1 Strathspey Proposal Empowering Mothers in Malaria Health Behaviour, Ghana

8/6/2019 1 Strathspey Proposal Empowering Mothers in Malaria Health Behaviour, Ghana

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CARE International UK – September 2009

10 – 13 Rushworth Street, London, SE1 0RB, Telephone: 020 7934 9334, Fax: 020 7934 9335

Email: [email protected] www.careinternational.org.uk Registered charitynumber: 292506

Empowering Mothers for Health Behaviour, Accra,

Ghana

CARE International is aglobal humanitarian

organisation and worksin over 70 countriesaround the world,tackling poverty,

injustice and humansuffering wherever the

need is greater.

Almost a third of Ghana’s population lives in extreme poverty. With

few resources, most people cannot access quality healthcare. Only

22 percent of children under five sleep under treated mosquito nets

and only 50 percent of births are attended by a skilled health care

worker (professional or volunteer). Lack of access to health care has

deadly consequences in this western African country where 7.3percent of children die before their first birthday and for every

100,000 live births, 560 women loose their lives.

To address these and other health issues, CARE is implementing

Empowering Mothers for Health Behaviour in the capital, Accra,

and the central and western regions of Ghana.

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GhanaA

Background to Ghana

• Please include context of poverty in Ghana

Poverty in Ghana

Ghana has witnessed a general decline in poverty levels by a large margin in the last

two decades. The incidence of poverty is relatively lower in female headed households

than in male headed household. It is endemic among rural folks than among urban

dwellers.

Whilst all the administrative regions saw a declining trend in poverty in the first half

of the period, Greater Accra and Upper West regions witnessed a reversal trend (an

increase) in poverty in the second half.

Despite the general positive outlook of poverty trends, the incidence of poverty is still

considerably high and relatively higher among Ghanaians in the informal and

agriculture sectors of the economy, particularly among food crop farmers who live in

the rural areas. Majority of the people living in rural areas fit into the World Bank

classification of extreme poverty, getting by on an income less than $1 a day.

Households cannot meet basic needs for survival.

Poverty among rural folks is said to be driven largely by environmental factors

including irregular rainfall patterns and poor soil fertility, whilst that among urban

dwellers is more by shifts in macro-economic conditions characterized by changes in

consumption and availability of cash employment (Ashong & Smith, 2001). It is also

argued that because of low level of education, rural folks are unable to diversify into

more productive livelihood activities. Additionally the social network systems are not

well developed to enable them gain access to finance and work opportunities, making

them more vulnerable to poverty (ibid).

Individuals and societies that are poor tend to remain so if they are not empowered to

participate in the decisions that shape their lives.

This calls for a more coordinated effort in addressing the remaining deficits in the

human development outcomes with emphasis on health improvements and macro-

economic management amongst others. Intervention in healthcare, human capital

development, microcredit provision, a strong savings promotion, capacity-building

training programmes for micro-enterprises and a generalfocus on women will

be able tomake a difference.

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• Stats on population and demographics

Greater Accra had a population of 2,905,726 in the 2000 National population

census and a growth rate of 4.4% which gives an estimated mid year population for

2006 of 3,762,336. The total fertility rate in the region of 2.9 from the 2003 Ghana

demographic and health survey is the lowest in the country. The high population

growth rate in the region is thus a mixture of natural increase and rapid migration

into the urban parts of the region from all over the country. Observation suggests

that a fair number of the migrants are unskilled rural migrants moving into the city

to look for non-existent jobs and ending up in the pool of urban poor.

Its population density from the 2000 census was 1,019 persons per squarekilometre. It is the only region in the country where the rural urban ratio is

reversed. Eighty eight percent (88%) of its population lives in localities defined as

urban (population five thousand or more) and only 12 percent live in small rural

communities.

Many of its urban localities are very large with population running into tens of

thousands. The region therefore currently has six administrative districts Accra

Metropolis, Tema Municipality, Ga West, Ga East, Dangme East and Dangme West.

• Please include information about the area where the project is operating and

context of poverty.

The project will be implemented in 25 communities in 2 districts in the Greater

Accra Region – Dangbe East and Ga East.

Dangbe East District

The Dangme East like the Dangme West district is completely rural and typical of rural

districts elsewhere in Southern Ghana. Dangme East had a population of 93,112 in the

2000 census. Poverty is widespread. Most of the population are subsistence farmers

using non-mechanized rain fed agriculture; and along the coast, fishermen.

Dangme East district has 2 functional CHPS compounds, 5 health centres and ahospital that was completed and started operation in 2003. There are four sub-districts

namely Ada-Foah, Kasseh, Sege and Pediatorkope.

Ga East District

The Ga East district used to be almost entirely rural but has been caught up in the

urban spread of the Accra metropolis and Tema municipality and is rapidly urbanizing

especially in the areas bordering Accra - Tema. Its estimated 2005 midyear population

is 258,478. There is one functional CHPS compound, 3 health centres, one small MCH

clinic and no government hospitals or polyclinics. The lack of health infrastructure is

because urban growth has rapidly outstripped the infrastructure that used to beadequate for a sparsely populated rural district. There are numerous small private

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clinics in the urbanized parts and one small CHAG hospital run by the church of

Pentecost.

• History of CARE working in Ghana and what it’s priority focus areas are

CARE has successfully implemented HIV & AIDS projects in Ghana since 1996. CARE

GoG has had the capacity and experience to build the capacity of partners to carry out

effective (a) Health and Nutritional Support and (b) HIV & AIDS programming.

CARE’s HIV/AIDS and Health programs in Ghana since 1996 have included projects like

SAPIMA and Wassa West Reproductive Health (WWRH) in Wassa West District in June

2003. WWRH was an integrated STI/HIV/AIDS and family planning project targeting

mine workers and their partners, CSWs and the general communities in mining towns

in two districts.

a) ARCH in Adansi West District,b) The Western and Ashanti STI/HIV & AIDS (WASH) project in eight districts and sub-

metros in Western and Ashanti Regions - funded by United States Department of Agriculture. WASH was implemented from 2002 to 2005 and it strengthened thecapacity of local institutions to implement STI/HIV & AIDS programs. It wasimplemented through 10 partner organizations (local NGOs, CBOs, FBOs) in theWestern and Ashanti regions of Ghana.

The youth project through HACI in the Wassa West District. As part of the WASH

project, CARE received funds from Hope for African Children Initiative (HACI) for a

project to target orphans and other vulnerable children (OVC).

PREVENT (August 2008 – December 2010)

The CARE consortium comprising CARE Denmark and Gulf of Guinea is implementing

PREVENT – Traditional Institutions and Positive People Preventing HIV/ AIDS and

Stigma.

Ahensan Water and Sanitation (AWSAN), 2007 -2008

The Ahensan Water and Sanitation (AWSAN) project provided:

• Clean water supply, sanitation facilities and hygiene education to selected schools.

• Pay-for-use toilet blocks in the community; and• Improved hygienic conditions at the Kumasi Abattoir through provision of water

reservoirs to augment the water available at the Abattoir for cleaning meat and theAbattoir premises

The Water and Sanitation for Urban Poor (WASUP) 2010-2013 is currently being

implemented in the city of Kumasi, which is the fastest growing city in Ghana with a

growing concern about environmental degradation due to poor sanitary conditions and

pollution of waterways.

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The project will deliver clean water, improved sanitation facilities, and environmental

and personal hygiene education to the urban poor dweller in five communities within

the Kumasi Metropolis.

The target communities have a total population of approximately 108,500. About 71%of the target population does not have access to hygienic toilet facilities. Women and

children spend long hours to fetch water

Trans-boundary Area (TBA) Water Project (2007 – 2008)

This a Water management and development alliance between the he Coca Cola

Company and the USAID focused on Community Water Management in Trans-

boundary Watersheds (western Ghana and Eastern Ivory Coast).

GHANA SUSTAINABLE CHANGE PROJECT (GSCP) –JUNE 2004 TO MAY 2009

In June 2004, USAID awarded the Ghana Sustainable Change Project (GSCP) to the

Academy for Educational Development and its partners, CARE, the Manoff Group and

EXP Momentum. This five-year Program had the mandate to support the Ghana

Health Service and other private and civil society groups to increase the health status

of Ghanaians through communication interventions which can be sustained over time.

The Project, with its partners and counterparts, ensured evidence-based

communication interventions that increasingly impacted on reproductive and child

health, and HIV/AIDS, and that took into consideration all aspects of a supportive

environment including capacity building, advocacy and social marketing. The GSCP

provided technical assistance to strengthen training and the implementation of

communication programs for health, along with limited commodity support to the

health sector under the four Project goals (Communication, Capacity Building, Social

Marketing and Advocacy.

CARE currently implements over twenty projects in 56 districts (7 regions) in

Ghana. For CARE, partnerships with, and capacity building for, government institutions

and civil society, including community based organizations, are central to its mission

in Ghana. CARE’s portfolio in Ghana includes a broad range of complementary

livelihoods and social services provision and capacity building in agriculture & naturalservices, girls’ education, health and HIV&AIDS, water/sanitation and community

micro-finance.

CARE has a long term presence in the Western Region of Ghana, and it is recognized

for its capacity building work at community, district and national levels, as well as its

policy advocacy and gender expertise. CARE’s experience in building local capacities

includes technical and organizational development training and facilitation of district

level service providers’ networks/forums in a dozen districts in Northern and Western

Ghana. Currently CARE works with over 200 women’s groups in Northern Ghana.

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Background to problem

• What is the problem relating to Health and Malaria in Ghana and more

specifically where the project is operating?

In Ghana, malaria is a major public health problem and cause of morbidity andmortality anddirectly contributes to poverty, low productivity, and reduced school attendance.Malariaaccounts for more than 61% of hospital admissions for children under age five, and 8%of pregnant women. Nearly 38% of outpatient visits are related to malaria, which is theleadingcause of lost workdays due to illness. It is estimated that malaria kills 22% of childrenunder age five (or 20,000 children every year) and is the main case of death amongchildren in the postnatal period, and 9% of maternal deaths.

Again in recent BCS advocacy meetings in the Ga East and Dangme East districtsmalaria emerged as the topmost issue in the districts of which women and children

are the most vulnerable (these came up in the presentations made by the District

Directors of Health Services).

To address these and other health issues, CARE is implementing Empowering Mothers

for Health Behaviour in the Greater Accra, central and western regions of Ghana. The

first phase will be implemented in two districts in the Greater Accra region.

Background to 4 year Programme supported by USAID and also CARE’s

experience in working in Health and Malaria prevention

The Behaviour Change Support (BCS), a 4-year Behaviour change CommunicationUSAID funded project (August 2009 - September, 2013) The project focuses onfostering positive health practices in households and communities by creating andstrengthening social norms around health thinking and health behaviour andsustaining these practices in three regions within Ghana (the Greater Accra, Centraland Western Regions – all communities 3,600).

The BCS Project is designed to create broad, ongoing interventions that addressmultiple, integrated health topics over the life of the project to bring aboutimprovement in health and works through four key elements - Behaviour ChangeCommunication(BCC), Community Mobilization(CM), Community BasedDistribution(CBD) and Capacity Building. These elements are well coordinated to formthe framework of - Communication for Social Change Framework (CFSC).In the CFSC framework, BCC campaigns serve as the catalyst of change; communitydialogue and action of CM accelerates and deepens that change; community-baseddistribution allowspeople to take action based on transformed community norms; and capacity building,sustains change.

The integrated thematic health areas are: Family Planning, Maternal Neonatal ChildHealth, Malaria, Nutrition, Water and Sanitation.

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The project teams work with counterparts in GHS units to maximize the contribution of BCC towards building on the successes, reversing the negative trends and creatingmomentum to move the stagnant indicators in a positive direction; as well as withother USAID funded projects, the private sector and stakeholders at the various levels

in the target areas to enable them to make input and have ownership of the processfor sustainability.

The Johns Hopkins Bloomberg School of Public Health Centre for CommunicationPrograms (JHU/CCP), in partnership with CARE Gulf of Guinea and PLAN International,form the team of choice to manage the implementation of the Project.

With over 15 years experience in Ghana, CARE has demonstrated extensive capacity

in community mobilization. CARE’s role in this partnership is to conduct and

coordinate both rural and urban community mobilization in two regions of Ghana

(Greater Accra and Western Region), and urban community mobilization in one region

(Central Region).

Our community mobilization approach will not only help people improve their health,

but by its very nature will strengthen and enhance the ability of the community to

work together for any goal that is important to its members. The end result will not

only be a health issue “addressed” but also increased capacity to successfully address

other community needs and desires (BCS Project Proposal, 2009).

• Information on Programme, objectives, who is involved and the timeframe

Goal

The overall goal of the project is to increase demand for and use of malaria

prevention services among women groups in the Greater Accra Region.

Objectives

o Adopt the VSLA strategy to attract and draw women to regular meetings

to share messages on malaria prevention and discuss how to apply

information to real life situation for sustainable behaviour change.

o Increase antenatal attendance and demand for SP by pregnant women.

o Improve the skills of women in the home management of malaria’

o Increase the demand and nightly use of LLINs by individuals and families.

o Form VSLA groups in 10 communities in the Ga East and 5 communities

in the Dangme East Districts with income generation as a driving force to

attract other women for health promotion in malaria.

• CARE’s experience and expertise in this area – Health and Malaria prevention

CARE has over 15 years experience in Ghana and has demonstrated extensive

capacity in community mobilization in health. Currently CARE plays a similar role in

the BCS partnership in conducting and coordinating both rural and urban communitymobilization in two regions of Ghana (Greater Accra and Western Region), and urban

community mobilization in one region (Central Region).

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Summary of Project

• A paragraph explaining project, the aim and how many women it will reach

• The ‘Empowering Mothers for Health Behaviour’ project aims at deepening the

existing activities being implemented by the GHS and NGOs with respect to the

adoption of healthy behaviours in Malaria and other related issues to improve

the health of the people in the selected communities and gradually expand

while building on the initial experiences. This initial phase will be implemented

in 15 communities in the greater Accra Region; 2 groups will be formed in each

community. The idea is to use the VSLA approach to attract and draw women to

regular meetings where malaria control messages will be consistently discussed

using materials produced by ProMPT and also used by BCS. Through this

initiative, the women will appreciate the relationship between health and

economic wellbeing. When the women start managing income from VSLA they

would want to be healthy always to continue to contribute to accumulate

wealth. They will therefore be motivated to apply the health messages for the

desired behaviour change to take place. The successes of the initial groups will

lead to the formation of more groups and the number of health advocates in the

communities will increase.

Implementation starts from the Greater Accra Region because Hopeline Institute

is currently implementing the VSLA in some communities in the Ga East District

and we plan to expand the base and at the same time introduce Prolink to the

VSLA strategy to be implemented in the Dangme East District. In this first phase

Hopeline will manage a minimum of 20 groups and Prolink, 10 groups. We hope

to extend to the Western and Central Regions in the next phase.

Because children are also vulnerable, 5 basic schools will be reached with

malaria prevention information; the emphasis will be on children at the

kindergarten level (the under 5 vulnerable group).

Project goal, objectives, activities and expected outputs

Please provide:

Project goal

The overall goal of the project is to support households to experience improved quality

life through a combination of health and financial behaviour change approaches.

Objectives and specific activities

Objectives

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o Adopt the VSLA strategy to attract and draw women to regular meetings

to share messages on malaria prevention/home management and discuss

how to apply information to real life situation for sustainable behaviour

change. The women will adopt healthy behaviours and become advocatesin their communities.

o Increase antenatal attendance and demand for SP by pregnant women.

o Improve the skills of women in the home management of malaria’

o Increase the demand and use of LLINs by individuals and families.

o Form VSLA groups in 10 communities in the Ga East and 5 communities

in the Dangme East Districts with income generation as a driving force to

attract other women for health promotion in malaria (form 2 VSLA groups

in each community with between 15 to 25 members per group).

Activities

Facilitation of workshops for about 500 women (15 women groups in rural areas,peri-urban, communities and market/trading communities of the Greater AccraRegion) to share knowledge, attitudes, and practices on malaria, using alreadydeveloped materials.

Training sessions to prepare the women’s groups to appreciate the concept of VSLA.

Capacity building workshops for the Prolink Organization, the NGO partner in theDangme East District on VSLA to enable them supervise the groups in theirdistrict.

Workshops with the communities to build commitment for specific actions,including support to the set up of group level malaria emergency funds within thevillage savings and loans group procedures;

Support the implementation of a Malaria day in 5 basic schools, to raiseawareness and commitment to actions amongst pupils and their families.

Facilitate 30 women groups’ representatives to attend major health meetings/eventsat the Regional level, to share their efforts and stories and influencerelevant decision makers with some key evidence from the communities.

This project will improve the health of thousands of Ghanaians and improve their

capacity to access and advocate for better health care in the future.

Expected outputs

Please provide timescale of project.

• Expected Outputs

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• Timescale of the project

Empowering Mothers for Health Behaviour

Activity Month Output Responsibility

Advocacy meeting with the

NGO partners

October,

2010

Hopeline Institute and Prolink

Organization CM staff (10)

CM Team/ VSLA Expert

Capacity building for theProlink Organization, theNGO partner in theDangme East District onVSLA to enable themsupervise the groups intheir district.

October,

2010

Prolink Staff trained, training

report produced

CM Team/ VSLA Expert

Identify VSLA communities October,

2010.

About 15 communities CARE/GHS/VSLA

Expert/NGO Partners.

Community entry –Advocacy meetings withstakeholders in thecommunities.

November,

2010

About 15 communities

covered

CARE/GHS.

Formation of the VSLAgroups and introduction toVSLA Approach

November,

2010

About 30 VSLA groups

formed

CARE/GHS/VSLA

Expert/NGO Partners.

Training of the women

groups

December,

2010.

About 600 women in 30

groups trained to manage

VSLA

CMTeam/VSLA Expert/NGO

Partners.

Implementation of VSLA in

the communities

Jan – Sept,

2011

List of group members and

their shares documented;

Terms of reference for each

group in place. Meeting

schedule developed.

CARE/NGOs/Mobilizers.

Communities workshops

on building commitment

for specific actions, e.g.

malaria emergency

funds within the VSLA

group procedures.

April, 2011 Workshops held in 15

communities; Malaria funds

set up for each community;

15 workshop reports

produced.


Partners/. VSLA Group

members

Support theimplementation of aMalaria day in 5 basicschools, to raiseawareness andcommitment to actions

amongst pupils and theirfamilies.

Feb-

March,

2011

Malaria day organized in 5

schools and reports produced


Partners/. VSLA Group

members

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Facilitate 30 womengroups’ representativesto attend major healthmeetings/events

Representatives of 30

women’s groups attended

Health meetings/events

CARE/NGOs/Mobilizers/GHS

Monitor implementation of

community Action Plans

October,

2010

September,

2011

Monitoring checklists

developed for use.

Monitoring visits conducted

by Mobilizers, NGO partners,

VSLA Expert and CM Team

CARE CM/NGOs/Mobilizers/

VSLA Expert.

Hold stakeholders review

meetings

August-

September,2011

Weekly meetings by group

members held.

Monthly review meetings with

mobilizers.

Quarterly review meetings

with, NGO Partners and CM

Team.

Stakeholders’ review

meetings

CARE CM/NGOs/Mobilizers/

VSLA Expert/VSLA groupmembers.

Location of project and a summary of the project beneficiaries

Monitoring and Evaluation

- Neighbour to neighbour information sharing pairs.

- No of VSLA women of women groups formed and the number of women whoparticipate in meetings regularly.

- List of best practices identified, documented, shared and employed by other

groups.

- No of schools reached, number of teachers and children, number of meetings

held with each school and action taken by the schools in response.

- % of pregnant women 15-45 years who slept under ITN/LLIN the previous night.

- % of children under 5 who slept under ITN/LLIN the previous night.

- % of pregnant women who have received IPT two times and above

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Can you describe how the project will be monitored (I assume that the larger project

will monitor these activities?)

- Development of workplans at all levels (VSLA groups, mobilizers, NGO

Partners, CM Team)

- Weekly meetings by group members. A checklist will be developed to be

completed by group leaders capturing data on the activities.

- Monthly review meetings – VSLA Groups with mobilizers; NGOs with mobilizers;

CM Team with NGO partners/mobilizers/VSLA group members.

- Quarterly review meetings with, NGO Partners/CM Team/ Community

stakeholders

- Activity reports, minutes of meetings, quarterly reports and annual report.

CARE Ghana is requesting £25,000. In summary the funds will be used (in up to 1 yr,

starting Oct, 08) see attached budget:

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1 Strathspey Proposal Empowering Mothers in Malaria Health Behaviour, Ghana

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