Care Group Implementation: challenges and solutions World Vision India’s experience

1. Care Group Implementation: challenges and solutions World Vision India’s experience Presented by Ms. Grana Pu Selvi, Strategic Lead, Child Health & Nutrition Ms. EmershiaSharmine, Regional Technical Specialist, Child Health & Nutrition 28th August, 2018

3. (2015 – 2020)

4. Technical Program on Child Health & Nutrition Improved access and utilization of Ante Natal / Post Natal care services Improve on health seeking behavior and practicing of healthy timing and spacing of pregnancies Strengthened community preparedness for disaster mitigation & management & linkages for food access & diversification Facilitate viable poverty alleviation on initiatives for families with malnourished children Improved Maternal Child health and Nutrition (MCHN) practices towards decreasing childhood malnutrition and morbidity Improved infant Young child feeding (IYCF) practices Increased nutritionally resilient households Reducing Childhood illness and Malnutrition Strengthened systems and structures towards reduction of childhood malnutrition & morbidity Increased coverage, access utilization for sustainable WASH practices Strengthened functioning of ICDS’s Improved access to safe drinking water Hygiene and sanitation on promotion Strengthened Village Health and Sanitation Committee Strengthened adolescent health (School and Non- School)

5. Baseline assessment Note: This baseline was conducted using a 30 cluster sampling methodology across the country during March, 2016 Contd.

6. Baseline assessment Note: This baseline was conducted using a 30 cluster sampling methodology across the country during March, 2016

7. Design for Behaviour Change Barrier Analysis was conducted for the following behaviours, • Mothers of children 2 – 24 months who don’t want to become pregnant, use a modern contraceptive method. • Mothers of infants 7 – 10 months feed them semi-solid foods. • Mother of children < 5 years old defecate in a latrine all the time. The barrier analysis was done during August, 2017. The findings were framed as design for behavior change.

8. Care Group Structure Care Group Volunteer Technical Specialist Care Group Mothers group Care Group- Coordinator Promoter

9. Care Group structure in WV India Program Manager (ADP) Care Group Co-ordinator Technical Specialist – Child Health and Nutrition Community Development Facilitator Care Group Promoter Care Group Volunteer Mothers Group Providing administrative and co-ordination support Providing technical advice and handholding

10. Care group – Operational Areas WV India – CG Operational Block Odisha Narla Khariar Loisingha Sambalpur West Bengal Burdwan Nabagram Basanti Andhra Pradesh Gantyada Telangana 1. Rajapur & Balanagar

11. Outcome level indicators • Percentage of mothers who report that they had four or more antenatal visits while they were pregnant with their youngest child • Percentage of children exclusively breastfed until 6 months of age • Percentage of children under 5 with diarrhoea who received effective treatment for diarrhoea • Percentage of children receiving a minimum meal frequency

12. Care group – Implementation

13. Care group – Implementation

14. Complementary feeding & timely care seeking Handwashing and latrine use Maternal Health

15. Care Group - Reach Note: PW – Pregnant Women, MG – Mothers Group as on July, 2018

16. Barriers and Solutions • In rural villages, getting promoters as per the criteria was a concern Engaging the key stakeholders for filling the positions in addition building the skill sets as a continuous process if they do not match the expectations. • Clustering a mothers group which has different ethnic and socio-cultural background Frequent discussions with these households has resulted in uniting these mothers for a common purpose.

17. Barriers and Solutions • Mothers in urban location occupied in domestic work, limiting their availability • Limited support for the mothers from their family to meet as groups. • Poor support for the mother leaders from their respective households to visit the mothers in the neighbourhood Mothers have now gained the recognition within the family and the community, which has given them the confidence to handle these issues.

18. What’s unique • Mother leaders are constantly supported and recognized by the Anganwadi system and the village leaders. • Major gathering for the care group volunteers once in every 6 months to share their case stories, celebrate their success and show case their talents. • Developed lyrics and composing songs with the key messages, mainly the promoters and coordinators • Cooking demonstrations are done as a mass community campaign with the use of low cost nutritious food materials (traditional foods)

19. What’s Unique • Cross learning field visits for the promoters and the coordinators • Seed bank – initiated by one of the promoter. • Identifying and recognizing the suggestions and recommendations of the promoters, coordinators and mothers group. • Seen a similar momentum in the non operational areas in the blocks of Odisha state. • In-building WASH specific IEC messages in the care groups as it has reach at the household level.

20. Short term results • Mothers are able to recollect the messages • Support of mother in law and the spouse is enhanced • Mother leaders are motivated to lead discussions, visit the families and they feel recognised • Unity among neighborhood women has increased Note: WV India, started implementing Care group from March, 2017 onwards