Impact Story: Distance Learning Course Closes the Nutrition Knowledge Gap among Nurses in Guatemala’s Western Highlands

women with children wait in line at a clinic while a nurse checks them in

Guatemala has over 13,000 nurses, but over 83% are auxiliary nurses, who have a low level of academic training, receiving only 10 months of preparation before entering the work force, only about 3 days of which is related to nutrition. Auxiliary nurses in Guatemala are responsible for providing the bulk of basic health services in the country. A low proportion of these nurses, only about 16%, are found in the Guatemala’s Western Highlands, where health and nutrition needs are great. The population of the Western Highlands is predominantly indigenous, living conditions are poor, and up to 70% of children under 5 years of age are stunted.

Although improving young child nutrition is a key priority of the Government of Guatemala, the nutrition knowledge of nurses, in particular auxiliary nurses, and their capacity to deliver nutrition services needs to be strengthened for the country to achieve quality implementation of nutrition programs at scale and national goals to reduce stunting by 10% over 4 years in prioritized departments, especially in the Western Highlands. Now, an innovative course is increasing opportunities for health facility staff, including auxiliary nurses, to gain knowledge in essential nutrition actions.

Topics in the Maternal and Child Nutrition Distance Learning Course

  1. Effective actions to improve maternal and child nutrition
  2. Nutrition during pregnancy
  3. Breastfeeding
  4. Complementary feeding from 6–24 months
  5. Feeding the sick child
  6. Water, sanitation, and hygiene
  7. Monitoring of child growth and development 
  8. Effective counseling 

With funding from the U.S. Agency for International Development (USAID)/Guatemala, the Food and Nutrition Technical Assistance III Project (FANTA) developed an 8-module distance learning course on maternal and child nutrition, launched in 2015, in collaboration with Guatemalan Ministry of Health, the Institute of Nutrition of Central America and Panama (INCAP), and the University Research Co., LLC’s Community Nutrition and Health Project (Nutri-Salud). This is the first full scale distance learning course on maternal and child nutrition specifically targeting frontline health workers, particularly auxiliary nurses, in the Guatemala’s rural Western Highlands. The course strengthens nurses’ nutrition knowledge and improves their skills in the delivery of nutrition-related interventions, especially those aimed at reducing stunting in young children. In addition to providing training in nutrition service delivery, the course also has a module for improving self-esteem among nurses. This is particularly important because nurses are often required to adapt to very challenging circumstances in their work, such as treating patients when necessary inputs such as medicines, micronutrient supplements, tools, and instruments are in short supply.

A total of 665 Ministry of Health personnel—primarily auxiliary nurses working in health centers and health posts in the Western Highlands—were trained by 65 course facilitators from January to October, 2015. Training facilitators early in the process was essential for enabling FANTA and its partners (Nutri-Salud and USAID/PlanFam) to train hundreds of health staff quickly. Enrolled participants received a USB and printed materials with the course content, completed each course module individually, and then joined a study group that met biweekly with the facilitator to discuss the lessons and ask questions.

Map of participation of frontline health workers in the Maternal and Child Nutrition Distance Learning Course, January to October, 2015

 2 study circles, 19 participants.

Participants: 665


  • Female: 59%
  • Male: 41%

Age Range

  • Mean: 31 years
  • Range: 19-64 years
  • < 30 years: 55%

Key Course Achievements/Highlights

  • First ever full scale nutrition distance learning course in Guatemala focused on frontline health workers in the Western Highlands
  • Implemented under the stewardship of the MOH, with support from USAID/Guatemala via FANTA, INCAP, and implementing partners 
  • Innovative cyclical “module-study circle” design
  • Participants are able to take the course during working hours
  • Provides participants with 25 continuing education credits upon course completion
  • 665 frontline health workers successfully completed the course in 2015

The course takes up to 120 hours to complete and is delivered over several months. The MOH allows participants to take the course during their normal working hours. Providing sufficient time for participants to complete the course not only prevented interruptions in health service provision, it also enabled participants to assimilate new knowledge and skills gradually as they applied what they were learning on the job and discussed their experiences at study circles. Upon course completion, the government acknowledged the participants’ accomplishments by awarding them a diploma and providing them with 25 continuing education credits from the MOH Training Department. 

Study circles

Study circles are groups of distance learning participants that live in the same area and meet every two weeks with a course facilitator to discuss the content of the module they have just studied on their own. This innovative approach allows the core group of MOH facilitators to tutor participants, follow up on their progress, reinforce the learning, and ensure course content is clearly understood and can be applied by participant’s on the job.

By presenting information on evidence-based interventions for reducing stunting, a subject that has been missing from most nursing school curricula in the country, the course has filled an important knowledge gap for nurses. After taking the course, on average, participants improved their knowledge in nutrition service delivery by over 20 points, based on comparisons of their pre- and post-test scores. Indeed, various participants said that the course helped improve their skills and gave them the confidence to better support the nutrition service needs of health facilities in the Western Highlands.

Future plans: Expand the Course’s Reach and Evaluate Effectiveness

Encouraged by the success of the first round of training, Guatemala’s MOH asked Nutri-Salud and INCAP to implement a second round of training for nurses and other frontline health workers. Plans are also underway to enable the country to use the course to train more health professionals in the future. FANTA has worked with the MOH and the Food Security and Nutrition Secretariat (SESAN) to transfer the course to their websites. In addition, FANTA and INCAP have adapted the course for universities, including additional technical content, exercises, and reference materials; adjusted the timeframe for completion within the university semester system, and trained professors in the Western Highlands as course facilitators. Making the course part of the curriculum in health-related fields will continue to strengthen the capacity of local health professionals in maternal and child nutrition. 

Importance of the Course

  • Fills a training gap, focusing on evidenced-based interventions to prevent stunting 
  • Integrates the nutrition course, core team of facilitators, competencies tool, supervision plan, and monitoring plan into the MOH system 
  • Strengthens in-service training and on-the-job training, and also pre-service training through the course’ incorporation into universities in the Western Highlands 
  • Learning modality and time span allows for deeper understanding and internalization of nutrition compared to short workshops

To help the MOH gauge the course’s relevance and effectiveness over time, FANTA and partners have supported the development of a database to monitor participants’ progress in the course and to assess their performance. FANTA and INCAP are also helping the MOH to develop a competency-based monitoring tool to assess nutrition competencies among participants after completing the course and ensure that the quality of health service delivery in nutrition continues to improve. The tool also helps strengthen the supervision capacity of the MOH staff who supervise nurses and other course participants in the field.  

The maternal and child nutrition distance learning course that FANTA developed with INCAP and USAID/Guatemala partners is strengthening Guatemala’s nutrition expertise by providing nurses, especially auxiliary nurses, as well as other course participants, with strong knowledge of nutrition for women and young children. With work already completed to transfer the course to Guatemalan government websites and add it to Western Highlands university health curricula, FANTA anticipates that hundreds of nurses and other health professionals will be trained in the next few years—these participants will be tomorrow’s nutrition leaders in the fight for a healthier future for Guatemala’s population.  

11 April 2017

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