQ using additional private funds to cover the excess spending, and thus, an over￾match. It also meant that most staff had to be terminated before the end of the project (up to three 
months early) and that management staff expended additional time on re-budgeting. 
The project has discussed future financing for supporting the training and BHUs with the Area 
Health offices, but the government cannot make financial plans at the Area level. The implications 
for sustainability were discussed above.
29
During the final evaluation, the evaluation team specifically a sked the plantation owners about their 
intentions to continue or increase financial support. With coffee prices rising, most were confident 
they would be able to increase financial support of the BHU and/or RHP and that the improved 
coffee price combined with need to compete for labor would lead them to make improvements to 
the living conditions for migrants.
6. Logistics
The project logistics system and procurement was quite unrelated to the on-going logistics and 
procurement of the partners. Project staff all feel that their logistics system functioned very well and 
there were no difficulties which impeded project implementation. They were also pleased with the 
handling by HQ of shipments of donated pharmaceuticals. This arrived once a year, was cleared 
through customs by a long-time HOPE partner the Knights of Malta (who received 10% of the 
goods for their effort) and was transported to the Quetzaltenango office by a truck belonging to one 
of the plantations. They were then packaged by Project HOPE logistics staff for equitable 
distribution to the health districts and HBUs. 
The final evaluation interviews revealed that the Area Offices of San Marcos and Quetzaltenango 
have better systems for logistics and procurement than other Area Health Offices, entirely unrelated 
to any project intervention, due to their capable pharmacology committees. Starting at the 
beginning of 2005, there has been a crisis in the country due to issues with MSPAS procurement of 
pharmaceuticals and pending legislation regarding the procurements. While other Health Areas and 
the national hospitals suffered complete stock-outs for lengthy periods, the two above-mentioned 
Health Areas foresaw the emerging problems and planned ahead, increasing normal procurement 
quantity, and hence, have had sufficient drugs all the time. This bodes well for the future stocking 
of the BHUs.
7. Information Management
Overall, the project information system was good at collecting on-going monitoring data, utilizing 
reports from the BHUs and district health offices and periodic LQAS surveys. This data was used 
to adjust project activities to improve outcomes and make decisions regarding prioritization of 
budget and activities. The program staff became skilled in using LQAS sampling, data analysis, data 
collection using PDAs, and performance monitoring.
The project conducted a number of assessments related to health worker capacity and quality of 
services. These are summarized in the chart below. The results of the assessments were used to
improve training and supervision.
Assessment or Study Date Use of Results
Evaluation of the results of TBA training on safe, 
clean deliveries.
11/03 Training curriculum revised to focus 
on danger signs and referrals.
Exit interviews with mothers leaving clinics about 
common childhood illnesses
12/02 Results used to tailor IEC messages.
Qualitative study of mother’s perceptions of 
danger signs in sick children under two years.
6/03 Information was used to develop the 
“mother reminder” materials.
Evaluation of the effectiveness of the “mother 6/04 No revisions were necessary. 
30
reminder” materials Printing and distribution were
expanded.
Evaluation of the knowledge and performance of 
institutional personnel in the standard management 
of cases
10/04 Results used to identify topics for 
reinforcement training and as a part 
of the final evaluation.
Evaluation of the performance of RHPs 6/03 Identified areas of weakness in 
training and the need for practical 
training.
Annual LQAS sample to monitor behavior 
changes in resident population
Annual Results used to strengthen health 
education and counseling.
Focus groups with Highland residents to learn 
local health practices.
12/02 Used for developing health 
education messages and materials.
Study of the actual situation of BHUs 7.04 Developed comprehensive plan for 
maintenance and support
Monitoring of skills of RHPs 8/03 Reinforced supervision.
Client satisfaction of users of UBS 10/04 Decision was made to provide 
additional training on health worker 
interpersonal skills.
The project worked directly with the partners to assure that they track and display data on service 
delivery and coverage for migrants. This is now done routinely and was observed posted in most 
health facilities. Various district staff showed evaluation team members the type of reports they can 
generate from the computer (hardware and training provided by Project HOPE in CS XIII.) The 
data is used to justify requests for pharmaceuticals and supplies to the Area Health Offices. They 
have not yet reached the level of analyzing the data to make other kinds of decisions regarding their 
service delivery. 
Data from the project and from the MSPAS HIS were routinely shared with the Area Health 
Councils and Area and district health staff. Various stakeholders were involved in the final 
evaluation or were interviewed as a part of that process. All were able to articulate the achievements 
of the project. The results of the final evaluation were shared in a presentation to representatives of 
all partners on August 19 and a separate presentation was made to the USAID/Guatemala on 
August 23.
8. Technical and Administrative Support
Virtually all of the technical assistance for this project came from within Project HOPE in the region 
or from consultants hired locally in Guatemala to help with assessments. (Please see the chart under
staff training.
During the project, the HOPE HQ MCH Unit, responsible for providing technical backstop to the
project, experienced significant staff turnover. As a result, the project did not benefit from adequate 
technical support, especially during the last two years. No one from HQ participated in the mid-term 
or final evaluations and no field visits were made to the project during the final years of the project. 
Needless to say a follow-up visit from HQ after the MTE would have been very useful in helping 
local staff decide how to implement recommendations and might have been key to helping them 
“think out of the box” to come up with truly effective approaches to BCC for migrants. 
31
 The M&E specialist from HOPE Center has provided excellent TA via e-mail and V-Class. He has 
arranged for cross visits from the Nicaragua project to train in PDA and LQAS and sent a project 
staff person to Nicaragua to learn EPI INFO. The regional health educator has also been very 
helpful and has been meeting with the staff monthly via V-Class.
9. Management Lessons Learned
Conclusions:
1. At the field office level, the project was very well managed. Staff morale was high, there was 
extremely low turn-over, and the staff was satisfied with logistics, supervision, and leadership.
2. Staff found the ECO capacity-building exercise to be very useful and applied the results of the 
process to improve administration, personnel management, and educational methodology.
3. Due to changes at HOPE Headquarters, the project did not have sufficient technical or financial 
backstopping from headquarters during the final half of the project. Headquarters staff did not 
participate in either the mid-term or final evaluation, missing opportunities to learn of achievements 
and lessons learned first-hand.
32
D. Other Issues Identified by the Team 
No other issues were identified by the team.
33
E. Conclusions and Recommendations
1. Based on the data from the baseline and final assessments, presented in the summary chart
on page 9, the project was successful in achieving the indicators set for resident mothers. 
More importantly, based on results for the objectives for sustainability and capacity-building 
shown in the relevant sections above, the project was very successful in facilitating the 
improvement of health service delivery for migrants and residents.
2. The one constraint which affected project performance was the dramatic decline in coffee 
prices which resulted in plantations either closing, laying off all workers, or withdrawing 
from the program. This affected the original goal of the number of BHUs to be established. 
Achievements:
· Direct coordination established and has become routine between the MSPAS, and IGSS at 
the national, Area, and local levels. On-going coordination now exists between these 
institutions and the National Association of Coffee Producers (ANACAFE) as well as with 
plantation administrators and owners at the local level.
· Involvement of plantation owners and administrators in support health services and
education for migrant workers, and of a growing number in improving living conditions for 
migrants on the plantations. Such improvements have occurred on about 20% of
plantations during the life of the project and it is hoped that this initiative will spread to 
other plantations in the near future, spurred by the rising price of coffee, labor shortage, and 
a desire to compete in the world market through mechanisms such as Fair Trade.
· Implementation of 152 Basic Health Units with very good potential for sustainability to 
serve migrants and residents dependent on coffee plantations. This has significantly
improved access to health care for these families. 
· Operationalization of the national policy for health attention to migrant populations which 
was established during Phase I of the project. This has been accomplished by each of the 
three Area Health Offices and by IGSS Suchitepequez with the support of Project HOPE.
· Implementation of norms for providing health care to migrants, including collecting and 
using data on migrants. Each Area Health Office and each target district how have 
operating plans and procurement allotments which take into account the migrant population.
· Institutionalization of IMCI and AMNE in the target districts of the three Departments and 
in San Felipe. This has resulted in significant improvement in quality of care through 
application of standardized procedures and improved communication skills with patients.
· Formation of teams of Master Trainers in each Health Area and in IGSS, who will continue 
to provide high quality training and follow-up to health personnel and RHPs.
34
Lessons learned:
The challenging task of effecting behavior change in a specific population is made all the more 
difficult in the absence of a detailed behavior change strategy. A monitoring system is needed to 
track the impact of the behavior change strategy in specific populations. Creativity is required to 
reach special populations with differing languages and customs from the mainstream, and who have 
to give economic needs priority.
When seeking to build the capacity of health care providers, it is useful to do a baseline to assess 
health worker skills/performance and health facility operations and to reassess periodically and at 
the end of the project.
Projects that focus on capacity building of health care providers need to have specific outcome-level 
indicators that measure changes in attitudes and practices at baseline and at the end of the project. 
All projects need to have indicators that effectively measure changes amongst the different target 
audience. Challenging situations require very creative solutions. 
When designing a project, a detailed analysis should be conducted regarding the material (and other) 
requirements of key interventions. Once identified, project designers need to identify mechanisms 
to ensure that these essential materials and supplies will be available in a timely manner and in 
adequate quantity. If deficiencies are identified mid-way through a project, creative solutions should 
be generated to address the deficiency (or redefine the problem) rather than suffer the
consequences. 
Projects, even those with very capable staff, benefit from repeat visits of outside or HQ technical 
support, which can assist with identifying and analyzing challenges and then generating solutions. 
Participation of HQ technical staff in the mid-term and final evaluations not only enhances their 
understanding of the project and context but also enables them to provide needed follow-up. 
When there is significant HQ input into the DIP, the HQ staff need to follow-up with the field 
office on the implementation of best practices and other HQ ideas that were incorporated.
3. Recommendations:
A. For the Ministry of Health Area Offices and IGSS Suchitepequez:
a. Sustain the BHUs through maintenance of current levels of supervision and supplies and 
annual assessment of RHP skills. 
b. Seek outside funding and lobby the central MOH for funding to continue training.
c. Maintain communication with currently supportive plantations and work to engage others.
B. For Project HOPE:
The quality of this project, including management and technical capacity, has been so
exceptional, that Project HOPE headquarters should proactively seek additional funding to 
replicate this project in other areas of the country or implement similar capacity-building 
35
activities for the MSPAS or ECP contractors in these departments or others in another issue 
such as HIV/AIDs, family planning or, in the Highlands, Infant and Young Child Feeding.
Project HOPE will take the lessons learned as recorded in this final evaluation report and 
circulate them to other child survival projects and projects within the Health of Women and 
Children portfolio, so that those project managers and their staff can also learn from the 
Guatemala experience. 
4. There is demand for replication of the health delivery services part of project in the other 
Health Areas (approximately four) which have numbers of coffee plantations with influxes 
of seasonal migrants. While the national MSPAS Coordinator for Migrant Health is
committed to this, any such effort would require external donor funding. 
The MSPAS is in the process of scaling up the IMCI/AINM-C training throughout the 
country. They are receiving technical support from USAID through the Calidad Project 
being implemented by University Research Corporation.
36
F. Results Highlight 
Reaching the Poorest Mothers – Improved Health Seeking Behavior and Knowledge
As a part of her doctoral research for Tulane School of Public Health, Keiko Yamaguchi evaluated 
the impact of the introduction of C-IMCI on the health seeking behavior (HSB) of resident mothers 
when their children have signs of diarrhea, pneumonia, or are due for immunizations. Project 
HOPE supported the Ministry of Health to introduce C-IMCI as a part of this Child Survival 
project, training a total of 333 community rural health promoters to use the approach.
 In a carefully designed study, she interviewed 2,258 mothers with children under age five from three 
project target districts and one comparison district which was not part of the project. Ms. 
Yamaguchi used a validated instrument called Health Seeking Survey as follow-on to a Rapid 
Anthropological Assessment. 
In general, there was no difference in knowledge of danger signs of common childhood illnesses 
between communities where this Child Survival project intervened and those of comparison
communities where the project did not intervene. However, the study showed significant
differences in care-seeking behavior by socio-economic status and education level.
The study concludes that mothers with 2 years or less of schooling from communities where Project 
HOPE and the MOH had trained promoters in C-IMCI and established a Basic Health Unit were 
more likely to seek care for a sick child than those in communities where the project did not 
intervene.
Secondly, mothers of the lowest socio-economic level in communities where the project introduced 
C-IMCI were more likely to seek care for a sick child and immunizations than mothers of a higher 
socio-economic level in the same communities.
Both of these findings indicate that the Child Survival project was successful in reaching the poorest 
resident families and those with low levels of education. Yamaguchi will continue analysis to 
determine why this occurred with the intention of sharing the key to this success through her 
dissertation to be submitted to Tulane early next year. 
37
ANNEXES:
A. Evaluation Team Members and their titles
B. Evaluation Assessment methodology
C. List of persons interviewed and contacted
D. Description of Guatemalan Health Delivery System
E. Final KPC report 
F. Project Data Sheet form – updated version 
ANNEX A: EVALUATION TEAM MEMBERS
ANNEX A: EVALUATION TEAM MEMBERS
Dr. Juan Chojoj Epidemiologist Dirección Area de Salud 
Quetzaltenango
Juan Manuel Mejía Coordinator of Dirección Area de Salud 
Rural Health Technicians Quetzaltenango
Joel Sarat Rural Health Technician Health Center
Pueblo Nuevo Suchitepéquez
Licda Juanita Xuruc Nursing Supervisor Instituto Guatemalteco Seguridad 
 Social (IGSS) Suchitepéquez
Dr. Renato Umaña Epidemiologist Instituto Guatemalteco Seguridad 
 Social Suchitepéquez
Dr. Jorge Lorenzana Migrant Program Coordinator Ministry of Health Guatemala
Dr. Mariano Navarro Municipal Health Coordinator Malacatán San Marcos
Miguel Pérez Rural Health Technician Dirección de Area de Salud
San Marcos
Luis Quemé Rural Health Technician Dirección de Area de Salud 
San Marcos.
Dr. Victor Calderón Country Director Project HOPE Guatemala
Brenda Yes Health Educator Project HOPE Guatemala
Anabela Aragón Assistant Director Project HOPE Guatemala
Marco Vinicio Cifuentes Computer Specialist Project HOPE Guatemala
Judiann McNulty, DrPH Consultant
Sandra Guzmán, Secretary Logistical Support Project HOPE Guatemala
Antonio de León, Driver
and interviewer
ANNEX B: FINAL EVALUATION METHODOLOGY
ANNEX B: FINAL EVALUATION METHODOLOGY
The final evaluation included quantitative and qualitative components. The first quantitative part 
was the KPC survey conducted in July. The survey used Lot Quality Assurance Sampling (LQAS) 
and the same instrument that was applied in the 2001 baseline survey. Full details of the 
methodology and results are given in the report in Annex E. 
Since the July survey focused on residents on and near the plantations, the Final Evaluation team 
decided to augment those findings with a short survey of migrants. Because the coffee harvest has 
not yet begun, the team had to use a convenience sample of migrants who were found in their 
communities of origin, and a small group of migrants which had already arrived on one plantation. 
The details of this survey are found in Annex F.
For the qualitative part of the evaluation, Project HOPE assembled a team made up of staff and of 
representatives from collaborating institutions. (Annex A.) The evaluation team was led by external 
consultant Judiann McNulty, PHD, who is very familiar with the project context. The schedule of 
activities for the final evaluation follows and the list of persons interviewed is found in Annex C. 
The team was able to go to all but one of the Boca Costa municipalities which have been involved in 
the project. Numerous interviews by multiple team members made it possible to corroborate 
findings. The plantations, UBS, and promoters to be interviewed were selected just prior to the field 
work, did not expect the evaluation team, and thus, could not “stage” something for the team. 
The evaluation team used semi-structured interviews during seven days of field work In addition, 
the team asked all promoters interviewed to demonstrate the use of a respiration timer, explain the 
rates for each age group, and to explain the use and dosage of a randomly selected antibiotic. The 
team also observed the kinds and quantities of medicines and equipment available in the BHUs. 
Interviews Total Number Interviewed
Area Health Officials and training teams 3
District health directors and teams 17
Plantation administrators 17
Community health workers (Promoters) 20
Focus Group of Trained TBAs 1
IGSS Suchitepequez officials and training team 1
In late 2004, Project HOPE and staff from the MSPAS and IGSS conducted an assessment of the 
skills of all the health promoters in applying C-IMCI and of the clinical facilities and the trained 
traditional birth attendants in understanding and application of AMNE. These results were taken 
into account as part of the triangulation of data for reaching conclusions in this final evaluation.
The C-IMCI assessment was undertaken using the monitoring tool for C-IMCI refined by the 
MSPAS with support from the Pan American Health Organization. The detailed assessment tool 
for AMNE was developed by JHPIEGO during their five years of implementing the Maternal 
Newborn Project for USAID in Guatemala.
All findings of the final evaluation were triangulated and all conclusions and recommendations were 
reached through consensus of team members during a group exercise following data collection and 
consolidation. 
SCHEDULE OF ACTIVITIES
Project HOPE Guatemala Final Evaluation
Child Survival Project
Date Location Activity Participants
Monday, August 8 HOPE Office 
Quetzaltenango
Evaluation Planning Workshop Evaluation Team Members
Tuesday, August 9 HOPE Office 
Quetzaltenango
Evaluation Planning Workshop Evaluation Team Members
Wednesday, August 10 Columba Validation of Instruments
Field Qualitative Data Collection 
Evaluation Team Members
Thursday, August 11 San Marcos Field Qualitative Data Collection Evaluation Teams 1, 2, 3*
Friday, August 12 Suchitepeques
Retahuleu
Coatepeque
Field Qualitative Data Collection Evaluation Teams 1, 2, 3
Saturday, August 13 Suchitepequez Field Qualitative Data Synthesis Team Leader
Sunday, August 14 Pueblo Nuevo Migrant Mini-KPC Surveys Team member
Monday, August 15 Suchitepequez
Columba
Field Qualitative Data Collection
Migrant Mini-KPC Surveys
Evaluation Teams 1, 2
Evaluation Team 3
Tuesday, August 16 Suchitepequez
Huehuetenango
Field Qualitative Data Collection
Migrant Mini-KPC Surveys
Evaluation Teams 1, 3
Evaluation Team 2
Wednesday, August 17 San Marcos
Huehuetenango
Migrant Mini-KPC Surveys
Workshop Preparation
Evaluation Teams 2, 3
Evaluation Team 1
Thursday August 18 HOPE Office 
Quetzaltenango
Workshop – Consolidation and 
Analysis of Field Work
Evaluation Team Members
Friday, August 19 HOPE Office 
Quetzaltenango
Preparation and Presentation of 
Results
Evaluation Team Members
*The evaluation team members were divided into 3 smaller teams for field work.
Detailed Field Schedule
Sub-team No. Vehicle MOH Facility Plantations USB Other activity
Wednesday, August 10
I- Quetzaltenango Montero Verde CS Colomba La Bolsa 1
II – Quetzaltenango Prado Carmen Amalia
Sta. Anita (Colomba) 
2
III –
Quetzaltenango 
Pick Up CS San Martin Sn. Fsco. Pie de la Cuesta
Las Violetas (Colomba)
2
Thursday, August 11
I – San Marcos Montero Verde DAS Malacatan Finca San Luis
San Pablo, Finca Ucubuja
1
1
Health Promotor 
Meeting
II – San Maqrcos Pick Up 
CS El Quetzal
Finca Concepcion Candelaria. 
(La Reforma), Finca Ona
1
1
III – San Marcos Pick Up BCS CS El Rodeo
CS El Tumbador
 Comunidad la Industria.
Finca Nueva Granada, El Ferrol.
1
2
Friday, August 12
I - Quetgo/Suchi. Montero Verde CS El Palmar
PS Sn. Fsco. Zap.
C. Calahuache 1
II – Quetgo. Pick Up BCS CS Coatepeque
CS Genova, CS Flores 
Health districts 
III - Retalhuleu Pick Up (San Felipe) Rosario Pecul
(San Felipe) Patio Bolas 
1
1
Sunday, August 14
I Suchitepeques Pueblo Nuevo Finca Hamburgo Migrant Surveys
Monday, August 15
I - Suchitepequez Montero Verde DAS (Santo Tomas) Santa Isabel, San Jaime. 2
II - Suchitepequez Prado PS Samayac
PS Cuyotenango
(Samayac) Parrache
(San Fsco. Zap.) Margaritas, 
Blanca Flor. 
1
2
III - Columba Pick Up Finca Las Victorias Migrant Surveys
Tuesday August 16 
I - Suchitepequez Montero Verde CS Chicacao
IGSS Mazate.
El Medellin
Valle de Oro 
1 Family Planning 
Distributor
II - Altiplano Pick Up Department of Huehuetenango
Communities of Origen
Migrant Surveys
III - Suchitepequez Pick Up BCS
 or Prado
CS Patulul, DAS
CS Santa Barbara 
Horizontes
Panama
1
1
TBA training
Training team
Wednesday, August 17
II Pick Up Department of Huehuetenango, Communities of Origen Migrant Surveys
III– San Marcos Pick Up San Miguel Ixtahuacan, Communities of Origen Migrant Surveys
DAS – Area Health Office UBS – Basic Health Unit
Participatory Planning Workshop
Time: Activity Facilitator
Monday, August 8
9:00-9:30 Welcome and Introduction of Evaluation Team Dr. Calderon
9:30-10:30 Presentation of the Project Dra. Aragon
10:45 – 11:30 Presentation of KPC Results Marco
11:30 – 12:30 Overview of the Evaluation Requirements Judiann
1:30- 3:30 Definition of Evaluation Objectives by Team Judiann
3:30-4:30 Evaluation Matrix Judiann
Tuesday, August 6
8:30 – 9:00 Formation of Evaluation Sub-teams Brenda/Judiann
9:00 – 9:30 Development of Field Work Schedule Dra. Aragon/Brenda
9:30 – 4:30 Development of Instruments Group work
Wednesday, August 12
morning Validation of Instruments All sub-teams
3:00 – 5:00 Revision of Instruments HOPE staff
Consolidation of Findings, Results, and Conclusions
Thursday, August 18
9:00 – 9:30 Review of Evaluation Objectives Judiann
9:30 – 12:30 Group work – triangulation of findings
1:30 – 4:30 Participatory exercise to reach consensus on all 
conclusions and recommendations 
Judiann
4:30 – 5:30 Review of migrant mini-KPC results
Verification of findings for each evaluation objective
Judiann
ANNEX C: PERSONS INTERVIEWED AND CONTACTED
ANNEX C: PERSONS INTERVIEWED AND CONTACTED
Area Health Directors and IGSS Administrator:
1. Quetzaltenango Dr. Diego Manríquez
2. San Marcos Dr. Albar Pérez
3. Suchitepèquez Dr. Guillermo Sánchez Benet
4. IGSS Lic. Juan José Campo Díaz 
District Directors Interviewed:°
QUETZALTENANGO
1. Coatepeque. Dr. Abrahán Pérez.
2. Flores Costa Cuca. Dra. Alba Díaz 
3. San Martín Sacatepéquez. EP. Jova Santizo
4. El Palmar. Dr. Marcos López Enrique. 
5. Génova Costa Cuca. EP. Hilda País.
6. Colomba Costa Cuca. Dr. Rolando Zúñiga
SUCHITEPÉQUEZ:
1. Cuyotenango. EP. Verónica Fernández.
2. Chicacao. Dr. Hugo Armas.
3. Santa Bárbara. Dr. Víctor Manuel Sánchez.
4. San Francisco Zap. TC. Henry Xiloj.
5. Samayac Dra. Gudielmy Porres 
SAN MARCOS:
1. El Tumbador. EP. Miriam Miranda.
2. El Quetzal Dr. Armando Mazariegos
3. San Pablo Dra. Mirna de Valdez
4. El Rodeo Dr. Hanrry de León
5. San Rafael Pie de la cuesta Dr. William de León.
RETALHULEU:
1. San Felipe Dr. Jesús Arriaga
Members of Master Training Teams:
SAN MARCOS 5 members
SUCHITEPEQUEZ 5 members
QUETZALTENANGO 7 members
IGSS Suchitepequez 8 members
 
°
 At all health districts, other staff, such as nurses, sanitary inspectors, and rural health technicians, involved in 
the project were also interviewed.
PLANTATION ADMINISTRATORS – 17
RURAL HEALTH PROMOTORS – 20
TRADITIONAL BIRTH ATTENDANTS – 9 (as a group)
FAMILY PLANNING DISTRIBUTOR – 1
ANNEX D: GUATEMALA HEALTH DELIVERY SYSTEM
ANNEX D: GUATEMALA HEALTH DELIVERY SYSTEM
Administratively, Guatemala is divided into seven Departments which are equivalent to provinces or 
states. Each Department is divided into multiple municipalities which consist of a main city or town 
and the surrounding area including small towns (aldeas), hamlets (caserios), and/or populated areas 
with no settlement (cantons).
The Ministry of Public Health and Social Assistance (MSPAS) has seven administration Areas, 
which correspond roughly to each Department. For many years, all health services were delivered 
directly by the MSPAS through the Health Centers and Posts or through IGSS. 
IGSS, though under the MSPAS, has always been largely autonomous. It is an employer-paid health 
insurance system with its own hospitals and clinics in each Department. Theoretically, all employers 
pay into IGSS for their employees, but few plantation owners have fully complied. In the 
Department of Suchitepequez only, IGSS has recently begun community outreach activities, 
In 1997, the government began the Expanded Coverage Program (ECP) to better serve residents of 
rural areas. The ECP is delivered through contracting municipalities or NGOs to cover a certain 
rural geographic area with all primary care services. Most NGOs contract medical personnel who 
rotate through the area, convening patients at locations convenient to several caserios or cantons. 
These are known as convergence centers. The BHUs started by Project HOPE on or near 35 
plantations have now been absorbed into this system, receiving, supplies, supervision, and periodic 
physician services from a contracting NGO. 
Ministry of Public Health and 
Social Assistance
Area Health Offices
(Departmental level)
District Health Centers
(Municipal level)
Health Posts
(Aldea o Canton)
Program for Expanded 
Coverage [ECP]
(contracted to NGOs)
Convergence Centers
(Caserios)
Guatemala Social Security 
Institute [IGSS]
Hospitals and Clinics
for subscribers
ANNEX E: FINAL KPC SURVEY REPORT
PROJECT HOPE
Improving the Health of Guatemala’s Most 
Vulnerable Population: Migrant Women and Children 
in the Boca Costa Region of Southwestern Guatemala
CS-17 Cooperative Agreement No. FAO-A-00-97-00030-00
FINAL KPC SURVEY REPORT
Project Location: Region of Southwestern Guatemala
Submitted to:
U.S. Agency for International Development
Child Survival and Health Grants Program (CSHGP)
USAID/GH/HIDN/CSHGP
Ronald Reagan Building
1300 Pennsylvania Avenue
Washington, DC 20004-3002
Submitted by:
Project HOPE – The People-to-People Health Foundation, Inc.
Millwood, Virginia 22646
Tel: (540) 837-2100
Fax: (540) 837-1813
August, 2005
TABLE OF CONTENTS
EXECTUTIVE SUMMARY 1
I. INTRODUCTION 1
A. Background
B. Objectives of the Survey
A. Location/Population
D. Schedule of Activities
II.METHODOLOGY 3
A. Questionnaire
B. Determination of the Sample Size
C. Selection of Communities
D. Selection of Sample
E. Procedures to Collect Clinical Information
F. Training of Supervisors and Interviewers
G. Interviewers
H. Data Handling and Processing
III. RESULTS 5
A. CS-17 target area 5
1. Child health, intervened area 5
a. Breastfeeding and Weaning Practices
b. Nutritious status
c. Diarrhea Case Management 
d. Immunizations
e. Acute Respiratory Infections
2. Maternal health 9
a. Place of birth
b. Antenatal care
c. Postpartum care
d. Family planning/child spacing
e. Exposure to health message
B. Survey of women of reproductive age 13
APPENDICES
A: Performance Indicators from DIP
B: Rapid CATCH Indicators
C: Survey Teams
D: List of Supervision Areas and Communities
E. Survey Questionnaires
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 1
EXECUTIVE SUMMARY 
From June 13-29, 2005 Project HOPE, with 
the participation of the Ministry of Health, 
and the Guatemalan Social Security Institute 
(IGSS), implemented the final Knowledge, 
Practice and Coverage (KPC) survey of its 
Child Survival (CS-17) project. The survey 
was implemented in the southwestern (Boca 
Costa) region of Guatemala that includes the 
departments of San Marcos, Quetzaltenango, 
and Suchitepequez.
 
The purpose of this final quantitative survey 
was to: 1) collect final results about the 
prevalence, knowledge, and practices 
regarding child survival and reproductive 
health interventions among mothers with 
children under two years of age and women 
of reproductive age in the project target area, 
and 2) to assess whether quantitative 
benchmarks set in 2001 by the Detailed 
Implementation Plan (DIP) of this CS-17 
project had been reached. 
The final KPC survey was implemented by 
Project HOPE field staff, MOH, IGSS and 
with technical support from Project HOPE’s 
headquarters in Millwood, Virginia.
The final KPC survey used the same survey 
instrument used at baseline (2001), which 
was developed based on the KPC 2000+ 
rapid survey tool developed by the CORE 
Group and the Child Survival and Technical 
Support Project (CSTS+) for Private and 
Voluntary Organizations (PVOs) 
implementing CS projects funded by 
USAID’s Child Survival and Health Grants 
Program (CSHGP). Wording and names of 
foods used in the survey instrument were 
revised to be culturally appropriate in the 
project target areas.
The final KPC survey was conducted using 
the Lot Quality Assurance Sampling 
(LQAS) methodology, which defined seven 
supervision areas (SAs) within the project 
catchment area for this particular final 
survey. Parallel sampling was used to 
include mothers of children under two years 
of age, and women of reproductive age. The 
local staff from Project HOPE/Guatemala 
provided all training for the implementation 
of the survey. Twenty-five interviews were 
conducted for each sample group–mothers 
and women of reproductive age–in each of 
the seven SAs. A total of 176 mothers of 
children under two and 176 women of 
reproductive age were surveyed.
An assessment of progress between baseline 
(2001) and final (2005) key indicators noted 
significant progress in immunization 
coverage among children aged 12-23 
months, proportion of children with a health 
card, early breastfeeding and complementary 
feeding, a slight increase in exclusive 
breastfeeding rates for the first six of months 
after birth. Survey results also revealed 
significant improvements in vitamin A 
supplementation coverage, ORT use rate, 
home fluids use rate during diarrhea, 
knowledge and use of child spacing 
methods, proportion of mothers with 
maternal cards, and proportion of mothers 
with children under two who received at 
least two tetanus toxoid vaccines before the 
birth of their youngest child.
On the other hand, survey results indicated 
no progress in reducing the proportion of 
children malnourished (WFA, -2Z) and a 
slight decline in the proportion of mothers 
with children under two whose last birth 
were attended by a trained health provider.
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 2
I. INTRODUCTION 
A. Background
Project HOPE was awarded a four-year 
extension to expand its successful CS-12
project aimed at improving the health of 
women and children migrating to or residing 
in or near (and dependant upon) coffee 
plantations in the Boca Costa region of 
southwestern Guatemala. The target 
population is 330,000 beneficiaries, 
including 162,304 children under age five 
and 171,959 women of reproductive age, 
providing benefits to migrants and residents 
in the target area through capacity building 
of Ministry of Health (MOH), Guatemala 
Institute of Social Security (IGSS), 3 local 
NGOs involved in the nationalIntegrated 
System for Health program (SIAS) in the 
target area (ADISS, Red Cross and Funrural, 
the development organization linked with 
ANACAFE, the coffee growers' national 
association), and community partners. 
The project worked with technical staff and 
a nucleus of Master Trainers in four Health 
Areas, equivalent to geographic 
Departments: San Marcos, Quetzaltenango, 
Retalhuleu and Suchitepequez. IGSS had
outreach responsibilities in the Department 
of Suchitepequez. The project assisted these 
partners in replicating training in several 
national health strategies -- Integrated 
Management of Common Childhood Illness 
(IMCI) in the clinical setting, IMCI/AINM-C
at the community level, and Maternal and 
Neonatal Care (MNC, promoted by 
JHPIEGO) -- with health staff and 
community volunteers through all health 
units in 28 municipalities2
. These trainings 
 
2
 The DIP mentions 30 municipalities; the only 
municipality programmed for entry in Solola 
Department was Santiago, which became 
covered by an organization contracted under the 
national SIAS extension of health services 
shortly after the DIP was prepared. The 
complementary HOPE/ILO project in the 
target 1,000 Rural Health Promoters, 1,000 
Traditional Birth Attendants, and 100 
Community Based Distribution Agents of 
family planning methods. In this way the 
extended project continued to support 
sustainable primary health care for children 
while increasing a focus on integrated 
reproductive health and strengthening 
capacity-building for sustainability of key 
project actions.
The project provided more direct support to 
Rural Health Promoters (RHPs) active in 
Basic Health Units (BHUs) established 
within coffee plantations with owner and 
administrator moral and financial support. 
Despite the fact that many plantations closed 
production or drastically reduced personnel 
due to the dramatic drop in coffee prices in 
the last few years, the project worked with a 
total of 183 of the originally proposed 200 
coffee plantations (this target was revised in 
2002 in the 1st annual report submitted to 
USAID’s CSHGP). In each coffee plantation 
there is one BHU. Out of the 183 active 
BHUs, 108 are located within coffee 
plantations; and the rest (75) active BHUs 
are located in adjacent communities. All of 
these BHUs are managed by trained RHPs, 
who are provided with essential medicines 
appropriate for IMCI/AINM-C services, 
including antibiotics, through the district 
Health Centers that oversee their activities. 
Project HOPE medical personnel, MOH 
local health personnel and, in 
Suchitepequez, IGSS health personnel 
provided periodic health campaign outreach 
services on plantations, especially between 
the months of October to February of every 
year when migrants are present for the 
coffee harvesting season.
The project is in line with Project HOPE 
strategies to evolve from direct 
 
highlands from which migrants originate has 
been active in 4 of the 5 municipalities cited in 
the DIP.
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 3
implementation to a greater emphasis on 
partnership and facilitation. Besides MOH 
and IGSS partners, the project also partnered
with JHPIEGO to extend the Maternal and 
Neonatal Care (MNC) approach, and with 
local NGOs (ADISS, Red Cross, the 
Suchitepequez branch of Funrural - the 
development organization of ANACAFE, 
the coffee grower's national association) to 
extend coverage of primary health care 
services to rural areas in accord with 
national strategies of the Integrated Systems 
of Health program (SIAS). 
The level of project effort was directed 
towards 5% for immunization, 10% nutrition 
and 5% breastfeeding, 3% Vitamin A and 
2% micronutrients, 15% acute respiratory 
infections, 10% control of diarrheic disease, 
5% malaria, 20% maternal and newborn 
care, 15% child spacing and 10% 
HIV/AIDS.
B. Objectives of the Survey
The main objective of the final KPC survey 
was to assess knowledge, practices and 
coverage rates related to child health and 
reproductive health in the targeted 
communities. (See Appendix B for a list of 
performance indicators). With such available 
quantitative data, Project HOPE would be 
able to assess progress and change on key 
child health and maternal health indicators 
set at the DIP in 2001. These quantitative 
results would serve to provide overall 
conclusions and recommendations during 
the final evaluation of this CS-17 project.
C. Location/Population
A total of seven supervision areas (SAs) or 
“lots” were defined within three departments 
in Southwestern Guatemala: 
Quatzaltenango, Suchitepequz, and San 
Marcos, all of them located in the Boca 
Costa region. The surveyed area included 
coffee plantations and nearby communities 
in the Boca Costa region. See Appendix D 
for a detailed list of SAs and the 
departments, municipalities, and 
communities that were sampled as part of 
this final KPC survey.
D. Schedule of Activities for the Final 
KPC survey
Table 1: Schedule of Activities
Date Activities
April Planning of this activity with the 
communities for the months of May, June, 
July and August.
May 1-25 Survey Planning
-organization and selection of the 
communities
-routes and dates to communities planned
May 25-30 Revision of survey materials and survey 
training
June 1-13 Final adjustments
- copying of questionnaire
- distribution of survey materials
June 13-29 Survey implementation
July 1-15 Review of data collected, and data entry 
into the computer
July 16-30. Preliminary data analysis and development 
of conclusions. Debriefing of USAID 
Mission in Guatemala.
Aug. 9-19 External Evaluation of the CS project
Aug. 20-30 Development of Report with conclusions 
and assessment of project outputs and 
progress.
Aug 30 Dissemination of Final KPC Report
II. METHODOLOGY
A. Questionnaire
The final KPC survey of Project HOPE’s 
CS-17 project in Southwestern Guatemala 
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 4
used the same questionnaire that was used in 
the previous KPC surveys conducted at 
baseline (2001) and midterm (2003). Such 
an instrument was developed based on the 
KPC 2000+ survey questionnaire, a rapid 
assessment tool developed by the CORE 
Group’s Monitoring & Evaluation Working 
Group and the Child Survival Technical 
Support Project (CSTS+) for Private and 
Voluntary Organizations (PVOs) 
implementing CS projects funded by 
USAID’s Child Survival and Health Grants 
Program (CSHGP). 
Wording and names of foods used in the 
original survey instrument (2001) at baseline 
were included in the survey to be culturally 
appropriate in the project target areas. The 
MOH and IGSS staff reviewed the survey 
instrument and gave their approval. All 
same survey questions from 2001 were 
included because:
a) They were aimed to assess if the 
quantitative targets set in the DIP were 
met; 
b) Were included in order to calculate 
Rapid CATCH indicators as required by 
CSHGP to all PVO grantees. 
B. Determination of Sample Size
Project HOPE’s CS-17 project in 
Southwestern Guatemala used the Lot 
Quality Assurance Sampling (LQAS) 
methodology to conduct the final KPC 
survey. Seven supervision areas (SAs) or 
“lots” were previously identified within the 
four target departments in Southwestern 
Guatemala: Quetzaltenango, Suchitepequez, 
and San Marcos. 
In each of the SAs, the survey interviewed 
25 mothers of children under two years of 
age as well as 25 women of reproductive 
age.
Such a sampling methodology reflects a 
statistical certainty of at least 95% (Z=1.96) 
with a margin of error of 10%.
In order to achieve statistical significance 
through the calculation of 95% Confidence 
Intervals (C.I.) for certain project indicators, 
this final KPC survey increased the 
recommended 19 interviews per SAs in 
cross-sectional household surveys that use 
LQAS as a sampling methodology to 25 
interviews per SA. 
In addition, the final KPC survey made use 
of parallel sampling by interviewing 25 
mothers with children under two years of 
age and 25 women of reproductive age. 
Thus, one questionnaire was used to 
interview mothers, and another 
questionnaire was used to interview women 
of reproductive age. However, both 
questionnaires were the same as the ones 
used for conducting the baseline assessment 
(2001) and the mid-term evaluation (2003).
C. Selection of Surveyed Communities
The probability of selection was proportio￾nal to the population of communities to be 
selected in the Departments of Quetzal￾tenango, San Marcos, and Suchitepequez,. 
See Appendix D with the complete list of 
SAs, municipalities, and communities 
randomly selected for this final KPC survey.
D. Selection of Households
Eligible households were those having at 
least one living and present child younger 
than two years of age or a woman of 
reproductive age. Only information from the 
youngest child in the family was collected, 
in the event that there was more than one 
child under 24 months of age. If no family 
member was able of giving the information, 
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 5
the family was immediately replaced, but 
this event was very uncommon.
Women of fertile age were selected with 
parallel sampling in the same SA. In no 
instance more than one woman per 
household was interviewed. 
 
E. Procedures to Collect Clinical 
Information
Anthropometry
The same methods were used as in previous 
surveys to weigh each child and collect 
height measurements in Guatemala. For the 
most part, the children were weighed 
without any clothing. When clothes were 
being worn, an amount of 2-3 oz. was 
subtracted to obtain the net weight. Scales 
(Salter-type, 3 oz. in precision, 50-pound 
capacity) were adjusted to zero prior to 
every measurement. Height was measured 
with a wooden infantometer while lying 
down.
F. Training of Supervisors and 
Interviewers
The training was conducted in a five-day 
period. The staff (HOPE and MOH) 
received training on survey methodology, 
KPC surveys, discussed and completed 
exercises for the sampling methodology, 
selection of first and consecutive 
households, anthropometric procedures, 
revision of survey questions and appropriate 
interviewing techniques. A written guide 
was also supplied to the field team. As same 
survey instruments were used from previous 
KPS surveys validation of questions and a 
pilot test of the survey instrument was not 
necessary.
G. Interviewers
The actual survey was conducted over 17 
days: June 13-29, 2005 (See table 1). There 
were three teams of interviewers. 
Supervisors of each team were responsible 
for the selection of the initial household and 
the geographical direction in which each 
person would proceed in order to collect 
his/her number of surveys. Each 
questionnaire was checked for completeness 
before the survey team left the survey area 
so that, in the case of missing or 
contradictory information, the mother and/or 
adult could be re-interviewed the same day. 
In addition, all questionnaires were checked 
again for completeness and accuracy at the 
end of each day by the supervisor. 
H. Data Handling and Processing
The data were entered to EPI INFO at 
Project HOPE/Guatemala office in 
Quetzaltenango. An administrative 
assistant entered the data in seven days. The 
project HIS staff who was previously trained 
in EPI INFO and who has knowledge in data 
analysis conducted the initial analysis. Such 
a preliminary analysis was further reviewed 
and completed by Project HOPE 
headquarters technical staff.
The exact age of the child was calculated 
subtracting the date of birth from the actual 
date of the interview. Anthropometric 
indeces, WAZ (Z-score for weight-for-age), 
HAZ (Z-score for height-for-age), WHZ (Z￾score for weight-for-height) were calculated 
along with 95% confidence intervals using 
Epinut directly from EPI INFO.
 
Frequencies were generated with EPI INFO 
directly. Graphs showing the results of the 
above analysis with the respective 
confidence intervals were generated with 
MS Excel. 
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 6
III. RESULTS 
For the CS-17 survey a total of seven 
supervision areas (SAs) were surveyed, with 
the aim of including a total of 175 mothers 
of children under two years of age and 175 
women of reproductive age. However, 
actual survey tallies registered 176 
interviewed mothers and a similar number of 
interviewed women of reproductive age.
Table 2. Distribution of the sample.
CS-17 Surveyed Area
Department
Supervision 
Areas
Number of 
Interviews
San Marcos 3 MC:76 WRA: 76
Quetzaltenango 2 MC: 50 WRA: 50
Suchitepéquez 2 MC: 50 WRA: 50
Total 7
MC: 176 
WRA: 176
MC: mothers with children under 2
WRA: women of reproductive age
A. CS-17 Target Area
1. Survey of resident mothers with 
children under the age of two: child 
health
A total of 176 mothers were surveyed and 
the results are presented below. As in the 
baseline, mothers were young (26.4 years 
old mean age). The proportion that had 
attended school was pretty much the same 
found at baseline (69.3% for year 2005), and 
the average number of schooling years was 
also about the same. The main languages 
spoken at home were Spanish and Mam, 
followed by Quiche. More than two-thirds 
(69.9%) of mothers did not work outside 
their home, while the number of mothers 
working in farms decreased from 21.6% at 
baseline (2001) to 8.5% at final (2003).
a. Breastfeeding and Weaning Practices
As shown in Figure 1, early initiation of 
breastfeeding has improved from 62.5% 
(2001) up to 75.0% (2003), which was the 
final benchmark set at the DIP.
Figure 2 shows the proportion of children 
under 6 months of age that are exclusively 
breastfed. The change (from 79.2% in 2001 
to 87.3% in 2005) is not statistically 
significant due to the fact that this variable 
uses a small sub-sample and the 
improvement was not large enough. Yet, the 
proportion of exclusive breastfeeding rate 
may have experienced a small increase from 
the baseline rate.
The proportion of children 5- 8.9 months 
receiving complementary feeding is shown 
Fig. 2: Exclusive Breastfeeding Rate for First Six Months 
after Birth
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2001 2003 2005
Fig. 1 Early Breastfeeding Practices Among Mothers with 
Children <2
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2001 2003 2005
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 7
in Figure 3. In spite of apparent increase, the 
difference is not statistically significant. 
The proportion of children eating three or 
more meals per day did significantly 
increase from 43.0% at baseline (2001) up to 
65.6% in the final KPC (2005), an increase 
that is statistically significant as shown in 
Fig. 4 with their respective 95% confidence 
intervals.
Children start complementary foods mostly 
with liquids. Most children under 2 years do 
not receive non-human milk. Foods made 
out of cereals and legumes -particularly 
beans and tortillas- are the main dietary 
staples. However the proportion of children 
eating meat has increased up to 29% 
compared to very few at baseline (2001), 
with still fewer children eating green leaves. 
The proportion of mothers reporting the 
consumption of foods rich in fat/oils is still 
below 5%, even for children in their second 
year of life. 
Not considering dark green leafy vegetables 
-with a low bioavailability for carotenoids, 
the proportion of mothers giving the child 
vitamin-A rich foods (such as dairy, animal 
liver or eggs) is very small. The local diet of 
children continues to lack energy density, 
and adequate available vitamin A.
Vitamin A supplements were given to more 
than 2/3 of the children according to the 
family/child health cards (Fig. 5). This is a 
significant increase over baseline as only 1/6 
of children received Vit. A in 2001.
b. Nutritional status of children
While 3.0% (C.I. = 1.1 - 7.2) of the children 
were wasted (WFH, Z<-2), 36.3% (C.I. = 
29.1 – 44.1) were stunted (HFA, Z<-2), and 
24.4% (C.I. = 18.4 – 31.6) were 
malnourished (WFA, Z<-2). These 
nutritional indicators revealed no major 
progress in children’s nutritional status from 
similar baseline indicators in 2001. 
c. Diarrhea Case Management
Fig. 3: Complementary Feeding Practices
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2001 2005
Fig. 4: Proportion of Children Eating Three or More Meals per Day
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2001 2003 2005
Fig. 5: Vit. A Supplementation in the Last Six Months
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
2001 2003 2005
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 8
Management of diarraheal cases improved 
among mothers with children under two. 
While 38.8% of children with diarrhea in the 
past two weeks preceding the survey 
received oral rehydration therapy (ORT) at 
baseline (2001), 53.1% reported receiving 
ORT at final (2005).
As for feeding practices during diarrheal 
episodes, mothers increased overall active 
feeding practices from baseline rates (see Fi. 
6). The proportion of mothers who gave 
more breastmilk during a diarrheal episode 
increased from 72% at baseline to 93.7% at 
final; the percentage of mothers who gave 
more fluids during diarrhea also increased 
from 55.6% (2001) to 87.5% (2005); and the 
percentage of mothers who gave the same or 
more solid foods during diarrhea increased 
from 36.5 (2001) up to 75.0% (2005). 
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
percent
Fig.6: Feeding practices during diarrheal episodes
more/same more liquids more/same 
 2001 2005
The percent of mothers whose children had 
diarrhea and sought help significantly 
increased (Fig. 8) from 44.4% (2001) up to 
83.0% (2005) among mothers who sought 
care from a trained provider either at the 
basic health unit, health center or health 
post.. The benchmark of the DIP (60% care 
seeking for cases with dehydration) was 
reached. 
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2001 2003 2005
percent
Fig 7: Care-seeking practices during diarrheal episodes
Looking at utilization rates for the basic 
health units in the plantations, the proportion 
of mothers with children under two who 
sought help at the BHU doubled from 43.5% 
at baseline (2001) to 97.2% at final (2005) 
d. Immunizations
Over 80% of children between 12-23 
months of age have complete immunization 
coverage, which reveal a significantly 
increased coverage from baseline (42.1% in 
2001). Almost all (99.0%) of children <2y 
had received BCG, while 82.1% had 
received measles immunization. Both of 
these immunization rates were also 
significantly higher from baseline rates, 
which indicates an overall significant 
increase in immunization coverage rates. 
Fig. 8: Complete Immunization Coverage
0
10
20
30
40
50
60
70
80
90
100
2001 2003 2005
BM foods
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 9
80.8% of the children (12-23 months) had 
received a complete set of vaccinations, 
compared with 42.1.1% at baseline (Fig. 8). 
To be completely immunized, the child 
needs to have at least received BCG, DPT3, 
OPV3, and a measles vaccine by the first 
birthday. The DIP target (80% of coverage) 
was achieved. 
The percent of mothers who know the age 
when a child should get the measles vaccine 
has changed from 21.4% in baseline to 
51.7% final). The DIP benchmark (50%) 
was achieved. Recent changes in 
immunization regulations, including the use 
of MMR administered after the first 
birthday.
The percent of children (12-23m) with 
measles immunization, when counting 
all children in the denominator (Rapid 
CATCH) was 82.1% .
e. Acute Respiratory Infections (ARI)
The percent of women that can name danger 
signs for pneumonia was 38.6% (Fig. 10). 
The target set in the DIP (40%) was not 
achieved.
The percent of mothers that sought help for 
cough or difficult breathing –as specified in 
the DIP- was increased from 56.6% at 
baseline (2001) to 76.0% at final (2005). 
This difference is statistically significant and 
the target set in the DIP was met. 
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2001 2003 2005
percent
Fig.11: Mothers who sought help if child had cough or 
difficult breathing
2. Maternal health
a. Place of birth
Of the 176 women interviewed, 44.3 had
their last birth assisted by a trained provider 
–not counting TBAs- in comparison with
58.3% at baseline, see Figure 12. 
b. Antenatal care
The proportion of women seeking antenatal 
care in their last pregnancy remained mostly 
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2001 2005
percentage
Fig.12: % births helped by a trained provider
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2001 2003 2005
percent
Fig.10: Percent of mothers naming pneumonia danger signs
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2001 2003 2005
percent
Fig. 9: Percent of children with health cards
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 10
the same: 53.8% at baseline (2001) and 
52.0% at final (2005).
The percentage of women with at least two 
doses of tetanus toxoid (TT) vaccine 
increased significantly from 22.6% in 2001 
to 50.6 in 2005 
The proportion of women able to show a 
maternal card increased significantly from 
23.3% at baseline (2001) to 52.8 % at final 
(2005).
c. Post partum care 
As for post partum care, the survey revealed 
an important increase in the proportion of 
women who had at least one post partum 
visit: from 13.2% at baseline (2001) to 
22.0% at final (2005). 
d. Child spacing
The percent of women that can name a 
family planning (FP) method increased 
from baseline (71.2%) to 87.5). The use of 
FP methods also increased significantly 
(21.6% a 40.4%). 
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
percent
Fig. 13: Family planning indicators
Child spacing methods most frequently 
mentioned by women in 2005 were 
injectables and oral anovulatories (pills) 
Knowledge of pills, injections, vasectomy, 
rhythm, and condoms at project end was 
higher than during the baseline survey.
e. Exposure to educational messages
When asked to recollect previous exposure 
to health messages through radio, 68.2% 
acknowledged hearing radio messages. The 
main topics mentioned by mothers were: 
- Child health (infant feeding, diarrhea, 
pneumonia, food hygiene, personal hygiene, 
immunizations, breastfeeding); 
- Maternal health (maternal feeding, 
prenatal care, safe delivery, pregnancy, 
breastfeeding); 
- Reproductive health (child spacing) and 
- Family Health (cholera, hygiene, dengue, 
safe food/water, latrines)
C. Survey of women of reproductive age 
The final KPC also interviewed 176 women 
of reproductive. Average age was 28 years, 
with a standard deviation of 7.518. Only 
11.4%were pregnant at the time of the 
survey. 76.7% of these women had attended 
school, and the average number years of 
schooling was 4; of the respondents that 
spoke Spanish at home was 86.4%; and 
42.6% were working outside the home, 
15.3% of these in agriculture.
STD/AIDS knowledge: 85.2% 
acknowledged having heard about HIV/ 
AIDS, 56.8% mentioned condoms as a way 
to prevent AIDS, and 60.2% mentioned 
monogamy.
Over 44.9 of the women do not know about 
signs and symptoms of STDs in males, 7.4% 
mentioned weight loss as a sign. They 
mentioned more signs of STDs affecting 
women: abdominal pain (17.6%), vaginal 
discharge (52.8%), pain when urinating 
(20.5%), and weight loss (8%).
Know FP Use FP
2001 2005
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 11
Family planning: Most frequently recalled 
methods were anovulatories –oral (76%) and 
injectable (80%)- followed by female 
sterilization (17%) and condoms (33%). 
While 50.6% of women said they wanted 
another child in the following two years, 
only 36.4% were using a FP method. 
Methods used most frequently were 
injections (23.9%) and female sterilization 
(6.8%). 
Personal hygiene: 92% of women reported 
handwashing before handling foods, 80.1% 
after going to the latrine, 66.5% before 
feeding the infant, and 38.6% after handling 
baby feces. The latter is consistently with 
local beliefs that baby stools are not 
harmful. 92.6% of women use a flush toilet 
or latrine consistently because they have one 
at home.
Radio messages: 68.2% recalled education 
messages disseminated by radio, mainly 
about child health, family health and 75% 
about maternal health. It is not clear 
whether there are fewer messages broadcast 
about maternal health or whether women are 
paying more attention to family and child 
health than to their own health.
Utilization of plantation health units 5.7% of 
surveyed women had visited a plantation 
HU in the last year. The same percentage 
would visit the unit again.
Project HOPE Guatemala CS Project 2005 Final KPC Report
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Appendix A:
PERFORMANCE INDICATORS FROM DIP
2005 FINAL EVALUATION
PROJECT HOPE/GUATEMALA
2001 2003 2005
PERFORMANCE INDICATORS FROM DIP TARGETS
%
% 95% C.I. % 95% C.I. % 95% C.I.
1. Percentage of children age 12–23 months who 
are fully vaccinated (against the five vaccine￾preventable diseases) before the first birthday
70 42.1 (33.2 - 51.5) 21.8 (14.9 - 29.0) 80.8% (72.06 - 89.54)
2. Percentage of children aged 6-23 months who 
received a dosage of Vit. A in the last six months 
preceding the survey
50 15.7 (10.7 - 20.7) 13.6 (9.3 - 18.6) 68.8% (60.77 - 76.83)
3. Percentage of children aged 0-23 who received 
immediate breastfeeding within the first eight hours 
after birth 
75 62.5 (56.7 - 68.0) 73.4 (67.9 - 78.0 75.0% (68.60 - 81.40)
4. Percentage of children age 0–5 months who were 
exclusively breastfed during the last 24 hours 70 79.2 (65.7 - 89.2) 65.3 (55.6 - 74.4) 87.5% (78.50 - 96.10)
5. Percentage of children age 0–23 months who are 
underweight (-2 SD from the median weight-for-age, 
according to the WHO/NCHS reference population) 
Reduction of 
10% from 
baseline
24.6 (20.1 - 29.9) 19.9 (15.6 - 24.5) 24.4% (18.4 - 31.6)
6. Percentage of mothers of children age 0–23 
months who know at least two signs of childhood 
illness that indicate the need for treatment
Increase of 
50% from 
baseline
34.4 (29.6 - 40.4) 65.6 (59.7 - 70.3) 90.9% (86.65 95.15)
7. Percentage of mothers of children aged 0-23 who 
give the same or more breastmilk, liquids, and/or 
solid foods during a diarrheal episode 
Increase of 
60% from 
baseline
34.9 (23.2 - 46.8) 41.7 (31.4 - 52.6) 84.3% (71.69 - 96.91)
Project HOPE Guatemala CS Project 2005 Final KPC Report
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8. Percentage of mohers of children aged 0-23 who 
seek care for their children’s diarrheal diseases with 
a trained provider 
44.4 (31.9 - 57.5) 34.5 (23.9 - 44.1) 84.3% (71.39 - 96.91)
9. Percentage of mothers who can mention at least 
two child health or reproductive health messages 
heard from a radio station 
60 6.1 (2.9 - 9.1) 0 (0.0 - 0.0) 53.4% (46.03 - 60.77)
10. Percentage of mothers with children age 0–23 
months who received at least two tetanus toxoid 
injections before the birth of their youngest child
60 22.56 (17.3 - 26.7) 10 (5.8 - 12.18) 49.4% (38.89 - 59.91)
11. Percentage of mothers who had at least three 
pre-natal visits during the last pregnancy 50 11.1 (6.6 - 13.4) 6.4 (3.4 - 8.6) 35.2% (23.31 - 47.09)
12. Percentage of mothers who reported at least 
two danger signs during pregnancy and post-partum 50 12.3 (6.7 - 17.3) 8.4 (3.7 - 12.3) 46.0% (38.64 - 53.36)
13. Percentage of mothers who have at least one 
post-partum visit during their last pregnancy 40 13.2 (9.7 - 17.8) 3.9 (31.6 - 72.4) 26.0% (13.72 - 38.28)
14. Percentage of mothers who are not pregnat, 
and do not desire or are not sure to have more 
children in the next two years and who are using a 
modern family planning method
40 15.1 (10.6 - 19.4) 32.6 (23.9 - 40.1) 52.8% (45.42 - 60.18)
15. Percentage of mothers who identify at least two 
danger signs of STIs in men and women 50 0 (0.0 - 0.0) 8.4 (4.5 - 13.5) 62.5% (55.35 - 69.65)
16. Percentage of mothers with children age 0–23 
months who cite at least two known ways of 
reducing the risk of HIV infection 70 17.3 (12.7 - 21.3) 41.9 (33.3 - 48.7) 79.5% (73.51 - 85.46)
Project HOPE Guatemala CS Project 2005 Final KPC Report
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Appendix B: Rapid CATCH Indicators – Project HOPE Guatemala: CS Project
2001 2003 2005
RAPID CATCH INDICATORS
% 95% C.I. % 95% C.I. % 95% C.I.
1. Percentage of children age 0–23 months who 
are underweight (-2 SD from the median weight-for￾age, according to the WHO/NCHS reference 
population)
24.6 (19.2 - 28.9) 19.9 (15.6 - 24.5) 24.4% (18.4 - 31.6)
2. Percentage of children age 0–23 months who 
were born at least 24 months after the previous 
surviving child
53.7 (48.3 - 59.7) 72.3 (67.0 - 76.9) 89.2% (84.61 - 93.79)
3. Percentage of children age 0–23 months whose 
births were attended by skilled health personnel 58.3 (52.4 - 63.6) 99.6 (95.5 - 102.5) 44.3% (36.96 - 51.64)
4. Percentage of mothers with children age 0–23 
months who received at least two tetanus toxoid 
injections before the birth of their youngest child
22.6 (17.3 - 26.7) 10 (65.8 - 12.2) 50.6% (39.99 - 61.01)
5. Percentage of children age 0–5 months who 
were exclusively breastfed during the last 24 hours 79.2 (68.0 - 89.9) 65.3 (55.6 - 74.4) 87.5% (77.88 - 96.72)
6. Percentage of children age 6–9 months who 
received breastmilk and complementary foods 
during the last 24 hours
57.8 (47.5 - 68.5) 40 (24.8 - 55.2) 64.0% (47.20 - 84.40)
7. Percentage of children age 12–23 months who 
are fully vaccinated (against the five vaccine￾preventable diseases) before the first birthday
42.1 (33.2 - 50.8) 21.8 (14.9 - 29.0) 80.8% (72.06 - 89.54)
8. Percentage of children age 12–23 months who 
received a measles vaccine 47.9 (39.1 - 56.9) 21.8 (14.9 - 29.0) 82.1% (73.59 - 90.61)
9. Percentage of children age 0–23 months who 
slept under an insecticide-treated net (in malaria 
risk areas) the previous night
32.7 (27.7 - 38.3) 33.1 (27.8 - 38.2) 40.3% (33.15 - 47.65)
10. Percentage of mothers with children age 0–23 
months who cite at least two known ways of 
reducing the risk of HIV infection
17.3 (12.7 - 21.3) 41.9 (33.3 - 48.7) 79.5% (73.54 - 85.46)
Project HOPE Guatemala CS Project 2005 Final KPC Report
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11. Percentage of mothers with children age 0–23 
months who report that they wash their hands with 
soap/ash before food preparation, before feeding 
children, after defection, and after attending to a 
child who has defecated
26 (0.3 - 0.7) 55.6 (50.5 - 61.5) 26.1% (13.41 - 38.79)
12. Percentage of mothers of children age 0–23 
months who know at least two signs of childhood 
illness that indicate the need for treatment
34.4 (29.6 - 40.4) 65.6 (59.7 - 70.3) 90.9% (86.65 - 95.15)
13. Percentage of sick children age 0–23 months 
who received increased fluids and continued 
feeding during an illness in the past two weeks 34.9 (23.2 - 46.8) 41.7 (31.4 - 52.6) 84.7% (79.61 - 90.19)
Project HOPE Guatemala CS Project 2005 Final KPC Report
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Appendix C: Survey Teams – 2005 Final KPC Survey – CS Project, Guatemala
Coordination and planning
Dr. Anabela Aragón 
Training
Anabela Aragon
Marco Cifuentes
Juan Carlos Reyes
Supervision
Dr. Anabela Aragón
Marco Cifuentes
Interviewers
Pedro Alvarado
Juan Carlos Reyes
Estuardo Ovalle
Antonio de León
Field support - MOH
Otto Boloví Vásquez
Isman Barrios
Julio Pérez
Francisco Soom
Florentino Ramos
Jhonatan
Henry Xiloj
Luís López
José Maria Estrada
Fernando Nazareno
Pedro Montalvan
Mario Méndez 
Data processing
Marco Cifuentes
Anabela Aragon
Thelma Barrio
Luis Diaz
Data analysis, Reporting
J.C. Alegre (HOPE Center)
Dra. Anabela Aragón (HOPE Guatemala)
Project HOPE Guatemala CS Project 2005 Final KPC Report
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Appendix D: 
LIST OF SUPERVISION AREAS, MUNICIPALITIES, AND COMMUNITIES SELECTED
2005 FINAL KPC SURVEY
PROJECT HOPE GUATEMALA
Departament Supervisión 
Area COMMUNITY NAME OF COMMUNITIES No. of interviews 
Colomba Colomba (1), Carmen Amalia, (1) La Fama (1), El Jardín (1) 4
Coatepeque La Unión (1), Magnolia (1), Nuevo Chuatuj (1)
San Rafael Pacaya I (1), San Juan El Horizonte (1)
Coatepeque (4) Bethania (1), El Troje (1), Los Cerritos (1)
Valparaíso (1), El Jardín (1)
14
San Martín San Martin (1), La Loma (1), Tojcoman (1), Santo Domingo (1) 4
No. 1 
Flores El Manantial (1), Morelia (1), Galvez (1) 3
Génova La Paz (1), Morazán (1), El Rosario (1)
Sector Méndez (1), Talsachún (2), La Floresta (1)
Génova (1), El Reposo (1), Canutillo (1)
10
El Palmar El Matasano (1), La Esperancita (1) 
Monte Margarita (1), San Miguelito Calahuaché (1)
La Alianza Miralta (1), San Marcos (1)
El Palmar (2) 
8
Zunil Santa María de Jesús 1 1
Quetzaltenango 
No. 2
San Felipe San Felipe (2) Candelaria (1)
Guadalupe(1) Nuevo Palmar(1) Tierra Colorada ( 1) 6
Cuyotenango Cuyotenango (3), Ican (1)
Chacalte SIS (1), Chacalte Aparicio No. 1 (1), Guachipilin No. 1 (1)
La Máquina centro urbano (2), San Isidro (1)
La Máquina (5)
15
San 
Francisco Zap
San Francisco Zapotitlán (1), El Rosario (1), Las Nubes (1)
Santa Cecilia (1), San José (1), Las Trinitarias (1)
6
Suchitepéquez No. 3 
Zunilito Mi Tierra (1) 1
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Pueblo Nuevo Pueblo Nuevo (1), Mangales (1), Guadalupe (1) 3
Chicacao Chicacao (8)
El Pito (1), María del Mar (1), San Pedro Cutzán (1)
San Bartola Nanzales (1), La Cruz (1), Portezuelo Moca (1)
14
Patulul Patulul (1), El Triunfo (1)
La Magnolia (1), Santa Luisa (1)
4
Santa 
Bárbara
Santa Bárbara (1), La Patria (1)
San José El Carmen (1), Toro Pinto Chipo (1)
4
No. 4
Samayac Samayac (2), Parraxe (1) 3
El Tumbador El Tumbador (1), Chamaque (1)
El Retiro (1), El Ferrol (1), San Bartolomé Izabal (1)
Liberación (1), La Viña (1)
Plan de la Gloria (1), Palestina (1)
9
Nuevo 
Progreso
Nuevo Progreso (1), Ixcahuin (1), Nueva Escocia (1)
Sombrerito Alto (1), Viena (1), Los Cardona (1)
6
El Quetzal Rancho Bojón (1), Sintaná (1), Maya (1)
Bella Rosita (1), La Unión (1)
5
No. 5 
La Reforma La Reforma (1), El Baluarte (1), Punta Arenas (1)
Las Palmas (1), Santa Teresa (1)
5
Concepción 
Tutuapa
Canchoche (1), Huispache (1)
La Laguna (1), Sochel (1), Tictucabe (1)
Tuininhuitz (1), San Luis (1)
Tzanquitzal (1), Chapil (1)
1 más
10
Sipacapa Cancil (1), Pie de la Cuesta (1), Independencia Chilil (1) 3
San Miguel 
Ixt.
Baljetre Buena Vista (1), Chesil (1), Siete Platos (1)
Salitre (1), Ladrillera (1)
5
San Marcos 
No. 6 
Comitancillo Primavera (1), Chicajalaj (1), Molino Viejo I (1)
Sabalique (1), Tuiscajchis (1), Tuilelen (1)
Los Bujes I (1), El Porvenir (1)
8
Project HOPE Guatemala CS Project 2005 Final KPC Report
Page 19
Malacatán Malacatán (2), El Naranjo (1), La Lima (1)
La Central (1), Malacatancito (1), Nueva Colonia (1)
San Antonio Socorro (1), San José Petacalapa (1)
11 de Julio (1), Buena Vista (1), Santo Domingo Belén (1)
12
El Rodeo El Rodeo (1), La Industria (1)
Santa Ana (1), Las Flores (1) 
4
San Pablo Colima I (1), El Porvenir (1), El Carmen (1)
Santa Elena II (1), La Joya (1), Tojoj (1)
6
No. 7 
San Rafael San Rafael (1), El Platanillo (1), Santa Julia (1) 3
Total de encuestas realizadas 175
Note: Mothers with children under 2 years of age and women of fertile age were randomly selected from those selected communities 
Project HOPE Guatemala CS Project 2005 Final KPC Report
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Appendix E: Survey Questionnaires
Project Hope
Survey for mothers with children under 2 years old
Knowledge, Practices and Coverage (KPC)
 Child Survival Project 
 Guatemala 2005
Identification
Identification No.: __ __ __ __
Department ___________________
Community ___________________
( )
( )
Municipality __________________
Farm_________________________
( )
( )
Interview Date:.….../.…….../.……
 Day Month Year
Interviewer Name _________________________________________________
Supervisor ____Dra. Anabela Aragón__________________________________
( )
( )
General Data from Mother
1. Name of the mother being interviewed ____________________________________
 First name Last name
2. How old are you exactly? _______ years _______ months
3. Have you ever attended school?
1. Yes……………….……………………..……………………………
Project HOPE Guatemala CS Project 2005 Final KPC Report
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2. No ‡ (go to question 5).……………………………………………
4. What was the last grade you completed in school?_______ grade
5. What is the most commonly used language in your home?
1. Spanish…..…………………………………………………………………….
2. Quiché….……………………………………………………………………...
3. Mam….………………………………………………………………………..
4. Other (please specify) _____________________________________
6. What kind of work do you do for gaining money? 
1. None (unremunerated domestic services)……….…………………………….
2. Craftsmanship.………………...………………………………………………
3. Harvest and gathering of fruits…………...……...……………………………
4. Selling of agro products………………….……………………………………
5. Selling meals/milky products…………………………………………………
6. Domestic services (remunerated).……..……………………………………...
7. Store owner/street seller………………...…………………………………….
8. Paid worker….……………………….………………………………………..
9. Other (please, specify) ________________________________
7. Who is taking care of your children while not being at home? 
1. She herself/ /taking them with her…………………………………………….
2. The husband.…………………………………………………………………..
3. Older kids……………………………………………………………………..
4. Another member in the family (please specify) _______________________
5. Friends/neighbors.………………………..…………………………………...
6. Other (please, specify) ________________________________
Project HOPE Guatemala CS Project 2005 Final KPC Report
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Listing of the children less than five years old 
8. How many children less than five years old live in your house? _____ 
9. How many of these kids are yours? ____ 
10. Please tell us the name, age and sex of each of the children (write data to the table), starting with the data of the younger 
children.
Name Sex Date of Birth Months 
of Age
Index 
case < 
than 2 
years 
old
1
M
F
___ / ___ / ___
Day Month Year X7
2
M
F
 ___ / ___ / ___
Day Month Year 
3
M
F
___ / ___ / ___
Day Month Year 
4
M
F
___ / ___ / ___
Day Month Year 
[The index case must be the youngest children]
11. Have you had another pregnancy between the births of your two younger children? (please give the name of the two youngest 
children)
1. Yes...………………………………………………………………………….. 
2. No. ………………………………………………………………………….
Breastfeeding Promotion and Nutrition of Children
12. Have you ever breast-fed (please give the name of the youngest children or the name of index case)? 
Project HOPE Guatemala CS Project 2005 Final KPC Report
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1. Yes…………..………………………………………………………………...
2. No ‡(go to question 14)..…………………………….………………………
13. How long did you breastfeed (please give the name of the girl/boy index) after birth? 
1. Immediately after birth or within an hour of birth……………..……………..
2. 1-8 hours after birth…………….……..…………………………………….
3. 8 hours after birth………………..…………………………………………...
14. Please tell me if (name of the girl/boy index) ate yesterday? (refers today and night, to breakfast, lunch, dinner and refreshments) 
INQUIRE ABOUT IT – DO NOT SUGGEST AN ANSWER
Food or drinks Within the past 24 
hours
1 Maternal Milk
2 Pure drinking water
3
Other milks: artificial baby milk, canned milk, fresh 
milk
4 Fruit Juices
5
Other liquids: herbal tea, soup/clear soup, soft drinks 
or aerated drinks, incaparina or cornflour drinks
6 Purees or solid foods
7
Foods made with: corn, wheat, oat, cereal, bread, 
cookies, pasta, “Tortrix” (calories 77, protein 1.1g, 
carbohydrate 6.8g, fat 5.0g, sodium 148.5mg) 
8
Zucchini, carrot, sweet potato, “ayote” (species of 
small pumpkin that eats like vegetable)
9 Other eatable tubercles/roots: potatoes, malanga, yucca
10
Green leaves: chaya leaves (richier in iron than the spinach 
and a powerful calcium and potassium source), hierbamora, 
amaranto (bledo)
Project HOPE Guatemala CS Project 2005 Final KPC Report
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11 Mango fruit, papaya fruit/other yellow fruits rich in 
vitamin A
12 Other fruits or vegetables (banana, apple, tomato)
13 Cow meat, hen meat, fishes and eggs
14 Foods made with: beans, lentil, soya 
15 Cheese
16 Fat foods: cream, alligator pear, nuts, food fried with 
scrambled eggs
15. How many times did (write the name of the boy/girl) ate/drink anything else besides breast milk yesterday? Include main
meals and refreshments [explain “yesterday” refers to day and night _______ number of times]
Maternal Health - Prenatal
16. Did you see anyone for prenatal care while you were pregnant with (name of the girl/boy)?
1. Yes.......………………………………………………………………………..
2. No ‡(go to question 22). ...………………………….……………………….
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17. Whom did you see for prenatal care? (you may give more than one answer)
1. Doctor....…………………………………………………………………….
2. Nurse.………………………………………………………………………….
3. Health promoter………...……………………………………………………
4. Midwife……...………………………………………………………………
5. Other (please specify) _____________________________________
18. Do you have the control card of your pregnancy? (or other document with the antenatal care registers)
1. Yes÷ ask her to show you 
it…………………………...………………………...
2. No ‡ go to question 22. ………………………………………………...
19. Write the number of TDA vacuums applied to the mother 
1. One…...……………………………………………………………………...
2. Two…...……………………………………………………………………...
3. More than two………………………………………………………………...
4. None………...………………………………………………………………...
20. Are there spaces for information regarding the prenatal visits in the card?
1. Yes…………………………………………………………………………..
2. No ‡ go to question 22. ………………………………………………...
21. How many visits for prenatal care did you have at the Health Center while you were pregnant with (name of the girl/boy)? 
(see the carnet)
5. One…...……………………………………………………………………...
6. Two…...……………………………………………………………………...
7. More than two………………………………………………………………...
8. None………...………………………………………………………………...
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22. Do you know the danger signs of pregnancy? Please mention them. (Do not suggest the answers). 
1. Headache……………………………………………………………………
2. Antepartum hemorrhage before labor pain………….……………………...
3. Face or hand swelling………………………………………………………..
4. Convulsions………...……….………………………………………………
5. High fever……….………………..…………………………………………
6. Palness, breathing 
trouble……………….…………………………………
7. Pain or ardency when urinating…………………………………………….
8. Other (please specify) _____________________________
9. Don't know ‡ (go to question 26)
23. Did you have any of these signs before labor began? 
1. Yes…………………………………………………………………………….
2. No ‡ go to question 26. ……………………………………………………..
24. Did you ask for help or advice? 
3. Yes………………………………………………………………………….
4. No ‡ go to question 26. ……………………………………………………..
25. Whom did you ask for help or advice? (you may give more than one answer)
1. Health Unit located on the farm…………………………………………...
2. Private Doctor……………...………………………………………………..
3. Drugstore # l.………………………………………………………………...
4. Promoter…..……………………………………………………………...
5. Health Center or Health Station of the Ministry of Health……...……..
6. Health Unit of the NGOs…………………………………………………….
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7. Midwife………...……………………………………………………………
8. Other (please specify) ___________________________________
Childbirth Characteristics
26. Where did you give birth to (write the name of the girl/boy)?
1. In your own home…………...…...…………………………………………..
2. In another house…...………………………………………………………...
3. In a health facility…………..………………………………………………...
4. In a hospital………………………………………………………………….
Other (please specify) ____________________________________
 
27. Who did assist you in giving birth to (please write the name of the girl/boy)? (you may give more than one answer)
1. Doctor…….………………………………………………………………….
2. Nurse.………....………………………………………
……………………..
3. Auxiliary nurse………………………………………………………………..
4. Traditional midwife………..………………………………………………….
5. Volunteer in your community…........……………………………………….
6. Family member (please specify the family relation) ______________
7. Other (please specify) _________________________________
8. Unassisted childbirth...……...………………………………………………...
28. How was done the cutting of the umbilical cord?
1. New razor…………………………………………………………………...
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2. Scissors..…………………………………………………………………….
3. Other instrument (please specify) _______________________________
4. Do not know, do not remember …………………………………………….
 
Postnatal
29. Are there spaces for information regarding the postnatal visits in the card? (please verify) IF APPLICABLE (IF SHE HAS 
HER CARD)
1. Yes…...……………………………………………………………………...
2. No ‡ go to question 31. ………………………………………………
30. How many postnatal visits do you have after giving birth to (name of the boy/girl)?
1. One……..……………………………………………………………………
2. Two…….……………………………………………………………………
3. Three or more.………………………………………………………….
4. None…........…………………………………………………………………
5. Do not know / Do not remember …………………………………………….
31. Do you know the danger signs after delivery? (Do not suggest the answers). 
1. Severe vaginal 
bleeding…….……….……………………………………..
2. High fever…………….……………………………………………………...
3. Foul vaginal odor……...……………………………………………………..
4. Sharp pain in the lower part of the stomach ………………………………….
5. Other (please specify) __________________________
6. Do not know ‡ (go to question 35). ………………………….………..
32. Did you have any of those danger signs after childbirth? 
1. Yes…………………………………………………………………………..
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2. No ‡ go to question 35. ………………………………………………
33. Did you ask for help or advice? 
3. Yes………………………………………………………………………..
4. No ‡ go to question 35. ……………………...………………………………
34. Whom did you ask for help or advice?
1. Health Unit located on the farm………...……..…………………………...
2. Private Doctor…...………………………………………………………..
3. Drugstore…………………………………………………………………
4. Promoter…...………………………………………………………………...
5. Health Center or Health Station of the Ministry of Health………………
6. Health Station of ONGs or ANACAFE /SIAS.……………………….….
7. Midwife…….…………………………………………………………………
8. Other (please specify) _____________________________________
Child Immunizations
35. Does (name of the girl/boy) have an immunization record card? May I see it?
1. She shows the immunization record card to the interviewer. 
………….………….
2. Not available, it was lost ‡ go to question 36..………..…………………
3. She did not have an immunization record card for this boy ‡ go to 
question 36……………………………………………………………….…..
4. Does not know, does not answer ‡ go to question 36….…………..
Write down the dates in the table below, exactly as on card
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Day Month Year
BCG
POLIO 0
POLIO 1
POLIO 2
POLIO 3
DPT 1
DPT 2
DPT 3
MEASLES
VITAMIN A
PENTAVALENT
TRIPLE VIRAL
36. At what age should be the measles /SPR vaccine given to child?
1. ________ months
2. Do not know…….…………………………………………………………….
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Malaria and fastidiousness:
37. What are malaria symptoms in children? (you may give more than one answer)
1. Do not know..……………………………………………………………….
2. Fever…...……………………………………………………………………
3. Recurring shivers and chills ..………………………………………………
4. Headache…………....………………………………………………………
5. Convulsions……..……………………………………………………………
6. Can not be breastfed……..…………………………………………………..
7. Other (please specify) _____________________________________
38. ¿What are fastidiousness symptoms in children? (you may give more than one answer)
1. Fever…...……………………………………………………………………
2. Headache………....…………………………………………………………
3. Muscular aches and pains……..……………………………………………..
4. Bone pain……………………………………………………………………
5. Orbit – eye pain………………...……………………………………………
6. Uneasy, irritated, crying……………….……………………………………...
7. Do not know……..………………………………………………………….
8. Other (please specify) ____________________________________
39. Do you have mosquito net / bed canopy at home?
1. Yes…...……………………………………………………………………...
2. No ‡ go to question 42 ………………...…..……………………………...
3. Do not know ‡ go to question 42 ……….………………………………...
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40. Who did sleep in a bed covered by a mosquito net / bed canopy yesterday? (you may give more than one answer)
1. The girl/boy (index 
case).…..………..………………………………………
.
2. The mother…...……………………………………………………………...
3. Other (please specify) ___________________
41. Does the mosquito net / bed canopy was treated with an insect-repelling liquid? (do not use an insecticide when use mosquito 
net / bed canopy)
1. Yes……………………………………………………………….………….
2. No…..……………………………………………………………………….
3. Do not know…….………………………………………………….………..
Childhood Illnesses and Management of Childhood Illnesses
42. How do you know when your kid is getting sick and needs treatment? (do not suggest the answers)
1. Looks sick, does not play as he/she used to do it……...…….………………..
2. Do not eat, do not drink……….………………………………………………
3. Lethargic, hard to wake………..…………………………………………….
4. High fever……...…………………………………………………………….
5. Rapid or difficult breathing…..……………………………………………..
6. Frequent vomiting……..……………………………………………………..
7. Convulsions. …………………………………..……………………………
8. Other (plese specify) ______________________________
9. Do not know..…………………..…………………………………………...
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43. Did (name of the girl/boy) have in the last two weeks any of these symptoms listed below?
Symptom or sign Long-continued 
diarrhea or defecates 
blood
Cough, rapid or 
difficult breathing
Malaria/
Fastidiousness 
fever or
convulsions
Other: Please 
describe……………………………
.
A. Did she/he have 
this symptom
1. Yes 2. No 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No, other
B. Did you seek for 
medical advice or 
attention when 
your kid became 
ill?
1. Yes 2. No 1. Yes 2. No 1. Yes 2. No 1. Yes 2. No
C. Whom did you ask 
for help or advice 
first?
1. BS Unit 
2. Promoter
3. Center or station
4. Private provider
5. Hospital
6. Drugstore
7. Charlatan
8. Family/friend
9. Other…………
10. None
1. BS Unit 
2. Promoter
3. Center or station
4. Private provider
5. Hospital
6. Drugstore
7. Charlatan
8. Family/friend
9. Other…………
10. None
1. BS Unit 
2. Promoter
3. Center or station
4. Private provider
5. Hospital
6. Drugstore
7. Charlatan
8. Family/friend
9. Other…………
10. None
1. BS Unit 
2. Promoter
3. Center or station
4. Private provider
5. Hospital
6. Drugstore
7. Charlatan
8. Family/friend
9. Other…………
10. None
D. Did anyone else 
give you help or 
advice?
1. BS Unit 
2. Promoter
3. Center or station
4. Private provider
5. Hospital
6. Drugstore
7. Charlatan
8. Family/friend
9. Other…………
10. None
1. BS Unit 
2. Promoter
3. Center or station
4. Private provider
5. Hospital
6. Drugstore
7. Charlatan
8. Family/friend
9. Other…………
10. None
1. BS Unit 
2. Promoter
3. Center or station
4. Private provider
5. Hospital
6. Drugstore
7. Charlatan
8. Family/friend
9. Other…………
10. None
1. BS Unit 
2. Promoter
3. Center or station
4. Private provider
5. Hospital
6. Drugstore
7. Charlatan
8. Family/friend
9. Other…………
10. None
E. Was the kid most, 
equal or less 
breastfed while 
she/he was sick?
1. Less
2. Equal
3. Most
4. Not breastfeding
1. Less
2. Equal
3. Most
4. Not breastfed
1. Less
2. Equal
3. Most
4. Not breastfed
5.
1. Less
2. Equal
3. Most
4. Not breastfeeding
F. Did you give 
her/him less, equal 
or more drinks 
while she/he was 
1. Less
2. Equal
3. More
1. Less
2. Equal
3. More
1. Less
2. Equal
3. More
1. Less
2. Equal
3. More
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Symptom or sign Long-continued 
diarrhea or defecates 
blood
Cough, rapid or 
difficult breathing
Malaria/
Fastidiousness 
fever or
convulsions
Other: Please 
describe……………………………
.
while she/he was 
sick?
G. Did she/he eat 
less, equal or more 
while she/he was 
sick? 
1. Less
2. Equal
3. More
4. Do not eat
1. Less
2. Equal
3. More
4. Do not eat
1. Less
2. Equal
3. More
4. Do not eat
1. Less
2. Equal
3. More
4. Do not eat
H. What treatment 
did the kid
receive? You may 
mark more than 
one answer. If she 
answers a
medicament, ask 
her to show you it. 
A. None
B. Package of oral re￾hydration 
(serum)
C. Home-made 
beverages
D. Medicaments……
.
E. Other…
A. None
B. Drinks
C. Medicaments
D. Food……
E. Other…
A. None
B. Drinks
C. Medicaments
D. Food……
E. Other…
A. None
B. Drinks
C. Medicaments
D. Food……
E. Other…
44. Did you bring your kid to the basic health unit at least once in the last year? (this question applies only for bordering farms 
and communities with basic health units)
1. Yes...…………………………………………………………………………..
2. No...…………………………………………………………………………
45. Would you bring her/him again? 
1. Yes (‡ go to question 47). ………………….………………………….
2. No ………………………………………………………………………..
46. Why not bring her/him again? 
1. Because it is constantly 
closed…………………………………………………..
2. Because of the lack of medicaments.………………….....…………………..
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3. Because services are not delivery all day long……………...………………
4. Other (please specify) _______________________________
Personal Hygiene
47. When should you wash your hands?
1. Never………………………………………………………………………...
2. Before cooking………………….……………………………………………
3. Before feeding 
children………..………………………………………
……...
4. After defecating………..……………………………………………………..
5. After cleaning the bottom of a baby or child who had just defecated……..….
6. Other (please specify) __________________________________
48. Where does (name of the child) usually defecate? (use the regional expression of “defecate”)
1. Sanitary or latrine facility….….……………………………..……………..
2. On any square or place of the family property………………………….….....
3. Open ground..……………………………..………………………………...
4. Directly into rivers, canals or water flowing..………….…………………….
5. Diaper/Small chamber pot……………..…………………………………….
6. Other (please specify) _______________________________
49. Do your family have access daily to any sanitary or latrine facility?
1. Yes. ………………………………………………………………………………
2. No. ………………………………………………………………………………..
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Radio Messages
50. Do you remember hearing any message regarding child or maternal health on the radio last month? 
1. Yes...…………………………………………………………………………..
2. No ‡ (go to question 52). ……………………………..
51. Do you remember the content of those radio messages? (please specify)
1. Do not remember…………………………………………………………….
2. Child health (please specify)_____________________________
3. Maternal health (please specify) _____________________________
4. Reproductive health (please specify)_________________________
5. Family health (please specify) _____________________________
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Anthropometry
52. Weigh the child and measure his/her length (lying down). Register the child's weight in pounds. Register the length to the
nearest centimeter. 
Weigh Pound
s
Length Cm
Age in months
 
Finish the interview
Project HOPE Guatemala CS Project 2005 Final KPC Report
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PROJECT HOPE
SURVEY OF WOMEN OF FERTILE AGE 
GUATEMALA 2005
Identification No.: __ __ __ __
(It does not include the mothers interviewed with children less than 2 years old)
Department ___________________
Community ___________________
( )
( )
Municipality __________________
Farm_________________________
( )
( )
A. Interview Date: .….../.…….../.……
 Day Month Year
Interviewer Name _________________________________________________
Supervisor ____Dra. Anabela Aragón__________________________________
( )
( )
General Data from Woman of Fertile Age
Name of the woman being interviewed _______________________________________
 First name Last name
1. Are you pregnant? 
1. Yes. ……………………………………….………………………………………
2. No. ………………………………………………………………………………..
2. How old are you exactly? _______ years _______ months
3. Have you ever attended school? 
Project HOPE Guatemala CS Project 2005 Final KPC Report
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1. Yes ………………………………………………………………………………
2. No ‡ (go to question 5). ……………………………………………………
4. What was the last grade you completed in school?_______ grade
5. What is the most commonly used language in your home?
1. Español. …………………………………………………………………………..
2. Quiché. ……………………………………………………………………………
3. Mam. ……………………………………………………………………………...
4. Other (please specify) _____________________________________
6. Do you work out of your house? 
1. Yes. ………………………………………………………………………………
2. No ‡ (go to question 8). …………………………………..…………………...
7. What kind of work do you do for gaining money?
1. None……………….…………………………………..………………………….
2. Craftsmanship. ……………………………………………………………………
3. Fruit harvest. ………………………………………...……………………………
4. Selling of agro products. ………………………………………………………….
5. Remunerated Domestic Services….………………………………………………
6. Store owner/street selle……………………..…………...………………………..
7. Paid worker. …………………………….………………………………………..
8. Other (please, specify) ________________________________
STIs/AIDS -Knowledge
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8. Have you ever heard of an illness called AIDS?
1. Yes..……….………………………………………………………………………
2. No ‡ Go to question 10. ……………………………………………………
9. Is there anything a person can do to avoid getting AIDS or the virus that causes AIDS? 
1. Nothing….………………………………………………………………………...
2. Abstinence: not having sexual intercourse………...……………………………...
3. Condom use………….…………………………………………………………....
4. Limit the sexual behavior to one partner, sexual fidelity ……………….………..
5. Limit the number of sexual partners….……………………………………….…..
6. Avoid sex with prostitutes…………………………………………………….…..
7. Avoid sex with persons who have a lot of sex partners…………………….…….
8. Avoid sex with persons of the same sex…..……………………………..……….
9. Avoid sex with persons who consume drugs……………………………………..
10. Avoid blood transfusions……...……………..…………………………………...
11. Avoid injections..………………………………………………………………….
12. Avoid kisses…..…………………………………………………………………...
13. Avoid mosquito bites ………………………………………...…………………...
14. Search for tradicional medicine………………………..………………………….
15. Avoid sharing razors, blades……………………………………..……………….
16. Don't know….……………………………………………………………………..
17. Other (please, specify) _____________________________________
10. When can you think a man may be infected by a sexually transmitted disease? 
1. Abdominal pain……………………...……………………………………………
2. Urethral secretion. ……………………………..…………………………………
3. Ill-smelling urethral secretion..…………………………………..………………..
4. Pain like ardency when urinating. ………...……………………………………...
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5. Inflammation of genital area (red, hot and swollen)……………….….………….
6. Genital ulceration……...………………………………………………………….
7. Genital warts……………………………………………………………………...
8. Bloody urine……………………..………………………………………………..
9. Weight lost………………………………………………………………………..
10. Impotence...……………………………………………………………………….
11. No symptoms ……………………..…………………….………………………...
12. Don't know ………………………………………………………………………..
13. Other (please, specify) ___________________________________
11. When can you think a woman may be infected by a sexually transmitted disease?
1. Abdominal pain……………………...……………………………………………
2. Vaginal secretion. ………………………….…..…………………………………
3. Ill-smelling vaginal secretion. ……..…………..…………………………………
4. Pain like ardency when urinating. ………...……………………………………...
5. Inflammation of genital area (red, hot and swollen)……………….….………….
6. Genital ulceration……...………………………………………………………….
7. Genital warts……………………………………………………………………...
8. Bloody urine……………………..………………………………………………..
9. Weight lost………………………………………………………………………..
10. Sterility…………………………………………………..………………………..
11. No symptoms ……………………..…………………….………………………...
12. Don't know ………………………………………………………………………..
13. Other (please, specify) ___________________________________
Family Planning
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12. What family planning methods do you know or have you heard about?
1. Female sterilization operation………………………………….…...…………….
2. Vasectomy/male sterilization operation…………………..………………………
3. Norplant birth control. ………………………………..………………………….
4. Contraceptive injections.………….………………………………………………
5. Pastillas anticonceptivas. …………………………………………………………
6. Intrauterine device/IUD……...……………………………………………..…….
7. Condoms…………………………………………………………………..……...
8. Contraceptive foam or gel.………………………………………………………..
9. Exclusive breastfeeding…………….……………………………………………..
10. Rhythm or “collar” method…………………………………..…………………...
11. Abstinence: not having sexual intercourse………...……………………………...
12. Sexual intercourse deliberately interrupted……………………………………….
13. Don't know ………………………………………………………………………..
14. Other (please, specify) ___________________________________
13. Do you want to have kids in the next two years?
1. Yes………………………………………………………………………………...
2. No. ………………………………………………………………………………..
3. Don't know/not sure ………….…………………………………………………..
14. Are you or your sexual partner using now a birth control method or avoiding the risk of having more babies?
1. Yes ………………………………….……………………………………………
2. No (go to question 16). ……………………………………………………….
15. Which method?
14. Female sterilization operation………………………………….…...…………….
15. Vasectomy/male sterilization operation…………………..………………………
16. Norplant birth control. ………………………………..………………………….
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17. Contraceptive injections.………….………………………………………………
18. Pastillas anticonceptivas. …………………………………………………………
19. Intrauterine device/IUD……...……………………………………………..…….
20. Condoms…………………………………………………………………..……...
21. Contraceptive foam or gel.………………………………………………………..
22. Exclusive breastfeeding…………….……………………………………………..
23. Rhythm or “collar” method…………………………………..…………………...
24. Abstinence: not having sexual intercourse………...……………………………...
25. Sexual intercourse deliberately interrupted……………………………………….
26. Don't know….……………………………………………………………………..
14. Other (please, specify) ___________________________________
Personal Hygiene
16. Hand-washing practices. When should you wash your hands?
1. Never..…………………………………………………………………………….
2. Before cooking……………..……………………………………………………..
3. Before feeding 
children…..………………………………………………
……….
4. After defecating………………………………...…………………………………
5. After cleaning the bottom of a baby or child who has just defecated……..……...
6. Other (please, specify) ___________________________________ 
17. Where do you and your family usually defecate? (use the term used locally for “defecate”) 
1. Sanitary or latrine facility….….…………………………………………………..
2. On any square or place of the family property………………………….………...
3. Open ground..……………………………..……………………………………...
4. Directly into rivers, canals or water flowing..……………………………...…….
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5. Other (please, specify) ___________________________________
18. Do you and your family have access daily to any sanitary or latrine facility?
3. Yes. ………………………………………………………………………………
4. No. ………………………………………………………………………………..
Radio Messages
19. Do you remember if you heard last month any message regarding child & maternal health on the radio? 
1. Yes …………………..……………………………………………………………
2. No ‡ go to question 21. ……………………………………………………….
20. Do you remember the content of those messages on radio?
1. Don't remember ………………...………………………………………………...
2. Child health (please specify) ______________________. ...………………….....
3. Maternal health (please specify) ______________________. …………………...
4. Reproductive health (please specify) ______________________. ……………....
5. Family health (please specify) ________________________. …………….…….
Health Services 
21. Have you receive the services of the on-farm basic health unit at least once during the last year? (Only for the nearby farms and 
communities with basic health units)
1. Yes …………...…………………………………………………………………...
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2. No (finish the interview). ………………………………………………………..
22. Would you come again? 
1. Yes (finish the interview).………………………………………………………...
2. No. ………………………………………………………………………………..
23.Why you wouldn't come again? 
1. Because it is constantly 
closed……………………………………………………
2. Because there aren't enough medicaments………...………………...……………
3. Services are not delivered all day long…………………….……………………..
4. Other (please, specify) _____________________________________
FINISH THE INTERVIEW
Project HOPE Guatemala CS Project 2005 Final KPC Report
ANNEX F: PROJECT DATA SHEET FORM 
Project HOPE Guatemala CS Project 2005 Final KPC Report
Child Survival and Health Grants Program Project Summary
Oct-06-2005 
() 
General Project Information: 
Field Program Manager Information: 
Name: Francisco Torres Address: Project 
HOPE/Nicaragua 
Managua , Nicaragua Phone: 011-505-278-0116, 270 31 24 E-mail: 
hopenic1@cablenet.com.ni 
Alternate Field Contact: 
Name: Alejandro Soza Address: Colonia Los Robles No. 72 De la Funeraria 
Managua , Phone: 011-505-270-3124 E-mail: hopenic2@cablenet.com.ni 
Funding Information: 
USAID Funding:(US $): PVO match:(US $) 
Project Information: 
Description: 
Project Partners: 
SILAIS Jinotega 
General Strategies Planned: 
Project HOPE Guatemala CS Project 2005 Final KPC Report
Private Sector Involvement Strengthen Decentralized Health System Information System 
Technologies 
M&E Assessment Strategies:
KPC Survey Health Facility Assessment Organizational Capacity Assessment with Local 
Partners Organizational Capacity Assessment for your own PVO Lot Quality Assurance 
Sampling Participatory Evaluation Techniques (for mid-term or final evaluation) 
Behavior Change & Communication (BCC) Strategies: 
Interpersonal Communication Peer 
Communication Support Groups 
Groups targeted for Capacity Building: 
PVO Non-Govt 
Partners 
Other Private 
Sector Govt Community 
Field Office 
HQ CS 
Project Team 
(None Selected) Business Dist. Health 
System Health 
Facility Staff 
CHWs 
Interventions/Program Components: 
Immunizations (7 %)
 (IMCI Integration) 
Nutrition (13 %)
 (IMCI Integration) (CHW Training)
-Comp. Feed. from 6 mos.
-Growth Monitoring
-Maternal Nutrition 
Pneumonia (10 %)
 (IMCI Integration) (CHW Training) 
-Pneum. Case Mngmnt.
-Access to Providers Antibiotics
-Recognition of Pneumonia Danger Signs 
Control of Diarrheal Diseases (15 %)
 (IMCI Integration) (CHW Training)
Project HOPE Guatemala CS Project 2005 Final KPC Report
-Hand Washing
-ORS/Home Fluids
-Feeding/Breastfeeding
-Case Mngmnt./Counseling 
Maternal & Newborn Care (30 %)
 (IMCI Integration) (CHW Training)
-Recog. of Danger signs
-Newborn Care
-Post partum Care
-Delay 1st preg Child Spacing
-Normal Delivery Care
-Birth Plans
-Emergency Transport 
Child Spacing (10 %)
 (IMCI Integration) (CHW Training)
-Child Spacing Promotion 
Breastfeeding (10 %)
 (IMCI Integration) (CHW Training)
-Promote Excl. BF to 6 Months
-Intro. or promotion of LAM 
HIV/AIDS (5 %)
 (CHW Training) 
Target Beneficiaries: 
Infants < 12 months: 8,101 
Children 12-23 months: 8,149 
Children 0-23 months: 16,250 
Children 24-59 months: 43,781 
Women 15-49 years: 70,827 
Population of Target Area: 254,192 
Rapid Catch Indicators:
Project HOPE Guatemala CS Project 2005 Final KPC Report
Indicator Numerator Denominator Percentage Confidence 
Interval 
Percentage of children age 0-23 
months who are underweight (-2 
SD from the median weight-for￾age, according to the 
WHO/NCHS reference 
population) 
18 304 5.9% 2.7 
Percentage of children age 0-23 
months who were born at least 
24 months after the previous 
surviving child 
263 304 86.5% 3.8 
Percentage of children age 0-23 
months whose births were 
attended by skilled health 
personnel 
172 304 56.6% 5.6 
Percentage of mothers of 
children age 0-23 months who 
received at least two tetanus 
toxoid injections before the birth 
of their youngest child 
114 304 37.5% 5.4 
Percentage of infants age 0-5 
months who were exclusively 
breastfed in the last 24 hours 
31 76 40.8% 11.0 
Percentage of infants age 6-9 
months receiving breastmilk and 
complementary foods 
41 53 77.4% 11.3 
Percentage of children age 12-23 
months who are fully vaccinated 
(against the five vaccine￾preventable diseases) before the 
first birthday 
123 152 80.9% 6.2 
Percentage of children age 12-23 
months who received a measles 
vaccine 
124 152 81.6% 6.2 
Project HOPE Guatemala CS Project 2005 Final KPC Report
Percentage of children age 0-23 
months who slept under an 
insecticide-treated bednet the 
previous night (in malaria-risk 
areas only) 
83 304 27.3% 5.0 
Percentage of mothers who 
know at least two signs of 
childhood illness that indicate 
the need for treatment 
275 304 90.5% 3.3 
Percentage of sick children age 
0-23 months who received 
increased fluids and continued 
feeding during an illness in the 
past two weeks 
21 158 13.3% 5.3 
Percentage of mothers of 
children age 0-23 months who 
cite at least two known ways of 
reducing the risk of HIV 
infection 
53 304 17.4% 4.3 
Percentage of mothers of 
children age 0-23 months who 
wash their hands with soap/ash 
before food preparation, before 
feeding children, after 
defecation, and after attending to 
a child who has defecated 
34 304 11.2% 3.5 
Comments for Rapid Catch Indicator