Transcript The integrated Care Group model

The Integrated
Care Group
Model
Supporting the
Burundi Ministry of
Health to deliver
quality health
communication at
scale
Gwyneth Cotes,
Health Support Unit
Community Health Workforce in Burundi
• Emerging from 13 years of conflict, Burundi has
limited experience in developing a community
health workforce
• The MOH is developing a community health
strategy, and holding elections for Community
Health Workers in each village
• CHWs receiving insufficient training and support
through uncoordinated efforts
• As a result, basic preventive and curative health
services are not readily available at the
community level
Strategic Health Communication
Effective behaviour change communication:
• Is multi-channeled; understanding and adoption
increases with the frequency and types of contacts
used to disseminate them (dose effect).
• Involves negotiation; caregivers feel their child’s
particular situation has been taken into account
• Can be expanded to scale
(Source: Victora, C.G., Fenn, B., Bryce, J. Kirkwood, B.R. Co-coverage of prevention interventions and
implications for child survival strategies: evidence from national surveys. Lancet 2005, Volume 366, Issue 9495,
Pages 1460-1466).
Mabayi District Child Survival Program:
The integrated Care Group model
• Baseline assessment found low coverage of key household
health behaviours
• The Care Group Model was identified as a powerful strategy
for community mobilization for widespread behaviour change
suitable to the context of Mabayi District.
• The project staff structure was recognized to be unrealistic
for the MOH to maintain after the life of a donor/NGO project.
Source: Philip Wegner, Concern Worldwide
Basic Description of a Care Group
A Care Group is a group of 10-15 volunteer community health educators who meet
regularly with a group leader for training, supervision and support.
• Care Groups are different from typical “Mother’s
Groups” in that each volunteer is responsible for
regularly visiting 10-15 of her neighbors, sharing
what she has learned.
• Goals are set for the group as a whole,
encouraging volunteers to support one another
• Household visits are targeted to the primary child
caregiver, usually a mother, but all family members
are invited to participate in the home visits
Magbontho Village School
Preliminary results
• 305 Care Groups formed as of October 2011, made up of 3,010 volunteers
• 74% of households with children <5 years of age or women of reproductive age have
received at least one household visit by a Care Group Volunteer per month in the previous
quarter (June-August 2011).
• Health facility staff (Titulaires) hold monthly training sessions for Community Health
Workers at the health centre
• Workload for CHW is approximately 12-15 hours per month, 6 hours for health facility
staff (usually shared by two staff members)
• Traditional and integrated Care Group models have achieved similar levels of
functionality thus far, in terms of regularity of meetings and reporting
• Qualitative mid-term assessment found evidence that household practices are already
beginning to change.
Future programming implications
• With the CGVs serving as “relays” for the CHWs, CWB’s Integrated Care Group Model
has been identified in national-level discussions as a promising model for implementing
a realistic community health worker strategy in Burundi.
• Need to address issue of incentives for CHWs and Care Groups
• Lobby for inclusion of CHW in performance-based financing
• Roll-out of Community Case Management is important for motivation of CHW
• Integrate C-HIS data into district HIS system
• Strengthen the link between community representatives (COSAs) and health facilities
• Ensure a viable exit strategy is in place
Thank you!
Acknowledgements:
Alyssa Davis, Health Advisor, Concern Worldwide Burundi
Jennifer Weiss, Health Advisor, Concern Worldwide US
Rosalyn Tamming, Head of Health Support Unit, Concern Worldwide