Every year, an estimated 9.7 million children under the age of five die from preventable and treatable causes.  This means that in the world’s least developed countries, one in every five children born will never reach his or her fifth birthday.  Most of these deaths are directly caused by illnesses such as pneumonia, diarrhea, malaria and measles or indirectly caused by HIV/AIDS.  Malnutrition, poor hygiene and lack of access to clean water and adequate sanitation contribute to more than half of child deaths worldwide.  Additionally, half a million women die in pregnancy each year, mostly during delivery or shortly thereafter.

Beginning in Mozambique in 1995, World Relief began to respond to the needs of vulnerable children and mothers through an innovative community-based approach, called the Care Group Model, which reaches mothers and children in the homes where they live.  The Care Group Model saturates entire villages with health information and support services through networks of devoted community volunteers, usually comprised solely of women.  About 10-15 women come together in a Care Group every two weeks to learn life-saving health messages from a health educator.  Each woman is then responsible to teach the health lessons they learn to 10-15 of her neighbors. The Care Groups reinforce health lessons through group interaction and become a primary source of support and encouragement for the volunteers.

Women are empowered with information to make their families and the families of their neighbors healthy.  They teach mothers how to cook nutritious meals from locally-available foods, how to care for children with diarrhea, how to prevent malaria by using insecticide-treated bednets and other life-saving health information.  Community leaders and local pastors also come together to learn the health messages, so that they can encourage the volunteers and reinforce essential health messages within their spheres of influence.  As women are empowered with this knowledge, their profile in their families and communities is heightened as their husbands and community leaders begin to recognize them as effective agents of change. 

Hallmarks

Sustainability: In our first project area in Mozambique, we conducted a survey two years after the project ended and found that more than 90 percent of our original volunteers were still active. A second survey completed four years after the end of the project found that beneficiaries had continued in healthy behaviors at rates that exceed our original project targets.

Volunteerism: Our model multiplies the effort of each paid staffer over 200 times through the efforts of thousands of volunteers. This exponential multiplication of effort leads to high efficiency and low costs. Based on the total four-year cost of our initiative in Mozambique ($1.4 million), costs per child per month are fractions of that of child sponsorship programs.

Change in behavior: As a result of the life-saving health messages received in Care Group meetings and distributed throughout the communities by volunteers, mothers begin to understand the causes of illness and ways to keep their children healthy. As their understanding grows, they stop depending on ineffective measures to care for their sick children.

Community saturation: Our approach ensures that every household in the project area with a child under age 5 or a woman of child-bearing age receives a visit at least twice a month. As the numbers reach a tipping point, new attitudes proliferate across the entire community, and even the oldest members of the community are convinced. When an evaluator asked a group of grandmothers in Mozambique what they thought of the project, they responded that they had been liberated from slavery and would never return to their old ways.[ad1] 

Efficacy: As a result of their newfound understanding of health, women access health services earlier and more often for themselves and their children. They collaborate to plant gardens with nutritious crops. Pastors launch care-giving ministries at their churches. Men in the community bring their wives and children to the hospital earlier and more often.

Policy change: Our work has demonstrated to national governments and the international community that the Care Group Model is an effective strategy for reaching communities with health information and services. For example, our work in Rwanda contributed to the development of a new national policy that increases access to malaria medications in the community. The Malawian minister of health invited World Relief to lead a working group on malaria control.

Reconciliation: Our work unites communities around a common vision for health and child survival, enhancing social cohesion. Neighbors are freed from resentment when they learn that illness is caused by behaviors, not spells or poison.  Communities are strengthened as community members realize the significant changes they can make when they work together.