Care Group innovations are being tested and implemented by multiple organizations. Presentations will discuss integrating savings groups into Care Groups, testing "Trios" as a modification to the Care Group model, and Concern Worldwide's "Integrated" Care Group approach. Participants will then split into groups to generate and prioritize important operations research questions related to Care Group effectiveness, implementation, combining with other models, and volunteer experiences that could help further advance the Care Group model.
Spotlight Webinar: Applying a health equity lens to program planningHealth Evidence™
This webinar will explore the Community Planning tool: Applying a health equity lens to program planning resource available from Fraser Health Authority in British Columbia. The resource will serve as an example of how to apply a health equity lens to complement current program planning practices. Speakers will reflect on practical examples where this tool has been applied and offer guidance on how to approach each of these steps. This webinar is co-hosted by the National Collaborating Centre for Determinants of Health (NCCDH) and the National Collaborating Centre for Methods and Tools (NCCMT).
Spotlight Webinar: Applying a health equity lens to program planningHealth Evidence™
This webinar will explore the Community Planning tool: Applying a health equity lens to program planning resource available from Fraser Health Authority in British Columbia. The resource will serve as an example of how to apply a health equity lens to complement current program planning practices. Speakers will reflect on practical examples where this tool has been applied and offer guidance on how to approach each of these steps. This webinar is co-hosted by the National Collaborating Centre for Determinants of Health (NCCDH) and the National Collaborating Centre for Methods and Tools (NCCMT).
Weight loss interventions for adults who are obese on mortality and morbidity...Health Evidence™
Health Evidence™ hosted a 60 minute webinar examining the effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease and cancer. Follow this link to access to the audio recording for this webinar: https://youtu.be/olF1bvaofXE
Dr. Alison Avenell, Clinical Chair in Health Services Research, and Sam (Chenhan) Ma, from the Health Services Research Unit at the University of Aberdeen presented an overview of findings from their latest systematic review and meta-analysis:
Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, et al. (2017). Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: Systematic review and meta-analysis. BMJ, 359, j4849.
Adults with obesity have an increased risk of premature mortality, cardiovascular disease, some cancers, type 2 diabetes, and many other diseases. This review assesses whether weight loss intervention for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight. Fifty-four randomized controlled trials (RCTs) with 30,206 participants were identified in the review. High quality evidence showed that weight loss interventions decrease all cause mortality, with six fewer deaths per 1000 participants. Moderate quality evidence showed an effect on cardiovascular mortality, and very low quality evidence showed an effect on cancer mortality. Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.
Positive deviance: an asset-based approach to improve malaria outcomesMalaria Consortium
This learning paper describes a pilot project in north-west Cambodia that used positive deviance as a method of behaviour change communication for malaria control. Positive deviance is a behaviour and social change approach that helps identify existing model behaviours within a community that can be shared and amplified by the rest of the community. The project discussed in this learning paper focused on mobile and migrant workers and resident communities in three villages in Simpov Loun, north-west Cambodia.
The positive deviance project involved selecting role models from within the community who practised uncommon but positive behaviour with regards to malaria prevention and control. These role models then worked within the community to show other individuals and families how they could act in similar ways, in order to improve malaria prevention and enhance malaria treatment.
The paper looks closely at what this project involved, discusses what worked well, what lessons were learned and the challenges met during the period it was running. A range of recommendations, covering many different aspects of positive deviance and malaria, has come out of this project and are provided for future malaria control work using positive deviance.
Improving Maternal and Neonatal Health Outcomes in MozambiqueJames Brown
In Mozambique maternal mortality rates are 550 per 100,000 and neonatal mortality is 39 per 1000 live births. This presentation was the output of a short research project looking at the ways in which technology might be used in development programming to improve maternal and neonatal health outcomes.
Can vouchers help move health systems toward universal health coverage? Ben Bellows
Universal health coverage is an aspirational goal "to ensure that all people obtain the health services they need without suffering financial hardship when paying for them." To move toward greater health coverage, low-income countries can foster health systems that increase utilization, improve scope of services, and reduce financial costs to care. Voucher programs operate on both the demand and supply sides to target subsidies to beneficiaries, who in the absence of the subsidy, would likely not afford the healthcare. Governments that create these programs and take them to scale can expect to see greater utilization of priority health services by disadvantaged and can protect low-income populations from catastrophic health expenditure. As national risk pools mature, these voucher programs can become the foundation for larger, more comprehensive health purchasing agencies that cover the whole population with high quality, low cost healthcare.
Addressing Health Care's Blindside in Albuquerque's South Side: Logic Model W...Practical Playbook
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
Mind the Gap: Social Media (SM) Strategy & Relationship Building for Health S...Paul Gallant
Presented at British Columbia Patient Safety and Quality Council 2012. Social Media Camp by Paul Gallant, Certified Health Executive, Mentor, Health Leader and Consultant, CHE, PhD(c), MHK.
Principal, Gallant HealthWorks
www.GallantHealthWorks.com
slides moved to my main slideshare account. Other link still works also.
Building Capacity to Improve Population Health using a Social Determinants of...Practical Playbook
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
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
Weight loss interventions for adults who are obese on mortality and morbidity...Health Evidence™
Health Evidence™ hosted a 60 minute webinar examining the effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease and cancer. Follow this link to access to the audio recording for this webinar: https://youtu.be/olF1bvaofXE
Dr. Alison Avenell, Clinical Chair in Health Services Research, and Sam (Chenhan) Ma, from the Health Services Research Unit at the University of Aberdeen presented an overview of findings from their latest systematic review and meta-analysis:
Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, et al. (2017). Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: Systematic review and meta-analysis. BMJ, 359, j4849.
Adults with obesity have an increased risk of premature mortality, cardiovascular disease, some cancers, type 2 diabetes, and many other diseases. This review assesses whether weight loss intervention for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight. Fifty-four randomized controlled trials (RCTs) with 30,206 participants were identified in the review. High quality evidence showed that weight loss interventions decrease all cause mortality, with six fewer deaths per 1000 participants. Moderate quality evidence showed an effect on cardiovascular mortality, and very low quality evidence showed an effect on cancer mortality. Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.
Positive deviance: an asset-based approach to improve malaria outcomesMalaria Consortium
This learning paper describes a pilot project in north-west Cambodia that used positive deviance as a method of behaviour change communication for malaria control. Positive deviance is a behaviour and social change approach that helps identify existing model behaviours within a community that can be shared and amplified by the rest of the community. The project discussed in this learning paper focused on mobile and migrant workers and resident communities in three villages in Simpov Loun, north-west Cambodia.
The positive deviance project involved selecting role models from within the community who practised uncommon but positive behaviour with regards to malaria prevention and control. These role models then worked within the community to show other individuals and families how they could act in similar ways, in order to improve malaria prevention and enhance malaria treatment.
The paper looks closely at what this project involved, discusses what worked well, what lessons were learned and the challenges met during the period it was running. A range of recommendations, covering many different aspects of positive deviance and malaria, has come out of this project and are provided for future malaria control work using positive deviance.
Improving Maternal and Neonatal Health Outcomes in MozambiqueJames Brown
In Mozambique maternal mortality rates are 550 per 100,000 and neonatal mortality is 39 per 1000 live births. This presentation was the output of a short research project looking at the ways in which technology might be used in development programming to improve maternal and neonatal health outcomes.
Can vouchers help move health systems toward universal health coverage? Ben Bellows
Universal health coverage is an aspirational goal "to ensure that all people obtain the health services they need without suffering financial hardship when paying for them." To move toward greater health coverage, low-income countries can foster health systems that increase utilization, improve scope of services, and reduce financial costs to care. Voucher programs operate on both the demand and supply sides to target subsidies to beneficiaries, who in the absence of the subsidy, would likely not afford the healthcare. Governments that create these programs and take them to scale can expect to see greater utilization of priority health services by disadvantaged and can protect low-income populations from catastrophic health expenditure. As national risk pools mature, these voucher programs can become the foundation for larger, more comprehensive health purchasing agencies that cover the whole population with high quality, low cost healthcare.
Addressing Health Care's Blindside in Albuquerque's South Side: Logic Model W...Practical Playbook
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
Mind the Gap: Social Media (SM) Strategy & Relationship Building for Health S...Paul Gallant
Presented at British Columbia Patient Safety and Quality Council 2012. Social Media Camp by Paul Gallant, Certified Health Executive, Mentor, Health Leader and Consultant, CHE, PhD(c), MHK.
Principal, Gallant HealthWorks
www.GallantHealthWorks.com
slides moved to my main slideshare account. Other link still works also.
Building Capacity to Improve Population Health using a Social Determinants of...Practical Playbook
The Practical Playbook
National Meeting 2016
www.practicalplaybook.org
Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was at the Hyatt Regency in Bethesda, MD, May 22 - 24, 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health. Key stakeholders from across sectors – representing professional associations, community organizations, government agencies and academic institutions – and across the country came together at the National Meeting to help catalyze a national movement, accelerate collaborations by fostering skill development, and connect with like-minded individuals and organizations to facilitate the exchange of ideas to drive population health improvement.
The National Meeting was also a significant source of tools and resources to advance collaboration. These tools and resources are available below and include:
Session presentations and materials
Poster session content
Photos from the National Meeting
The conversation started at the National Meeting is continuing in a LinkedIn Group "Working Together for Population Health" and Twitter. Use #PPBMeeting to provide feedback on the National Meeting.
The Practical Playbook was developed by the de Beaumont Foundation, the Duke University School of Medicine Department of Community and Family Medicine, the Centers for Disease Control and Prevention (CDC), and the Health Resources & Services Administration (HRSA).
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
At the 2016 CCIH Annual Conference, Dr. Tonny Tumwesigye of the Uganda Protestant Medical Bureau discusses how UPMB incorporated fertility awareness methods into its Family Planning services to expand options for families.
CORE Group Fall Meeting 2010. Key Findings from Care Group Operational Research. Sofala, Mozambique Research conducted from April to May 2010 as part of the project: Achieving Equity, Coverage, and Impact through a Care Group Network. - Carolyn Wetzel, Food for the Hungry
A project proposal for East Timor on improving health and nutrition for women...Kazuko Yoshizawa
The presentation outlines a project proposal aimed at capacity building in health and nutrition for Timor-Leste, developed through extensive consultation with the Ministry of Health, development partners, NGOs, and civil society. The primary objective of the project is to enhance the nutritional status of women and children who are particularly vulnerable to malnutrition. The project proposal comprises four key areas that address the capacity gaps identified through stakeholder consultations and documented in published reports and strategies. By providing additional support and interventions, as well as strengthening existing structures, the proposed interventions would help to improve the nutrition status of children and women. The proposal further suggests that the capacity of Integrated Community Health Services (Sisca) could be enhanced to improve rural health services. Such improvements would help to address the existing disparities in health outcomes between rural and urban areas in Timor-Leste. Through the proposed interventions, the project aims to support the overall development of the health and nutrition sector in Timor-Leste. By addressing the identified capacity gaps, the project would help to build sustainable systems that can deliver effective health and nutrition services to the population.
In conclusion, the presentation explains a comprehensive project proposal that aims to improve the nutritional status of vulnerable women and children in Timor-Leste. The proposal is based on extensive consultation with stakeholders and would address capacity gaps identified through published reports and strategies. Through this project, it would be possible to enhance rural health services by strengthening the capacity of Integrated Community Health Services (Sisca) and supporting existing structures. Ultimately, the proposed interventions would contribute to the development of sustainable health and nutrition systems in Timor-Leste.
The Chakra System in our body - A Portal to Interdimensional Consciousness.pptxBharat Technology
each chakra is studied in greater detail, several steps have been included to
strengthen your personal intention to open each chakra more fully. These are designed
to draw forth the highest benefit for your spiritual growth.
The Good News, newsletter for June 2024 is hereNoHo FUMC
Our monthly newsletter is available to read online. We hope you will join us each Sunday in person for our worship service. Make sure to subscribe and follow us on YouTube and social media.
Exploring the Mindfulness Understanding Its Benefits.pptxMartaLoveguard
Slide 1: Title: Exploring the Mindfulness: Understanding Its Benefits
Slide 2: Introduction to Mindfulness
Mindfulness, defined as the conscious, non-judgmental observation of the present moment, has deep roots in Buddhist meditation practice but has gained significant popularity in the Western world in recent years. In today's society, filled with distractions and constant stimuli, mindfulness offers a valuable tool for regaining inner peace and reconnecting with our true selves. By cultivating mindfulness, we can develop a heightened awareness of our thoughts, feelings, and surroundings, leading to a greater sense of clarity and presence in our daily lives.
Slide 3: Benefits of Mindfulness for Mental Well-being
Practicing mindfulness can help reduce stress and anxiety levels, improving overall quality of life.
Mindfulness increases awareness of our emotions and teaches us to manage them better, leading to improved mood.
Regular mindfulness practice can improve our ability to concentrate and focus our attention on the present moment.
Slide 4: Benefits of Mindfulness for Physical Health
Research has shown that practicing mindfulness can contribute to lowering blood pressure, which is beneficial for heart health.
Regular meditation and mindfulness practice can strengthen the immune system, aiding the body in fighting infections.
Mindfulness may help reduce the risk of chronic diseases such as type 2 diabetes and obesity by reducing stress and improving overall lifestyle habits.
Slide 5: Impact of Mindfulness on Relationships
Mindfulness can help us better understand others and improve communication, leading to healthier relationships.
By focusing on the present moment and being fully attentive, mindfulness helps build stronger and more authentic connections with others.
Mindfulness teaches us how to be present for others in difficult times, leading to increased compassion and understanding.
Slide 6: Mindfulness Techniques and Practices
Focusing on the breath and mindful breathing can be a simple way to enter a state of mindfulness.
Body scan meditation involves focusing on different parts of the body, paying attention to any sensations and feelings.
Practicing mindful walking and eating involves consciously focusing on each step or bite, with full attention to sensory experiences.
Slide 7: Incorporating Mindfulness into Daily Life
You can practice mindfulness in everyday activities such as washing dishes or taking a walk in the park.
Adding mindfulness practice to daily routines can help increase awareness and presence.
Mindfulness helps us become more aware of our needs and better manage our time, leading to balance and harmony in life.
Slide 8: Summary: Embracing Mindfulness for Full Living
Mindfulness can bring numerous benefits for physical and mental health.
Regular mindfulness practice can help achieve a fuller and more satisfying life.
Mindfulness has the power to change our perspective and way of perceiving the world, leading to deeper se
The PBHP DYC ~ Reflections on The Dhamma (English).pptxOH TEIK BIN
A PowerPoint Presentation based on the Dhamma Reflections for the PBHP DYC for the years 1993 – 2012. To motivate and inspire DYC members to keep on practicing the Dhamma and to do the meritorious deed of Dhammaduta work.
The texts are in English.
For the Video with audio narration, comments and texts in English, please check out the Link:
https://www.youtube.com/watch?v=zF2g_43NEa0
HANUMAN STORIES: TIMELESS TEACHINGS FOR TODAY’S WORLDLearnyoga
Hanuman Stories: Timeless Teachings for Today’s World" delves into the inspiring tales of Hanuman, highlighting lessons of devotion, strength, and selfless service that resonate in modern life. These stories illustrate how Hanuman's unwavering faith and courage can guide us through challenges and foster resilience. Through these timeless narratives, readers can find profound wisdom to apply in their daily lives.
In Jude 17-23 Jude shifts from piling up examples of false teachers from the Old Testament to a series of practical exhortations that flow from apostolic instruction. He preserves for us what may well have been part of the apostolic catechism for the first generation of Christ-followers. In these instructions Jude exhorts the believer to deal with 3 different groups of people: scoffers who are "devoid of the Spirit", believers who have come under the influence of scoffers and believers who are so entrenched in false teaching that they need rescue and pose some real spiritual risk for the rescuer. In all of this Jude emphasizes Jesus' call to rescue straying sheep, leaving the 99 safely behind and pursuing the 1.
Lesson 9 - Resisting Temptation Along the Way.pptxCelso Napoleon
Lesson 9 - Resisting Temptation Along the Way
SBs – Sunday Bible School
Adult Bible Lessons 2nd quarter 2024 CPAD
MAGAZINE: THE CAREER THAT IS PROPOSED TO US: The Path of Salvation, Holiness and Perseverance to Reach Heaven
Commentator: Pastor Osiel Gomes
Presentation: Missionary Celso Napoleon
Renewed in Grace
What Should be the Christian View of Anime?Joe Muraguri
We will learn what Anime is and see what a Christian should consider before watching anime movies? We will also learn a little bit of Shintoism religion and hentai (the craze of internet pornography today).
The Book of Joshua is the sixth book in the Hebrew Bible and the Old Testament, and is the first book of the Deuteronomistic history, the story of Israel from the conquest of Canaan to the Babylonian exile.
1. Care Group Innovations
Carolyn Kruger
Senior 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. 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. What are Care Groups?
• Developed by Dr. Pieter Ernst with
World Relief/ Mozambique, and
championed by FH and WR for the
past decade.
• Care Group Criteria document is
available here:
www.caregroupinfo.org/blog/crite
ria
• A community-based strategy for
improving coverage and behavior
change
• Different from typical mothers groups:
Each volunteer is chosen by her peers,
and is responsible for regularly visiting
10-15 of her neighbors.
5. Time Contribution (in hours) of
CG Volunteers and Other Project Staff
October 2005 – September 2010
Hours Dedicated to FH/Mozambique Care Group Project
Sofala Province, Mozambique (Oct '05 - Sept '10)
7,067, 0.2%
61,659, 2%
401,824, 14%
2,453,726, 84%
Volunteers
Promoters
FH/Moz Local Manag.
FH/US staff
Community driven …
84% of the work was done by Care Group Volunteers, and
98% by community members (CGVs + paid local CHWs).
Total value of volunteer time (@$2.98/8hrs) = $904,811
Promoters
(CHWs)
6. International Aid
International Medical
Corps
International Rescue
Committee
Medical Teams
International
Pathfinder
PLAN
Salvation Army World
Service
Save the Children
World Relief
World Vision
ACDI/VOCA
ADRA
Africare
American Red Cross
CARE
Concern Worldwide
Catholic Relief
Services
Curamericas
Emmanuel
International
Food for the Hungry
Future Generations
GOAL
Bangladesh
Bolivia
Burkina Faso
Burundi
Cambodia
DRC
Ethiopia
Guatemala
Haiti
Indonesia
Kenya
Liberia
Malawi
Mozambique
Niger
Peru
Philippines
Rwanda
Sierra Leone
Zambia
Who is using Care Groups and where
are they being used?
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 CareGroupInfo.org 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. 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. 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. Care Group Performance: Perc. Reduction in Child Death Rate (0-59m)
in Thirteen CSHGP Care Group Projects in Eight Countries
through Seven PVOs
23%
33%
48%
36%
42%
32%
28% 29%
14%
26%
12%
35%
30%
14%
33%
0%
10%
20%
30%
40%
50%
60%
ARC/Cam
bodiaW
R/VurIW
R/VurII
W
R/VurIVFH/Moz
W
R/Cam
bodia
W
R/M
alawi
W
R/M
alawiII
W
R/Rwanda
Curam
./Guat
Plan/Kenya
SAW
SO/Zam
bia
M
TI/Liberia
Avg.CareGrpProj.
Avg
CS
Proj.
CSHGP Project
%Red.U5MR
U5MR Red.
11. Care Groups Outperform in Behavior Change:
Indicator Gap Closure: Care Group Projects
vs. CSHGP Average
32
41
35
52
71
59
39
53
51
77
49
63
37
53
0
10
20
30
40
50
60
70
80
90
U
nderw
t
Birth
Spac
SBA
TT2
EBF
C
om
pFeed
AllVacs
M
easles
ITN
D
angerSigns
IncFluids
AID
SKnow
H
W
W
S
AllR
apid
Percent
RapidCATCH Indicator
Indicator Gap Closure on Rapid Catch Indicators:
Care Groups CSHGP Projects vs. All CSHGP Projects
All CSHGPs,
2003-2009 (n=58)
CSHGP using Care
Groups (2003-2010,
n=9)
Gap closure
range for Care
Group projects:
~35 – 70%
(Avg = 57%)
Gap closure
range in non-CG
projects ~25 –
45%
(Avg. = 37%)
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. 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. Food for the Hungry
CG Innovations
Can we address
maternal depression
through Care
Groups?
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 Pamela J Surkan, Caitlin E Kennedy, Kristen M Hurley & Maureen M Black. Maternal depression and early
childhood growth in developing countries: Systematic review and meta-analysis. Bulletin of the World
Health Organization 2011;89:608-615 http://www.who.int/bulletin/volumes/89/8/11-088187/en/
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: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525093/
Study: http://jama.jamanetwork.com/data/Journals/JAMA/4884/JOC30288.pdf
18. FH’s CG Innovation for
Maternal Depression
Given the link with stunting -- FH plans to test ways to
prevent/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. Ideas for testing IPT-G
with Care Groups
A) 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. Measuring Changes
TOPS/ FSN Network Care Groups Implementation Manual (and
Trainings): See.. http://fsnnetwork.org/event/care-groups-
implementation-training
The manual includes a Care Group OR annex – here are the areas
that 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. 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. 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. Acknowledgment
This presentation was made possible by the
generous support of the American people
through the United States Agency for
International Development (USAID). The
contents are the responsibility of Food for the
Hungry and do not necessarily reflect the views
of USAID or the United States Government.
Editor's Notes
1.5 minute video. (Connect speakers.)
This is the study that showed a 38% reduction in underweight. Several lessons learned about how and why Care Groups work were mentioned in this recently published article on the project in Sofala. I won’t go through those here, because I want you to read the paper. This journal is a great place for you to consider publishing your papers on your projects.
So I wanted to establish first that we are looking at innovations with a model that is already outperforming many of our more standard approaches (such as having CHWs work directly with mothers rather than through peer educators). But just because the model is performing well doesn’t mean that we should not continue to push the envelope. As we discuss innovations, you should be asking several questions: (1) Does the innovation lead to more cost-effective results in terms of lives saved? Usually that will mean that you will see better behavior change happening, as well, but there are other ways that they may be saving lives. (2) Secondly, does the innovation lead to better sustainability? That may be sustainability by having the MOH adopt the model, it may be sustainability by having CGVs continuing to do health promotion for years afterwards, or for the system to become part of some private system. We should not get stuck on one view of what sustainability will look like. There may be other things that you will measure, such as satisfaction with the model, but in the end, if you are having worse results in terms of cost-effectiveness or sustainability, it’s probably not something that we should be promoting.Also, as we innovate, we should be trying to do so with randomization and measurement. At the very least, I think we need to be trying out changes in the model in one set of districts and comparing it with the standard model used in another set of districts (i.e., a quasi-experimental design). And we need to measure our work in such a way that we can detect differences in results in those different areas, and also assure that we follow the protocols we have set out for how the work should differ in the two areas … for example, tracking attendance at Care Group meetings, tracking contact between CGVs and mothers (and/or fathers, grandmothers), and tracking quality of health promotion.Now not everything you will hear about today will meet these criteria. Often a first step is just to see if a change is feasible – such as working with mothers, spouses, and grandmothers – and to see if it appears to be at least as effective as the standard model in terms of results and sustainability. Later on, implementers can and should test it head-to-head with the standard model before promoting the change widely. I think we should be doing the same thing with testing Care Groups against more traditional CHW models where funding allows, as well, but from the data I have presented, I don’t know that that work is the most pressing.Mary DeCoster is the Coordinator of SBC Programs for FH and the TOPS Project, and she and I will now talk to you about some of FH’s plans to tweak the Care Group model, and other things we are doing in Food for the Hungry concerning Care Groups.
Other studies show compromised parenting behaviors linked with depression. “Our findings indicate that a reduction in the incidence of maternal depressive symptoms in developing countries would not only have a beneficial effect on mothers, but would also improve child growth substantially…”
IPT-G is short term therapy, focuses on improving symptoms and interpersonal functioning, and based on Interpersonal Psychotherapy (IPT) is a time-limited treatment that encourages the patient to regain control of mood and functioning typically lasting only 12–16 weeks. IPT is based on the common factors of psychotherapy: a "treatment alliance in which the therapist empathically engages the patient, helps the patient to feel understood, arouses affect, presents a clear rationale and treatment ritual, and yields success experiences."
Sometimes in Care Groups we see uptakes in new behaviors that haven’t been promoted yet – after a few successes, mothers feel an increase in hopefulness and “agency”. So sometimes we can see increases in adoption of family planning, antenatal care, or care seeking… before you even get to the point in the project where you are teaching that module. This is most likely due to this increase in generalized self-efficacy, decrease in depression, or some effect on overall motivation and will.
Option #1: Run IPT-G process through regular Care Group structure. Select depressed women reached by CGs in a couple of communities and use IPT-G with them over 4 months, replacing the CG teaching normally done with them during that period with this IPT-G intervention. Teach non-depressed mothers in same groups other coping and “learned optimism” skills. This would be similar to how FH has integrated PD/Hearth with Care Groups. Option #2: Run IPT-G groups simultaneously with Care Groups for prevention and treatment of depression(separate staff running separate groups, with CGVs helping to identify women who could benefit). Do a prevention of depression module with non-depressed mothers at the same time through the CGVs. With both options, we would identify mothers in control communities and measure changes in depression. Second comparison group could be all mothers in standard CGs.Expected Outcome: Reduction in stunting and underweight, depression in mothers, and others.
We’re working on a Care Groups implementation manual, with many of you from the FSN Network Care Groups Forward Interest Group, based on the manual developed by FH last year, in collaboration with World Relief. There’s an OR annex in there to help/encourage Care Groups implementers to do operations research
We will now hear about a range of other innovations to the Care Group model being tried out. First up, Carolyn Kruger from PCI and Melanie Morrow from World Relief will talk about combining savings groups with Care Groups.