Care Groups in Emergency Settings_Davis

1. feedthechildren.org
Create a world where
no child goes to bed hungry.
Care Groups in
Emergencies
TomDavis
ChiefProgramOfficer

2. feedthechildren.org
Session Objectives
• To leave you some time to talk during lunch. 
• To inform CORE Group members and practitioners on new
guidance on the use of Care Groups in emergency settings.
• To explain the findings from a review of the use of Care
Groups in emergency settings and how those led to the
development of the guidance.
• To share a case study on the use of Care Groups in Liberia
during the Ebola outbreak and lessons learned.
• To explain some of the added value of using Care Groups in
emergency settings.

3. feedthechildren.org
What are Care Groups?
• A community-based strategy for
improving coverage and behavior
change
• Developed by Dr. Pieter Ernst with
World Relief/ Mozambique, used
subsequently 27 organizations in 23
countries.
• Focuses on building teams of
volunteer women who are selected
by their peers, and represent, serve,
and do health promotion with blocks
of 10-15 households each
• “Pure” volunteers – no monetary
incentives, just job aids

4. feedthechildren.org
-20
0
20
40
60
80
100
MeanChangeinCoverage
Coverage Indicators
Care Group Projects
Non-Care Group Projects
1
64
9
3
2 3
5
7
8
9
7
3
2
4
8
5
8
9
8
5
9 5
9
3
8
2
6
3
3
1
0
High Impact Child Survival Indicator
Coverage Changes

5. feedthechildren.org
Some Benefits of Using Care Groups in an
Emergency Setting
• Most important factor in the speed and level of recovery of
communities and households after a disaster is social capital.
(Daniel Aldrich findings. See @6m
mark: http://www.youtube.com/watch?v=tx4Ii5tueDo)
• In relief settings, people are more likely to look at what others are
doing and saying to decide what they should do (see Principles of Persuasion,
Part 2: Social Proof and Reciprocation)
• Neighbors visit existing neighbors as well as forming new social
bonds. (414K contacts [w/27K HHs] in 9m). High-quality BCC
messages can reach a high proportion of households regularly.
• Great for piggy-backing other activities

6. feedthechildren.org

7. 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00%
% of respondents who say they can resolve
problems if they try hard
% who say they have confidence that they can
handle problems that come up unexpectedly
% who say they know how to handle unforeseen
situations
% who say that they can solve many of their
problems if they invest the necessary effort
% who say that they can remain calm when
facing difficulties because they can rely on their
coping abilities
% who say that when they are confronted with a
problem, they can usually find several solutions
% who say that if they are in trouble, they can
usually think of what to do
% who say that they can usually handle
whatever comes their way
Proportion of Mothers
Indicator
Comparison of Generalized Self-efficacy Elements
Baseline Final
Baseline: April 2010
Final: December 2010

8. feedthechildren.org
Presentations
• Sandra Wilcox: The Care Group Approach in
Emergencies
• Florence Amadi: Use of Care Groups in Public Health
Emergencies – The Case of Ebola
Curamericas.org

9. The Care GroupApproach in
Emergencies
CORE Spring Meeting
April 14, 2015
Washington, DC
Presenter: Sandra Wilcox

10. Disclaimer
This workshop was made possible by a grant from the USAID
Technical and Operational Performance Support (TOPS)
program. The TOPS Micro Grants Program is made possible by
the generous support and contribution of the American people
through the United States Agency for International Development
(USAID). The contents of the materials produced through the
TOPS Micro Grants Program do not necessarily reflect the views
of TOPS, USAID or the United States Government.

11. CG-E Outline
1. Introduction
2. Background
3. Methodology
4. Findings
5. Recommendations
(UNICEF)

12. Introduction
Care Groups (CG) traditionally a development methodology
Recent use of CGs in emergency settings
Objectives:
1) Conduct an analysis of peer support group models used
in emergency contexts
2) Use these findings to develop guidance on adapting the
CG model for emergencies
3) Disseminate findings within the programming
community

13. Background: Defining CGs
are Groups
• A group of 10-15 community volunteers (mothers) who
regularly meet with project staff for training and supervision.
• Each volunteer is responsible for regularly visiting 10-15 of
her neighbors, sharing nutrition and hygiene information.
• CGs create a multiplying effect with interpersonal behavior
change communication.
Cascade Groups
• Using the cascading and multiplying structure of the CG
model for purposes other than reducing maternal and child
mortality, morbidity and malnutrition.

14. Background: Defining CGs
Mother-to-Mother Support Groups (MtMSG):
• Group Meetings to discuss infant and child nutrition
• One member trained to facilitate the meeting
• Participatory, interactive learning
(Save the Children, Jordan)

15. Defining CGs: Quick Comparison
Care Groups Cascade Groups MtMSGs
Child Nutrition
Focus
✔ ✖ ✔
Group Meetings ✔ ✔ ✔
Household visits ✔ ✔ ✖
All three peer-support models were included in the analysis

16. Background: Defining Emergencies
Type of emergency:
Natural disasters
Epidemics
Conflict
Stage of emergency:
Acute: Typhoon, Earthquake
Protracted: Conflict, Drought
Emergency setting:
Camp setting: IDPs, Refugees
Host community: Returnees

17. Methodology
Literature Review
• Gray literature
• Project documents on CGs in emergencies
Interviews (Implementers)
• Follow-up to Lit Review
• Skype
• Survey Monkey
Field visits
(Implementers & beneficiaries)
• Ethiopia IMC/STC
• Philippines FH
(FH, Philippines)

18. Methodology (cont’d)
Sum Total of 24 Interviews
• 14 Countries
• 12 NGOs

19. Methodology (cont’d)
Analysis
Interviews + Field visits  Data tables
Data tables
• Project/respondent information
• Peer support model structure & management
• Advantages & Challenges
Limitations
Defining CGs and emergencies
Time constraints: written surveys
Evaluating CGs independently

20. Findings:Adaptations
CG Elements Care Group Model Adaptations
Care Group Size Up to 16 2 Somalia
8-10 Liberia
Target Population PLW U2 U5 Entire Community
CGV Selection Elected Selected by staff or community leaders
Meeting Length Up to 2 hours More than 2 hours
Topics covered Nutrition/hygiene ARI, GBV, psychosocial, family planning
M&E* Vital statistics data Only attendance
Formative Research i.e. Barrier analysis Rarely conducted
Ministry of Health Integrated CG model Coordination levels varied widely
*Workshop Topic

21. Findings: Benefits
 Documented Effectiveness
 Cost Effectiveness
 Large Coverage
 Rapid Dissemination of Information
 Peer Support
 Rapid Behavior Change
 Structure to be Leveraged
 System for monitoring, screening and referrals
 Sustainability

22. Findings: Challenges
- Initial Set-up of Care Groups
- Development of Program Materials
- Community Buy-in
- Finding Qualified Program Staff
- Knowledge of CG Methodology
- Incentives
- Insecurity
- Population Mobility
- Sustainability
Workshop Topic

23. Recommendations
Overall Recommendations
TYPE REC RATIONALE
Acute Emergencies Not recommended Time constraint: Staff capacity, Initial
set-up, Short funding cycle
Transitional:
E  D
Recommended D  E: Infrastructure in place
E  D: Behaviors carry over
Protracted Emergencies Recommended Complements health infrastructure
Mobile Populations Not recommended Difficult to monitor beneficiaries and
supervise volunteers

24. www.curamericas.org
The Case of Ebola
FlorenceAmadi,MPH
ProgramManager

25. Background
Curamericas.org
• In 2008, Curamericas Global
was awarded a Child Survival
grant by USAID
• Curamericas successfully
implemented the Nehnwaa
project in Nimba County, Liberia
in partnership with Ganta United
Methodist Hospital
• Over 65,000 beneficiaries by
end of project
• Over 1,700 Care Group
Volunteers (CGVs)

26. The CBIO+CG Methodology
Curamericas.org
• CBIO = Community/Census-Based, Impact-Oriented approach to
the practice of community-oriented public health
 Involves mapping and census of every community/beneficiaries
in the target area and monitoring of services and vital events
• CG = Care Group with NGO staff serving as Promoters
 Compliments the CBIO
• Key successes include:
 Reduction in child mortality in Bolivia of 62%
 Reduction in child mortality in Liberia of 63%
 Reduction in child mortality in Guatemala of 54%

27. Care Groups and Ebola
Curamericas.org
• Care Groups were key in developing trust in the community and
allowed us to stay connected beyond the Child Survival program
and continue with activities
• With the initial outbreak of Ebola in March 2014, Nehnwaa staff
continued to conduct regular Care Group meetings and house-to-
house visits
• Behavior promotion included basic messages on Ebola prevention
• By June 2014, more Ebola cases were detected in Liberia including
Nimba County, precipitating a shift in health activities at all levels
• In August 2014, the president declared a state of emergency

28. Ebola Response Activities
Curamericas.org
Curamericas is partnering with Feed the Children, Ganta United Methodist
Hospital, and the Liberia (Methodist) Annual Conference to respond to Ebola in
Nimba County
• Eleven communities identified as most at risk are targeted
• Census and mapping of households in all 11 communities using CBIO
• 110 Care Group Volunteers per community trained on Ebola
• 120 Care Groups – approximately 10 per community
• Ebola education to 2,119 people through community outreach activities
(community forums)
• 22 Behavior Change Communication sessions – approximately 2 per
community
• 3 people identified with Ebola-like symptoms
• 21 referrals – for various conditions
• Zero confirmed Ebola cases

29. Usefulness of CGs and Lessons Learned
Curamericas.org
• Community outreach is critical in any public health emergency
response. How the outreach is done is as important.
• The Care Group approach is:
 Flexible and adoptable and easy to weave into community
 Leverages behavior change as people need to change in order to
survive
 Allow us to stay connected with the communities we serve
 Can provide multiple behavior promotion messages
 Cost effective and large coverage
 Provide house-to-house visitations
 Create a community level surveillance system
 Are community owned – local resource
 Mostly consists of women who are providers and care givers

30. Thank You!!!
Curamericas.org

31. feedthechildren.org
Several Support Mechanisms for Scale-up
• Website: www.CareGroupInfo.org – Narrated
presentations, training manuals, sample
flipcharts/lesson plans, project evaluations, blog
posts, support tools, etc.
• Materials and discussions also posted on
www.FSNNetwork.org
• New resource: Ebola Care Group Lesson Plans
(done) and flipchart (soon).

32. feedthechildren.org
Questions and Comments
• Please write your questions and comments on
the cards on your table and bring to us.
• We are available for questions at our table.