- 1. Care Group InnovationsCarolyn KrugerSenior Advisor,
Maternal, Newborn and Child Health, PCIJennifer WeissHealth
Advisor, Concern WorldwideMary DeCosterCoordinator for SBC
Programs, FH/TOPSMelanie MorrowDirector of MCH Programs, World
ReliefTom DavisChief Program Officer, FH &Senior Specialist for
SBC, TOPS Project
2. Objectives Hear several presentations on ways in whichthe
Care Group model is being modified andtested by multiple PVOs. Hear
an update on multi-sectoral peereducation models which are similar
to CareGroups. Generate operations research questions thatcan be
used to further advance the model. 3. What are Care Groups?
Developed by Dr. Pieter Ernst withWorld Relief/ Mozambique,
andchampioned by FH and WR for thepast decade. Care Group Criteria
document isavailable here:www.caregroupinfo.org/blog/criteria A
community-based strategy forimproving coverage and behaviorchange
Different from typical mothers groups:Each volunteer is chosen by
her peers,and is responsible for regularly visiting10-15 of her
neighbors. 4. Short video (edited) on CareGroup Structure 5. Time
Contribution (in hours) ofCG Volunteers and Other Project
StaffOctober 2005 September 2010Hours Dedicated to FH/Mozambique
Care Group ProjectSofala Province, Mozambique (Oct 05 - Sept
10)7,067, 0.2%61,659, 2%401,824, 14%2,453,726,
84%VolunteersPromotersFH/Moz Local Manag.FH/US staffCommunity
driven 84% of the work was done by Care Group Volunteers, and98% by
community members (CGVs + paid local CHWs).Total value of volunteer
time (@$2.98/8hrs) = $904,811Promoters(CHWs) 6. International Aid
International MedicalCorps International RescueCommittee Medical
TeamsInternational Pathfinder PLAN Salvation Army WorldService Save
the Children World Relief World Vision ACDI/VOCA ADRA Africare
American Red Cross CARE Concern Worldwide Catholic ReliefServices
Curamericas EmmanuelInternational 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 ZambiaWho is
using Care Groups and whereare they being used? 7. TOPS Survey
onCare Groups Usage Recent TOPS survey (95% response rate): 65% of
FoodSecurity project implementers are aware of the CG model orwith
some of the resources associated with it. Most common ways that
people learn about the model areby 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
ofmethods. 100% of respondents who knew of the CG model said
thatthey had used the model; 64% said they were very effectiveand
27% said they were somewhat effective. Becoming the default model
for some organizations:Having CHWs work with volunteer peer
educators throughthe CG structure still a role for CHWs! 8. GHI:
National Scale-up inBurundi Burundi Global Health Initiative
Strategy: Onegoal is to expand the USAID MCH programcurrently
implementing Care Group activities,which focuses on providing
high-qualitynutritional support to pregnant and lactatingwomen. USG
aims for national adoption of thisstrategy by GOB. 9. Summary of
Results CGs have on average double the estimatedU5MR reduction as
compared to non-CGprojects. Better than average behavior change
(54%higher performance on RapidCATCHindicators) Recent publication:
38% decrease inmoderate/severe underweight in SofalaProvince,
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 Countriesthrough Seven PVOs23%33%48%36%42%32%28%
29%14%26%12%35%30%14%33%0%10%20%30%40%50%60%ARC/CambodiaWR/VurIWR/VurIIWR/VurIVFH/MozWR/CambodiaWR/MalawiWR/MalawiIIWR/RwandaCuram./GuatPlan/KenyaSAWSO/ZambiaMTI/LiberiaAvg.CareGrpProj.AvgCSProj.CSHGP
Project%Red.U5MRU5MR Red. 11. Care Groups Outperform in Behavior
Change:Indicator Gap Closure: Care Group Projectsvs. CSHGP
Average32413552715939535177496337530102030405060708090UnderwtBirthSpacSBATT2EBFCompFeedAllVacsMeaslesITNDangerSignsIncFluidsAIDSKnowHWWSAllRapidPercentRapidCATCH
IndicatorIndicator Gap Closure on Rapid Catch Indicators:Care
Groups CSHGP Projects vs. All CSHGP ProjectsAll CSHGPs,2003-2009
(n=58)CSHGP using CareGroups (2003-2010,n=9)Gap closurerange for
CareGroup projects:~35 70%(Avg = 57%)Gap closurerange in
non-CGprojects ~25 45%(Avg. = 37%) 12. WHY/HOW CGs Work 13. Purpose
of Innovations Purpose of good innovation in child survival:
(1)Increase cost-effectiveness decrease dollarsper life saved; and
(2) increase sustainability. Ideally, use randomization to compare
area withtraditional CG model vs. modified model, andmeasure each
area separately. Usual first step: See if change is feasible, look
forapparent effectiveness. Later test head-to-head. 14. FH CG
Innovations Given results in health/nutrition, FH will be using
CascadeGroups in many of our multisectoral programs
worldwide.Difference between Cascade and Care Groups: Care Groups
often (but not always) reach only parents ofchildren 0-23m/0-59m
and pregnant women. CascadeGroups will reach parents of children
0-18 years of age. Care Groups (per the CG Criteria document)
mainly focuson promoting MCHN behaviors. Cascade Groups
aremulti-sectoral, and focus on promoting
health/nutrition,livelihoods (including Ag/NRM), education, and
disasterrisk reduction behaviors. FH is now using a model in Ag/NRM
in the DRC calledAgricultural Cascade Education (ACE) which is
based onCGs but reaches farmers and mainly focuses on ANR topics.
15. Food for the HungryCG InnovationsCan we addressmaternal
depressionthrough CareGroups? 16. Maternal Depression is Highly
Linkedwith Stunting in Children Surkan et al1 found a strong
association betweenmaternal depression and underweight and
stuntingin children. Incidence of depression in developing
countries isbetween 15-57%. Women suffer twice as much depression
as men;mothers are at even greater risk. Elimination of maternal
depression could result in areduction 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 earlychildhood
growth in developing countries: Systematic review and
meta-analysis. Bulletin of the WorldHealth Organization
2011;89:608-615
http://www.who.int/bulletin/volumes/89/8/11-088187/en/ 17. We can
Decrease MaternalDepression in Developing Countries World Vision
and researchers (Bolton, Verdeli, et al) did RCTs ofInterpersonal
Therapy in Groups (IPT-G) including: depressed adults in South
Uganda, depressed adolescents in refugee camps in North Uganda
(manywere child soldiers) IPT-G is used to address grief,
devastating life changes, issues of respectin family life Community
workers trained for 2 weeks to deliver the interventionover 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 onits own.)Method
Description:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525093/Study:
http://jama.jamanetwork.com/data/Journals/JAMA/4884/JOC30288.pdf
18. FHs CG Innovation forMaternal DepressionGiven the link with
stunting -- FH plans to test ways toprevent/treat depression
through Care Groups Weve used DBC/BA with Care Group projects to
find outhow 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 differencein behavior change and outcomes in CG
projects?We welcome others to study this too, and encourage you
toshare your results! 19. Ideas for testing IPT-Gwith Care GroupsA)
Option #1: Run IPT-G process through regularCare Group structure,
separate process fordepressed and non-depressed.B) Option #2: Run
IPT-G groups simultaneously withCare Groups for prev/tx of
depression (separatestaff running separate groups, with CGVs
helpingto identify women who could benefit). Separateprocess 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
ChangesTOPS/ FSN Network Care Groups Implementation Manual
(andTrainings): See..
http://fsnnetwork.org/event/care-groups-implementation-trainingThe
manual includes a Care Group OR annex here are the areasthat can be
explored with that: Process vs. plan Care Group Volunteer
motivation Changes in depression and generalized self-efficacy
involunteers and beneficiaries Changes in Intimate Partner Violence
Changes in respect for women (volunteers andbeneficiaries) 21.
InnovationsPresentations PCI / WR: Care Groups + Savings
Groupsinnovation PCIs "Trios" Care Group innovation Concern
Worldwides Integrated Care Groupinnovation Q&A, 2-3 mins after
each presentation Generating operations research questions
(20-30mins) 22. Operations ResearchQuestions Split into three
groups Generate a list of the most interesting and important
questions thatneed to be answered regarding Care Groups. Consider
questions about: Effectiveness for specific purposes (e.g.,
reducing newborndeaths, lowering IPV/GBV, increasing social
capital, improvingdisaster response) vs. other models How they work
(mechanisms more trusted source of info?Problem-solving / removing
barriers? Decreasingdepression/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. AcknowledgmentThis presentation was made
possible by thegenerous support of the American peoplethrough the
United States Agency forInternational Development (USAID).
Thecontents are the responsibility of Food for theHungry and do not
necessarily reflect the viewsof USAID or the United States
Government.
