Vurhonga Expanded Impact CSP<br />Lessons Learned in Gaza Province, Mozambique<br />CORE Group Fall Meeting  <br />Septemb...
Gaza Province, Mozambique<br />WR Moz CSHGP Districts<br />Vurhonga 1 :                 Guija & Mabalane<br />Vurhonga 2: ...
Original Care Group StructureWorld Relief MozambiqueVurhonga 1 CSP 1995-1999 <br />• Each block of 10 HH had a volunteer<b...
Expanded Impact Districts<br />• Lower population density  <br /><ul><li>Villages small in size and far apart
Lower levels of literacy and education
 Stronger traditional beliefs
 Much longer distances to access treatment
 Limited public transportation</li></li></ul><li>Changes in Promoter Role<br /><ul><li> Recruited locally
 Not WR staff
 Paid a stipend per CG supervised
 Promoters responsible for limited number of groups reachable by foot or by bicycle (1-3 vs 8) </li></li></ul><li>Promoter...
More entrenched in traditional beliefs re: illness
Required more training to internalize and </li></ul> accurately transmit new health messages<br /><ul><li>Trained in Chokw...
Promoter performance reduced </li></ul> <br />
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CORE Group Fall Meeting 2010. Vurhonga Expanded Impact CSP. Lessons Learned in Gaza Province, Mozambique. - Melanie Morrow, World Relief

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  • The northern districts in Gaza Province are remote and much less densely populated relative to those in the south. By way of comparison, the combined population in all five districts covered in the Expanded Impact project was less than twice that of the rural population served by Vurhonga 2 in Chokwe District.
  • Instead of using full-time paid promoters to train Care Groups, local women were identified from the very same villages in which they would work.  They were trained as trainers and paid a small stipend based on the number of Care Groups they were responsible for.  The number of groups was reduced from 8 to no more than 3, less if distances were greater than what could be covered by foot or bicycle.  
  • Relative to prior projects, these promoters had even less formal education (limited primary education), were more entrenched in traditional beliefs about illness and required more training and review in order to retain and accurately transmit new health information.  Promoters spent three months being trained in all interventions at a central location prior to returning to their home village to begin work.  This extended camp helped the promoters to overcome their own initial resistance to new information and behaviors while also enabling them to have greater authority upon returning home.   Lessons learned:             Less “control” over part-time promoters with very limited formal education (relative to full-time staff with some secondary education) working in more remote villages with more difficult access to Health Centers and Hospitals resulted in reduced (but still significant) impact.   While low very low levels of formal education were inherent to the most remote districts, improved selection of staff could have taken place by engaging potential promoters in census and other activities prior to making a final decision on who to invest in training as a promoter.   Close, supportive supervision is essential .  Another way the project compensated for the long distances was for supervisors and District Coordinators (all from Chokwe) to spend three weeks straight in their supervision areas rather than making weekly trips home as had been done in prior projects with more manageable distances.  Approximately 2/3 of supervisors’ time was spent in the communities checking on training, fidelity of message transmission and home visits.   Support from village leadership and health committees is important  for local ownership and problem resolution.  Local data from the community and project HIS supported this further.
  • Paying the promoters a stipend based on the number of groups rather than a salary reduced the cost of promoter salaries and transportation but increased the overall number of promoters who needed to be trained and supervised.  The performance of promoters was also reduced (in part because of the lower educational level, as mentioned).
  • AlthoughVurhonga Expanded Impact did not achieve the same levels of behavior change on all indicators as Vurhonga 2, for example, the estimated cost per life saved was less due to economies of scale.
  •  
  • While low very low levels of formal education were inherent to the most remote districts, improved promoter selection could have taken place by engaging potential promoters in census and other activities prior to making a final decision on who to invest in training as a promoter.   
  • Close, supportive supervision is essential .  Another way the project compensated for the long distances was for supervisors and District Coordinators (all from Chokwe) to spend three weeks straight in their supervision areas rather than making weekly trips home as had been done in prior projects with more manageable distances.  Approximately 2/3 of supervisors’ time was spent in the communities checking on training, fidelity of message transmission and home visits.   
  • This has always been the case but all the more with remote villages that need to be able to stand on their own.
  • Morrow care groups

    1. 1. Vurhonga Expanded Impact CSP<br />Lessons Learned in Gaza Province, Mozambique<br />CORE Group Fall Meeting <br />September, 15, 2010<br />
    2. 2. Gaza Province, Mozambique<br />WR Moz CSHGP Districts<br />Vurhonga 1 : Guija & Mabalane<br />Vurhonga 2: Chokwe District<br />Expanded Impact (V4): Massangena, Chicualacuala, Chigubu, Massingir, & Chibuto Districts<br />
    3. 3. Original Care Group StructureWorld Relief MozambiqueVurhonga 1 CSP 1995-1999 <br />• Each block of 10 HH had a volunteer<br />• Volunteers in Care Groups of 8-12 members<br />• Full time, paid promoters (called animators) each responsible for 8 Care Groups<br />• One supervisor for every 5 promoters <br />
    4. 4. Expanded Impact Districts<br />• Lower population density <br /><ul><li>Villages small in size and far apart
    5. 5. Lower levels of literacy and education
    6. 6. Stronger traditional beliefs
    7. 7. Much longer distances to access treatment
    8. 8. Limited public transportation</li></li></ul><li>Changes in Promoter Role<br /><ul><li> Recruited locally
    9. 9. Not WR staff
    10. 10. Paid a stipend per CG supervised
    11. 11. Promoters responsible for limited number of groups reachable by foot or by bicycle (1-3 vs 8) </li></li></ul><li>Promoters in Expanded Impact<br /><ul><li>Less formal education (limited primary school)
    12. 12. More entrenched in traditional beliefs re: illness
    13. 13. Required more training to internalize and </li></ul> accurately transmit new health messages<br /><ul><li>Trained in Chokwe in all interventions up front; refresher training in respective districts </li></li></ul><li>Tradeoffs<br />Upside<br /><ul><li> Cost savings </li></ul> - Stipend per Care Group vs. fulltime salaries<br /> - Reduced transport costs for promoter level<br /><ul><li> Promoters remain in village post-project</li></ul>Downside<br /><ul><li> Overall increase in the number of promoters who need to be trained and supervised.
    14. 14. Promoter performance reduced </li></ul> <br />
    15. 15. Estimated Cost per Life Saved using the LiST Tool<br /> <br />Vurhonga 1 $2600<br />Vurhonga 2 $2000<br />Expanded Impact $1640<br />
    16. 16. Lessons Learned <br />Less “control” over part-time promoters resulted in reduced activity and impact on some behavior change indicators, though the inmpact (as estimated by the Lives Saved Calculator) was greater due to economies of scale. <br />
    17. 17. Lessons Learned<br />2. Improved promoter selection could have taken place by engaging potential promoters in census and other preliminary activities prior to making a final decision on who to invest in promoter training. <br />
    18. 18. Lessons Learned<br />Close, supportive supervision is essential. <br /> 2/3 of supervisor’s time was spent in the communities to enhance this.<br /> Supervision was maximized by supervisors (all from Chokwe) spending three weeks straight in their supervision areas vs. weekly trips – needed because of distances.<br />
    19. 19. Lessons Learned<br />Support from village leadership and health committees is important  for local ownership and problem resolution.  <br /> Local data from the community and project HIS supported this further. <br />
    20. 20. Thank You<br />
    21. 21. The preceding slides were presented at the<br />CORE Group 2010 Fall Meeting<br />Washington, DC<br />To see similar presentations, please visit:<br />www.coregroup.org/resources/meetingreports<br />

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