Transcript Slide 1

Using Care Groups
for Behavior
Change in Nutrition
and Health
Tom Davis, MPH
TOPS Senior Specialist for SBC
Session Objectives
Participants will be able to:
1.
Explain the impact of behavior change on child mortality.
2.
Define Care Groups and name Care Group
characteristics.
3.
Explain the main result areas of Care Groups.
4.
Explain the rationale behind each of the Care Group criteria.
5.
List the main processes and tools used with Care Groups
(Beneficiary Planning Sheet, major programmatic inputs,
forming/working with CDCs, incentives, visual aids, lesson
plans, worldview messages, stories, the ASPIRE method,
formative research [BA and LDM Studies], Mini-KPCs, and
other Care Group monitoring tools.)
Five-day trainings on Care Groups and other coverage strategies
will be provided in 2012/2013 for FS implementers: Three
Regional Trainings and Six Country-level Trainings.
The Care Group Strategy:
A Strategy for Rapid, Equitable and Lasting
Impact for Maternal and Child Health Programs
By Carolyn Wetzel (FH Director of Health Programs ) and
Tom Davis Jr. (Senior Specialist for SBC, TOPS Project)
The Goal of Care Groups
• Create a system whereby volunteer
Community Health Workers can sustainably
do effective behavior change with pregnant
women and mothers of children 0-23m
• Reduce U5MR, MMR, and malnutrition to
contribute to the accomplishment of MDGs:
 1:Eradice extreme hunger and poverty
 3: Promoter Gender Equality & Empower Women
 4: Reduce child mortality rates
 5: Improve maternal health
 6: Combat HIV/AIDS, malaria and other diseases
Household-level Behavior
Change is Key
• A major key to successful and sustainable community
health interventions is household-level behavior change.
• Improvements in health facilities, the quality of care
provided in health facilities and the availability of
commodities are important to community health.
However…
These factors will not lead to long-term
impact on health outcomes unless there are
innovative delivery strategies using
evidence-based, community-informed
solutions that lead to individual behavior
change.
A child death is a food
security failure
Do you agree?
T ab l e 2 : Under-5 deaths that could be prevented in the 42
countries with 90% of worldwide child deaths in 2000
through achievement of universal
coverage
withdeaths
individual
Estimated
under-5
interventions
prevented
Number of
deaths (~103 )
Preventive interventions
Breastfeeding
Insecticide-treated materials
Complementary feeding
Zinc
Clean delivery
Hib vaccine
Water, sanitation, hygiene
Antenatal steroids
Newborn temperature management
Vitamin A
Tetanus toxoid
Nevirapine and replacement
feeding
Antibiotics
for premature rupture
of membranes
Measles vaccine
Antimalarial intermittent
preventive treatment in pregnancy
Treatment interventions
Oral rehydration therapy
Antibiotics for sepsis
Antibiotics for pneumonia
Antimalarials
Zinc
Newborn resuscitation
Antibiotics for dysentery
Vitamin A
Proportion of all
deaths
1301
691
587
459 (351)*
411
403
326
264
227 (0)*
225 (176)*
161
150
13%
7%
6%
5% (4%)*
4%
4%
3%
3%
2% (0%)*
2% (2%)*
2%
2%
133 (0)*
1% (0%)*
103
1%
22
<1%
1477
583
577
467
394
359 (0)*
310
8
15%
6%
6%
5%
4%
4% (0%)*
3%
<1%
Cumulative Impact of
Household Behavior Change
Interventions on Child Mortality
Reduction:
13%
7%
6%
5%
4%
3%
2%
2%
15%
57%
Jones G, Steketee R, Bhutta Z, Morris S. and the Bellagio Child Survival Study Group. "How many child deaths can
we prevent this year?" Lancet 2003; 362: 65-71.
What are Care Groups?
A community-based strategy for
improving coverage and behavior
change
 Developed by Dr. Pieter Ernst with
World Relief/ Mozambique, and
pioneered by FH and WR for the
past decade. Now used by at least
22 organization in 20 countries.
 Focuses on building teams of
volunteer women who represent,
serve, and do health promotion
with blocks of <15 households
each
Small Group Activity:
Care Group Criteria
• Divide into groups of about 5 people.
• Go through the Care Group Criteria Small
Group Questions. Write your responses on
newsprint.
• Small groups will report out responses when
we come back to plenary.
• 30 mins for this small group work. You don’t
have to finish all questions.
The Care Group Model
1
Supervisor
Promoters (example,
one district)
Each Promoter educates and
motivates 5-9 Care Groups (9 in
this example). Each Care Group
has 6-16 CG Volunteers (12 in
this example)
Care
Groups
Promoter #2
12 Leader Mothers
Promoter #1
Promoter #3
12 Leader Mothers
12 Leader Mothers
Promoter #5
Promoter #4
Promoter #6
12 Leader Mothers
12 Leader Mothers
12 Leader Mothers
Promoter #7
12 Leader Mothers
12 Leader Mothers
12 Leader Mothers
This example: “9x12x14 structure”
Each Leader Mother educates
and motivates pregnant
women and mothers with
children 0-23m of age in <15
households every two weeks.
Children in households with
children 24-59m are visited
every six months.
14 families
14 families
14 families
14 families
14 families
14 families
14 families
14 families
14 families
14 families
14 families
14 families
With this model, one Health Promoter can cover up to 2,016 beneficiary households.
Mum
Mum #1 Mum
#12
#2
Mum
Small Mum
#11
Group #3
Mum
#10
#1
Mum
#4
CGV
Mum
Mum
#1
#9
#5
Mum
Mum
Mum #6
#8
#7
Mum
Mum #1 Mum
#12
#2
Mum
Small Mum
#11
#3
Group
Mum
#10
#2
Mum
Mum #1 Mum
#12
#2
Mum
Small Mum
#11
#3
Mum
#4
Group
#3
Mum
#10
CGV
Mum
Mum
#12
#9
#5
Mum
Mum
Mum #6
#8
#7
#12
Mum
#4
CGV
Mum
Mum
#2
#9
#5
Mum
Mum
Mum #6
#8
#7
CGV
#11
Mum
#10
#11
CGV
#12
Mum
#10
CGV
#9
CGV
#7
Mum
#9
Mum
#8
CGV
#9
Mum
#4
Mum
#5
Mum
Mum #6
#7
Group
#6
Mum
#4
Mum
CGV
Mum
#9
#8
#5
Mum
Mum
Mum #6
#8
#7
CGV
#5
Mum
Mum #1 Mum
#12
#2
Mum
Small
Mum
#11
Group #3
CGV
Mum
Mum
#3
#9
#5
Mum
Mum
Mum #6
#8
#7
Mum
Mum #1 Mum
#12
#2
Mum
Small
Mum
#11
Group #3
Mum
#9
Mum
#8
#5
Mum
#10
Mum
#10
Mum
#4
Mum
#10
Mum
Mum #1 Mum
#12
#2
Mum
Small Mum
#11
Group #3
Mum
Mum #1 Mum
#12
#2
Mum
Small Mum
#11
#3
CGV
#4
CGV
#6
Mum
#4
CGV
Mum
Mum
#10
#9
#5
Mum
Mum
Mum #6
#8
#7
CGV
#3
Prom
CGV
#8
Group
#4
CGV
#1 CGV
#2
Care
Group
CGV
#10
Mum
Mum #1 Mum
#12
#2
Mum
Small Mum
#11
Group #3
Mum
#4
Mum
CGV
Mum
#9
#11
#5
Mum
Mum
Mum #6
#8
#7
Mum
Mum #1 Mum
#12
#2
Mum
Small Mum
#11
Group #3
Mum
#10
Mum
Mum #1 Mum
#12
#2
Mum
Small Mum
#11
#3
#10
CGV
#4
Mum
#4
Mum
#5
Mum
Mum #6
#7
Mum
Mum #1 Mum
#12
#2
Mum
Small
Mum
#11
Group #3
Mum
#10
#9
Mum
#4
Mum
CGV
Mum
#9
#5
#5
Mum
Mum
Mum #6
#8
#7
Mum
Mum #1 Mum
#12
#2
Mum
Small
Mum
#11
Group #3
Mum
#10
#8
Mum
#4
CGV
Mum
Mum
#6
#9
#5
Mum
Mum
Mum #6
#8
#7
Mum
#10
#7
Mum
#4
Mum
CGV
Mum
#9
#7
#5
Mum
Mum
Mum #6
#8
#7
Who is Using Care
Groups?












ACDI/VOCA
ADRA
Africare
American Red Cross
CARE
Concern Worldwide
Catholic Relief Services
Curamericas
Emmanuel International
Food for the Hungry
Future Generations
GOAL










International Aid
International Medical Corps
International Rescue
Committee
Medical Teams
Interenational
Pathfinder
PLAN
Salvation Army World
Service
Save the Children
World Relief
World Vision
Where are Care Groups
being Used?










Bangladesh
Bolivia
Burkina
Faso
Burundi
Cambodia
DRC
Ethiopia
Guatemala
Haiti
Indonesia

Kenya

Liberia

Malawi

Mozambique

Niger

Peru

Philippines

Rwanda

Sierra Leone

Zambia
What works in behavior change?
Findings from Powerful to Change
Studies

CORE SBCWG compared low and high performers for several
behaviors (e.g., exclusive BF, hand washing with soap) – what
works?
1.
Using formative research (e.g., positive deviance
studies, Barrier Analysis, Trials of Improved Practices) to
find the determinants of behaviors and to choose the
right messages/activities; and
2.
Using a comprehensive coverage strategy: Using
systematic home visitation or Care Groups to reach
almost all beneficiaries very often (e.g., 95% every two
weeks).
Care Groups Outperform in Behavior Change:
Indicator Gap Closure: Care Group Projects
vs. CSHGP Average
Indicator Gap Closure on Rapid Catch Indicators:
Care Groups CSHGP Projects vs. All CSHGP Projects
All CSHGPs, 20032009 (n=58)
90
77
80
71
70
63
59
53
52
51
50
41
40
53
49
39
37
35
32
30
20
10
RapidCATCH Indicator
lR
ap
id
Al
W
S
HW
IT
N
Da
ng
er
Si
gn
s
In
cF
lui
ds
AI
DS
Kn
ow
ea
s le
s
M
lV
ac
s
Al
ee
d
EB
F
2
TT
SB
A
Co
mp
F
Bi
rth
Sp
ac
0
Un
de
rw
t
Percent
60
CSHGP using Care
Groups (2003-2010,
n=9)
Gap closure
range in non-CG
projects ~25 –
45%
(Avg. = 37%)
Gap closure
range for Care
Group projects:
~35 – 70%
(Avg = 57%)
Care Groups and Estimated Reduction in
Child Deaths
Care Group Performance: Perc. Reduction in Child Death Rate (0-59m)
in Thirteen CSHGP Care Group Projects in Eight Countries
(Green line = average of USAID child survival programs)
am
bo
W di a
R
/V
W ur
R
/V I
FH W
u
/M R/V r II
oz
ur
(
W Be IV
R
/C ll ag
am i o
)
W bod
R
ia
W /Ma
R
/M la w
W ala i
R
/R wi I
C wa I
ur
am nd a
Pl ./Gu
SA a n
a
W /K t
SO en
/Z ya
am
Av
M
b
g.
C TI/L i a
ar
e i be
ri a
G
r
Av p P
g
C roj .
S
Pr
oj
.
AR
C
/C
% Red. U5MR
60%
48%
50%
41% 42%
34%
40%
33%
33%
32%
30%
29%
28%
26%
30% 23%
14%
14%
20%
12%
10%
0%
CSHGP Project
Series1
Care Groups Can Bring about
Rapid and Significant Changes in BF Behavior
Percent of infants aged 0-5 months who were fed breastmilk
only in the last 24 hours
Child Survival Project Sofala, USAID Mini-KPC Data
02/06 to 12/09
95%
100%
90%
75%
80%
Percentage of
infants aged 0-5
months who were
fed breastmilk
only in the last 24
hours
Target
67%
70%
60%
Target 60%
50%
40%
30%
20%
17%
10%
0%
Feb 2006
Baseline
May-06
Sep-07
Dec 07
Midterm
(22m)
Care Groups Can Bring about
Rapid and Significant Changes in Health Service Coverage
Percentage of children 12-23m who have received de-worming
medication in the last six months
Child Survival Project Sofala, USAID Mini-KPC Data 02/06-12/07
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
86%
83%
68%
Target 75%
Target
24%
Feb 2006
Baseline
Percentage of
children 12-23 months
who received
deworming medication
in the last six months
May-06
Sep-07
Dec 07
Midterm
Care Groups Can Bring about
Rapid and Significant Changes in Feeding Behavior
Percentage of children 6-23m who have consumed at least one
vitamin A rich food in the previous day
Child Survival Project Sofala, USAID Mini-KPC Data 02/06-12/07
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
95%
83%
87%
Target 80%
29%
Feb 2006
Baseline
May-06
Sep-07
Dec 07
Midterm
Percentage of
children 6-23m who
have consumed at
least one vitamin A
rich food in the
previous day
Target
Care Groups Can Bring about
Significant Changes in Feeding Behavior
FH-Moz CS Final Eval, Changes in Food Consumption,
Children 6-23m of age, 2005-2010
Added oil to meal
Foods
3+ meals/snacks consumed past day
Food made with other oil, fat or butter
Nuts
Foods made from beans, peas, or lentils
Fresh or dried fish or shellfish
Eggs
Other fruits or vegetables
Ripe mangoes or papayas
Dark green leafy vegetables
Vitamin A foods starches/vegetables
Potatoes, manioc, & other roots
Foods made from grains
Soup (intended decrease)
-60%
Area B
Area A
-40%
-20%
0%
20%
40%
60%
Percent Point
Changes in Consumption
80% of these are statistically-significant changes
Care Groups Can Bring about
Rapid and Significant Changes in Health Service
Utilization (FH/Moz)
Institional Births in Project Districts and Comparison Districts
6000
5000
4000
Caia,Chemba, Marin
(Proj Dists)
3000
Buzi, Chib (Comp
Districts)
2000
Number of Births
1000
0
1s 2006
1s 2007
1s 2008
Oct09-Mar10
Source: Moz MOH
Time Period
Care Groups Can Bring about
Rapid and Significant Changes in Impact
(Underweight reduction, Feb ‘06-July ’10, FH/Moz)
FH/Moz CS Final Evaluation: Changes in Underweight (WAZ<-2)
29.5%
26.2%
30.0%
20.5%
19.6%
25.0%
20.0%
15.0%
Over a five
year period
Over a 20
month period
Baseline
Final
10.0%
5.0%
0.0%
Area A
22% reduction
Area B
34% reduction
What about sustainability??
•
The plan: Interventions phased in then responsibilities slowly shifted
from project-paid Promoters to MOH staff or Care Group leaders.
Actuality: CG Volunteers continue home visits on their own, and
sometimes meet together.
•
WR Data from Gaza Province, Mozambique: 93% of the 1,457
volunteers active at the end of WR’s Care Group project were active
meeting with mothers or doing home visits with flipchart 20 months
after end of project.
•
Out of the vacant roles, communities replaced 1/3 of them and trained
them on their own.
•
Changes brought about in the original program were maintained: A
full 45 months after the end of the project (all interventions and
funding ceased), final program goals on eight key indicators continued
to be exceeded.
Sustainability of Final Indicator Levels Four-Years Post-Project in the
WR-Mozambique Care Group Project: Home Care of Sick Children
(Note: Black line is project goal. Red line is actual indicator levels.)
Children with Diarrhea Treated with ORS
45m postproject
100
90
80
70
60
50
40
End of Project
30
20
10
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Sustainability of Final Indicator Levels Four-Years
Post-Project (WR-Mozambique Care Group Project):
Preventive Services
Children 12-23m Completely
Vaccinated
45m postproject
100
90
80
70
60
%
50
End of Project
40
30
20
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Small Group Brainstorm



Divide into same small groups and
brainstorm a list of WHY you think
Care Groups are outperforming other
behavior change methods.
This list can include anything that we
can/should apply to other behavior
change approaches.
15 mins for this small group work.
Time Contribution (in hours) by Type of Project Staff
FH/Mozambique Care Group Project
October 2005 – September 2010
Community driven …
80% of the work was done by Care Group Volunteers, and 97% by
community members (CGVs + Promoters).
Other Care Group Best Practices
• Have the neighbors in the 5-14
households that the CGV will
serve (visit and teach) elect the
CGV.
• Contact with beneficiary mothers
by the CGV can be through group
meetings but also through
individual home visits. (In FH/Moz
CG Project, 70% of CGVs had
contact with their mothers mostly
or exclusively in group settings,
and 30% had contact with
beneficiary mothers
mostly/exclusively through
individual home visits.)
Regardless, home visits are made
to meeting defaulters.
• Groups should be facilitated by
paid Promoters or other
health/nutrition staff.
Other Care Group Best Practices
•
Care Group Volunteers should not
be paid, but only receive very
infrequent small non-monetary
incentives like wrap-around skirts
every two years. Respect is
probably the most important
incentive. (See
www.CareGroupInfo.org)
•
Turnover of Care Group
Promoters and Volunteers has
generally been very low when
incentives are used in this way.
•
Training of Care Group members
should be done in the community
(at low cost).
A Care Group Promoter
Other Care Group Best Practices
• Messages – including gender
messaging – should also be
communicated to other family
members, daughters in
particular. Changes in
relationships and genderbased violence are sometimes
seen.
• Low Cost: By using this
cascading structure, for the
entire FH/Mozambique CG
project, the cost per
beneficiary per year was USD
$2.78. (The cpb range for nine
CG projects was $2.78 - $7.91;
average was $5.77.)
A Beneficiary Mother
Gender Equity Improvements:
Respect
Selected Gender Indicators measured in the Care Group O.R. KPC
% of CGVs who say they have gained more respect from.. since they
began participating in the project
… from health facility personnel
…from their extended family
… from their parents or husbands’ parents
… from their husbands
… from their community leaders
… from their mothers / other women / mother beneficiaries
% of CGVs who say that it is okay for a husband to hit his wife if he is
not satisfied with her (final level shown; baseline was ~64%)
Mother
Leader
25%
41%
48%
61%
64%
100%
3%
Wetzel, C, Davis Jr., T. Results of Care Group Operational Research conducted April to May 2010 as part of the project:
Achieving Equity, Coverage, and Impact through a Care Group Network. Funded by USAID, Cooperative Agreement: GHSA-00-05-00014-00.
How can your
Organization Use Care
Groups?
Design and
Implementation
of Care Groups
Projects
By Carolyn Wetzel (FH Director of
Health Programs ) and
Tom Davis Jr. (Senior Specialist for
SBC, TOPS Project)
“How To” Topics
•
•
•
•
•
•
•
•
•
•
Major Programmatic Inputs
Use of the Care Group Beneficiary Worksheet
Use of Community Development Committees
Use of visual aids
Use of worldview messages
Use of lesson plans
Use of stories
Use of the ASPIRE health promotion method
Use of formative research
Use of Mini-KPC surveys
NOTE:
• The Care Group Difference manual is available at CORE Group website
and www.CareGroupInfo.org.
• Three Coverage Strategies / Care Group Regional Trainings and six
country-level trainings to be offered by TOPS in the coming years
(beginning FY13).
What you Need:
Major Programmatic Inputs
• One paid Promoter minimum (7th grade education or higher)
per 2,016 beneficiary households, and one Supervisor (nurse)
per 7-10 Promoters.
• 4-5 day training on each module (module taught in Care
Groups in a 2-3m period), 3-4 trainings/year for first two
years. Often 8-12 modules. C-IMCI training, optional.
• Color health promotion materials (e.g., flipcharts or cards) for
Promoters and CGVs, bicycles for Promoters, Motorcycles for
Supervisors, and some supplies for beneficiaries (e.g., vitamin
A, deworming meds).
• One Program Manager, 0.5 FTE M&E staff, 1 FTE Trainer is
helpful, 0.25-0.75 FTE HQ backstop is common.
• MOH involvement (coordination, joint supervision, etc.) is very
helpful and may increase sustainability.
Planning Care Group
Staffing/Volunteers
Click to Open
Forming or working with
Community Development Committees
• Formed in each area with a Care Group – comprised of men,
women, religious leaders, political leaders, etc. Try to include
at least one CGV if not one from each CGV in the area.
• Leadership training provided, often includes Participatory
Rural Appraisal and the development of a community
workplan.
• Role:
– Taking responsibility and ownership in planning and implementing
community development activities
– Encouraging and supporting existing community groups (Care Groups,
Farmer Field School groups, others)
– Advocacy for community needs to wider community and district
governance structures
• May require additional staffing
Purpose of Visual Aids used in
Care Groups
Purpose of the visual aids is NOT primarily to
teach new facts, but to change BEHAVIOR and
help GUIDE THE CGV in what they promote.
To assure this happens, you should:
– Teach Promoters and CGVs in the use of simple
non-formal education techniques, and
– Conduct Formative Research to modify the
curricula according to (1) what is driving
malnutrition and (2) what barriers exist to
behavior change.
Use of Worldview Messages
• Worldview messages relate to how one views life
including the environment, germs and people, and can
block people from practicing healthy behaviors.
• Teaching people new prevention practices sometimes
will not be enough – sometimes new perspectives on
life are needed.
• Example: “I can change, and I can and should be an
agent of change in my community.”
What is done in the CG Meeting?
Example Lesson Plan Outline
• Game (e.g., Germ in the Circle; blindfolded tag game)
• Take attendance and Troubleshooting
• Share the story and ask about current practices:
Hardship (boy’s name) Has Diarrhea
• Show pictures and share key messages on flipchart pages
6-11 about diarrhea transmission, care and treatment.
• Activity: Dehydration Demonstration (with water in bag)
• Probe about possible barriers and help them to find
solutions (inform)
• Practice with flipchart and Coaching in a small group
• Request a commitment
• Examine previously promoted practices (e.g., going to a
GM/P post).
Use of Open-ended Stories
• Open-ended stories are usually used in FH’s Care Groups. The
ending is provided by the participants.
• Open-ended stories get people to imagine their response to a
situation, and to reflect on what they know and believe.
• Open-ended stories help people to talk about difficult
situations without people taking the discussion personally.
• Consider using a wise mother and a new mother in stories.
• Lessons usually begin with a story: Usually Mother B
practicing an unhealthy behavior or having a problem and
needing help.
• The discussion after the story gives participants a chance to
discuss Mother B’s behavior and give her advice.
Non-formal education techniques:
The ASPIRE Method
• A– Ask about mothers’ current practices based on a
discussion about Mother B’s situation.
• S – Show/Share key messages from the flipchart pages.
• P – Probe, asking the mothers and families what they think
about these practices and barriers to adoption. Is there
anything that would prevent you from doing [these
practices]?
• I – Inform them of ways to overcome the barriers mentioned;
clarify misunderstandings.
• R – Request a verbal commitment to the new practices
(however, they can say NO – it is their choice to decide; don’t’
ask unless they sound interested).
• E – Evaluate their past behaviors related to the last session –
sees how they are doing keeping these commitments.
How ASPIRE is Integrated into the
Lesson Plan
Section name
Time needed
for this section
Game
Attendance and Troubleshooting
Ask about current practices after Story (pic. 1)
Show/share key msgs and Explain (picture 2)
Show and Explain (pic.3)
Show and Explain (picture 4)
Activity (e.g., demonstration)
Probe (about ideas on behavior and barriers)
Inform (on ways to overcome barriers)
Practice and Coaching
Request (a commitment)
Examine (previously promoted practices)
10 minutes
15 minutes
10 minutes
5 minutes
5 minutes
5 minutes
15 minutes
10 minutes
5 minutes
20 minutes
2 minutes
5 minutes
1 hour, 50
minutes
Pictures in Flipchart Remind CGV
of ASPIRE Steps
Ask about mothers’
current practices
Probe mother’s
ideas and barriers
Show/Share key
messages
Request a verbal
commitment
Alternative to ASPIRE
1. Ask about Current
Behaviors
2. Show/Share key messages
3. Prober for Barriers
4. Request Commitments
Using the Curricula
• See Sample Care Group Lesson Plan List Handout –
Many lesson plans available on curricula page of
www.CareGroupInfo.org.
• In most Care Group projects one lesson is covered
every two weeks, so if you have six lessons in a
module it will take three months to teach the
module.
• In rural areas, seasons of rain or harvest may affect
the ability of Care Groups to meet. It is
recommended that your teaching schedule be
adapted to allows for time periods of low CG activity.
Using Formative Research to adapt
curricula to local context
• What sort of formative research studies do you think are the
most helpful in developing behavior change curricula, whether
you are using Care Groups or not?
• Positive Deviance Inquiries can be useful (e.g., Local
Determinants of Malnutrition Studies) to identify the most
important behaviors to change (those linked with malnutrition).
• Barrier Analysis or Doer/NonDoer Analysis to help staff to
better understand how to successfully promote behavior change
by identifying the most important barriers to change. (Also used
Verbal Autopsy and HF Assessment in Moz.)
• Barrier Analysis will be discussed on Thursday, 2:00p, as part
of the Designing for Behavior Change session.
• Narrated presentations on Care Groups, LDM Studies, and
Barrier Analysis available at www.CareGroupInfo.org.
Important BF Results of a
Local Determinants of Malnutrition Study
(Mozambique)
45% of mothers of
PD children said that
they usually or
always completely
emptied their breasts
when breastfeeding
their PD child.
Only 10% of mothers of
malnourished children said that
they did usually or always do so.
(p=0.006) The odds ratio for this
variable was 7.09 (1.36 < OR <
46.45) meaning that mothers of
PD children were about seven
times more likely to do this.
KEY Message:
When breastfeeding a
child, it is important to
always completely empty
each breast so that the
child gets all of the
calories and nutrients that
they need.
KEY MESSAGE:
The Milk Changes during Breastfeeding. The
longer the child breastfeeds on one breast the
richer the milk becomes in protein and fat.
The FIRST
milk
(watery
milk)
The
SECOND
Milk
(normal)
The THIRD
Milk
(creamy)
Important BF Results of a
Local Determinants of Malnutrition Study
(Mozambique)
67% of mothers of PD
children vs. 32% of
mothers of malnourished
children took at least one
month of iron
supplements during the
months that they were
breastfeeding.
The odds ratio for this variable
was 4.05 (0.99<OR<18.83).
Mothers of PD children were
more than four times as likely to
take iron supplements during
breastfeeding as were mothers of
malnourished children.
KEY Message:
All mothers should take
iron supplements during
pregnancy and while
lactating as a way to help
their children grow.
Monitoring of Care Groups:
Mini-KPCs
• Development projects typically measure impact and
progress toward targets at midterm when only 40%
of the project is left to be completed.
• Mini-KPCs can be used to to improve program
effectiveness by targeting indicators that are not
improving as expected.
• Mini-KPC’s are short surveys that are conducted
every three to twelve months.
• Survey results can be easily analyzed by field offices
and the results quickly obtained to inform program
decisions.
Complete vs Mini KPC
Complete KPC
Mini-KPC
• Include many questions (+/60)
►
Includes 12-20 question (23 page questionnaire)
• Require large amounts of
staff time for training,
implementation, and
analysis
►
Is done frequently, so after
the initial training can be
easily implemented and
analyzed.
• Attempts to provide
information that allows for
a program (or program
area) to be completely
assessed or evaluated.
►
Staff with little statistical
training can do the analysis
and quickly use the results.
LQAS often used.
►
Attempts to provide
frequent feedback about
specific aspects of a
program.
Mini-KPC Example
• The results of the December 2007 mini-KPC indicated
that children 6-23m receiving 3+ meals a day was
below target in 2 of the 5 project districts.
Child ate solid or semi-solid foods 3+ times last 24h
19
20
Decision Rule is 10 for
proj. target of 65%
15
15
13
8
10
7
5
0
Manga
Caia
Marromeu
Chemba
Maringue
Child ate solid or semi-solid
foods 3+ times last 24h
Mini-KPC Example
• Program management realized that unless
feeding frequency was increased the project
goal of decreasing malnutrition would not be
reached.
• The team decided that more health
promotion and skill building needed to be
done in promoting snacks for children.
• Created snack recipes and shared them with
mothers.
Mini-KPC Example
One Year Later
Child ate solid or semi-solid foods 3+ times last 24h
12
11
10
10
11
10DecisionDecision
is 9
Rule isRule
8 or
10 for proj. target
of 65%
8
8
6
September 2008
4
2
0
Manga
Caia
Marromeu
Chemba
Maringue
Monitoring of Care Groups:
Other Tools
• Main monitoring tool should be the Mini-KPC
looking for behavior change.
• Promoter Monthly Report and Program
Manager Monthly Report
• Quality Improvement and Verification
Checklists: Full session on use of QIVCs on
Thursday at 4:00p
Your Questions on…
•
•
•
•
•
•
When to use and not use Care Groups?
Incentives?
Developing lesson plans and flipcharts?
Promoter’s, CGV’s, or Supervisor’s role?
Monitoring CGs?
Anything else?
Remember:
Respond to the call for participants for the three
regional and six country-level five-day skill-building
trainings on Care Groups and other coverage
strategies that will be provided in 2012/2013 for FS
implementers
This presentation was made
possible by the generous support
of the American people through
the United States Agency for
International Development
(USAID). The contents are the
responsibility of Save the Children
and do not necessarily reflect the
views of USAID or the United
States Government.