Care Groups: Care Groups: The Essential The Essential IngredientsIngredientsApril 2010April 2010

Carolyn Carolyn Wetzel, MPHWetzel, MPHSenior Senior Coordinator for Coordinator for Health Health ProgramsProgramsFood for the Food for the HungryHungry

Melanie Melanie Morrow, MPHMorrow, MPHDirector of MCH Director of MCH ProgramsProgramsWorld ReliefWorld Relief

Thomas P. Thomas P. Davis Jr., MPHDavis Jr., MPHSenior Director Senior Director of Health of Health ProgramsProgramsFood for the Food for the HungryHungry

Description of a Care Description of a Care GroupGroup

They are different from typical mother’s 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.  . 

A Care Group is a group of 10-15 volunteer, community-based health educators who regularly meet together with project staff for training and supervision. 

Description of a Care Description of a Care GroupGroup

Care Groups create a multiplying effect Care Groups create a multiplying effect to equitably reach every beneficiary to equitably reach every beneficiary household with interpersonal behavior household with interpersonal behavior change communication.  change communication. 

They also provide the structure for a They also provide the structure for a community health information system community health information system that reports on new pregnancies, births that reports on new pregnancies, births and deaths detected during home visits and deaths detected during home visits

Results: KPC and Results: KPC and AnthropometryAnthropometry

IndicatorFY97

(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 42% decrease in underweight from Feb/06 to underweight from Feb/06 to Sept/08 in a 2.5 year time Sept/08 in a 2.5 year time

period in Sofala, period in Sofala, MozambiqueMozambiqueUnderweight, FH Care Group Project, Four Districts, Central Mozambique

26.8

15.6 15.6

0.0

5.0

10.0

15.0

20.0

25.0

30.0

1 2 3

Anthropometry Study Date

% u

nd

erw

eig

ht

(WA

Z<

-2)

Caia, Chemba, Manga, and Marringue Districts(LOP Target was 18%)

Sept 07Feb 06 Sept 08

Weighings per Child

0%

20%

40%

60%

80%

100%

120%

140%

160%

1s 2006 1s 2007 1s 2008

Period

Co

vera

ge

Caia, Chemba, Mar.(Project Districts)

Buzi, Chib, Dondo(Control Districts)

Initial Prenatal Consults

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1s 2006 1s 2007 1s 2008

Period

Co

nsu

lts

per

Pre

g. W

om

an

Caia, Chemba,Maring (ProjectDistricts)

Buzi, Chib, Dondo(Control Districts)

Institutional Deliveries (Coverage)

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1s 2006 1s 2007 1s 2008Period

Co

vera

ge Caia, Chemba, Maring

(Project Districts)

Buzi, Chib, Dondo(Control Districts)

Infant Health Facility Consults (Care Seeking)

0

1

2

3

4

5

6

7

1s 2006 1s 2007 1s 2008

Period

Con

sults

/ In

fant Caia, Chemba, Mar

(Project Districts)

Buzi, Chib, Dondo(Control Districts)

Differences in Health Service Utilization: Care Group vs. Non-Care Group Districts (Sofala, Mozambique)

Results: Mortality Rate Changes Results: Mortality Rate Changes (CMR)(CMR)

41

32

17

6

3

0

5

10

15

20

25

30

35

40

45

Year

Child Deaths (CMR), FH Care Group Areas, Sofala Provinces, Mozambique

1999/2000 to 2003/2004

Year

Year 41 32 17 6 3

99/00 00/01 01/02 02/03 03/04

94% decrease in CMR

Reduction in Under-five Reduction in Under-five Mortality Rate:Mortality Rate:

Seven Care Group ProjectsSeven Care Group ProjectsPerc. Reduction in Estimated U5MR (Lives Saved Calculator)

CSHGP Care Group Projects

2733 32 29

14

31

18

43

05

101520253035404550

CSHGP Project

% R

ed. U

5MR

Series1

Why Criteria for Care Why Criteria for Care GroupsGroups

14 PVO’s using the model since 1995 14 PVO’s using the model since 1995 Increased attention to the model and its Increased attention to the model and its

repeated association with decreases in repeated association with decreases in mortalitymortality ..

Wide variations in what is called a “Care Wide variations in what is called a “Care Group” can lead to the use of less effective Group” can lead to the use of less effective strategies that do not fit within the model.strategies that do not fit within the model.

Fewer opportunities to advocate for the Care Fewer opportunities to advocate for the Care Group Model and it’s role in child survival if Group Model and it’s role in child survival if the name is applied to less effective the name is applied to less effective strategies. strategies.

Why Criteria for Care Why Criteria for Care GroupsGroups

Criteria formed by the two Criteria formed by the two organizations that are recognized as organizations that are recognized as having a history of using and promoting having a history of using and promoting Care Groups extensively (WR being the Care Groups extensively (WR being the original developer) original developer)

We hope that by informing donors and We hope that by informing donors and others about these criteria, they will others about these criteria, they will use the criteria to decide to what use the criteria to decide to what degree a proposed implementation degree a proposed implementation strategy is really based on the Care strategy is really based on the Care Group model. Group model.

Establishment of Criteria Establishment of Criteria During meetings between World Relief and During meetings between World Relief and

Food for the Hungry staff members on April 23, Food for the Hungry staff members on April 23, 2009, the Care Group criteria were agreed 2009, the Care Group criteria were agreed upon.  upon. 

The list is divided into those that we feel should The list is divided into those that we feel should be required to be present when using the term, be required to be present when using the term, “Care Group,” and other criteria that we feel “Care Group,” and other criteria that we feel have been helpful when included in the model, have been helpful when included in the model, but that should not be considered required.  but that should not be considered required. 

Edits to this list were then made by the two Edits to this list were then made by the two founders of the model, Dr. Pieter Ernst and Dr. founders of the model, Dr. Pieter Ernst and Dr. Muriel Elmer. Muriel Elmer.

The Care Group CriteriaThe Care Group CriteriaEssential characteristics for a model of community

based health promotion to be considered the "Care Group" Model.

1 The model is based on peer-to-peer health promotion (Mother-to-mother for MCH and nutrition behaviors.) CG Volunteers should be chosen by the mothers within the group of households that they will serve or by the leadership in the village.

2 The workload of CG volunteers is limited: No more than 15 HH per CG volunteer.

3 The Care Group size is limited to 16 members and the project attains at least 70% monthly attendance. Coverage is monitored.

4CG volunteer contact with her assigned beneficiary mothers is monitored and should be at a minimum once a month, preferably twice monthly.

5 The plan is to reach 100% of households in the targeted group on at least a monthly basis, and the project attains at least 80% monthly coverage of households within the target group. Coverage is monitored.

6Care Group Volunteers (e.k.a. “Leader Mothers”) collect vital events data on pregnancies, births, and death.

7 The majority of what is promoted through the Care Groups is directed towards reduction of mortality and malnutrition (e.g., Essential Nutrition Actions, Essential Hygiene Actions).

8The Care Group volunteers use some sort of visual teaching tool (e.g., flipcharts) to do health promotion at the household level.

9 Participatory methods of BCC are used in the Care Group with the CG Volunteers, and by the volunteers when doing health promotion at the household or small-group level.

10The Care Group instructional time (when a Promoter teaches CG Volunteers) is no more than two hours per meeting.

11Supervision of Promoters and at least one of the Care Group Volunteers (e.g., data collection, observation of skills) occurs at least monthly.

Answer the questions on Answer the questions on your handout for the Care your handout for the Care Group Criteria assigned to Group Criteria assigned to

your group. your group. 30 people

Small Group 1 2 3 4

Care Group Criteria

to Cover

1 4 6 8

2 5 7 9

3 11   10

Answer the questions on Answer the questions on your handout for the Care your handout for the Care Group Criteria assigned to Group Criteria assigned to

your group. your group. 35+ people

Small Group 1 2 3 4 5

Care Group Criteria

to Cover

1 2 4 5 88

7 3 11 6 99

        1010