SCOPE: Care Groups
What is a Care Group?
Global evidence has shown the effect of the Care Group model for improved maternal and child survival outcomes. A Care Group (CG) is composed of 10-15 Care Group Volunteers (CGVs) who meet regularly for social behavior change communication (SBCC) and related skills building, on various topics. After receiving the lessons, each CGV cascades information to neighbor mothers in nearby households through home visits.
By emphasizing the creation of positive new norms, creating a safe space for critical community reflection, CGs are a community-led effective behavior change strategy that deploys organized diffusion for social norm change around key behaviors.
In 1995, World Relief developed the CG model in Mozambique, and CGs quickly gained global recognition and have received significant funding through USAID-sponsored programs. Due to its effectiveness, since its inception, the CG model has been implemented by multiple NGOs throughout 27 different countries. CGs’ ability to extend the health system’s reach through the multiplication of volunteer effort, peer support, and community mobilization makes the model ideal for many projects and programs.
How Care Groups Impact Survival Outcomes
Extending the Reach of the Health System
CGs extend the reach of the Ministry of Health (MOH) down to the household level, ensuring that even the most vulnerable members of the community know how and when to access health services. This is done particularly to serve those who live in hard-to-reach areas to improve health outcomes. World Relief implements CG training using a cascade approach to diffuse messaging at the household level. CGVs are equipped to deliver SBCC messages on maternal-newborn health, family planning, and the three major childhood illnesses of diarrhea, malaria, and pneumonia. By universally reaching every household in the target population with SBCC on health behaviors, CGVs complement the work of overburdened community health workers (CHW) by allowing them to emphasize their clinical roles and provision of health services, such as Community-Based Distribution of Family Planning and Integrated Community Case Management (iCCM).
Providing a Key Source of Referrals
CGVs are a source of linkage between the community and facility services, in that they become a mechanism of the local referral system. Not only do CGVs provide evidence-based information to their neighbor group members, but they are also trained to make referrals from the communities to the CHWs and nearest health facilities. CGVs report on key vital events such as childbirth, pregnancy, child illnesses and deaths. They are also trained to recognize danger signs amongst pregnant and postpartum women and sick children, and make timely referrals to MOH-appointed/approved CHWs who can feed vital information and data into health information systems. This referral relationship also highlights the difference between CHWs and CGVs: CHWs have a health background and training that CGVs do not, so the two should be viewed as an extension of each rather than parallel entities. The CG model is particularly useful as it can reach a large population while maintaining cost-efficiency, sustainability, and intensive support to CGVs and beneficiaries.
Development and Monitoring of Care Groups
CGs are designed to encourage health seeking behavior and improve the linkages between the community and the health system. Before establishing new CGs, households of families with children under age five and/or women of reproductive age who are not currently connected with an existing CG are identified. Using a CG mapping tool and household census form to identify these households, CGs aim to reach as many households as possible according to budgetary and contextual allowances. Once households with direct beneficiaries are mapped, local stakeholders are provided with identification and introduction to the CG program. CG settings are determined by moderate population density, and CGVs are selected based on geographic proximity to potential CG meetings and Neighbor Women households. Households are divided and assigned to CGVs, who are formed into CGs. Training for CG supervisors and promoters is provided. The training covers strategies for curriculum delivery and CG monitoring and support.
Monitoring data is collected using Neighbor Women Registers and CG Registers. These forms record reach-data (through meeting attendance or household visits), health events (births, pregnancies, illnesses, etc.), and health services referrals. Both Neighbor Women Registers and CG Registers are completed bi-monthly, by a CGV and a CG Promoter, respectively. Then, each promoter provides the supervisor with a summary report of her compiled CG registers (about 5-9 per promoter) and Neighbor Group registers (approximately 100 per promoter). The supervisor compiles all promoter reports monthly stored summary reports using a CG Summary Form. This thorough and consistent monitoring throughout CG implementation ensures necessary referrals to health services are made for mothers and children under five through a CHW.
Quality Improvement Verification Checklists (QIVC) are a key component on these registers that gather targeted observations on the delivery of CG lessons at every level. The information collected through these quality-improvement checklists promotes each facilitator’s encouragement, monitoring, and improvement.
Coordinators (paid staff) are responsible for 3-6 Supervisors. Supervisors (paid staff) are responsible for 4-6 Promoters. Promoters support 4-9 CGs which are composed of 10-15 CGVs. CGVs share lessons with 10-15 Neighbor Groups (made up of Neighbor Women and their families). Through this cascade process each Promoter reaches approximately 500-1,200 women via CGVs.
Care Groups for Improved Family Planning and Maternal and Child Health Outcomes
CGs are a core strategy for the SCOPE project’s goals to increase access to family planning/maternal and child health information, improve health seeking behavior and strengthen community-facility linkages. CGs provide the teaching tools and supervisory structure to fulfill SCOPE RMNCH’s vision to see people of reproductive age, pregnant women, and caregivers of children under five adopt healthy behaviors and seek necessary care. SCOPE works with established leaders in the community, usually from faith institutions, to educate community members on health topics and the local resources available to them.
Over two years, the CG curriculum within SCOPE addresses a range of reproductive, maternal and newborn health topics and is adapted for COVID-19 awareness. Curriculum development included a desk review of existing material and adaptation of existing toolkits to create content aligned with the latest global guidelines and evidence for community-based family planning and maternal and child health. SCOPE implements the CG training using a cascade approach from supervisors to promoters, from promoters to CGVs. Two CG lessons are provided every month from promoter to CGV and from CGV to neighbor women. CGVs deliver these lessons and conduct home visits to Neighbor Women in groups. If a CGV or Neighbor Woman misses a lesson, then the promoter or CGV will make a home visit to deliver lessons and brainstorms solutions to barriers for meeting attendance. During CG meetings, guided discussions center around clear learning objectives. The content of each lesson is user-friendly, interactive, and carefully contextualized to each country’s local context. Each CGV is equipped with a pictorial flip chart of lesson topics to share with neighbors. This system of training and group lesson delivery, home visits, and role modeling, and regular monitoring of CGs fosters peer-to-peer support and facilitates community-wide interest and improved health seeking health behavior among caregivers.
Care Groups Curriculum
In addition to the English versions below, each module has been contextualized and translated into local languages for the relevant implementing SCOPE countries (Chichewa, Maasai, Kiswahili, Turkana, Creole, and Zande). If you'd like to access copies of these resources please reach out to InfoInternational@wr.org.
Despite the challenges from COVID and region-specific political and environmental factors, CGs have demonstrated positive results even in hard-to-reach areas of SCOPE-supported countries. Field teams report stories of community members turning their knowledge to action, rallying around women and young children to advocate for their healthcare needs at local facilities. As of March 2022, the CG model has brought the following results in the four SCOPE countries:
Hear the stories of transformation through SCOPE Care Groups
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