This document summarizes Mercy Corps' PM2A program in Guatemala from 2009-2015 that aimed to prevent malnutrition in children under 2. The program worked through existing health structures and coordinated with the Ministry of Health and other government agencies. It provided behavior change communication, health system strengthening, preventative food rations to over 50,000 families. Key successes included adopting the program's model by the Ministry of Health and research coordination. Challenges included financial limitations of health providers and high turnover of government personnel.

1. Pioneering the Prevention of
Malnutrition Under 2 Approach
(PM2A): Challenges and
Opportunities in Government
Coordination
Mercy Corps Experience
Guatemala

2. Mercy Corps Guatemala PM2A -
PROCOMIDA
General PM2A elements
– Formative research
– Behavior change communication
– Health system strengthening
– Preventive food rations
Mercy Corps PM2A program funded by USAID/Food for
Peace 2009 – 2015
– 50,000 mother-child units
2

3. Program Design and Implementation
Participants
– Pregnant or lactating mothers and mothers of children
under 24 months of age
– Continuous enrollment (under 18 months of age) until last
month of intervention
Geographic focus
– Alta Verapaz
– Vulnerable municipalities (SESAN)
Implementation through existing health structures
(MOH contracts with NGO health providers)
3

4. Research Components
PM2A Research Program
– 5 different rations, including two types of micro nutrients
– No livelihood component
IFPRI
– Formative research
– Longitudinal impact study
– Operational evaluation
– Cost study
Mercy Corps
– Anthropological studies
– Barrier analysis
– Impact evaluation
4

5. Program Implementation
Training and Distribution Points (TDP)
6
24
121
161
180
221
270
284
347 356
227
00
50
100
150
200
250
300
350
400
TDP
Micro
nutrients
ExpansionsClose out
Start up

6. Health System in Guatemala
7
MOH
Departmental
Health area
Health
districtDepartmental
Health area
Departmental
Health Area
Health
district
Health
District
Health
Dis999
99trict
Direct MOH
interventions
Coverage
Extension
Program
Local
NGOLocal
NGO
Local
NGO
Health
Center
Health
CenterHealth
Center
Health
Posts
Health
Posts
Health
Posts
Convergence
Center
Convergence
Center
Convergence
Center

7. Local Context
In Guatemala, existing Title II programs already had a
preventive approach; 2012 RFA includes specifically PM2A
Signed agreements with Ministry of Health (MOH) and
Secretary of Food Security (SESAN)
IFPRI negotiation of research protocol with MOH
Two different governments
Presidential initiative within SUN: Zero Hunger Pact
Negotiation to prevent duplication of rations (Zero Hunger
Pact) with MOH
8

8. Successes
Adoption of model mothers and community health commissions
by MOH
Adoption of household action plan by SESAN
Coordination with MOH
– Interventions
– Micro nutrients
– Growth monitoring
– Training
Coordination with other NGOs
Transfer of strategies and materials
Hiring of key staff with experience in GOG institutions
9

9. Challenges
10
Financial limitations of health provider NGOs due to
late/incomplete disbursements by MOH
Cross contamination of
Control Groups
Coordination with
government food
distribution to avoid
overlap
Sustainability
High level of turn-over in key government personnel

10. Thank you!
Gracias
B’antiox