Care Groups and Income GenerationLessons Learned from World Relief Rwanda Umucyo CSP (2001-2006)

Melanie Morrow & Melene KabadegeCORE Group Spring MeetingApril 23, 2013

World Relief’s Umucyo CSP Location: Nyamasheke District, Western Province, Rwanda

(Former Kibogora Health District)

6 Interventions: Malaria, HIV/AIDS, Nutrition and Breastfeeding, Diarrhea, Immunization, and Maternal & Newborn Care.

Total Population: 152,981 people in 29,166 HH

Care Groups: >2800 Volunteers in 202 Care Groups; HH visits 2x/mo

Persistent Request: “We want to do income generating activities!”

Backstop Fears: “The project will lose focus!”

Care Groups and Income GenerationWorld Relief Rwanda Umucyo CSP (2001-2006)

What happened instead, after midterm: Care Groups registered as formal associations, were trained in financial record keeping, opened bank accounts. (CS staff trained by Urwego, WR’s microfinance institution, to train CG associations).

Association Governance: President, VP, Secretary & Treasurer Different from CG leadership (division of labor) but business transacted during CG Meeting, after health agenda.

Care Group Volunteers = Social Marketing Sales ForceORS packets, ITNs, water chlorinationGrowth Monitoring

Each CG Volunteer tracked the stock and sales of a separate item, with signoff from the treasurer. Other special roles: Hearth, GMP

Care Groups and Income GenerationWorld Relief Rwanda Umucyo CSP (2001-2006)

More of what happened…Additional IGAs: animal husbandry, crafts, joint crop harvest and sale, selling small fish procured trips to the lake, etc.

Annual Volunteer Incentives: Care Groups requested investment in Associations (e.g. a pair of goats) over individual volunteer incentives.

Savings and Loan: CG volunteers contributed their personal savings on a monthly basis; After one year from savings and IGA, the associations were allowed to make their first withdrawals. Many chose to make small loans to members at terms set by the association (3% over a three month period). Some associations chose to lend money specifically for school fees for members’ children.

Care Groups and Income GenerationWorld Relief Rwanda Umucyo CSP (2001-2006)

Using the Revenue

Every three months, the associations reviewed their earnings and

decided how to use the revenue:

Health insurance membership,

Buying agreed items for members (soap, cloth, etc.)

Contributions to PD/Hearth menu to benefit children in Hearth

Reinvestment

e.g. “Ambulance Hammock” rental for emergency transport

Care Groups and Income GenerationWorld Relief Rwanda Umucyo CSP (2001-2006)

Assets and Achievements

Project Input for Annual Incentives: 836 goats

Care Group Association Assets after two years:

1,443 goats, 9 cows, and $13,000 USD cash (in RWF)

Sustainability: 6+ years post-project: 11% (23/202) CG Assoc. still active

ITN Coverage (CG Associations sold subsidized ITNs)

*Prior to national campaign for mass distribution later in 2006

Care Groups and Income GenerationWorld Relief Rwanda Umucyo CSP (2001-2006)

ITN use prior night Baseline 2002 Final 2006* DHS 2005, Western Prov.

Children 0-23m ~2% 70% 12% (U5)

Pregnant women ~2% 78% 16%

Project Impact: Estimated Annual Mortality Reduction using LiST Community-based intervention packages facilitated by NGOs demonstrate plausible evidence for child mortality impact. (Health Policy and Planning, 2013: 1-13. Jim Ricca, Nazo Kureshy, Karen LeBan, Debra Prosnitz, and Leo Ryan)

From Table 5: Changes in U5MR directly measured by DHS and estimated for project area by modeling with LiST.

Measured annual decrease in U5MR (DHS)

Estimated annual decrease in U5MR modeled using LiST, ONLY PROJECT interventions modeled in LiST

World Relief Rwanda

-3.4 7.0

The annual mortality rate for the region (Cyangugu & West Province) increased according to sub-analysis of the DHS from 2000 to 2005, while decreasing in the project area from 2001 to 2006, the latter based on project intervention data modeled in LiST.

Lessons

• Start with a well-managed program• Introduce $ activities after Care Group Volunteers have

demonstrated their commitment to health aims of project and trust has been built amongst members.

• IGAs can further health objectives (sale of health-related commodities, nutritious foods)

• Financial benefits can be socially directed (PD/Hearth)

• Adding IGAs and savings to Care Groups can be an incentive to

volunteer participation rather than a distraction.

Care Groups and Income GenerationWorld Relief Rwanda Umucyo CSP (2001-2006)