Background• USAID-Child Survival and Health Grants Program inMabayi Health District 2008 – 2013• Care Group Model is powerful strategy for communitymobilization and widespread behavior change• However, staffing structure recognized to beunrealistic for the MoH to maintain after the life of theproject• Operations Research testing an “Integrated” CareGroup model
Traditional and Integrated ModelsDomain Traditional Care Groups Integrated Care GroupsTraining Promoters train CHWs and LeaderMothers each month (CHWs participatein Care Group meetings) Project staff (Animators) trains healthfacility staff each quarter Health facility staff train CHWs once amonth CHWs train Leader Mothers twice a monthMeetingFacilitationand Reporting Care Group Meetings facilitated byPromoter Reports submitted to Promoter who thensubmits to health center/MoH Care Group Meetings facilitated by CHW Reports submitted to CHW who thensubmit to health center/MoHSupervision 2 Animators oversee 5 Promoters 5 Promoters facilitate 41 Care Groups(approx. 8 each) 2 Animators and 2 district-level MoH staffsupport 3 health centers Health center staff supervise 18 CHWs 18 CHWs facilitate 35 Care Groups(approx 2 each)
Traditional and Integrated Models
OR Questions and MethodsResearch Question Methods1. Does the Integrated Care Group model achieve thesame or better improvements in the knowledge of keyMNCH behaviors as the traditional Care Group model? Comparison of baseline (October 2010) andendline (May 2013) KPC data Non-inferiority testing; sample size of 320 in eachstudy arm2. Does the Integrated Care Group model achieve thesame or better improvements in the practice of keyMNCH behaviors as the traditional Care Group model?3. Does the Integrated Care Group model achieve thesame level of functionality as the traditional Care Groupmodel? Monthly data collection of 5 key Care Groupfunctionality indicators (June 2011 – February2013)4. Does the Integrated Care Group model achieve thesame level of sustainability as the traditional Care Groupmodel? Monthly monitoring of 5 key functionalityindicators after withdrawal of Concern support toboth areas (March – September 2013)Qualitative mid-term review (October 2012) conducted to identify and document benefits and challengesassociated with the implementation of each model . FGDs and KIIs with all key stakeholders.
Results to Date: Functionality
Preliminary ConclusionsCare Group ComparisonIntegrated and traditional CG models appear to have similar levels of functionality, withboth surpassing targetsKnowledge and practice gains appear to be significant in both areasRole of NGO in Care Group FacilitationAnimators play a key role in facilitating the implementation of Care Group activities inthe Integrated Area Supervision of CHWs and CG activities is a challenge for the head nurse Recommendation to appoint “Care Group focal person” at each health centerStakeholders in Integrated area report feeling much more self-efficacy to continue CGactivities once project ends (midterm qualitative review)Support from local leaders has greatly contributed to smooth implementation of CGactivities in both study areas
Preliminary Conclusions: Policy Level CHWs are an essential component ofthe MoH community health policy,however an effective CHW policy hasnot yet been successfullyoperationalized Widespread acknowledgement thatCHWs alone will not attain completehousehold coverage Integrated Care Group model seen as apromising strategy to achieve realisticCHW strategy while leveraging existingstructuresJanvier Niandwi- Community Health Worker
Care Group Operations Research: NigerUSAID Child Survival and HealthGrants Program: Tahoua, Niger 2009 –2014OR Objective: Assess the potential forCare Group Leader Mothers to deliverintegrated community case management(iCCM)•24 Care Groups with 270 LeaderMothers•1 Leader Mother from each CG will beselected to implement CCM
Care Group Operations Research: NigerFormative Research:•How would key stakeholders accept Leader Mothers delivering iCCM?•What are the best training tools for Leader Mothers to implement iCCM?•What are the best processes for implementing iCCM through Care Groups?Findings to date: Encouraging community perceptions that iCCM will increaseaccess to care; development of training tools in processEvaluative Research:•Are Leader Mothers able to provide quality iCCM?•Does Leader Mother provision of iCCM affect care-seeking behavior among caregivers ofchildren under five?•What are community members and stakeholders’ perceptions of iCCM provided byLeader Mothers?