The Care Group Model is a strategy used to promote community health. It involves training community health volunteers who each visit 10-15 neighboring households on a regular basis to share health information and facilitate behavior change. Care Groups aim to equitably reach all women and children in a community with individualized behavior change messaging and social support. The document discusses an operations research study in Burundi that compares the effectiveness of an integrated Care Group model using fewer project resources to the traditional higher-input Care Group model. It aims to test whether the adapted model can achieve similar health knowledge, practices, and group functionality and sustainability. Challenges of the research and lessons learned around obtaining ethics approval and integrating data collection into routine monitoring are also outlined.

1. The Care Group Model Alyssa L. Davis Health Advisor, Concern Worldwide Burundi Operations Research: Methods, Challenges, Emerging Lessons and Opportunities CORE Group Spring Meeting May 12, 2011 Operations Research in Burundi

5. Under-five deaths could be could be preventing in 42 countries with 90% of worldwide child deaths in 2000 through achievement of universal coverage with individual interventions. Source of Table: Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS. The Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003; 362 : 65-71. The Care Group Model has been used to promote and support highly effective child survival interventions—and could be used to promote and support even more in the future. Focus on High Impact Interventions in Child Survival

6. Contact Intensity Index Source: Jim Ricca, Senior Technical Advisor, MCHIP Project Country 1. Health facility improvement 2. Governance 3. Behavior Change – one-on-one 4. Outreach Services 5. Comm. treatment 6. Comm. Finance 7. Behavior change - mass media Nepal x x x x x x Mali x x x x x Benin x x x Rwanda 2 x x x x Ethiopia x x x x x Cambodia 3 x x x x Madagascar x x x Guinea x x x x x Senegal x x x x x x x Cambodia 2 x x x x x Rwanda 1 x x x x x Kenya x Haiti x x x x x Mozambique x x x Malawi x x x x x Cambodia 1 x x x x More successful 82% 82% 91% 73% 36% 73% 36% Less successful 100% 80% 20% 80% 40% 20% 20% Odds Ratio 0.8 1.0 4.6 0.9 0.9 3.6 1.8 Fisher Exact Test NS NS 0.05 NS NS 0.08 NS Significant at the level p < 0.05 Significant at the level p < 0.10

7. The Care Group network of volunteers extends the REACH of the formal health system. Health Center Care Group Volunteers Community Health Workers Household Child Caregivers

8. 26 Project Staff Train 200 Care Groups -> 2,600 Care Group Volunteers Train 34,000 Households -> Total Target Population Reached: 40,000 Women of Reproductive Age 24,000 Child under Five Years.

10. 22 Health Center Titulaires Train 153 Community Health Workers -> 153 Community Health Workers Train 300 Care Groups -> 2,952 Care Group Volunteers Train 44,000 Households -> Total Target Population Reached: 53,000 Women of Reproductive Age 41,000 Child under Five Years

15. Key Operational Monitoring Indicators Operation Research Indicator Target Value Percentage of beneficiary households that received at least one Care Group Volunteer visit per month. 80% Percentage of Care Groups that held a meeting at least once per month. 80% Percentage of Care Group Volunteers that reported registration and C-HIS data to their supervising Promoter/CHW per month. 80% Percentage of CHWs that reported registration and C-HIS data to their associated Health Center per month. 80% Percentage of CHWs that attended at least one COSA meeting per month. 80% Percentage of Care Group Volunteers who received at least one visit from a Promoters/CHW per month. 80% Percentage of Care Group meetings that are conducted according to minimum standards of quality per month. 80% Percentage of Care Group registers that meet minimum standards of quality per month. 80% Percentage of CHW supervision visits to Care Group Volunteers conducted according to minimum standards of quality per month. 80%

19. Murakoze chane! (Thank you very much) Source: Alyssa L. Davis, Concern Worldwide Source: Philip Wegner, Concern Worldwide … et bonne chance!