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Care Group Approach

Introduction

The Care Group Approach is a community-based social and behavior change intervention strategy that leverages community health volunteers who promote behaviors and are trained and supervised by paid community health workers (CHWs). They promote maternal, neonatal, and child health and nutrition (MNCH&N) behaviors and behaviors in other sectors (e.g. WASH, education) in resource-constrained settings. The approach has now been used by 30 NGOs working in more than 40 countries. It was developed to address high maternal and child mortality rates, particularly in underserved regions, this approach utilizes a dual-cadre workforce combining both paid CHWs and volunteers to maximize reach and effectiveness at relatively low costs.

Background

The Care Group model was pioneered in 1995 by World Relief in Mozambique under the leadership of Drs. Pieter Ernst and Muriel Elmer. In 1997, Food for the Hungry (FH) adopted the model in Mozambique after discussions with WR project staff, and both organizations have co-pioneered the use of the model since then. Early funding of Care Group projects came from the United States Agency for International Development (USAID) through their grants programs (e.g. the Child Survival and Health Grants Program [CSHGP]). The first Care Group projects were launched in Mozambique, Cambodia, Malawi, and Rwanda, focusing on promoting critical MNCH&N behaviors at the community level.

Structure and Function

Care Groups are composed of approximately 10-15 community health volunteers (called Care Group Volunteers [CGVs]) who meet biweekly (or sometimes monthly) with a paid CHW for training and supervision. Each volunteer is responsible for promoting behaviors among 10-15 households, using peer-to-peer communication and visual aids (e.g. flipcharts, counseling cards). Essential criteria for Care Groups include assuring that the CGVs have manageable workloads (e.g. 6 hours or less per week), consistent contact (at least monthly) with the caregivers in the households that they serve, and regular supervision by paid CHWs to ensure quality and sustainability.

Evidence of Effectiveness

Numerous studies have documented the effectiveness of the Care Group Approach. Projects using this model have reported a 32% reduction in under-five mortality, significant decreases in diarrheal disease prevalence, and high coverage of practices like oral rehydration therapy and the use of insecticide-treated bed nets. The cost-effectiveness of Care Group projects is notable, with average costs of $3-8 per beneficiary per year and costs per life saved ranging from $441 to $3,773.

Adaptations and Expansions

Since its inception, the Care Group model has been adapted to address a broader array of development issues and populations, including child protection, maternal mental health, tuberculosis control, promotion of gender norms, and improved engagement of fathers.The approach has also been applied successfully in post-emergency and refugee settings, such as in Uganda's refugee camps and integrated with food security initiatives.

Challenges and Future Directions

While the Care Group Approach has proven effective in numerous contexts, challenges remain in implementing this approach within government health systems and securing sustainable financing. Future directions include expanding the approach in high-mortality regions and further integrating it into national health systems with support for long-term funding.

References

- Perry H, et al., Care Groups I: An Innovative Community-Based Strategy for Improving Maternal, Neonatal, and Child Health in Resource-Constrained Settings, Global Health: Science and Practice, 2015.

- Perry H, et al., Care Groups II: A Summary of the Child Survival Outcomes Achieved Using Volunteer Community Health Workers in Resource-Constrained Settings, Global Health: Science and Practice, 2015.

- Davis T., Morrow M., Kabadege M. Paper 5. History and Evolution of the Care Group Approach, 2024.

External links

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