Calling on Kawok: Digital Health Solutions in Rural Guatemala

Thelma Aguilar is the chief medical officer for the province (known as a department) of Izabal, Guatemala. Before taking on this position—and following her own career as a healthcare professional—she worked in the Guatemalan Ministry of Public Health and Welfare (MSPAS). It was at MSPAS, she says, that she had a troubling and life-changing encounter.

“During a health campaign, a woman brought her baby to be seen at a health center, but the baby no longer had vital signs,” recalls Aguilar. “This mother had walked a long way so we could help her with the baby, but by the time she got to us, he was already gone. That moment really shook me, and it had such a big impact on my life because it made me realize that our strategy must be to bring health services closer to the people.”

It was also while at MSPAS that Aguilar learned about TulaSalud and the Kawok program that uses smartphone-based technology to improve infant and maternal health outcomes in rural Guatemala. An assessment of health indicators in the department of Izabal prompted Aguilar to reach out to TulaSalud’s executive director, Isabel Lobos.

“Kawok is a strategy that aligns with the ministry’s mission and vision—to provide access, coverage, and healthcare services at the community level,” says Aguilar. “In our department we need to strengthen our strategies in maternal and child health. I believe Kawok can help us do that.”

Aguilar’s conversations with Lobos led to a meeting in June 2025 at TulaSalud’s headquarters, located in the city of Cobán in the department of Alta Verapaz. The visit included a presentation by frontline health worker Juan José Bac Soria.

“The purpose of our visit to Cobán was to learn about best practices and bring them to our communities,” says Aguilar. “We know Kawok has been successful in other departments, so why not bring it to Izabal as well?”

A crucial digital health ecosystem for saving lives

TulaSalud has trained and supported thousands of frontline health workers serving remote Guatemalan communities. Guatemala remains near the bottom of Latin America’s development indicators—including those related to poverty, inequality, health, and human rights—and women, Indigenous people, and rural populations often experience these challenges more severely.

A critical part of TulaSalud’s support for frontline healthcare workers is a digital ecosystem. Healthcare workers are provided with smartphones—enabling the use of WhatsApp and other messaging platforms for coordination and communication—as well as the Kawok mobile app that can monitor and synchronize health data in real time.

Kawok tracks current data on thousands of children and pregnant women, enabling nurses and doctors to respond to what is happening at the community level.

Health workers have used the digital health ecosystem to make approximately one million calls per year relating to patient follow-up, clinical consultation, and emergency transportation, and the Kawok app has registered more than 500,000 pregnancies and more than 950,000 children for nutrition monitoring.

“I always want to point out that Kawok is not just data, or the form on the smartphone that gets filled in by a frontline nurse,” says TulaSalud president Christy Gombay. “It’s everything put together. Kawok is the training that is behind the nurses’ ability to use the app. It’s the ability to make a phone call, and the ability to send and receive messages quickly in these very remote areas. It’s all of the embedded tools that have been automated and that have evolved over the last 20 years.”

“It’s essential to start from scratch”

Digital services and automation are the foundation of Kawok, but at the heart of TulaSalud’s success is the direct outreach to communities by frontline health workers. This is one of the strengths that makes Kawok unique, Aguilar says, and it points to the need for person-to-person contact that is sometimes missing from big-picture healthcare strategies.

“We said, ‘Izabal needs this strategy because the people—especially the communities—need it,’” recalls Aguilar.

“We tend to focus on large-scale strategies and expanding coverage, but we forget the community. And that’s the starting point for any real implementation—getting close to the people, understanding their needs. I think it’s essential to start from scratch, and that begins with face-to-face contact.”

Aguilar went to Cobán with the hope that Izabal would be able to adopt the Kawok strategy. She was accompanied in Cobán by members of her nutrition and IT teams, and recalls their conversations afterward.

“They told me, ‘Doctor, we’re truly impressed by the strategy. We believe we can do it. We can make it happen.’ I saw a lot of hope and excitement in their eyes,” she says, offering gratitude to TulaSalud for opening the doors to her team in Cobán.

Recent signals from colleagues and officials look promising, including a meeting with Guatemala’s vice president Karin Herrera.

“We talked about nutrition and, during my presentation, I mentioned that we would rely on Kawok,” says Aguilar. “She smiled and gave us a thumbs up.”

At that point, Aguilar realized Herrera already knew about Kawok. “Her reaction said it all, says Aguilar. “I thought, We’re on the right path.”

The response from the vice president encouraged Aguilar to pursue the meeting with TulaSalud in Cobán. Afterward, when she spoke with local authorities in Izabal about adapting the Kawok program, they told her they were “fully on board.”   

This is excellent news, says Gombay. 

“In the past when we have had similar visits, TulaSalud team members have had to sell the benefits of what we are doing with Kawok. Now we have people coming to us who know its value, know what it can achieve, and want to learn how they can do the same thing. That to me is a really significant shift.”

Change will take time, adds Gombay, explaining that it has taken 20 years for TulaSalud to create the Kawok program and build its impact. 

“There are no quick and simple solutions, and we are not expecting miracles, particularly if there is no outside funding coming through,” he says. “But to see this interest from health authorities outside Alta Verapaz is, for me, inspiring and heartening. It seems that it could be very good news for the people and communities of Izabal.”

The future is always uncertain, but for her part, Aguilar is optimistic. 

“Like those on our team who were with me, I also believe it can be done. I believe that with support from organizations like TulaSalud, we can bring about change, and, God willing, we will succeed.”