Care Group Trios: Incorporation of Influencers


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Care Group Trios: Incorporation of Influencers

  1. 1. Program for Strengthening Household Access to Resources(PROSHAR) Dr. Ayan Shankar Seal Team Leader-Health & Nutrition, PROSHAR Care Group Technical Advisory Group (TAG) Meeting May 29 – 30, 2014; Washington DC , USA Care Group Trios: Incorporation of Influencers
  2. 2. •Funded by USAID/FFP with ACDI/VOCA as Prime. •From June 2010 to May 2015 •350,000 direct beneficiaries •Implementing Partners: GOB, ACDI/ VOCA PCI & 3 Local Partner NGOs (CODEC, Muslim Aid and Shushilan), iDE as Technical Partner PROSHAR OVERVIEW
  4. 4. Income and access to food for poor and ultra poor households increased Health of pregnant and lactating women and children under 5 (with particular attention to children under 2) improved Institutions and households prepared to respond effectively to shocks Goal: Reduced Food Insecurity Among Vulnerable Rural Populations in Selected Upazilas in Khulna Division INTEGRATED PROGRAM DESIGN
  5. 5.  During the design of PROSHAR, research demonstrated that:  Mothers have little influence in household decisions concerning nutrition & health care  Fathers & mothers-in-law were found to have the strongest influence on these behaviors  fathers dictate care seeking behaviors  mothers-in-law set child rearing practices  Thus, an innovative CGT approach was developed to involve fathers & mothers-in-law in order to sustainably change behaviors DEVELOPMENT OF CARE GROUP TRIOS (CGT)
  6. 6. WHAT INFLUENCES NUTRITION PRACTICES? 8% 6% 2% 24% 41% 10% 22% 12% 28% 40% Husband Mother-in-law* Sister-in-law Neighbors No one Who disapproves of pregnant women consuming extra food during pregnancy? NonDoers Doers Targeting influential people
  7. 7. 55% 20% 33% 12% 0% 12% 61% 57% 31% 14% 10% 4% Sufficient breastmilk Family Support* Don't need extra food Less work load No expense* Baby doesn't cry What made it easier for you to exclusively breastfeed (EBF)? NonDoers Doers Improving the knowledge and responsibility of family members on the importance of EBF and their support of the mother WHAT INFLUENCES NUTRITION PRACTICES?
  9. 9. CARE GROUP TRIO STRUCTURE CG Supervisor Health Promoter Health Promoter Health Promoter Health Promoter Health Promoter
  10. 10. MOTHER CG • Health Promoter meets with Mother Leaders 2x/month in CG meeting • MLs organize meeting with their neighbor groups the following week • Flipchart with specific health & nutrition messages used • MLs plan HH visit GRAND MOTHER CG • Health Promoter meets with Grandmother Leaders (GmL)s monthly; • GmLs also meet with their groups every month • Flash card set is used with specific health & nutrition • GmL do HH visits as needed FATHER CG • HP meets with the Father Leaders (FL)s 1x in every two month; • FLs meets with their groups in the following two months • Flash card set is used with specific messages • FL do HH visit as needed Care Group (Trio Leaders) • HP meets three leader groups together 1x/quarter • Trio leaders interact in clusters with similar leaders • CGTs share challenges; success stories; and plans for addressing challenges IMPLEMENTATION OF CGTS
  11. 11. 41.4 38.2 32.3 34.6 29.2 56 88.7 53 73 40.9 67.3 91 93.7 95 50.2 Exclusive Breast Feeding Early Initiation of BF 3+ ANC Visits Post Partum Vit-A 3 Correct IYCF Behaviors Baseline, Nov 2010 Annual Survey,Sept 2012 Annual Survey Sep 2013 BEHAVIOR CHANGE TRENDS
  12. 12. 22.7 21.6 21.2 Baseline Nov 2010 Sep-12 Sep-13 Regular service data( <-2SD) PERCENTAGE OF UNDERWEIGHT AMONG UNDER 2
  13. 13. HAND WASHING BEHAVIORS 58.3 60.9 92.3 46.2 64.5 59.8 88.8 83.8 Before child feeding During food handling After defecation/urination After cleaning a child that has defecated Sep-12 Mar-14
  14. 14. 38.7 28.5 17.1 53.7 22.3 67 71.8 63.8 38.5 70.8 Vitamin A rich fruits and vegetables Flesh Foods(Fish, Meats) Legumes and Nuts Dairy Products Eggs HFSNA 2009 PROSHAR Semi annual Survey 2014 DIVERSIFIED FOOD CONSUMPTION AMONG CHILDREN 6-23 MONTHS
  15. 15.  The CGT approach is a “promising practice” that makes a significant difference in changing behaviors among PLW and their family members  CGTs allow time for discussion among the groups and how their roles can influence behavior change  CGTs overall have a high level of participation (even for fathers and grandmothers who have greater participation challenges).  CGTs should meet together to identify barriers to change, to discover solutions to these barriers, and to be accountable for change in their families and communities. LESSONS LEARNED
  16. 16.  Fathers remark they are more supportive to their wives & children, more sensitive to their children’s needs, and overall responsible for the health/ wellbeing of their families (e.g. buying nutritious food!)  Targeting key influencers is critical to changing behaviors (e.g. early initiation & exclusive breast feeding)  Impact evaluations/experimental design (beyond the scope of this project) are needed EXPERIENCE WITH CGTS
  17. 17. THANK YOU!