Intended for healthcare professionals

Analysis Making Multisectoral Collaboration Work

Making the health system work by and for Indigenous women in Guatemala: a community led multisectoral collaboration

BMJ 2018; 363 doi: (Published 07 December 2018) Cite this as: BMJ 2018;363:k4677
  1. Claudia Nieves Velásquez, independent consultant1,
  2. Maria del Rosario Garcia Meza, independent consultant1,
  3. Daria Ukhova, independent consultant2,
  4. Silvia Xinico, national coordinator3,
  5. Susana Palma, senior civil society adviser4,
  6. Sarah Simpson, independent consultant5
  1. 1Guatemala City, Guatemala
  2. 2Berlin, Germany
  3. 3Alianza Nacional de Organizaciones de Mujeres Indigenas por la Salud Reproductiva Nutrición y Educación (ALIANMISAR), Guatemala City, Guatemala
  4. 4USAID Health Education and Policy Project, Guatemala City, Guatemala
  5. 5EquiACT, Lyon, France
  1. Correspondence to: S Xinico silviaxinico{at}

Claudia Nieves Velásquez and colleagues report how a community led national alliance of Indigenous women’s organisations is working to improve the delivery of healthcare for Indigenous women through collaboration with other community based organisations, government (health and ombudsman), and international partners

Inequities in indigenous peoples’ health persist, reflecting the continued disadvantage and discriminatory attitudes experienced by indigenous people worldwide that affect their use of health services.12 For Guatemala, where nearly half of the population is indigenous—mainly Mayan groups—inequities remain a persistent challenge. Most of the country’s Indigenous peoples have higher rates of poverty and were profoundly affected by the civil war (1960-96), with about 83% of the two million victims belonging to one of the Mayan Indigenous groups.13456 The Alianza Nacional de Organizaciones de Mujeres Indigenas por la Salud Reproductiva Nutrición y Educación (National Alliance of Indigenous Women’s Organizations for Reproductive Health, Nutrition, and Education, ALIANMISAR) is one example of how Guatemala’s Indigenous communities are working to deal with these challenges. ALIANMISAR’s efforts built on the 1996 Peace Accords, which marked the end of the civil war and emphasised the need for civil society stewardship and active involvement in governance.7 The accords also mandated a 50% increase in the public health budget, focused on preventing ill health, decreasing maternal and infant mortality, and eradicating polio and measles.

ALIANMISAR is a network led by Indigenous women and was formed in 2006 to improve the quality and cultural acceptability of healthcare provided to Indigenous women.5 As part of its mission, ALIANMISAR monitors a range of public health services at national, departmental, and municipal levels, in collaboration with other community based organisations, the executive and legislative sectors of the government (the Ministry of Health and the Ombudsman for Human Rights), and international partners (see …

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