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Care Groups. Introduction Web X Session June 2, 2009. Lauren Erickson-Mamane APCD Health – Peace Corps Benin. The main idea: Care Groups improve behavior change and build a sustainable community-level structure for health promotion. What are Care Groups?.
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Care Groups Introduction Web X Session June 2, 2009 Lauren Erickson-Mamane APCD Health – Peace Corps Benin
The main idea:Care Groups improve behavior change and build a sustainable community-level structure for health promotion.
What are Care Groups? • A community-based strategy for improving coverage and behavior change • Developed by Dr. Pieter Ernst with World Relief/ Mozambique, used subsequently by various international development organizations. • Focuses on building teams of volunteer women who represent, serve, and do health promotion with blocks of eight to fifteen households each
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
What is a Care Group, and Why Care Groups? Objective: Define the concept of a Care Group as a strategy to achieve a large scale coverage Appreciate the advantages of the Care Group model vs. the traditional community health agent model
Why Care Groups? How does the traditional community health agent model function?
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)
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. How are Care groups organized?
Potential PCV Care Group Model PCV Volunteers + Counterparts Each PCV & their counterpart educates and motivates 1-3 Care Groups. Each Care Group has 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). PCV #2 Care Groups 10 families 10 families PCV #1 PCV #3 PCV #4 10 Leader Mothers 10 families 10 families 10 Leader Mothers 10 families 10 families 10 Leader Mothers PCV #5 10 families 10 families 10 families 10 families With this model, one RCH volunteer and their counterpart can cover 100 – 300 Families.
Nutrition education Breast feeding Supplementary feeding Promotion of Vit. A rich foods, Iron rich food, vegetables, etc. Nutrition during pregnancy 2. Health education Malaria Sanitation & Hygiene Managing diarrhea ARI Immunizations Reproductive health: Family planning STDs and HIV/SIDA Example of Topics Covered During Care Group Meetings
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
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
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
What else do Leader Mothers do? Care group volunteers mobilize mothers for: Mosquito Net Distribution Immunization Vitamin A distribution Growth monitoring Deworming
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
PCVs and Health Promoters facilitate the Care Group process • Live in the communities where they work • Train 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 leadership • Help form Village Health Committees • Trains the Leader Mothers during their Care Group meetings, • Collect and analyze Health Data from Leader Mothers
What have the results of Care Groups shown? • Dramatic, rapid changes in • Knowledge, and • Practice For Example….
Case Study on Care Groups:A methodology for Sustainable Improvements in Nutritional Status Food for the Hungry International/ Mozambique
And dramatic, rapid changes in • coverage Such as….
Each woman visits “her” 10-15 households during the following two weeks • CG 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 well • Sometimes CG members pair up to do education • Each woman visits “her” 10-15 households during the following two weeks • CG 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 well • Sometimes CG members pair up to do education • Each woman visits “her” 10-15 households during the following two weeks • CG 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 well • Sometimes CG members pair up to do education • And decreases in disease prevalence Such as….
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 deathsdecreased by 62% in areas where Care Groups were used.
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.
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.
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?
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
… 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.
… Why are Care Groups so successful? 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. 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.
Benefits of Using Care Groups • Effective in boosting knowledge and practice levels. • Assures equitable access at the community level. • Improved sustainability by creating better self-sustaining structures at the community level, and better ties among community leaders, health facilities, and CHWs. • Care Groups provide an ideal structure for implementing the Hearth Nutritional Rehabilitation model and other positive deviance approaches.
