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Care Group Innovations_Tom Davis, et. al._4.23.13


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Care Group Innovations_Tom Davis, et. al._4.23.13

  1. 1. Care Group Innovations Carolyn KrugerSenior Advisor, Maternal, Newborn and Child Health, PCI Jennifer Weiss Health Advisor, Concern Worldwide Mary DeCoster Coordinator for SBC Programs, FH/TOPS Melanie Morrow Director of MCH Programs, World Relief Tom Davis Chief Program Officer, FH & Senior Specialist for SBC, TOPS Project
  2. 2. Objectives• Hear several presentations on ways in which the Care Group model is being modified and tested by multiple PVOs.• Hear an update on multi-sectoral peer education models which are similar to Care Groups.• Generate operations research questions that can be used to further advance the model.
  3. 3. What are Care Groups? • A community-based strategy for improving coverage and behavior change • Developed by Dr. Pieter Ernst with World Relief/ Mozambique, and championed by FH and WR for the past decade. • Care Group Criteria document is• Different from typical mothers groups: available here: Each volunteer is chosen by her peers, and is responsible for regularly visiting ria 10-15 of her neighbors.
  4. 4. Short video (edited) on Care Group Structure
  5. 5. Time Contribution (in hours) of CG Volunteers and Other Project Staff October 2005 – September 2010Community driven … Hours Dedicated to FH/Mozambique Care Group Project Sofala Province, Mozambique (Oct 05 - Sept 10) 61,659, 2% 7,067, 0.2% 401,824, 14% Promoters (CHWs) Volunteers Promoters FH/Moz Local Manag. FH/US staff 2,453,726, 84%84% of the work was done by Care Group Volunteers, and98% by community members (CGVs + paid local CHWs).Total value of volunteer time (@$2.98/8hrs) = $904,811
  6. 6. Who is using Care Groups and where are they being used?  Bangladesh ACDI/VOCA  International Aid  Bolivia ADRA  International Medical  Burkina Faso Africare Corps  Burundi  International Rescue  Cambodia American Red Cross Committee  DRC CARE  Ethiopia  Medical Teams  Guatemala Concern Worldwide International  Haiti Catholic Relief  Pathfinder  Indonesia Services  Kenya  PLAN  Liberia Curamericas  Salvation Army World  Malawi Emmanuel Service  Mozambique International  Save the Children  Niger Food for the Hungry  Peru  World Relief  Philippines Future Generations  World Vision  Rwanda GOAL  Sierra Leone  Zambia
  7. 7. TOPS Survey on Care Groups Usage• Recent TOPS survey (95% response rate): 65% of Food Security project implementers are aware of the CG model or with some of the resources associated with it.• Most common ways that people learn about the model are by working with someone who has used them (67%), training events (50%), the website (42%) using the manual on their own (42%), or a combination of methods.• 100% of respondents who knew of the CG model said that they had used the model; 64% said they were very effective and 27% said they were somewhat effective.• Becoming the “default model” for some organizations: Having CHWs work with volunteer peer educators through the CG structure … still a role for CHWs!
  8. 8. GHI: National Scale-up in Burundi• Burundi Global Health Initiative Strategy: One goal is to “expand the USAID MCH program currently implementing Care Group activities, which focuses on providing high-quality nutritional support to pregnant and lactating women.”• “USG aims for national adoption of this strategy by GOB.”
  9. 9. Summary of Results• CGs have on average double the estimated U5MR reduction as compared to non-CG projects.• Better than average behavior change (54% higher performance on RapidCATCH indicators)• Recent publication: 38% decrease in moderate/severe underweight in Sofala Province, Mozambique at $0.55 per capita.
  10. 10. Care Group Performance: Perc. Reduction in Child Death Rate (0-59m) in Thirteen CSHGP Care Group Projects in Eight Countries through Seven PVOs 60%% Red. U5MR 48% 50% 42% 33% 33% 36% 32% 35% 40% 28% 29% 26% 30% U5MR Red. 30% 23% 20% 14% 12% 14% 10% 0% Rw i II R/ r II z bia ala i rI W dia FH V m da oj. ria R/ dia a at aw CS oj. Ca /Mo rI SO eny Vu w Pl /Gu Vu Pr ibe an r am bo bo W M al Vu Av p P R/ K R/ /L m m . /Z SA an/ M Gr Ca W TI ra R/ W R/ g W M re C/ Cu R/ W W Ca AR W g. Av CSHGP Project
  11. 11. Care Groups Outperform in Behavior Change: Indicator Gap Closure: Care Group Projects vs. CSHGP Average Indicator Gap Closure on Rapid Catch Indicators: Care Groups CSHGP Projects vs. All CSHGP Projects 90 All CSHGPs, 2003-2009 (n=58) 80 77 71 CSHGP using Care 70 Groups (2003-2010, 63 n=9) 60 59 52 53 51 49 53 Gap closure range in non-CG 50Percent 41 40 35 39 37 projects ~25 – 30 32 45% (Avg. = 37%) 20 10 Gap closure range for Care Group projects: 0 ac s F d s N S t 2 es ns id w A w id ac ee TT EB W ~35 – 70% IT no SB ap er Sp sl ig u lV W pF ea Fl rS SK nd lR Al rth H c om ge Al M U In D Bi (Avg = 57%) AI an C D RapidCATCH Indicator
  12. 12. WHY/HOW CGs Work
  13. 13. Purpose of Innovations• Purpose of good innovation in child survival: (1) Increase cost-effectiveness … decrease dollars per life saved; and (2) increase sustainability.• Ideally, use randomization to compare area with traditional CG model vs. modified model, and measure each area separately.• Usual first step: See if change is feasible, look for apparent effectiveness. Later test head-to-head.
  14. 14. FH CG Innovations• Given results in health/nutrition, FH will be using Cascade Groups in many of our multisectoral programs worldwide. Difference between Cascade and Care Groups:  Care Groups often (but not always) reach only parents of children 0-23m/0-59m and pregnant women. Cascade Groups will reach parents of children 0-18 years of age.  Care Groups (per the CG Criteria document) mainly focus on promoting MCHN behaviors. Cascade Groups are multi-sectoral, and focus on promoting health/nutrition, livelihoods (including Ag/NRM), education, and disaster risk reduction behaviors.• FH is now using a model in Ag/NRM in the DRC called Agricultural Cascade Education (ACE) which is based on CGs but reaches farmers and mainly focuses on ANR topics.
  15. 15. Food for the Hungry CG Innovations Can we addressmaternal depression through Care Groups?
  16. 16. Maternal Depression is Highly Linked with Stunting in Children• Surkan et al1 found a strong association between maternal depression and underweight and stunting in children.• Incidence of depression in developing countries is between 15-57%.• Women suffer twice as much depression as men; mothers are at even greater risk.• Elimination of maternal depression could result in a reduction in stunting of 29-34% (based on the PAR).1 PamelaJ Surkan, Caitlin E Kennedy, Kristen M Hurley & Maureen M Black. Maternal depression and earlychildhood growth in developing countries: Systematic review and meta-analysis. Bulletin of the WorldHealth Organization 2011;89:608-615
  17. 17. We can Decrease Maternal Depression in Developing Countries• World Vision and researchers (Bolton, Verdeli, et al) did RCTs of Interpersonal Therapy in Groups (IPT-G) including:  depressed adults in South Uganda,  depressed adolescents in refugee camps in North Uganda (many were child soldiers)• IPT-G is used to address grief, devastating life changes, issues of respect in family life• Community workers – trained for 2 weeks to deliver the intervention over 4 months• After 16 weeks, depression decreased:  86% to 6.5% in the IPT-G intervention group – 92% reduction  94% to 55% in the control group. (Note: Some depression does resolve on its own.)Method Description:
  18. 18. FH’s CG Innovation for Maternal DepressionGiven the link with stunting -- FH plans to test ways toprevent/treat depression through Care Groups • We’ve used DBC/BA with Care Group projects to find out how to motivate change in specific behaviors. • Sometimes more generalized motivation is the problem – low motivation due to depression, hopelessness, etc. OR Question: Will addressing depression make a difference in behavior change and outcomes in CG projects? We welcome others to study this too, and encourage you to share your results!
  19. 19. Ideas for testing IPT-G with Care GroupsA) Option #1: Run IPT-G process through regular Care Group structure, separate process for depressed and non-depressed.B) Option #2: Run IPT-G groups simultaneously with Care Groups for prev/tx of depression (separate staff running separate groups, with CGVs helping to identify women who could benefit). Separate process for depressed and non-depressed. • Compare to controls. • 2nd Comparison Group: Standard CGs. • Outcome: Reduction in stunting and underweight, depression in mothers, and others.
  20. 20. Measuring ChangesTOPS/ FSN Network Care Groups Implementation Manual (andTrainings): See.. manual includes a Care Group OR annex – here are the areasthat can be explored with that:  Process vs. plan  Care Group Volunteer motivation  Changes in depression and generalized self-efficacy in volunteers and beneficiaries  Changes in Intimate Partner Violence  Changes in respect for women (volunteers and beneficiaries)
  21. 21. Innovations Presentations• PCI / WR: Care Groups + Savings Groups innovation• PCI’s "Trios" Care Group innovation• Concern Worldwide’s “Integrated” Care Group innovation• Q&A, 2-3 mins after each presentation• Generating operations research questions (20-30 mins)
  22. 22. Operations Research Questions• Split into three groups• Generate a list of the most interesting and important questions that need to be answered regarding Care Groups.• Consider questions about:  Effectiveness for specific purposes (e.g., reducing newborn deaths, lowering IPV/GBV, increasing social capital, improving disaster response) vs. other models  How they work (mechanisms –more trusted source of info? Problem-solving / removing barriers? Decreasing depression/improving generalized self-efficacy? Reducing fear (re: HFs)?)  Effect of combining CGs w/something (e.g., w/savings groups; w/empowerment groups).  Effect on CG Volunteers (e.g., in leadership skills/role; advocacy; relationship with spouse)• Report out
  23. 23. AcknowledgmentThis presentation was made possible by thegenerous support of the American peoplethrough the United States Agency forInternational Development (USAID). Thecontents are the responsibility of Food for theHungry and do not necessarily reflect the viewsof USAID or the United States Government.