Changing Maternal and Child Health - Celebrating 20 Years of Care Groups

Dr. Pieter Ernst with Care Group volunteers in Mozambique
Dr. Pieter Ernst with Care Group volunteers in Mozambique

In 1995, a small group of thoughtful people noticed an injustice and were not content to sit back and wait for someone else to do something about it. The problem was that too many women and children were dying from preventable and treatable diseases. 12.7 million children under the age of five died in 1990 alone. Dr. Pieter Ernst worked with World Relief in Mozambique at the time and saw firsthand the unnecessary suffering of women and children. But he knew the potential existed to combat this injustice. All that was needed was some initial training and teaching of health practices and treatments and then local citizens could implement what they had learned. So the Care Group movement was created.

This award winning model of healthcare provides regular health training to groups of 10-15 volunteers in each community. These volunteers, mostly women, are taught the simple health practices like washing hands as well as how to treat and prevent serious illnesses like malaria, diarrhea and pneumonia. Each volunteer is then responsible for visiting 10-15 of their neighbors regularly, sharing what they’ve learned and caring for any illnesses they come across. This multiplying process not only helps save lives, but the entire community becomes aware of how to prevent these illnesses before they start.

As we celebrate 20 years of Care Groups, we commemorate the millions of lives that have been saved by this method of effective grassroots health education. It’s played an important role in contributing to progress on the Millennium Development Goal of significantly reducing child mortality and USAID's call to End Preventable Child and Maternal Deaths. Recognized as an innovative program, Care Groups have been implemented by more than 25 organizations in over 25 countries.

People like Miseria and her daughter, Lucrencia, know firsthand the kind of life-saving impact Care Groups have. Lucrencia is the youngest of 7 children and was chronically malnourished, thin and unable to walk as an 18 month old. Children in that state used to die because of local traditional beliefs that the disease was caused by spirits that sat on the child, preventing it from growing. But when a local Care Group Volunteer visited their home, she immediately recognized the problem and included mom and daughter in a community training about preparing enriched meals with locally available ingredients to improve the nutrition of malnourished children. Several years later, Lucrencia is an energetic and healthy teenager who is a huge help to her mother.

Miseria and her daughter Lucrencia
Miseria and her daughter Lucrencia

One of the local Care Group trainers recently commented, “After seeing Miseria and her once malnourished child Lucrencia at the brink of death, now full of joy and growing into womanhood I could only thank God for what He has done, not only for Lucrencia, but also for so many other families with similar experiences in Gaza Province (Mozambique) through the World Relief Care Group program.”

To join us in this movement of life-saving empowerment, visit

Transforming Lives and Agriculture- a Story from Mozambique

Out of the five farmers’ groups in Massingir West, Mozambique, the Chinhangane group was by far the least successful. Aside from one strong harvest in 2010, the group suffered through years of poor growth and broken relationships. Like the weeds that tangled their rows of overgrown crops, conflict and division choked any hope of improving their harvests or friendships.

In their August 2014 meeting, the Chinhangane group learned about the fields of other farmers’ associations in the area that consistently out-performed theirs. They compared the neat rows and flourishing fruits in the other groups’ fields with their own meager progress. After the meeting, their hope and confidence were shaken.

“We were really at the end of ourselves and realized only God can change hearts and attitudes,” said Dr. Pieter Ernst, who’s led World Relief’s health and development programs in Mozambique since 1995. Today, his work focuses on agriculture – a mainstay of the Mozambican economy. Farmers make up 80 percent of the country’s workforce. When fields aren’t producing, the consequences are severe for individual subsistence farmers who rely on their crops to eat and generate income.

In World Relief’s Mozambican farmers’ associations, group members study the Bible together as they learn sustainable agriculture techniques. “We discussed the goal of the church as we find it in Ephesians 4, to have all come to the maturity of Christ,” Dr. Ernst explained. But at the end of the August meeting, he was unsure that maturity, unity or peace would ever come to the group.

But as they reflected on Ephesians 4 that day, something changed in the hearts and minds of the Chinhangane members. Most of them attended church – they reasoned – so why didn’t their fruit, both in their spirits and in their fields, match their belief in Jesus?

Several months later, Dr. Ernst visited the group again. To his great surprise the fields at Chinhangane were nearly unrecognizable. Compared to the other farmers’ groups, he said, “Chinhangane’s field was the best of all, with almost no weeds, healthy tomato plants stacked up neatly in their rows…their attitude was also different.”

The growth of fruit in their fields reflected a deeper level of change that had at last taken place in their lives. “I praised the Lord in my heart knowing that this could only be his doing,” Dr. Ernst said. Since the Chinhangane group’s transformation, 90 percent of the members have already made enough profit to pay back the initial costs to grow this seasons’ crops.

Health for the Future: Care Groups Make a Mark


When Dr. Pieter Ernst, a World Relief Project Director in Mozambique, saw the suffering of women and children from preventable and treatable diseases, he knew there needed to be a solution. And the awakening of healthier communities through education and more sustainable efforts is just what the doctor ordered. Following a 17-year civil war in the Gaza Province of Mozambique, the Care Group Model developed out of World Relief’s first Child Survival Project. Dr. Ernst designed a way to reach a large group of people through generating a network of volunteers within each community.

With this, the need for a more comprehensive method to engage community members in becoming educators and leaders who support and encourage one another grew at a steady rate. Care Group numbers multiplied as a small project staff grew in the ability to reach a larger population. Without straining individual volunteers, Care Groups mobilized communities to address various health issues and take extensive action.

Since its formation in 1995, the Care Group Model has been adopted by 23 NGOs and implemented in over 21 countries. In 2009, this model reached over 44% of the total population of Mozambique and nurtured relationships that continue to thrive today. All over the world, this sustainable system has:

  1. Decreased infant mortality rate
  2. Increased uses of modern family planning methods
  3. Provided children with up-to-date immunizations

ALL while creating a lasting and continual difference within communities.

Dr. Ernst recently received the 2014 Dory Storms Child Survival Recognition Award for the design of the revolutionary Care Group Model. Together with Dr. Ernst and others who have participated in the Care Group Model, World Relief will celebrate 20 years of this innovative project in 2015.

Through this program, we have seen God do great things in countries and communities where health information is seldom provided. Simple explanations can truly change countries and empower people to become heroes in their communities.

A friendship that brought life

Proverbs 17:17 says,"A friend loves at all times, and a brother is born for a time of adversity." World Relief empowers the local Church in Mozambique to serve the most vulnerable by training community health workers to provide in-home care for the marginalized. Often, these volunteers provide lasting friendship to the people they serve, meeting not only their health needs but their spiritual and relational needs as well.

Esmeralda Fernandowas in a very vulnerable state before a trained community health worker reached out to her and helped her achieve a better quality of life. She has HIV/AIDS and Tuberculosis. At only 22 years old, she is a widow and a single parent to her seven year-old child. Her husband passed away in 2013.

When she was first visited by the volunteer, Esmerelda and her husband both knew they had HIV/AIDS but had not been adhering to treatment. After her husband passed away, Esmerelda began heeding the words of the volunteer.

“When she first came to talk about our health and our possibility to re-start our normal life if we do regular treatment, we didn’t believe her because, for us, our life was close to the end," said Esmerelda. "When my husband passed away, [she] visited me more times and one day asked me who is going to take care of my child if I die.”

The community health worker helped Esmerelda realize that her health was fragile, precious and vital for the well-being of her daughter. Esmerelda began treatment and today, her health has improved.

Esmerelda Mozambique

When we spoke to her, Esmeralda Fernando had a lot to say about the volunteer who showed her the love of Christ in word and deed. “I feel relief because of the work [she] did in my life,” she said. “She is like a sister to me. I decided to restart the treatment again and with the support of the [health worker] and my relatives even, [though we were not] sure of the results.”

The volunteer also helped Esmerelda enroll her daughter in school and obtain necessary school supplies. “Today, I am feeling good,” said Esmerelda. “I farm and produce my own food. I and my child are very happy and I am thankful too because it was able to help enroll my child in the school I also was able to learn a lot about community health. I am willing to pass the message to other people in the community."

Mozambique: The Courage to Replant

Maggie Konstanski is the Asia & Southern Africa Program Officer for World Relief. Just back from her trip to Mozambique and Malawi, Maggie reflects on her visit. Recently I had the privilege of going to Mozambique and meeting women who did not give up. In January, flooding in the Gaza Province in Mozambique devastated villages close to the river. Homes were destroyed and crops that were almost ready to harvest were washed away. Significant damage was done to the infrastructure of these small farms, which many women depend on for survival.


Flooding in Mozambique is not uncommon, but floods of this magnitude are only expected to strike every ten years or so. The trouble with this most recent flood is that only last year floods destroyed homes and livelihoods in these same villages. Two years in a row these farmers have watched their livelihoods swept away by flood waters. Two years in a row these farmers have suffered significant losses. Two years in a row they have faced the discouragement of loss…and they have not given up.

When I showed up at the first farm I was expecting to see damaged fields. Yes, there was significant damage. The harvest had been lost, much of the infrastructure was destroyed and sand from the river covered the soil. Then I looked further and I saw a makeshift nursery full of little seedlings popping out of the soil.


The start of new life breaking forth from the soil always gives me a sense of hope. Women were hard at work in the field preparing to transfer the seedlings from the tray into the ground, doing the hard work of removing sand, repairing damaged structures and preparing the field.

This is no easy job. I helped lift a few bags of cement and fertilizer. I am a relatively strong person and I could barely manage on my own. I think these women are some of the strongest women in the world. Most of them were lifting far more than me and they had babies on their back!  I think I need to start lifting weights when I get home!

It is not necessarily that I was surprised to see these women hard at work. This is how they survive and it makes sense that they would want to replant as soon as possible. What surprised me was the resilience. I feel like if I was a farmer I would have a somewhat fatalistic attitude towards the field. I would be expecting something to go wrong and express anger when hard times struck. Yet these women were working together to make sure that everything was planted in time and they worked with grace and joy. They were quick to express their desire to replant and repair the fields. Yes, there was discouragement, but they did not let the discouragement defeat them. They would replant and wait for that new life to grow.

I have a lot to learn from these women. It is easy to become discouraged and to want to give up. They reminded me that we will face many trials, but we must have the strength to keep going. We do not know when floods will strike, it could be next year and it could be in ten years from now. But we can choose how we respond. We can get stuck in discouragement and give up, or we can return to the field and place the seedlings in the ground as we cling to hope.

Mohambe field with sand

“Have I not commanded you be strong and courageous? Do not be terrified. Do not be discouraged. For the Lord your God will go with you wherever you go.”

Follow Maggie Konstanski on her blog.

Following the Flood - Part 2

Paul Erickson continues his account of his journey through Gaza Province, Mozambique.  To see more pictures, click here.It will take months and months for everyone to establish their normal lives again, if at all.  But this will be unlikely if they don’t receive food and potable water and electricity soon.  Those who stayed behind or returned to Chokwe after the waters began to recede, are far from the relocation centers where at least some basic provisions are being distributed.


As we leave Chokwe late in the afternoon, I notice with great sadness that the horrific sight that greeted me this morning while driving into town is still there – a precious life lost, the body still uncollected.   I can’t make sense of it.  All I’m clear about is that the residents of Chokwe and those thousands who fled the floodwaters and who have little or nothing to return to need our help.  In times like these, which seem ever more frequent, Christ calls us still to reach out with compassion to a world in need.

The latest figures reported by AFP are that at least 36 Mozambicans have been killed and nearly 70,000 have been displaced.

Later in the afternoon, as we make the return drive to Macia, we stop to drop off Maposse at his makeshift, under-a-tree shelter. Maposse is a local World Relief staff person and now also a displaced former resident of Chokwe who, together with his family, is himself sheltering in the temporary resettlement camp in Chihaquelane.

The vast increase in the number of relocated victims here now compared to when we passed by only several hours earlier is astonishing.  Initially set up to “house” perhaps 20-30,000 people, the makeshift camps have been burgeoning with people fleeing with their families and belongings.  In the hours between morning and afternoon, the numbers increased visibly, and as the waters recede further, relief agencies are predicting that more people will arrive from across the Limpopo River.  As the camps are just being set up today, systems for food and water distribution are still being prepared.  Key problems are latrines as well as shelter, as more and more people arrive to the site.  Without adequate sanitation, disease will spread quickly; and if cholera strikes, a new disaster may begin.


Both in the camps and in the town, food is a serious issue.  Food stores in Chokwe and other affected towns were destroyed, and people – mainly women and children – are waiting desperately for distributions to reach them.

Aid is arriving.  While we were there, helicopters and trucks were passing through the area, leaving supplies, and seeking out still stranded people.  Those in the camp, however, must simply wait.  They will not be able to return to what is left of their homes for weeks or even months.  They will eventually receive temporary shelter – tents or supplies to build a makeshift roof – and they will receive stipends of food or water.  Children will learn to play between the tents and under the trees, and some lucky ones may even get to go to school, but life will never be the same for any of them.

Paul Erickson Maputo, Mozambique

Click here for World Relief’s response to the flood.