title: Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings.
abstract: BACKGROUND
  Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamérica 2015 Initiative (SM2015), a results-based financing initiative, was established.
  
  
  METHODS
  For each of the eight participating countries, health targets were set to measure the progress of improvements in maternal and child health produced by the Initiative. To establish a baseline, we conducted censuses of 90,000 households, completed 20,225 household interviews, and surveyed 479 health facilities in the poorest areas of Mesoamerica. Pairing health facility and household surveys allows us to link barriers to care and health outcomes with health system infrastructure components and quality of health services.
  
  
  RESULTS
  Indicators varied significantly within and between countries. Anemia was most prevalent in Panama and least prevalent in Honduras. Anemia varied by age, with the highest levels observed among children aged 0 to 11 months in all settings. Belize had the highest proportion of institutional deliveries (99%), while Guatemala had the lowest (24%). The proportion of women with four antenatal care visits with a skilled attendant was highest in El Salvador (90%) and the lowest in Guatemala (20%). Availability of contraceptives also varied. The availability of condoms ranged from 83% in Nicaragua to 97% in Honduras. Oral contraceptive pills and injectable contraceptives were available in just 75% of facilities in Panama. IUDs were observed in only 21.5% of facilities surveyed in El Salvador.
  
  
  CONCLUSIONS
  These data provide a baseline of much-needed information for evidence-based action on health throughout Mesoamerica. Our baseline estimates reflect large disparities in health indicators within and between countries and will facilitate the evaluation of interventions and investments deployed in the region over the next three to five years. SM2015's innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. mokdaa@uw.edu.
authors: Ali H
authors: AH
authors: Mokdad
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Katherine Ellicott
authors: KE
authors: Colson
authors: Salud Mesoamérica 2015/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panama.
authors: Paola
authors: P
authors: Zúñiga-Brenes
authors: Salud Mesoamérica 2015/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panama.
authors: Diego
authors: D
authors: Ríos-Zertuche
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Erin B
authors: EB
authors: Palmisano
authors: Universidad de Costa Rica, Ciudad Universitaria Rodrigo Facio Brenes, San Jose, Costa Rica.
authors: Eyleen
authors: E
authors: Alfaro-Porras
authors: RAND, 1776 Main Street, Santa Monica, CA, 90401, USA.
authors: Brent W
authors: BW
authors: Anderson
authors: UNIMER, Calle Los Abetos Pje. 4 N° 3 Col. San Francisco, San Salvador, El Salvador.
authors: Marco
authors: M
authors: Borgo
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Sima
authors: S
authors: Desai
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Marielle C
authors: MC
authors: Gagnier
authors: Children's National Health System, 111 Michigan Avenue NW, Washington DC, USA.
authors: Catherine W
authors: CW
authors: Gillespie
authors: FES Foundation, Avenida 8 Norte 22AN-15, Colombia, Colombia.
authors: Sandra L
authors: SL
authors: Giron
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Annie
authors: A
authors: Haakenstad
authors: UNIMER, Calle Los Abetos Pje. 4 N° 3 Col. San Francisco, San Salvador, El Salvador.
authors: Sonia López
authors: SL
authors: Romero
authors: FES Foundation, Avenida 8 Norte 22AN-15, Colombia, Colombia.
authors: Julio
authors: J
authors: Mateus
authors: University of Belize, Belmopan, Belize.
authors: Abigail
authors: A
authors: McKay
authors: Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
authors: Ali A
authors: AA
authors: Mokdad
authors: University of Washington School of Social Work, 4101 15th Avenue N, Seattle, WA, USA.
authors: Tasha
authors: T
authors: Murphy
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Paria
authors: P
authors: Naghavi
authors: Salud Mesoamérica 2015/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panama.
authors: Jennifer
authors: J
authors: Nelson
authors: Centro de Investigacion y Estudios de la Salud de la Universidad Nacional Autónoma de Nicaragua (CIES-UNAN), Managua, Nicaragua.
authors: Miguel
authors: M
authors: Orozco
authors: George Washington University, 950 New Hampshire Ave, NW, Washington DC, USA.
authors: Dharani
authors: D
authors: Ranganathan
authors: Health Departament, El Colegio de la Frontera Sur, Carretera panamericana y periférico sur s/n, Barrio Maria Auxiliadora, CP 20290, San Cristóbal de las Casas, Chiapas, Mexico.
authors: Benito
authors: B
authors: Salvatierra
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Alexandra
authors: A
authors: Schaefer
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Gulnoza
authors: G
authors: Usmanova
authors: FES Foundation, Avenida 8 Norte 22AN-15, Colombia, Colombia.
authors: Alejandro
authors: A
authors: Varela
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Shelley
authors: S
authors: Wilson
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Sarah
authors: S
authors: Wulf
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Bernardo
authors: B
authors: Hernandez
authors: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors: Rafael
authors: R
authors: Lozano
authors: Salud Mesoamérica 2015/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panama.
authors: Emma
authors: E
authors: Iriarte
authors: Inter-American Development Bank, 1300 New York Avenue, NW, Washington, D.C, USA.
authors: Ferdinando
authors: F
authors: Regalia
keywords: Anemia; Antenatal care; Contraceptives; Health facilities; Results-based financing; Salud Mesoamerica 2015; Skilled birth attendance; Vaccination; Wasting