logging in or signing up Care_Groups tdavismph Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 32 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: November 06, 2011 This Presentation is Public Favorites: 0 Presentation Description This video discusses the life-saving power of Care Groups. A Care Group is a group of 10-15 volunteer, community-based health promoters who regularly meet together with NGO project staff for training and supervision. Each of these volunteers then go out at least monthly to do health promotion with a small cohort of mothers of young children. They are different from typical mothers groups in that each volunteer is responsible for regularly visiting 10-15 of her neighbors, sharing what she has learned and facilitating behavior change at the household level. Care Groups create a multiplying effect to equitably reach every beneficiary household with interpersonal behavior change communication. Data from 13 projects in 8 countries show that Care Groups can cut the child death rate on average 30%, more than double that of other child survival projects. Comments Posting comment... Premium member Presentation Transcript Reducing Malnutrition and Child Deaths Using Care Groups: Reducing Malnutrition and Child Deaths Using Care Groups Thomas P. Davis Jr., MPH Director of Health Programs Food for the Hungry October 26, 2009Overview: Overview Background on two Mozambique projects using Care Groups The main challenges that we see in reducing child malnutrition and deaths What Care Groups are and how have used them. Some of the results we have seen using this model, and results of other organizations in terms of preventing child deaths and malnutrition. Sustainability of the model. How we plan to use them in our Burundi MYAP.Program Background: Program Background Food for the Hungry (FH) is a FBO working in 26 countries. Currently managing CSHGP, Title II, USDA, PEPFAR and other USAID- and privately-funded projects. (MYAPS currently in Mozambique, Ethiopia, DRC, and Burundi [sub to CRS].) USAID Title II : FY98-FY01 (first DAP), FY02-FY07 (second DAP w/extension). Mortality study examined communities involved in both DAPs: 1999/2000 to 2003/2004 in four districts of Sofala Province, Mozambique. Prime objective : Decrease chronic malnutrition in children 6-59 months of age + other behavior objectives (e.g., ↑EBF/PBF, ORT/feeding during diarrhea). Interventions : Child survival -- Nutrition, CDD, ARI, malaria, safe motherhood, HIV. Outpaced other health projects in Mozambique (and other countries) in terms of reductions in child malnutrition and speed of behavioral change.Slide 5: Cumulative Impact of 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.The Challenge: The Challenge To decrease child deaths/malnutrition, need to improve health behaviors through a structure that… Facilitates behavior change Reaches large numbers of care givers of young children on a regular basis with high-quality health promotion at low cost Assures equitable, universal coverage (not just for “those who show up”) Allows for mothers to have a trusting relationship with the health promoter, receive tailored messages Strengthens social support to decrease drop-out of volunteers and to assure continued health promotion after project ends Builds capacity in the community Keeps tasks for volunteers light to decrease drop-out Uses few paid staffWhat are Care Groups?: 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 World Relief in Cambodia and Malawi, and Food for the Hungry in Mozambique Focuses on building teams of volunteer women who represent, serve, and do health promotion with blocks of 10-15 households eachMajor Programmatic Inputs: Major Programmatic Inputs One paid Promoter (7 th grade education or higher) per 1,680 beneficiary households, and one Supervisor (nurse) per 7-10 Promoters. 4-5 day training on each of eight modules, 3-4 trainings/year for first two years. Educational materials (e.g. flipcharts) for Promoters and Leader Mothers, bicycles for Promoters, vitamin A, deworming meds, other supplies. One Child Survival or Nutrition Program Manager, 0.33 FTE M&E staff, 0.65 FTE HQ backstop in current project (expect 1.0 FTE FH/HQ for PM2A support in Yr 1; lower after that). MOH involvement is helpful, but does not require a high level of integration.Community Development Committees: Community Development Committees Formed in each area with a Care Group Leaders trained by FH project staff Role: Taking responsibility and ownership in planning and implementing community development activities Encouraging and supporting existing community groups (care groups, agriculture groups, other) Advocacy for community needs to wider community and district governance structures Given small fund (e.g., $500) to manage for health-related projects to support health promotion in Care Groups Requires additional staffingBurundi (PM2A) Care Group Model: Burundi (PM2A) Care Group Model BCC Technical Advisor BCC Coordinator 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter MB MB MB MB MB MB MB MB MB MB MB MB BCC Coordinator BCC Coordinator BCC Coordinator Mother Beneficiaries & their householdsSlide 12: What happens during Care Group meetings? Reporting of vital events and illnesses and progress in health promotion: troubleshooting Demonstration with flipchart/ posters of this week’s 2-3 health messages Group reflection on the messages then practice with the flipchart Other social activities (e.g,. songs, dramas, games) Meetings generally last two hoursSlide 13: What happens after Care Group Meetings? Each Leader Mother visits “her” 10 households in the following two weeks Each Leader Mother educates her mothers on the key health and nutrition messages for the week using a small B&W flipchart. The Promoter supervises the health promotion done by Leader Mothers Deworming and vitamin A given during campaigns; coordination with MOH on immunizations Very little health facility improvement: focus on community-level health promotionMonitoring Quality: Quality Improvement and Verification Checklists: Monitoring Quality: Quality Improvement and Verification ChecklistsSlide 15: Differences with Burundi PM2A Care Groups During any given month, the Leader Mother does one home visit to each beneficiary mother/child + one group meeting with all beneficiary mothers. During the home visit, in addition to sharing the regular module message, they share 2-3 age specific messages. In Burundi, a health system strengthening IR is included, as well.How effective are Care Groups in reducing child morbidity and mortality? : How effective are Care Groups in reducing child morbidity and mortality?Mortality & Behavior Change Study Methods: Instruments: Mortality & Behavior Change Study Methods: Instruments Baseline, Mini-KPC, and final KPC Surveys. Mortality Study through Johns Hopkins using a modified DHS approach: Pregnancy history questionnaire, modified from the 2003 Mozambique DHS birth history questionnaire.Results: KPC and Anthropometry: Results: KPC and Anthropometry In general, large and rapid changes in key child survival behaviors.Results: KPC and Anthropometry: Results: KPC and Anthropometry Indicator FY97 (Baseline) FY 2000 Percentage of children with diarrhea receiving appropriate oral rehydration liquids 26% 95% Percentage of children 0-4m exclusively breastfeeding 46% 83% Percentage of children 12-23m who received a vitamin A capsule in the last six months 1% 97% Percentage of children with diarrhea in the last two weeks 44% 28% Severe stunting, children 6-23m of age 25% 13% All of these changes were statistically significant (p<0.05).42% decrease in underweight from Feb/06 to Sept/08 in a 2.5 year time period in Sofala, Mozambique: 42% decrease in underweight from Feb/06 to Sept/08 in a 2.5 year time period in Sofala, Mozambique (LOP Target was 18%) Sept 07 Feb 06 Sept 08Current FH/Moz CS Project Results: Current FH/Moz CS Project Results Indicator Baseline Feb 06 Midterm (Aug 08) % Change since BL Percentage of infants aged 0-5 months who were fed breast milk only in the last 24 hours 17% 77% 353% increase Percentage of children 9-23m who receive food other than breast milk at least three times per day 33% 58% 76% increase Percentage of children 6-23m who have consumed at least one vitamin A rich food in the previous day 29% 81% 179% increase % of mothers of children 6-23 months who know at least 3 child danger signs 29% 93% 221% increaseSlide 28: Differences in Health Service Utilization: Care Group vs. Non-Care Group Districts (Sofala, Mozambique)Project vs. Regional Changes in Mortality Rates: Project vs. Regional Changes in Mortality Rates Project Changes Regional Changes Indicator Mar 99 – Feb 00, FH Project Mar 03 – Feb 04, FH Project Four-yr Change ’87-’97 Sofala (DHS) ‘93 – ‘03 Sofala (DHS) Six-yr Change Project vs. Regional U5MR(FH) (DHS: 5 Q 0 ) 107 41 -62% 242 205 -15.3% 3X better IMR (FH) (DHS: 1 Q 0 ) 66 38 -42% 173 149 -13.9% 2X better CMR (FH) (DHS: 4 Q 1 ) 41 3 -94% 83 66 -20.5% 3.6X better Note: DHS data is for probability of death; FH project data are estimates of death.Results: Mortality Rate Changes (CMR): Results: Mortality Rate Changes (CMR) 94% decrease in CMRSlide 31: What about cost per beneficiary?? The cost per beneficiary per year was $4.50 in this Care Group project. ($2,461,599/5/ 108,782). FH has made additional changes to the model in its Expanded Impact Child Survival Project in Sofala Province, dropping the CPB to $3.21.Other Evidence of Success of the CG Model in Mortality Reduction: Other Evidence of Success of the CG Model in Mortality Reduction World Relief found a 49% reduction in the IMR and 42% reduction in the U5MR in their CG project between March 2000 and Feb 2003 in Gaza Province, Mozambique. (World Relief’s cpb was $6.50.)Reduction in Under-five Mortality Rate: Seven Care Group Projects: Reduction in Under-five Mortality Rate: Seven Care Group ProjectsSlide 35: What about sustainability?? WR found 93% of Leader Mothers were still active 20 months after the project ended, and half of the women in communities had received a visit from the LM in the past two weeks. Measured at 2.5 and 4 years post project, results were sustained or improved. EOP, End of $$Slide 36: What about sustainability?? Communities, on their own, replaced 40 of the 132 vacant volunteer positions. Remaining Leader Mothers trained new Leader Mothers and gave them educational materials.Slide 37: Sustainability of Final Indicator Levels 2.5 and Four-Years Post-Project (WR-Mozambique Care Group Project): Preventive Services You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Care_Groups tdavismph Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 32 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: November 06, 2011 This Presentation is Public Favorites: 0 Presentation Description This video discusses the life-saving power of Care Groups. A Care Group is a group of 10-15 volunteer, community-based health promoters who regularly meet together with NGO project staff for training and supervision. Each of these volunteers then go out at least monthly to do health promotion with a small cohort of mothers of young children. They are different from typical mothers groups in that each volunteer is responsible for regularly visiting 10-15 of her neighbors, sharing what she has learned and facilitating behavior change at the household level. Care Groups create a multiplying effect to equitably reach every beneficiary household with interpersonal behavior change communication. Data from 13 projects in 8 countries show that Care Groups can cut the child death rate on average 30%, more than double that of other child survival projects. Comments Posting comment... Premium member Presentation Transcript Reducing Malnutrition and Child Deaths Using Care Groups: Reducing Malnutrition and Child Deaths Using Care Groups Thomas P. Davis Jr., MPH Director of Health Programs Food for the Hungry October 26, 2009Overview: Overview Background on two Mozambique projects using Care Groups The main challenges that we see in reducing child malnutrition and deaths What Care Groups are and how have used them. Some of the results we have seen using this model, and results of other organizations in terms of preventing child deaths and malnutrition. Sustainability of the model. How we plan to use them in our Burundi MYAP.Program Background: Program Background Food for the Hungry (FH) is a FBO working in 26 countries. Currently managing CSHGP, Title II, USDA, PEPFAR and other USAID- and privately-funded projects. (MYAPS currently in Mozambique, Ethiopia, DRC, and Burundi [sub to CRS].) USAID Title II : FY98-FY01 (first DAP), FY02-FY07 (second DAP w/extension). Mortality study examined communities involved in both DAPs: 1999/2000 to 2003/2004 in four districts of Sofala Province, Mozambique. Prime objective : Decrease chronic malnutrition in children 6-59 months of age + other behavior objectives (e.g., ↑EBF/PBF, ORT/feeding during diarrhea). Interventions : Child survival -- Nutrition, CDD, ARI, malaria, safe motherhood, HIV. Outpaced other health projects in Mozambique (and other countries) in terms of reductions in child malnutrition and speed of behavioral change.Slide 5: Cumulative Impact of 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.The Challenge: The Challenge To decrease child deaths/malnutrition, need to improve health behaviors through a structure that… Facilitates behavior change Reaches large numbers of care givers of young children on a regular basis with high-quality health promotion at low cost Assures equitable, universal coverage (not just for “those who show up”) Allows for mothers to have a trusting relationship with the health promoter, receive tailored messages Strengthens social support to decrease drop-out of volunteers and to assure continued health promotion after project ends Builds capacity in the community Keeps tasks for volunteers light to decrease drop-out Uses few paid staffWhat are Care Groups?: 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 World Relief in Cambodia and Malawi, and Food for the Hungry in Mozambique Focuses on building teams of volunteer women who represent, serve, and do health promotion with blocks of 10-15 households eachMajor Programmatic Inputs: Major Programmatic Inputs One paid Promoter (7 th grade education or higher) per 1,680 beneficiary households, and one Supervisor (nurse) per 7-10 Promoters. 4-5 day training on each of eight modules, 3-4 trainings/year for first two years. Educational materials (e.g. flipcharts) for Promoters and Leader Mothers, bicycles for Promoters, vitamin A, deworming meds, other supplies. One Child Survival or Nutrition Program Manager, 0.33 FTE M&E staff, 0.65 FTE HQ backstop in current project (expect 1.0 FTE FH/HQ for PM2A support in Yr 1; lower after that). MOH involvement is helpful, but does not require a high level of integration.Community Development Committees: Community Development Committees Formed in each area with a Care Group Leaders trained by FH project staff Role: Taking responsibility and ownership in planning and implementing community development activities Encouraging and supporting existing community groups (care groups, agriculture groups, other) Advocacy for community needs to wider community and district governance structures Given small fund (e.g., $500) to manage for health-related projects to support health promotion in Care Groups Requires additional staffingBurundi (PM2A) Care Group Model: Burundi (PM2A) Care Group Model BCC Technical Advisor BCC Coordinator 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders 12 Mother Leaders Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter Promoter MB MB MB MB MB MB MB MB MB MB MB MB BCC Coordinator BCC Coordinator BCC Coordinator Mother Beneficiaries & their householdsSlide 12: What happens during Care Group meetings? Reporting of vital events and illnesses and progress in health promotion: troubleshooting Demonstration with flipchart/ posters of this week’s 2-3 health messages Group reflection on the messages then practice with the flipchart Other social activities (e.g,. songs, dramas, games) Meetings generally last two hoursSlide 13: What happens after Care Group Meetings? Each Leader Mother visits “her” 10 households in the following two weeks Each Leader Mother educates her mothers on the key health and nutrition messages for the week using a small B&W flipchart. The Promoter supervises the health promotion done by Leader Mothers Deworming and vitamin A given during campaigns; coordination with MOH on immunizations Very little health facility improvement: focus on community-level health promotionMonitoring Quality: Quality Improvement and Verification Checklists: Monitoring Quality: Quality Improvement and Verification ChecklistsSlide 15: Differences with Burundi PM2A Care Groups During any given month, the Leader Mother does one home visit to each beneficiary mother/child + one group meeting with all beneficiary mothers. During the home visit, in addition to sharing the regular module message, they share 2-3 age specific messages. In Burundi, a health system strengthening IR is included, as well.How effective are Care Groups in reducing child morbidity and mortality? : How effective are Care Groups in reducing child morbidity and mortality?Mortality & Behavior Change Study Methods: Instruments: Mortality & Behavior Change Study Methods: Instruments Baseline, Mini-KPC, and final KPC Surveys. Mortality Study through Johns Hopkins using a modified DHS approach: Pregnancy history questionnaire, modified from the 2003 Mozambique DHS birth history questionnaire.Results: KPC and Anthropometry: Results: KPC and Anthropometry In general, large and rapid changes in key child survival behaviors.Results: KPC and Anthropometry: Results: KPC and Anthropometry Indicator FY97 (Baseline) FY 2000 Percentage of children with diarrhea receiving appropriate oral rehydration liquids 26% 95% Percentage of children 0-4m exclusively breastfeeding 46% 83% Percentage of children 12-23m who received a vitamin A capsule in the last six months 1% 97% Percentage of children with diarrhea in the last two weeks 44% 28% Severe stunting, children 6-23m of age 25% 13% All of these changes were statistically significant (p<0.05).42% decrease in underweight from Feb/06 to Sept/08 in a 2.5 year time period in Sofala, Mozambique: 42% decrease in underweight from Feb/06 to Sept/08 in a 2.5 year time period in Sofala, Mozambique (LOP Target was 18%) Sept 07 Feb 06 Sept 08Current FH/Moz CS Project Results: Current FH/Moz CS Project Results Indicator Baseline Feb 06 Midterm (Aug 08) % Change since BL Percentage of infants aged 0-5 months who were fed breast milk only in the last 24 hours 17% 77% 353% increase Percentage of children 9-23m who receive food other than breast milk at least three times per day 33% 58% 76% increase Percentage of children 6-23m who have consumed at least one vitamin A rich food in the previous day 29% 81% 179% increase % of mothers of children 6-23 months who know at least 3 child danger signs 29% 93% 221% increaseSlide 28: Differences in Health Service Utilization: Care Group vs. Non-Care Group Districts (Sofala, Mozambique)Project vs. Regional Changes in Mortality Rates: Project vs. Regional Changes in Mortality Rates Project Changes Regional Changes Indicator Mar 99 – Feb 00, FH Project Mar 03 – Feb 04, FH Project Four-yr Change ’87-’97 Sofala (DHS) ‘93 – ‘03 Sofala (DHS) Six-yr Change Project vs. Regional U5MR(FH) (DHS: 5 Q 0 ) 107 41 -62% 242 205 -15.3% 3X better IMR (FH) (DHS: 1 Q 0 ) 66 38 -42% 173 149 -13.9% 2X better CMR (FH) (DHS: 4 Q 1 ) 41 3 -94% 83 66 -20.5% 3.6X better Note: DHS data is for probability of death; FH project data are estimates of death.Results: Mortality Rate Changes (CMR): Results: Mortality Rate Changes (CMR) 94% decrease in CMRSlide 31: What about cost per beneficiary?? The cost per beneficiary per year was $4.50 in this Care Group project. ($2,461,599/5/ 108,782). FH has made additional changes to the model in its Expanded Impact Child Survival Project in Sofala Province, dropping the CPB to $3.21.Other Evidence of Success of the CG Model in Mortality Reduction: Other Evidence of Success of the CG Model in Mortality Reduction World Relief found a 49% reduction in the IMR and 42% reduction in the U5MR in their CG project between March 2000 and Feb 2003 in Gaza Province, Mozambique. (World Relief’s cpb was $6.50.)Reduction in Under-five Mortality Rate: Seven Care Group Projects: Reduction in Under-five Mortality Rate: Seven Care Group ProjectsSlide 35: What about sustainability?? WR found 93% of Leader Mothers were still active 20 months after the project ended, and half of the women in communities had received a visit from the LM in the past two weeks. Measured at 2.5 and 4 years post project, results were sustained or improved. EOP, End of $$Slide 36: What about sustainability?? Communities, on their own, replaced 40 of the 132 vacant volunteer positions. Remaining Leader Mothers trained new Leader Mothers and gave them educational materials.Slide 37: Sustainability of Final Indicator Levels 2.5 and Four-Years Post-Project (WR-Mozambique Care Group Project): Preventive Services