Key Findings from Care Group

Operational Research

Sofala, MozambiqueResearch conducted from

April to May 2010As part of the project:

Achieving Equity, Coverage, and Impact through a Care

Group Network

Carolyn Wetzel, RN, MPH&TM

Objective of OR

Identify the key components to the effective use of the Care Group Methodology.

The OR included qualitative and quantitative survey methods to determine if the Care Group methodology was carried out as designed and identified methodological adaptations that occurred based on problems and difficulties that arose.

Methodology

The research consisted of three components: • Focus Group Discussions

– 5 Promoter FG– 15 CG Volunteer FG– 25 Beneficiary Mother FG– 10 Community Leader FG

• The development and implementation of a KPC Survey - Stratified Random Sampling was used to identify 100 CGV and 100 CGB in Phase I and Phase II Districts (400) - All CS Promoters (60) were interviewed by non-CS staff.

• Four day workshop with selected project staff to interpret and draw conclusions from the results of the Focus Group Discussions and KPC Survey results.

  PHASE I PHASE

II PHASE I

& II

Mean age of CG Volunteer 41 34 37

% of CGV who have children < 2 years

of age or are pregnant

36% 50% 43%

Mean age of CG Beneficiary 29.7 26.2 27.9

% of CGB who have children < 2 years

of age or are pregnant

95% 97% 96%

Mean age of Promoter 31 29 30

% of Promoter's who are Female 28% 20% 23%

• CG Volunteers were older than expected (average 37 years), especially in Phase I with an average age of 41 years. (Life expectancy in Mozambique is 48 years)

• Beneficiary Mothers are on average 10 years younger than CG Volunteers.

• No association was found between the age of the CGV or CGB and key knowledge.

Age and Key Knowledge

Lesson Learned: Select CB Volunteers based on respect, influence, and experience. CB Volunteers do not have to be in the target beneficiary group.

Perceived and Actual Literacy of CG Volunteers

Literacy Level of Care Group Volunteers and Beneficiaries

29%

21%18%

24%

44%

11%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Phase I Phase II

CGB who can read thewords on theeducational material.

CGV who can read thewords on theeducational material.

% of Promoters whobelieve CGV can readthe words on theeducational material.

How well did the visual images convey key messages?

Take a minute to create an image to represent the following key message:

Breastfeeding prevents malnutrition and other illnesses.

66%

Breastfeeding prevents malnutrition and other illnesses.

Diarrhea for more than ten days is an emergency

Children >12m of age should take de-worming medicine every six months

25%

65%Lesson Learned: Plan time and money for image development, testing, and refinement. Improve training on key message image recognition.

Attendance, Turnover and Replacement

How replacement works: If a woman indicates her child is out of the age range then she is asked to bring another woman in the community who is pregnant or has a child under 2 years of age to the next meeting.

Care Group Volunteer and Care Group Beneficiary attendance at Care Group meetings

84.0%98% 96%

5%

78.0%

0.0%20.0%40.0%60.0%80.0%

100.0%120.0%

Attended Most or AllMeetings (>75%)

Met every tw o w eeks forhealth education and

behavior change

CGB reporting rate of CBVturnover of ML in a 12 month

period

CGV

CGB

70-75% of CGV share messages mostly or only through group teaching sessions. 25-30% share mostly or only through home visits.

Lesson Learned: CGV’s providing bi-monthly education through home visits or group education is a realistic expectation.

Distance Traveled and Length of Meetings

• On average, CGB spend 13 minutes walking to CGV led meetings• On average, CGV spend 16 minutes walking to visit their CGB• On average, CGV spend 17 minutes walking to Promoter led meetings

• 77% of CGB who missed a lesson received the information• 99% of CGV who missed a lesson received the information

70-75% of CGV share messages mostly or only through group teaching sessions. 25-30% share mostly or only through home visits. 82% of CGV report having group meeting that lasted at least one hour.

Lesson Learned: It is important to assure that CGVs do not have to travel long distances to beneficiary households. Beneficiaries can be reached through a combination of group and HH visits and still be effective.

Reaching Men and Women

Present during Mother Leaders Home Visit to Mother Beneficiary

0% 10% 20% 30% 40% 50% 60%

Daughter

Mother

Female Friend

Son

Father / Husband

Male Friend

No one else

All Districts

• Men learn Care Group material when his wife shares with him what she has learned or he asks.• Men are reached through bi-annual community leader meetings (normally only men present).• Sensitive topics should only be discussed in single sex groups according to the KPC review panel.• Care Group material being developed includes pictures of men caring for children and learning from or with their wives .

• Two or at times three generations of Mothers reached during Care Group Visits

Time Contribution (in hours) by Type of Project Staff

October 2005 – September 2010

Dondo Success Story:

How treating Intestinal Worms changed a Family

There are changes in relationships as a result of Care Groups. Changes in marital relationships, possibly domestic abuse, changes in how women are viewed, their relationship with community leaders and with their neighbors and extended family that we need to capture and document

The preceding slides were presented at theCORE Group 2010 Fall Meeting

Washington, DC

To see similar presentations, please visit:www.coregroup.org/resources/meetingreports