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Care Group Operations Research in Burundi and

Niger

Jennifer WeissHealth

Advisor, Concern

Worldwide

CORE Spring Meeting 2013

Background

• USAID-Child Survival and Health Grants Program in Mabayi Health District 2008 – 2013

• Care Group Model is powerful strategy for community mobilization and widespread behavior change

• However, staffing structure recognized to be unrealistic for the MoH to maintain after the life of the project

• Operations Research testing an “Integrated” Care Group model

Background

Background

Traditional and Integrated Models

Domain Traditional Care Groups Integrated Care Groups

Training Promoters train CHWs and Leader Mothers each month (CHWs participate in Care Group meetings)

Project staff (Animators) trains health facility staff each quarter

Health facility staff train CHWs once a month

CHWs train Leader Mothers twice a month

Meeting Facilitation and Reporting

Care Group Meetings facilitated by Promoter

Reports submitted to Promoter who then submits to health center/MoH

Care Group Meetings facilitated by CHW Reports submitted to CHW who then

submit to health center/MoH

Supervision 2 Animators oversee 5 Promoters 5 Promoters facilitate 41 Care Groups

(approx. 8 each)

2 Animators and 2 district-level MoH staff support 3 health centers

Health center staff supervise 18 CHWs 18 CHWs facilitate 35 Care Groups

(approx 2 each)

Traditional and Integrated Models

OR Questions and MethodsResearch Question Methods

1. Does the Integrated Care Group model achieve the same or better improvements in the knowledge of key MNCH behaviors as the traditional Care Group model?

Comparison of baseline (October 2010) and endline (May 2013) KPC data

Non-inferiority testing; sample size of 320 in each study arm 2. Does the Integrated Care Group model achieve the

same or better improvements in the practice of key MNCH behaviors as the traditional Care Group model?

3. Does the Integrated Care Group model achieve the same level of functionality as the traditional Care Group model?

Monthly data collection of 5 key Care Group functionality indicators (June 2011 – February 2013)

4. Does the Integrated Care Group model achieve the same level of sustainability as the traditional Care Group model?

Monthly monitoring of 5 key functionality indicators after withdrawal of Concern support to both areas (March – September 2013)

Qualitative mid-term review (October 2012) conducted to identify and document benefits and challenges associated with the implementation of each model . FGDs and KIIs with all key stakeholders.

Results to Date: Functionality

Preliminary ConclusionsCare Group ComparisonIntegrated and traditional CG models appear to have similar levels of functionality, with both surpassing targets Knowledge and practice gains appear to be significant in both areas

Role of NGO in Care Group Facilitation Animators play a key role in facilitating the implementation of Care Group activities in the Integrated Area

Supervision of CHWs and CG activities is a challenge for the head nurse Recommendation to appoint “Care Group focal person” at each health center

Stakeholders in Integrated area report feeling much more self-efficacy to continue CG activities once project ends (midterm qualitative review)Support from local leaders has greatly contributed to smooth implementation of CG activities in both study areas

Preliminary Conclusions: Policy Level CHWs are an essential component of

the MoH community health policy, however an effective CHW policy has not yet been successfully operationalized

Widespread acknowledgement that CHWs alone will not attain complete household coverage

Integrated Care Group model seen as a promising strategy to achieve realistic CHW strategy while leveraging existing structures

Janvier Niandwi- Community Health Worker

Care Group Operations Research: Niger

USAID Child Survival and Health Grants Program: Tahoua, Niger 2009 – 2014

OR Objective: Assess the potential for Care Group Leader Mothers to deliver integrated community case management (iCCM) •24 Care Groups with 270 Leader Mothers •1 Leader Mother from each CG will be selected to implement CCM

Care Group Operations Research: NigerFormative Research:•How would key stakeholders accept Leader Mothers delivering iCCM? •What are the best training tools for Leader Mothers to implement iCCM?•What are the best processes for implementing iCCM through Care Groups?

Findings to date: Encouraging community perceptions that iCCM will increase access to care; development of training tools in process

Evaluative Research:•Are Leader Mothers able to provide quality iCCM?•Does Leader Mother provision of iCCM affect care-seeking behavior among caregivers of children under five? •What are community members and stakeholders’ perceptions of iCCM provided by Leader Mothers?

Thank you!