In rural Guatemala, small-scale farming is increasingly untenable due to factors such as conflict and violence, stagnant wages, land grabbing, the presence of agribusiness, and the challenges posed by climate change. As a result, high levels of out-migration from rural spaces is occurring across the region, primarily by men in search of better economic opportunities. This socio-demographic shift - termed the “feminization of agriculture” - is associated with women being ‘left behind’ on the farm to navigate changing productive and reproductive responsibilities, decision-making and community dynamics. This research aims to understand how the lives and livelihoods of rural women are impacted by the complex, and often contradictory effects of male out-migration, with an attentiveness to how this transition influences health and wellbeing outcomes. Grounded in feminist political ecology (FPE), we sought to understand how the ‘feminization of agriculture’ affects individuals, households, and communities in overlapping ways. Collaborating with a local non-governmental organization, we conducted semi-structured interviews, key informant interviews, and participant observation with 73 individuals in Tojchoc Grande, San Marcos. Informed by the domains of the Women’s Empowerment in Agriculture Index (WEIA), collected data included demographic information, assets, gender roles in agricultural activities and decision-making, as well as perceptions and experiences of wellbeing. A key finding of this research is that rural outmigration impacts women’s roles in agriculture and related activities, which affects productivity and gender equity. In Tojchoc Grande, the feminization of agricultural labour and management has myriad drawbacks; women are doubly burdened by missing on and off-farm labour, end up with less time for leisure and socializing, and face more socioeconomic, physical, and psycho-social health challenges. Opportunities exist for social and policy interventions to leverage women’s increased role in farming, however, generalized state abandonment and minimal social support are entrenching and feminizing agrarian distress.

Stable and secure water systems are critical for health, wellbeing, and local economic development among small-scale farmers in rural Guatemala. However, water systems in the Western Highlands are highly vulnerable to climate change and other socio-ecological disturbances. In this context, this study aimed to describe diverse stakeholder perspectives on local water system governance in relation to users' health and community wellbeing in a Western Highland community. In partnership with local NGOs, we conducted semi-structured interviews with small-scale farmers (n=25), local water managers (n=10) and healthcare workers (n=5) in Tojchoc Grande, San Marcos. Perspectives of local water governance differed between small-scale farmers, water managers and healthcare workers. Although farmers held positive views toward available water resources for supporting overall health, water managers and healthcare workers had concerns of water-borne illness, poor water system and healthcare funding, and inadequate system capacity to meet community needs. Further, water managers and healthcare workers expressed confusion over organizational jurisdication of water and public health resources. However, all stakeholders pointed to government corruption and the absence of state support as major contributors to local system weaknesses. Local development efforts aimed at improving water systems and community health should consider the long-lasting impact of decentralized natural resource laws enacted following the Guatemalan civil war. Critically, the downstream impacts of these laws and challenges surrounding system-level coordination and associated corruption issues may have consequences for local resource administration and community health. Further water monitoring research is needed to assess health risks connected to water use and consumption.

Issue/objective: The Philippines remains one of the most vulnerable countries to extreme weather events, which will continue to increase in both frequency and severity. Community health workers (CHWs) often act as an important resource to deliver health-related support in resource-constrained settings during crises and may improve community adaptation amid disasters. In this context, the objective of this study was to examine experiences of extreme weather event preparedness, response, and recovery among CHWs across resource-constrained communities in Negros Oriental, Philippines.

Methodology: This study was conducted in partnership with International Care Ministries (ICM), a Philippines-based non-governmental organization. We conducted 51 semi-structured interviews with CHWs across four regions in Negros Oriental, Philippines.

Results: While most participants described challenges surrounding preparedness for extreme weather events within their community, many CHWs also commented on how their recent experience of Typhoon Odette (December 2021) contributed to disaster preparedness activities for subsequent threats. During recent disasters, most CHWs focused on taking care of their immediate family members; however, they also described the role of community cooperation when recovering from the impacts of these disasters. Further, CHWs expressed that their health-related training from ICM enhanced their capacity to respond to Typhoon Odette and share health education with other community members.

Discussion/conclusion: CHWs may be able to support community-based preparedness, response, and recovery efforts amid extreme weather events if provided with appropriate training and resources. However, efforts to equip CHWs to support communities amid extreme weather events need to consider the individual- and household-level impacts experienced by CHWs themselves.

Achieving the health-related Sustainable Development Goals will require scaling up promising community-based health interventions. Within the Philippines, International Care Ministries (ICM), a non-governmental organization, employs a network (1300 individuals) of volunteer community health workers (CHWs) to extend the reach of the health system into resource-constrained communities across the Visayas and Mindanao. In February 2023, ICM piloted a new iteration of this 'Community Health Champions' program in one province (Negros Oriental). The program aims to improve maternal and child health outcomes, as well as facilitate health care access among households experiencing poverty. A process evaluation of the implementation of the ‘Community Health Champions’ program was conducted to assess readiness for and inform scale-up across the Philippines. In total, 11 participatory focus groups (n=75 participants) and 64 semi-structured interviews were conducted with CHWs (program implementers) across six locations within Negros Oriental, Philippines. New intervention components introduced in the pilot program, including the provision of basic medical treatment facilitated through an mHealth app, were perceived to enhance the effectiveness and impact of CHWs in addressing maternal and child health needs. Pilot program implementation was further facilitated through the positionality of implementers, including their embeddedness within their communities and their pre-existing social connections (including collaboration with the public sector to provide quality care). The introduction of new intervention components also created new opportunity costs among implementers, as some participants perceived the pilot program as more time consuming and complex than their previous CHW work. The presence of supportive group spaces for training and learning, facilitated by CHW trainers, were perceived to enhance CHW confidence with new intervention components. Inclusion of implementer knowledge and insights within process evaluations of pilot programs can enhance understandings of how implementer characteristics may influence program scale-up.