S10E3: Health Systems Strengthening - Participatory Action Research in Guatemala

Connecting Citizens to Science

In this episode we hear about a participatory action research project in Guatemala, funded by the Director's Catalyst Fund at LSTM, that co-designed a tool for health leaders and community partners to assess and improve urban health governance.

The project was based in two Guatemalan urban municipalities; Villa Nueva and Mixco. We speak with Guillermo Hegel, the project lead who was also the Health Director at Villa Nueva Municipality at the time of the project. We also hear from Yaimie Lopez and Cintia Cansado who coordinated and evaluated the project. They share their experience of participatory research and working with policy makers.

The research team together with co-researchers who were urban health stakeholders looked at 4 domains, Governance, leadership accountability and multi-sectoral action. They first defined what these terms were, then they co-analysed existing tools to measure governance performance and designed an online tool which could be used to rank current performance and areas for improvement which could then track over time.

The tool involved a number of qualitative questions that required discussions and reflections about governance in their work and required a level of trust and transparency which is further explored by our guests. 

This Episode features:

Wesam Mansour (co-host) - Health Systems Researcher, Liverpool School of Tropical Medicine

Wesam is a Health System Researcher with research expertise in health workforce and health systems strengthening in fragile contexts using qualitative research and participatory action research approaches. Her work includes working in the areas of gender, equity and justice and how to apply those concepts to develop gender-equitable, resilient and inclusive health systems. She is currently working, in LSTM, on the ReBUILD4Resilience project which is health system research in Fragile and Shock-Prone (FASP) settings in 4 countries (Nepal, Myanmar, Sierra Leone, and Lebanon). In ReBUILD, they worked with the Close to Community (CTC) providers in FASP settings to explore how participatory action research can support CTC providers to address gender norms and power relations within their communities and in the health systems in Lebanon and Nepal.

Links:

LSTM - Wesam Mansour

ReBUILD Consortium

ReBUILD - Gender Project

Guillermo Hegel, Project Coordinator, INCAP

Since 2020 Guillermo has been a researcher at CIIPEC. He coordinates a participatory action research project in collaboration with the Liverpool School of Tropical Medicine. From 2014 to early 2020, he was health director of the municipality of Villa Nueva, Guatemala. A core part of his tasks was to articulate 'Health-in-All Policies' and to improve the primary health care system in urban setting through participatory processes. Between 2008-2013, he worked at PAHO/WHO Guatemala, as an advisor for social determinants of health and the ´Healthy Cities´ initiative, leading and contributing to several programs in Guatemala and Latin America. He began his career in public health in 2000, promoting small-scale projects at the community level with an environmental and inter-sectoral approach. Since 2016 Guillermo holds a master's degree in public health from the Institute of Tropical Medicine, Antwerp, Belgium, in addition to a previous master's degree in development (2011) and a BA in environmental science (2004), both from Universidad del Valle de Guatemala. As of 2018 he is a member of Health Systems Global and Emerging Voices for Global Health.

Yaimie López, Research Assistant, Centre for Health Studies, Universidad del Valle de Guatemala

Yaimie is a biologist from Guatemala with research experience in vector borne diseases and strengthening of health systems. She has been involved in several quantitative research projects focused on the biological side of the diseases, and in one qualitative project to understand the perception of key actors involved. The qualitative project was done with the participatory action research methods, with municipal stakeholders acting as co-researchers. The aim of the project was to develop a tool that would help to measure and improve the governance, leadership, multi-sectoral action and accountability of two municipal health systems. The project used PAR for the development of the tool, including the co-selection of questions, rating criteria and the visual presentation of the tool.

Ms Cintia Cansado-Utrilla, PhD student, Liverpool School of Tropical Medicine

Cintia comes from a background in molecular biology. Her bachelor’s degree is in Biotechnology and her master’s degree is in Medical Parasitology and Entomology. Most of her expertise involves lab work with some field work in Guinea, studying mosquitoes. At the beginning of her PhD, she enrolled in an MRes in Global Health where she acquired translational skills and became interested in qualitative research. She had the opportunity to participate in the GOBLAR project with Kim, Guillermo, Yaimie and the rest of the participants and she cites it as a very positive experience for her. She believes there is a gap between basic and applied science, and although her PhD focuses on molecular biology of mosquitoes, she would like to incorporate some qualitative methods to her research to understand the perceptions of novel mosquito control methods from a community perspective and contribute to close this gap. 

For more information about the tool mentioned in this episode, see this video on our YouTube channel:

https://youtu.be/nXxOoN74OAc

This episode is dedicated to the memory of Oscar Hernandez.

Guillermo and Yaimie, who worked with Oscar (mentioned in the episode), pay tribute to their valued and much missed co-worker;

“Oscar Hernandez was a medical doctor from Guatemala who died in 2020 while working in the front lines against the Covid-19 pandemic. He believed so much in his work that he had isolated from his family while working in the hospital to avoid infecting them. He was one of the first people to be on the participatory action research team and worked hard to lay the foundation of the project.

Oscar was a highly energetic person, eager to learn. He knew how to see the bright side of difficult situations. He was very funny, always making jokes.”

Follow Connecting Citizens to Science on your usual podcast platform or YouTube to hear our equitable global health research podcast connect discussing how researchers connect with communities and people to co-develop solutions to global health challenges. The series covers wide ranging topics such as TB, NTD’s, antenatal and postnatal care, mental wellbeing and climate change linked to health. 

If you would like your own project or programme to feature in an episode, get in touch with producers of Connecting Citizens to Science, the SCL Agency.