Care Groups: The Essential Ingredients
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Care Groups: The Essential Ingredients

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Care Groups: The Essential Ingredients...

Care Groups: The Essential Ingredients

Melanie Morrow, World Relief
Thomas P. Davis Jr., Food for the Hungry
Carolyn Wetzel, Food for the Hungry

CORE Group Spring Meeting, April 29, 2010

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  • To Be or Not to be a Care Group
  • To begin, I’m going to give you a short description of Care Groups – in case you are a CORE member but have been living under a rock somewhere – and tell you a little bit about the results that we are seeing with them.
  • Now for some of the results. These statistics are from our use of Care Groups in a Title II program – the level of behavior change and use of health services was pretty astounding, and these are not that unusual when compared with the changes seen in other projects using Care Groups … but quite different from the average child survival project.
  • These changes in behavior and health services lead to a reduction in malnutrition and deaths. This shows our reduction in underweight in one year of a Care Group program in Mozambique.
  • We also have seen large increases in health service utilization, just from motivation of mothers through the Care Groups. The blue lines represent changes from 2006 to 2008 in districts in Mozambique using Care Groups, the blue lines show lack of change in nearby comparison districts.
  • Most importantly, this graph shows the results of a retrospective mortality study done in conjunction with Johns Hopkins University. There was a 94% decrease in the Child Mortality Rate in the areas where Care Groups were used between 1999 and 2004. The U5MR decreased 62%. When we compared mortality changes with regional mortality changes from the DHS, we saw that the U5MR for the project decreased three times as much, the IMR decreased twice as much, and the CMR decreased almost four times as much as the regional rate. The cost per beneficiary in this model is $3.21/beneficiary/year, and the estimated cost per life saved in our Mozambique Care Group project is $305, about a fourth of the average cost per life saved of a CSHGP-funded CS grant. World Relief saw similar large decreases in mortality, a 49% decline in IMR, and 42% decline in U5MR.
  • This is why we are excited about Care Groups. Using the Bellagio Lives Saved Calculator – which is similar to the LIST tool which some of you may have used – we found that Care Group projects generally out-performed the average child mortality reduction of child survival projects by 50 – 138%, or 9 to 25 percentage points. This data is from five different countries.
  • Carolyn: Since 1995, WR, FH, and more than 12 others PVOs in more than 14 countries have “adopted the model,” but the degree to which organizations adhere to the original components of the model varies greatly.  While there has been increased attention to the model and its effectiveness in lowering child deaths (e.g, mentioned in the UNICEF’s 2008 State of the World’s Children report), there is a danger that the wide variations in what is called a “Care Group” by various agencies will lead to misunderstandings about the model and the use of less effective strategies that do not fit within the model.  These variations, in turn, could lead to fewer opportunities to advocate for the Care Group model and its role in child survival since the term “Care Groups” may come to mean many different things to different people, and will probably develop a very mixed track record.
  • Of course there is no way to enforce the use of these criteria – people will use the term how they wish – but by having two organizations that are recognized as having a history of using and promoting Care Groups extensively (one organization being the original developer), defining formal criteria should provide a stronger basis for recognition of the model and lead to better adherence to the most effective components of the model.  We also hope that by informing donors and others about these criteria, they will use the criteria to decide to what degree a proposed implementation strategy is really based on the Care Group model.  We would like to request that the CORE Social & Behavioral Change Working Group (SBCWG) help with the dissemination of this document.  We expect that dissemination by the SBCWG will further legitimize the list, and will lead to better compliance with the recommended criteria.
  • Select the table to use, depending on group size. Every person has a handout, so they just look at the handout to start small group work.
  • Select the table to use, depending on group size. Every person has a handout, so they just look at the handout to start small group work.

Care Groups: The Essential Ingredients Care Groups: The Essential Ingredients Presentation Transcript

  • Care Groups: The Essential Ingredients April 2010 Carolyn Wetzel, MPH Senior Coordinator for Health Programs Food for the Hungry Melanie Morrow, MPH Director of MCH Programs World Relief Thomas P. Davis Jr., MPH Senior Director of Health Programs Food for the Hungry
  • Description of a Care Group
    • They are different from typical mother’s groups in that each volunteer is responsible for regularly visiting 10-15 of her neighbors, sharing what she has learned and facilitating behavior change at the household level . 
    A Care Group is a group of 10-15 volunteer, community-based health educators who regularly meet together with project staff for training and supervision. 
  • Description of a Care Group
    • Care Groups create a multiplying effect to equitably reach every beneficiary household with interpersonal behavior change communication. 
    • They also provide the structure for a community health information system that reports on new pregnancies, births and deaths detected during home visits
  • Results: KPC and Anthropometry All of these changes were statistically significant (p<0.05). Indicator FY97 (Baseline) FY 2000 Percentage of children with diarrhea receiving appropriate oral rehydration liquids 26% 95% Percentage of children 0-4m exclusively breastfeeding 46% 83% Percentage of children 12-23m who received a vitamin A capsule in the last six months 1% 97% Percentage of children with diarrhea in the last two weeks 44% 28% Severe stunting, children 6-23m of age 25% 13%
  • 42% decrease in underweight from Feb/06 to Sept/08 in a 2.5 year time period in Sofala, Mozambique (LOP Target was 18%) Sept 07 Feb 06 Sept 08
  • Differences in Health Service Utilization: Care Group vs. Non-Care Group Districts (Sofala, Mozambique)
  • Results: Mortality Rate Changes (CMR) 94% decrease in CMR
  • Reduction in Under-five Mortality Rate: Seven Care Group Projects
  • Why Criteria for Care Groups
    • 14 PVO’s using the model since 1995
    • Increased attention to the model and its repeated association with decreases in mortality .
    • Wide variations in what is called a “Care Group” can lead to the use of less effective strategies that do not fit within the model.
    • Fewer opportunities to advocate for the Care Group Model and it’s role in child survival if the name is applied to less effective strategies.
  • Why Criteria for Care Groups
    • Criteria formed by the two organizations that are recognized as having a history of using and promoting Care Groups extensively (WR being the original developer)
    • We hope that by informing donors and others about these criteria, they will use the criteria to decide to what degree a proposed implementation strategy is really based on the Care Group model.
  • Establishment of Criteria
    • During meetings between World Relief and Food for the Hungry staff members on April 23, 2009, the Care Group criteria were agreed upon. 
    • The list is divided into those that we feel should be required to be present when using the term, “Care Group,” and other criteria that we feel have been helpful when included in the model, but that should not be considered required. 
    • Edits to this list were then made by the two founders of the model, Dr. Pieter Ernst and Dr. Muriel Elmer.
  • The Care Group Criteria Essential characteristics for a model of community based health promotion to be considered the &quot;Care Group&quot; Model. 1 The model is based on peer-to-peer health promotion (Mother-to-mother for MCH and nutrition behaviors.) CG Volunteers should be chosen by the mothers within the group of households that they will serve or by the leadership in the village. 2 The workload of CG volunteers is limited: No more than 15 HH per CG volunteer. 3 The Care Group size is limited to 16 members and the project attains at least 70% monthly attendance. Coverage is monitored.
  • 4 CG volunteer contact with her assigned beneficiary mothers is monitored and should be at a minimum once a month, preferably twice monthly. 5 The plan is to reach 100% of households in the targeted group on at least a monthly basis, and the project attains at least 80% monthly coverage of households within the target group. Coverage is monitored. 6 Care Group Volunteers (e.k.a. “Leader Mothers”) collect vital events data on pregnancies, births, and death. 7 The majority of what is promoted through the Care Groups is directed towards reduction of mortality and malnutrition (e.g., Essential Nutrition Actions, Essential Hygiene Actions).
  • 8 The Care Group volunteers use some sort of visual teaching tool (e.g., flipcharts) to do health promotion at the household level. 9 Participatory methods of BCC are used in the Care Group with the CG Volunteers, and by the volunteers when doing health promotion at the household or small-group level. 10 The Care Group instructional time (when a Promoter teaches CG Volunteers) is no more than two hours per meeting. 11 Supervision of Promoters and at least one of the Care Group Volunteers (e.g., data collection, observation of skills) occurs at least monthly.
  • Answer the questions on your handout for the Care Group Criteria assigned to your group. 30 people Small Group 1 2 3 4 Care Group Criteria to Cover 1 4 6 8 2 5 7 9 3 11   10
  • Answer the questions on your handout for the Care Group Criteria assigned to your group. 35+ people Small Group 1 2 3 4 5 Care Group Criteria to Cover 1 2 4 5 8 7 3 11 6 9         10