CORE Group Fall Meeting 2010. Findings and Reflections on the Food for the Hungry Care Group Child Survival Project in Sofala Province, Mozambique. - Henry Perry, Johns Hopkins

1. Findings and Reflections on the Food for the Hungry Care Group Child Survival Project in Sofala Province, Mozambique Henry Perry Department of International Health CORE Group Fall Meeting 15 September 2010

4. Project Background 1.2 million people of all ages in project area Area A: 42% of population (54m intervention) Area B: 58% of population (16m intervention) Interventions: Nutrition (70%), CDD (30%), IMCI

5. Area B Project Indicators

6. Area B Project Indicators Same targets as Area A (54m of interventions); 79% of targets met, 100% of changes are statistically-significant

7. Achievement of Nutrition Targets, Food for the Hungry Child Survival Project, Sofala Province, Mozambique, 2006-10 36% reduction (ss) 26% reduction

8. Severe Underweight Decreases 51% reduction 29% reduction

10. Supporting Evidence for Improvement in Nutrition Increased coverage of exclusive breastfeeding Improved complementary feeding Increased utilization of nutritious foods, including addition of oil, increased feeding (24h dietary recall), and feeding during illness Increased growth monitoring, deworming, ORS

11. Rapid Indicator Changes In general, in both Areas A and B, the increases in coverage of indicators were rapid, achieved within 12-18 months after the implementation of the educational module for that intervention

12. Mortality Impact Assessment (Indirect and Direct) Mortality monitoring led to the realization that many deaths were occurring in the neonatal period, so a new activity was added (home visitation to neonates) Indirect estimates based on Lives Saved Calculator (“old” Bellagio Calculator and “new” LiST Tool) Direct estimates based on vital events registration

13. Estimated U2MR Reported through Community Vital Events System Lesson learned: Start mortality measurement early…

14. Estimated Changes in Under-2 Mortality in Food for the Hungry Project Areas A and B Using Project Vital Events Data The estimated 0-23m mortality rates for Sofala Province have been calculated by assuming that they are 80% of the estimated under-5 mortality rates

15. Estimate: Lives Saved Analysis (Lancet methodology [LIST])

16. Figure 2. Cost per DALY Averted with Integrated Community-Based Interventions to Improve Child Health Abbreviations: DALY-disability-adjusted life year; USAID-United States Agency for International Development; PHC-primary health care. References: Ricca

17. Lessons Learned Care Groups can bring about rapid changes in behavior, nutritional status, mortality, and health care utilization. Changes in Area B (16m intervention) as good as changes in Area A (54m intervention). Mini-KPCs show trend. Care Groups are particularly good at changing key indicators that have low coverage in most countries which are not on track for achievement MDG4 (e.g., EBF, HWWS [vs. immunizations, Vitamin A])

18. Lessons Learned (cont.) FH’s model drives costs down by: Targeting under-twos / pregnant women only Use Promoters from the local area (with bicycles, not motorcyles, serving 5 rather than 10+ communities) Only one supervision layer Starting in one project area and later expanding to second project area (since most of effect achieved in less than 2 years, and CGVs say they plan to continue activities after 16m)

19. Census-Based, Impact-Oriented Approach (CBIO) Principles

20. Care Groups Respond to Two Criticisms of CBIO Approach “CBIO is a promising approach that deserves further development and replication in other settings” As implemented in Bolivia, it had two drawbacks: relative high cost ($9 per capita per year for comprehensive primary health care services) and creating of dependence (by paying health workers to visit homes)

21. Conclusion As far as we know, this is among the most cost-effective child survival projects ever implemented at scale.

22. CBIO Principles Fundamental to Bangs Work at SEARCH and to Care Groups

23. Power of Care Group Approach Gives tools (via education) to women (and communities) to improve their health and builds on the inherent effectiveness of peer-to-peer health education Reaches every household in the community

24. Care Groups Respond to the Two Criticisms of CBIO Made by an Expert Panel in 1993

25. Area B RapidCATCH Indicators

26. Area B RapidCATCH Indicators

27. The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: www.coregroup.org/resources/meetingreports