Abstract
BackgroundCommunity-based strategies that foster frequent contact between caregivers of children under five and provide credible sources of health information are essential to improve child survival. Care Groups are a community-based implementation strategy for the delivery of social and behavior change interventions. This study assessed if supervision of Care Group activities by Ministry of Health (MOH) personnel could achieve the same child health outcomes as supervision provided by specialized non-governmental organization (NGO) staff.MethodsThe study was a pretest-posttest quasi-experimental design implemented in Burundi. A total of 45 MOH-led Care Groups with 478 Care Group Volunteers (CGVs) were established in the intervention area; and 50 NGO-led Care Groups with 509 CGVs were formed in the comparison area. Data were collected from 593 and 700 mothers of children 0-23 months at baseline and endline, respectively. Pearson’s chi-squared test and difference-in-difference analysis assessed changes in 40 child health and nutrition outcomes. A qualitative process evaluation was also conducted midway through the study.ResultsThe MOH-led Care Group model performed at least as well as the NGO-led model in achieving specific child health and nutrition outcomes. Mothers of children 0-23 months in the intervention and comparison sites reported similar levels of knowledge and practices for 38 of 40 dependent variables measured in the study, and these results remained unchanged after accounting for differences in the indicator values at baseline. Process monitoring data confirmed that the MOH-led Care Group model and the NGO-led Care Group model were implemented with similar intervention strength.ConclusionsThe study demonstrated that behavior change interventions traditionally led by NGOs can be implemented through the existing MOH systems and achieve similar results, thereby increasing the potential for sustainable child health outcomes. Future research on the MOH-led Care Group model is required to systematically document all inputs and monetary costs borne by the MOH to implement the model.
Highlights
Community-based strategies that foster frequent contact between caregivers of children under five and provide credible sources of health information are essential to improve child survival
The Care Group Community Volunteer System is a community-based implementation strategy for the delivery of social and behavior change interventions [11]. The linchpin of this approach is the Care Group Volunteer (CGV); a woman living in the community who is elected by her peers and who herself has a child under the age of five years
More households in the comparison area sold their crops at local markets, and while households who sell cash crops are generally better off than those who rely on subsistence farming, it may be that households sold their crops to earn cash for other non-food items; which would be considered a coping strategy [21]
Summary
Community-based strategies that foster frequent contact between caregivers of children under five and provide credible sources of health information are essential to improve child survival. Care Groups are a community-based implementation strategy for the delivery of social and behavior change interventions. As a critical cadre of the health workforce, Community Health Workers (CHWs) are essential to achieve behavior change outcomes and sustained improvements in household practices [6,7]. Despite their potential, CHWs may face unmanageable workloads and large catchment areas, which limit their effectiveness for optimal behavior change [8]. By collectively ‘saturating’ the target area, Care Groups have contributed to improved child health outcomes in a number of contexts [12,13]
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