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Create a world where no child goes to bed hungry.

Care Groups in Emergencies Tom Davis Chief Program Officer

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Session Objectives • To leave you some time to talk during lunch.

• To inform CORE Group members and practitioners on new guidance on the use of Care Groups in emergency settings.

• To explain the findings from a review of the use of Care Groups in emergency settings and how those led to the development of the guidance.

• To share a case study on the use of Care Groups in Liberia during the Ebola outbreak and lessons learned.

• To explain some of the added value of using Care Groups in emergency settings.

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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

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Coverage Indicators

Care Group Projects

Non-Care Group Projects

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6 4

9

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2 3 5

7 8

9 7

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2

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8 5

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9 8

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9 5

9

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2 6

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High Impact Child Survival Indicator Coverage Changes

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Some Benefits of Using Care Groups in an Emergency Setting • Most important factor in the speed and level of recovery of

communities and households after a disaster is social capital. (Daniel Aldrich findings. See @6m mark: http://www.youtube.com/watch?v=tx4Ii5tueDo)

• In relief settings, people are more likely to look at what others are doing and saying to decide what they should do (see Principles of Persuasion,

Part 2: Social Proof and Reciprocation)

• Neighbors visit existing neighbors as well as forming new social bonds. (414K contacts [w/27K HHs] in 9m). High-quality BCC messages can reach a high proportion of households regularly.

• Great for piggy-backing other activities

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0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00%

% of respondents who say they can resolve problems if they try hard

% who say they have confidence that they can handle problems that come up unexpectedly

% who say they know how to handle unforeseen situations

% who say that they can solve many of their problems if they invest the necessary effort

% who say that they can remain calm when facing difficulties because they can rely on their coping abilities

% who say that when they are confronted with a problem, they can usually find several solutions

% who say that if they are in trouble, they can usually think of what to do

% who say that they can usually handle whatever comes their way

Proportion of Mothers

Indicator Comparison of Generalized Self-efficacy Elements

Baseline Final Baseline: April 2010 Final: December 2010

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Presentations

• Sandra Wilcox: The Care Group Approach in Emergencies

• Florence Amadi: Use of Care Groups in Public Health Emergencies – The Case of Ebola

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The Care Group Approach in Emergencies

CORE Spring Meeting April 14, 2015

Washington, DC

Presenter: Sandra Wilcox

Disclaimer This workshop was made possible by a grant from the USAID Technical and Operational Performance Support (TOPS) program. The TOPS Micro Grants Program is made possible by the generous support and contribution of the American people through the United States Agency for International Development (USAID). The contents of the materials produced through the TOPS Micro Grants Program do not necessarily reflect the views of TOPS, USAID or the United States Government.

CG-E Outline

1. Introduction

2. Background

3. Methodology

4. Findings

5. Recommendations

(UNICEF)

Introduction Care Groups (CG) traditionally a development methodology

Recent use of CGs in emergency settings

Objectives: 1) Conduct an analysis of peer support group models used in emergency contexts

2) Use these findings to develop guidance on adapting the CG model for emergencies

3) Disseminate findings within the programming community

Background: Defining CGs are Groups

• A group of 10-15 community volunteers (mothers) who regularly meet with project staff for training and supervision.

• Each volunteer is responsible for regularly visiting 10-15 of her neighbors, sharing nutrition and hygiene information.

• CGs create a multiplying effect with interpersonal behavior change communication.

Cascade Groups • Using the cascading and multiplying structure of the CG

model for purposes other than reducing maternal and child mortality, morbidity and malnutrition.

Background: Defining CGs Mother-to-Mother Support Groups (MtMSG): • Group Meetings to discuss infant and child nutrition

• One member trained to facilitate the meeting

• Participatory, interactive learning

(Save the Children, Jordan)

Defining CGs: Quick Comparison

Care Groups Cascade Groups MtMSGs

Child Nutrition Focus

✔

✖ ✔

Group Meetings ✔

✔

✔

Household visits ✔

✔

✖

All three peer-support models were included in the analysis

Background: Defining Emergencies Type of emergency: Natural disasters Epidemics Conflict Stage of emergency: Acute: Typhoon, Earthquake Protracted: Conflict, Drought Emergency setting: Camp setting: IDPs, Refugees Host community: Returnees

Methodology Literature Review

• Gray literature • Project documents on CGs in emergencies

Interviews (Implementers) • Follow-up to Lit Review • Skype • Survey Monkey

Field visits (Implementers & beneficiaries)

• Ethiopia IMC/STC • Philippines FH

(FH, Philippines)

Methodology (cont’d)

Sum Total of 24 Interviews • 14 Countries • 12 NGOs

Methodology (cont’d) Analysis Interviews + Field visits Data tables Data tables

• Project/respondent information • Peer support model structure & management • Advantages & Challenges

Limitations Defining CGs and emergencies Time constraints: written surveys Evaluating CGs independently

Findings: Adaptations CG Elements Care Group Model Adaptations

Care Group Size Up to 16 2 Somalia 8-10 Liberia

Target Population PLW U2 U5 Entire Community

CGV Selection Elected Selected by staff or community leaders

Meeting Length Up to 2 hours More than 2 hours

Topics covered Nutrition/hygiene ARI, GBV, psychosocial, family planning

M&E* Vital statistics data Only attendance

Formative Research i.e. Barrier analysis Rarely conducted

Ministry of Health Integrated CG model Coordination levels varied widely

*Workshop Topic

Findings: Benefits Documented Effectiveness Cost Effectiveness Large Coverage Rapid Dissemination of Information Peer Support Rapid Behavior Change Structure to be Leveraged System for monitoring, screening and referrals Sustainability

Findings: Challenges

- Initial Set-up of Care Groups - Development of Program Materials - Community Buy-in - Finding Qualified Program Staff - Knowledge of CG Methodology - Incentives - Insecurity - Population Mobility - Sustainability Workshop Topic

Recommendations

Overall Recommendations

TYPE REC RATIONALE

Acute Emergencies Not recommended Time constraint: Staff capacity, Initial set-up, Short funding cycle

Transitional: E D

Recommended D E: Infrastructure in place E D: Behaviors carry over

Protracted Emergencies Recommended Complements health infrastructure

Mobile Populations Not recommended Difficult to monitor beneficiaries and supervise volunteers

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The Case of Ebola

Florence Amadi, MPH Program Manager

Background

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• In 2008, Curamericas Global was awarded a Child Survival grant by USAID

• Curamericas successfully implemented the Nehnwaa project in Nimba County, Liberia in partnership with Ganta United Methodist Hospital

• Over 65,000 beneficiaries by end of project

• Over 1,700 Care Group Volunteers (CGVs)

The CBIO+CG Methodology

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• CBIO = Community/Census-Based, Impact-Oriented approach to the practice of community-oriented public health Involves mapping and census of every community/beneficiaries

in the target area and monitoring of services and vital events

• CG = Care Group with NGO staff serving as Promoters Compliments the CBIO

• Key successes include: Reduction in child mortality in Bolivia of 62% Reduction in child mortality in Liberia of 63% Reduction in child mortality in Guatemala of 54%

Care Groups and Ebola

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• Care Groups were key in developing trust in the community and allowed us to stay connected beyond the Child Survival program and continue with activities

• With the initial outbreak of Ebola in March 2014, Nehnwaa staff continued to conduct regular Care Group meetings and house-to-house visits

• Behavior promotion included basic messages on Ebola prevention • By June 2014, more Ebola cases were detected in Liberia including

Nimba County, precipitating a shift in health activities at all levels

• In August 2014, the president declared a state of emergency

Ebola Response Activities

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Curamericas is partnering with Feed the Children, Ganta United Methodist Hospital, and the Liberia (Methodist) Annual Conference to respond to Ebola in Nimba County

• Eleven communities identified as most at risk are targeted • Census and mapping of households in all 11 communities using CBIO • 110 Care Group Volunteers per community trained on Ebola • 120 Care Groups – approximately 10 per community • Ebola education to 2,119 people through community outreach activities

(community forums) • 22 Behavior Change Communication sessions – approximately 2 per

community • 3 people identified with Ebola-like symptoms • 21 referrals – for various conditions • Zero confirmed Ebola cases

Usefulness of CGs and Lessons Learned

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• Community outreach is critical in any public health emergency response. How the outreach is done is as important.

• The Care Group approach is: Flexible and adoptable and easy to weave into community Leverages behavior change as people need to change in order to

survive Allow us to stay connected with the communities we serve Can provide multiple behavior promotion messages Cost effective and large coverage Provide house-to-house visitations Create a community level surveillance system Are community owned – local resource Mostly consists of women who are providers and care givers

Thank You!!!

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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

• New resource: Ebola Care Group Lesson Plans (done) and flipchart (soon).

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Questions and Comments

• Please write your questions and comments on the cards on your table and bring to us.

• We are available for questions at our table.