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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

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Perry care groups

  1. 1. Findings and Reflections on the Food for the Hungry Care Group Child Survival Project in Sofala Province, Mozambique<br />Henry Perry<br />Department of International Health<br />CORE Group Fall Meeting<br />15 September 2010 <br />
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  4. 4. Project Background<br />1.2 million people of all ages in project area<br />Area A: 42% of population (54m intervention)<br />Area B: 58% of population (16m intervention)<br />Interventions: Nutrition (70%), CDD (30%), IMCI<br />
  5. 5. Area B Project Indicators<br />
  6. 6. Area B Project Indicators<br />Same targets as Area A (54m of interventions); 79% of targets met, 100% of changes are statistically-significant<br />
  7. 7. Achievement of Nutrition Targets, Food for the Hungry Child Survival Project, Sofala Province, Mozambique, 2006-10<br />36% reduction (ss)<br />26% reduction<br />
  8. 8. Severe Underweight Decreases<br />51% reduction<br />29% reduction<br />
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  10. 10. Supporting Evidence for Improvement in Nutrition <br />Increased coverage of exclusive breastfeeding<br />Improved complementary feeding<br />Increased utilization of nutritious foods, including addition of oil, increased feeding (24h dietary recall), and feeding during illness<br />Increased growth monitoring, deworming, ORS<br />
  11. 11. Rapid Indicator Changes<br />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<br />
  12. 12. Mortality Impact Assessment (Indirect and Direct)<br />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)<br />Indirect estimates based on Lives Saved Calculator (“old” Bellagio Calculator and “new” LiST Tool)<br />Direct estimates based on vital events registration<br />
  13. 13. Estimated U2MR Reported through Community Vital Events System<br />Lesson learned: Start mortality measurement early…<br />
  14. 14. Estimated Changes in Under-2 Mortality in Food for the Hungry Project Areas A and B Using Project Vital Events Data<br />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<br />
  15. 15. Estimate: Lives Saved Analysis (Lancet methodology [LIST])<br />
  16. 16. Figure 2. Cost per DALY Averted with Integrated Community-Based Interventions to Improve Child Health<br />Abbreviations: DALY-disability-adjusted life year; USAID-United States Agency for International Development; PHC-primary health care.<br />References: Ricca<br />
  17. 17. Lessons Learned<br />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.<br />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])<br />
  18. 18. Lessons Learned (cont.)<br />FH’s model drives costs down by:<br />Targeting under-twos / pregnant women only<br />Use Promoters from the local area (with bicycles, not motorcyles, serving 5 rather than 10+ communities)<br />Only one supervision layer<br />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)<br />
  19. 19. Census-Based, Impact-Oriented Approach (CBIO) Principles <br />
  20. 20. Care Groups Respond to Two Criticisms of CBIO Approach<br />“CBIO is a promising approach that deserves further development and replication in other settings”<br />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)<br />
  21. 21. Conclusion<br /> As far as we know, this is among the most cost-effective child survival projects ever implemented at scale.<br />
  22. 22. CBIO Principles Fundamental to Bangs Work at SEARCH and to Care Groups<br />
  23. 23. Power of Care Group Approach<br />Gives tools (via education) to women (and communities) to improve their health and builds on the inherent effectiveness of peer-to-peer health education<br />Reaches every household in the community<br />
  24. 24. Care Groups Respond to the Two Criticisms of CBIO Made by an Expert Panel in 1993<br />
  25. 25. Area B RapidCATCH Indicators<br />
  26. 26. Area B RapidCATCH Indicators<br />
  27. 27. The preceding slides were presented at the<br />CORE Group 2010 Fall Meeting<br />Washington, DC<br />To see similar presentations, please visit:<br /><br />