1. Insert photo here.
Care Group
Operations
Research in
Burundi and
Niger
Jennifer Weiss
Health Advisor,
Concern
Worldwide
CORE Spring
Meeting 2013

2. Background
• USAID-Child Survival and Health Grants Program in
Mabayi Health District 2008 – 2013
• Care Group Model is powerful strategy for community
mobilization and widespread behavior change
• However, staffing structure recognized to be
unrealistic for the MoH to maintain after the life of the
project
• Operations Research testing an “Integrated” Care
Group model

3. Background

4. Background

5. Traditional and Integrated Models
Domain Traditional Care Groups Integrated Care Groups
Training  Promoters train CHWs and Leader
Mothers each month (CHWs participate
in Care Group meetings)
 Project staff (Animators) trains health
facility staff each quarter
 Health facility staff train CHWs once a
month
 CHWs train Leader Mothers twice a month
Meeting
Facilitation
and Reporting
 Care Group Meetings facilitated by
Promoter
 Reports submitted to Promoter who then
submits to health center/MoH
 Care Group Meetings facilitated by CHW
 Reports submitted to CHW who then
submit to health center/MoH
Supervision  2 Animators oversee 5 Promoters
 5 Promoters facilitate 41 Care Groups
(approx. 8 each)
 2 Animators and 2 district-level MoH staff
support 3 health centers
 Health center staff supervise 18 CHWs
 18 CHWs facilitate 35 Care Groups
(approx 2 each)

6. Traditional and Integrated Models

7. OR Questions and Methods
Research Question Methods
1. Does the Integrated Care Group model achieve the
same or better improvements in the knowledge of key
MNCH behaviors as the traditional Care Group model?
 Comparison of baseline (October 2010) and
endline (May 2013) KPC data
 Non-inferiority testing; sample size of 320 in each
study arm
2. Does the Integrated Care Group model achieve the
same or better improvements in the practice of key
MNCH behaviors as the traditional Care Group model?
3. Does the Integrated Care Group model achieve the
same level of functionality as the traditional Care Group
model?
 Monthly data collection of 5 key Care Group
functionality indicators (June 2011 – February
2013)
4. Does the Integrated Care Group model achieve the
same level of sustainability as the traditional Care Group
model?
 Monthly monitoring of 5 key functionality
indicators after withdrawal of Concern support to
both areas (March – September 2013)
Qualitative mid-term review (October 2012) conducted to identify and document benefits and challenges
associated with the implementation of each model . FGDs and KIIs with all key stakeholders.

8. Results to Date: Functionality

9. Preliminary Conclusions
Care Group Comparison
Integrated and traditional CG models appear to have similar levels of functionality, with
both surpassing targets
Knowledge and practice gains appear to be significant in both areas
Role of NGO in Care Group Facilitation
Animators play a key role in facilitating the implementation of Care Group activities in
the Integrated Area
 Supervision of CHWs and CG activities is a challenge for the head nurse
 Recommendation to appoint “Care Group focal person” at each health center
Stakeholders in Integrated area report feeling much more self-efficacy to continue CG
activities once project ends (midterm qualitative review)
Support from local leaders has greatly contributed to smooth implementation of CG
activities in both study areas

10. Preliminary Conclusions: Policy Level
 CHWs are an essential component of
the MoH community health policy,
however an effective CHW policy has
not yet been successfully
operationalized
 Widespread acknowledgement that
CHWs alone will not attain complete
household coverage
 Integrated Care Group model seen as a
promising strategy to achieve realistic
CHW strategy while leveraging existing
structures
Janvier Niandwi- Community Health Worker

11. Care Group Operations Research: Niger
USAID Child Survival and Health
Grants Program: Tahoua, Niger 2009 –
2014
OR Objective: Assess the potential for
Care Group Leader Mothers to deliver
integrated community case management
(iCCM)
•24 Care Groups with 270 Leader
Mothers
•1 Leader Mother from each CG will be
selected to implement CCM

12. Care Group Operations Research: Niger
Formative Research:
•How would key stakeholders accept Leader Mothers delivering iCCM?
•What are the best training tools for Leader Mothers to implement iCCM?
•What are the best processes for implementing iCCM through Care Groups?
Findings to date: Encouraging community perceptions that iCCM will increase
access to care; development of training tools in process
Evaluative Research:
•Are Leader Mothers able to provide quality iCCM?
•Does Leader Mother provision of iCCM affect care-seeking behavior among caregivers of
children under five?
•What are community members and stakeholders’ perceptions of iCCM provided by
Leader Mothers?

13. Thank you!