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Care GroupsIntroduction

Web X SessionJune 2, 2009

Lauren Erickson-Mamane

APCD Health – Peace Corps Benin

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The main idea: Care Groups improve behavior change and build a sustainable community-level structure for health promotion.

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What are Care Groups?What are Care Groups?A community-based A community-based strategy for improving strategy for improving coverage and behavior coverage and behavior changechangeDeveloped by Dr. Pieter Developed by Dr. Pieter Ernst with World Relief/ Ernst with World Relief/ Mozambique, used Mozambique, used subsequently by various subsequently by various international development international development organizations.organizations.Focuses on building teams Focuses on building teams of volunteer women who of volunteer women who represent, serve, and do represent, serve, and do health promotion with health promotion with blocks of eight to fifteen blocks of eight to fifteen households eachhouseholds each

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A group of 5-10 volunteer community-based health educators who regularly meet together with PCV and their counterpart for training, supervision and support.

Examples: Care Group Leader Mothers in Child Survival programs and Leader Youth in HIV/AIDS project

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What is a Care Group, and Why Care Groups?

Objective:1. Define the concept of a Care Group

as a strategy to achieve a large scale coverage

2. Appreciate the advantages of the Care Group model vs. the traditional community health agent model

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Why Care Groups?

How does the traditional community health agent model function?

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Why Care Groups?The traditional community health agent:

Covers wider geographic area

Work responsibilities often demand full time

High turnover of health agents due to a high workload

Usually hand picked and leaves their responsiveness & representation questionable

Task mainly on health tasks (GM/P)

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How are Care groups organized?Households with children <5 years and pregnant women are identified by a census and grouped in blocks of 10.

One volunteer Leader Mother is selected from each block in a village; she is responsible for visiting the 10 HH in her block.

10 Leader Mothers volunteers form a Care Group that meets every two weeks .

A health promoter (PCV Homologues) and the PCV trains the volunteers during their Care Group meetings, teaching lessons that the Leader Mothers pass on to other mothers during home visits.

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Potential PCV Care Group Model

PCV Volunteers + Counterparts

PCV #2

PCV #3

PCV #5

PCV #1 PCV #4

Each PCV & their counterpart educates and motivates 1-3 Care Groups. Each Care Group has 10 Leader Mothers.

Care Groups

10 Leader Mothers

10 Leader Mothers

10 Leader Mothers

Each Leader Mother educates and motivates pregnant women and mothers with children 0-5 years of age in 10 households every two weeks (then monthly).

10 families

10 families

10 families

10 families10 families

10 families

10 families

10 families

10 families

10 familiesWith this model, one RCH volunteer and their counterpart can cover 100 – 300 Families.

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Example of Topics Covered During Care Group Meetings1. Nutrition

educationBreast feedingSupplementary feedingPromotion of Vit. A rich foods, Iron rich food, vegetables, etc.Nutrition during pregnancy

2. Health educationMalariaSanitation & HygieneManaging diarrhea ARI ImmunizationsReproductive health: Family planningSTDs and HIV/SIDA

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Other Care Group Activities

3. Growth Monitoring & Nutrition rehabilitation using the “PD/Hearth” model

4. Campaigns – LLTIN distribution, Vitamin A capsules & Deworming

5. Data Collection

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What happens during Care Group meetings?

• Songs, dramas, • Verbal reporting of vital

events and illnesses• Discussion of progress and

challenges in health promotion

• Education aided by pictures (flip charts), stories, songs and dance

• Recap of the week’s key messages

• Leader Mothers (volunteers) practice sharing what they have learned

• Meetings last about 2 hours

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What happens after Care Group Meetings?• Each Leader Mother

visits “her” 10 households during the following two weeks.

• Each Leader Mother educates her mothers and caregivers on the key messages for the month using flip charts

• Leader Mothers can work on mothers’ current concerns. Leader Mother can seek input from their promoter if they are unsure of how to deal with a difficult situation

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What else do Leader Mothers do?

Care group volunteersmobilize mothers for:

Mosquito Net Distribution

Immunization

Vitamin A distribution

Growth monitoring

Deworming

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Sample Leader Mother Data Collection Tool

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Monitoring and Evaluation

• Oral reports on specific households are given at Care Group meetings.

• PCVs and Promoters collect information from each Care group and submit quarterly reports to Peace Corps and the Health Centers in their communities

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PCVs and Health Promoters facilitate the Care Group process

Live in the communities where they workTrain and supervise Leader Mothers in up to 3 different Care Groups.Health Promoters may provide distribution of services like Vitamin A and deworming tabs.Establish relationships with village leadershipHelp form Village Health Committees Trains the Leader Mothers during their Care Group meetings,Collect and analyze Health Data from Leader Mothers

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What have the results of Care Groups shown?

Dramatic, rapid changes in Knowledge, andKnowledge, andPracticePractice

For Example….

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Food for the Hungry International/ Mozambique

Case Study on Care Case Study on Care Groups:Groups:A methodology for Sustainable A methodology for Sustainable Improvements in Nutritional StatusImprovements in Nutritional Status

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ORT

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Exclusive breastfeeding...

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And dramatic, rapid changes in coveragecoverage

Such as….

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Vitamin A coverage...

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Deworming...

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Each woman visits “her” 10-15 households during the following two weeksCG women educate their mothers on the key messages for the month using a small B&W flipchart“Key messages of the week” are almost always discussed, but CG members can work on mothers’ current concern, as wellSometimes CG members pair up to do education

Each woman visits “her” 10-15 households during the following two weeksCG women educate their mothers on the key messages for the month using a small B&W flipchart“Key messages of the week” are almost always discussed, but CG members can work on mothers’ current concern, as wellSometimes CG members pair up to do education

Each woman visits “her” 10-15 households during the following two weeksCG women educate their mothers on the key messages for the month using a small B&W flipchart“Key messages of the week” are almost always discussed, but CG members can work on mothers’ current concern, as wellSometimes CG members pair up to do education

And decreases in disease prevalence

Such as….

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Diarrheal prevalence...

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Malnutrition (stunting, stat. sig.)...

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Malnutrition (severe stunting, stat. sig.)...

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Impact -- Decrease in Child Mortality:A study by Johns Hopkins University (conducted in conjunction with World Relief and Food for the Hungry) found that child deaths decreased by 62% in areas where Care Groups were used.

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Decrease in Child Mortality:

A study by Johns Hopkins University (conducted in conjunction with World Relief and Food for the Hungry) found that child deaths decreased by 62% in areas where Care Groups were used.

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How is sustainability encouraged?

Responsibilities are phased over from the health promoter to Care Group Leader Mothers

During the final evaluation all groups have expressed “high level of confidence” that they would continue after the project phases out.

One year later, over 90% care groups were still doing home visits.

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Small Group Exercise

What are the things that make this model successful? What’s different about it?

What are the benefits of this model as compared with others you have seen or used?

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Why are Care Groups so successful?

1) The unit of work and analysis is a neighborhood or part of a neighborhood instead of an entire community. It builds on small groups of 8-10 members. Many other community structures and community-building organizations have experienced the fastest growth when built upon on intensive use of small groups

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… Why are Care Groups so successful?

2) Social support is increased so fewer incentives are needed, drop-out is lower, less retraining is necessary, and more happens outside of meetings.

Meetings have a social as well as health purpose.

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… Why are Care Groups so successful?

4) Care Group members really “know their households”. Behavior change and identification and follow-up of defaulters is easier.

5) More highly-trained health workers are used more efficiently in a multiplier model.

3) Tasks for community-level volunteers are light (i.e., one home visit per day on average). “Doing less more often” is a useful strategy for populations where literacy is low and volunteers have little free time.

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Benefits of Using Care Groups 1) Effective in boosting knowledge and

practice levels.

2) Assures equitable access at the community level.

3) Improved sustainability by creating better self-sustaining structures at the community level, and better ties among community leaders, health facilities, and CHWs.

4) Care Groups provide an ideal structure for implementing the Hearth Nutritional Rehabilitation model and other positive deviance approaches.