Reducing Malnutrition and Child Deaths Using Care Group

1. Reducing Malnutrition and Child
Deaths Using Care Group
Judy Lewis, Board Chair, CORE Group
Karen LeBan, Executive Director, CORE Group
Tom Davis, Chief Program Officer Feed the Children
Janine Schooley, Sr. VP for Programs, PCI
Dennis Cherian, Sr. Director of Health, HIV and AIDS, World
Vision, Inc.

3. What are Care Groups?
 A community-based strategy for
improving coverage and behavior
change
 Developed by Dr. Pieter Ernst with
World Relief/ Mozambique, used
subsequently 27 organizations in
23 countries.
 Focuses on building teams of
volunteer women who are
selected by their peers, and
represent, serve, and do health
promotion with blocks of 10-15
households each
 “Pure” volunteers – no monetary
incentives, just job aids

4. Major Programmatic Inputs
 One paid Promoter (7th grade education or higher) per 1,680
beneficiary households, and one Supervisor (nurse) per 7-10
Promoters.
 Some projects use MOH staff as Promoters, others work with
the MOH in other ways.
 4-5 day training on each of eight behavior promotion
modules, 3-4 trainings/year for first two years.
 Educational materials (e.g. flipcharts) for Promoters and Care
Group Volunteers, bicycles for Promoters, vitamin A,
deworming meds, other supplies.
 One Child Survival or Nutrition Program Manager, 0.33 FTE
M&E staff, 0.65 FTE HQ backstop.
FH/Mozambique Care Group Model
Promoter #6
Promoter #3
Promoter #7
12 Leader Mothers
12 families
12 families
12 families
12 families
12 families
12 families
12 families
12 families
Promoter #5
Promoter #4
Promoters
(Paid CHWs)
Each Health Promoter
educates and motivates 5 Care
Groups. Each Care Group has
12 Care Group Volunteers
(a.k.a., Leader Mothers)
12 families
12 families
Promoter #2
Promoter #1
12 families
12 families
12 Leader Mothers
12 Leader Mothers
Each Care Group Volunteer
educates and motivates
pregnant women and mothers
with children 0-23m of age in 12
households every two weeks.
Children in households with
children 24-59m are visited every
six months.
Care
Groups
With this model, one Health Promoter can cover 720 beneficiary households.
12 Leader Mothers
12 Leader Mothers

5. What happens during Care Group meetings?
 CGVs generally have a short walk to the
meeting site. Mozambique: CGVs walked on
average 15 minutes to meet with the group
 Reporting of vital events and illnesses and
progress in health promotion: troubleshooting
 Demonstration with flipchart of this week’s 2-
3 health messages
 Group reflection on the messages then
practice with the flipchart in pairs
 Other social/teaching activities (e.g., songs,
dramas, games)
 Meetings generally last 1.5 – 2 hours every two
weeks

6. What happens after Care Group Meetings?
 Each Care Group Volunteer visits “her” 12
households in the following two weeks promoting
the key health and nutrition messages for the week
using a small flipchart.
 The Promoter directly supervises the health
promotion done by one of the CGVs in the group
every two weeks
 Deworming and vitamin A are given during
campaigns to all eligible preschool children;
coordination with MOH on immunizations
 Most of the focus is on HH/community-level
health/nutrition promotion, but sometimes Health
Facility Assessment and improvement is included.
 “Cycle” of modules usually repeated after 18-24
months.

7. Area B Results
Dondo, Gorongosa, &
Nhamatanda Districts

8. Area B Project Indicators
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Underweight Exc. BF Ate 3+ meals Oil added to meal Vit. A supp.
FH/Moz CS Final Evaluation: Area B Project Indicators (Pt. 1)
Baseline, Area B
Final, Area B

9. Area B Project Indicators
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Vit. A foods Dewormed Weighed last
4m
ORS/RHF Same/more
food during
diarrhea
Correctly
prepare ORS
Knows 3+
danger signs
FH/Moz CS Final Evaluation: Area B Project Indicators (Pt. 2)
Baseline, Area B
Final, Area B
p<0.001 p<0.001
p<0.001
p<0.002
p<0.001
p<0.001 p<0.0001

10. Lives Saved Analysis
(Lives Saved Tool [JHSPH LiST])
Districts
(Sofala)
Benefic.
Est. #
of Lives
Saved
(Uncorr.)
Est. %
reduction
in U5MR
Project
Costs
Cost
per
Life
Saved
Cost per
DALY
Averted
Area A: Caia,
Chemba, Manga,
Maringue
92,239 5,032 32% $2,026,191 $403 $13.42
Area B: Dondo,
Gorongosa,
Nhamatanda
127,432 1,816 26% $997,975 $550 $18.32
All 7
Districts
219,671 6,858 29% $3,024,166 $441 $14.72
USD $0.55 per capita…

11. 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.

12. Care Group Performance

13. Several Support Mechanisms for Scale-up
 Website: www.CareGroupInfo.org – Narrated
presentations, training manuals, sample
flipcharts/lesson plans, project evaluations,
blog posts, support tools, etc.
 Materials and discussions also posted on
www.FSNNetwork.org

14. Thank you!