Poverty and Chronic Malnutrition in Guatemala - An Integrated Solution to a Complex Problem

This post, by Michelle Dworkin from USAID's mission in Guatemala, originally appeared on USAID's ProgramNet on July 10, 2015.

Guatemala's Western Highlands are a region of spectacular beauty and cultural richness. Dominated by a chain of volcanoes along the southern edge, and the highest mountain range in Central America - reaching 14,000 feet above sea level - to the north, vegetation varies from lush lowland tropical forests to pine, cedar and oak forests at higher elevations. But when you look closer, a different picture emerges. Food insecurity and chronic malnutrition levels in the Western Highlands are among the worst in the world. The poverty rate for the majority indigenous population reaches 76% and the chronic malnutrition rate for children under five is 67%, even reaching 80% in some municipalities. This is a paradox in which large segments of the population are malnourished in the midst of abundant fertile land. The roots of the problem are complex - not only poverty, but insufficient knowledge of nutritional needs and how to meet them, historic social exclusion leading to lack of access to health and education services, not to mention corruption and low levels of investment in the region.

The USAID Mission in Guatemala was considering this challenge when we began developing our Country Development Cooperation Strategy (CDCS) in 2011. Our experience in the Western Highlands made it clear where to focus and concentrate the mission's programming - our CDCS Goal identifies greater socio-economic development in the Western Highlands, and DO 2 is focused exclusively on the region. But given the complexity of the underlying problems, "focus and concentrate" wasn't enough. We realized that continuing to implement activities in various sectors in parallel but "stovepiped" fashion wasn't going to achieve our desired results; only breaking down barriers between offices and programs to truly integrate our efforts would get us to where we want to be.

"Why Integration? Because we share a common goal...the success of one is the success of all. We thought that by working together, we can achieve greater impact."

The Western Highlands Integrated Program (WHIP) was launched as a conceptual framework for the collaborative implementation of USG-funded activities in the Western Highlands shortly after the approval of the CDCS. Beginning with the FTF multi-year strategy, the Program evolved to include programming under three Presidential Initiatives - Feed the Future, the Global Health Initiative, and the Global Climate Change Initiative. WHIP integrates activities in agriculture, economic development, Food for Peace, health and nutrition, family planning, education, adaptation to the impacts of climate change, local governance, and gender equity. The Program works in 30 municipalities and more than 2,500 communities in Guatemala's Western Highlands. USAID collaborates with Guatemalan officials and leaders at the community, municipal, departmental, and regional levels to achieve shared goals, especially under Guatemala's national plan to reduce chronic malnutrition, known as the "Zero Hunger Pact."

One of the most important steps that USAID Guatemala has taken as a whole, but especially under WHIP, is increased engagement with indigenous leaders. The population in the Western Highlands represents diverse Mayan ethnic groups who speak approximately 15 languages and maintain distinct cultural traditions and systems of governance. While previously excluded from broad civic engagement in Guatemala, indigenous communities are now part of a growing, vibrant civil society that is actively engaged in advocacy for improved services and development in their communities.

The value of integration is in coordinating on the ground to capture synergies among activities in the field, so that "the whole will be greater than the sum of the parts." Before instructing our partners to integrate, we had to first begin addressing our own internal organizational barriers between and across offices to change our attitudes and approaches. We started by combining funding from different offices under implementing mechanisms - putting agriculture funds into our local governance activity, adding environment funds to a justice sector activity, and using education funds to support a component of an agriculture activity. Doing so forced us to coordinate and relinquish the idea that one office had sole control over certain activities. We contracted a full-time consultant and a field coordinator to assist with coordination and emphasize the cross-cutting nature of the Program. Today, it is common practice for mission staff from different offices to conduct joint site visits and contribute to joint portfolio reviews. Turning to our partners, we facilitated the creation of committees at the central and departmental levels to make the rubber meet the road when it comes to integration. To facilitate the contractual support to enable their full coordination, we worked internally and with our partners to create incentives and recognize partners for their integration efforts. We included language in Requests for Application (RfAs) and Request for Proposals (RfPs) regarding integration and activities in the target municipalities. We also published a set of "Guiding Principles for Integration" that have clarified the shared values and responsibilities of WHIP stakeholders.

Though the road to integration has at times been bumpy, much like those of the Western Highlands, our efforts have already begun to pay off as synergies are emerging. For example, agriculture and health activities held joint training on family planning and gender-based violence; a watershed management activity funded cisterns constructed by Food for Peace participants whose labor counted towards food for work; and USAID's agriculture implementing partners, USDA, and the Guatemalan Ministry of Agriculture collaborated to start a nursery for coffee plants resistant to the rust fungus. Is your mission thinking of adopting an integrated programming approach? Here are some lessons we have learned along the way that may help you:

First and foremost, integrate mission processes and actions - project and activity design, site visits, portfolio reviews, etc. Remember that successful integration within the mission must include support offices as well as technical offices. Be sure to:

• Write language into instruments from the start to precisely define integration and vision
• Build money, time and personnel into instruments for integration
• Define outcomes, harmonize indicators, and set shared indicators
• Harmonize institutional and social and behavior change communication messaging Involve local voice in design processes as much as possible
• Be prescriptive on geographic location
• Allow for evolution of vision and approach

In this mission's experience, managing such a complex endeavor can be daunting, but the payoff can be significant. It is too soon to tell if this integrated approach can "solve" the puzzle of chronic malnutrition in the Western Highlands, but it is a risk worth taking. We are convinced that this new approach will lead us forward in exciting new directions. To learn more, see this short video that discusses the hopes and challenges of the WHIP program.

CLA in Action articles are intended to paint a more detailed picture of what collaborating, learning, and adapting (CLA) looks like in practice. Unlike other disciplines, CLA is not a technical "fix;" it looks different in different contexts. This series will showcase examples of intentional collaboration, systematic learning, and resourced adaptation, some of which you may find applicable to your own work. The case studies, blogs, and resources represented in this series document the real-world experiences of development practitioners experimenting with these approaches for the benefit of sharing what's possible.