Program for Strengthening Household Access to Resources(PROSHAR)

Dr. Ayan Shankar SealTeam Leader-Health & Nutrition, PROSHAR

Care Group Technical Advisory Group (TAG) Meeting

May 29 – 30, 2014; Washington DC , USA

Care Group Trios: Incorporation of Influencers

• Funded by USAID/FFP with ACDI/VOCA as Prime.

• From June 2010 to May 2015 • 350,000 direct beneficiaries• Implementing Partners: GOB, ACDI/

VOCA PCI & 3 Local Partner NGOs (CODEC, Muslim Aid and Shushilan), iDE as Technical Partner

PROSHAR OVERVIEW

MAP OF PROSHAR

Income and access to food for poor and ultra poor

households increased

Health of pregnant and lactating women and children under 5 (with particular attention to children under 2) improved

Institutions and households prepared to

respond effectively to shocks

Goal:Reduced Food

Insecurity Among Vulnerable Rural Populations in

Selected Upazilas in Khulna Division

Goal:Reduced Food

Insecurity Among Vulnerable Rural Populations in

Selected Upazilas in Khulna Division

INTEGRATED PROGRAM DESIGN

During the design of PROSHAR, research demonstrated that: Mothers have little infl uence in household decisions

concerning nutrition & health care Fathers & mothers-in-law were found to have the

strongest infl uence on these behaviors fathers dictate care seeking behaviors mothers-in-law set child rearing practices

Thus, an innovative CGT approach was developed to involve fathers & mothers-in-law in order to sustainably change behaviors

DEVELOPMENT OF CARE GROUP TRIOS (CGT)

WHAT INFLUENCES NUTRITION PRACTICES?

Husband Mother-in-law* Sister-in-law Neighbors No one

8%6%

2%

24%

41%

10%

22%

12%

28%

40%Who disapproves of pregnant women consuming extra food during

pregnancy?

NonDoers Doers

Targeting influential people

Suffi

cien

t bre

astm

ilk

Fam

ily S

uppo

rt*

Don't

need

ext

ra fo

od

Less

wor

k load

No ex

pens

e*

Baby

doe

sn't

cry

55%

20%33%

12%0%

12%

61% 57%

31%

14% 10%4%

What made it easier for you to exclusively breastfeed (EBF)?

NonDoers Doers

Improving the knowledge and responsibility of family

members on the importance of EBF and their support of the

mother

WHAT INFLUENCES NUTRITION PRACTICES?

TRADITIONAL CARE GROUP STRUCTURE

CARE GROUP TRIO STRUCTURE

   

 

   

 

   

 

   

 

CG Supervisor

 

 

Health Promoter

Health Promoter

Health Promoter

Health Promoter

Health Promoter

MOTHER CG• Health

Promoter meets with Mother Leaders 2x/month in CG meeting

• MLs organize meeting with their neighbor groups the following week

• Flipchart with specific health & nutrition messages used

• MLs plan HH visit

GRAND MOTHER CG• Health Promoter

meets with Grandmother Leaders (GmL)s monthly;

• GmLs also meet with their groups every month

• Flash card set is used with specific health & nutrition

• GmL do HH visits as needed

FATHER CG• HP meets with

the Father Leaders (FL)s 1x in every two month;

• FLs meets with their groups in the following two months

• Flash card set is used with specific messages

• FL do HH visit as needed

Care Group (Trio Leaders)

• HP meets three leader groups together 1x/quarter

• Trio leaders interact in clusters with similar leaders

• CGTs share challenges; success stories; and plans for addressing challenges

IMPLEMENTATION OF CGTS

Exclus

ive

Brea

st Fee

ding

Early

Initi

ation

of B

F

3+ A

NC Visi

ts

Post P

artu

m V

it-A

3 C

orre

ct IY

CF Be

havior

s

41.4 38.2 32.3 34.6 29.2

56

88.7

53

73

40.9

67.3

91 93.7 95

50.2

Baseline, Nov 2010 Annual Survey,Sept 2012 Annual Survey Sep 2013

BEHAVIOR CHANGE TRENDS

Baseline Nov 2010 Sep-12 Sep-13

22.7

21.6

21.2

Regular service data( <-2SD)

PERCENTAGE OF UNDERWEIGHT AMONG UNDER 2

HAND WASHING BEHAVIORS

58.3 60.9

92.3

46.264.5 59.8

88.8 83.8

Sep-12 Mar-14

38.728.5

17.1

53.7

22.3

67 71.8 63.8

38.5

70.8

HFSNA 2009PROSHAR Semi annual Survey 2014

DIVERSIFIED FOOD CONSUMPTION AMONG CHILDREN 6-23 MONTHS

The CGT approach is a “promising practice” that makes a significant difference in changing behaviors among PLW and their family members CGTs allow time for discussion among the groups

and how their roles can influence behavior change CGTs overall have a high level of participation

(even for fathers and grandmothers who have greater participation challenges).

CGTs should meet together to identify barriers to change, to discover solutions to these barriers, and to be accountable for change in their families and communities.

LESSONS LEARNED

Fathers remark they are more supportive to their wives & children, more sensitive to their children’s needs, and overall responsible for the health/ wellbeing of their families (e.g. buying nutritious food!)

Targeting key influencers is critical to changing behaviors (e.g. early initiation & exclusive breast feeding)

Impact evaluations/experimental design (beyond the scope of this project) are needed

EXPERIENCE WITH CGTS

THANK YOU!