Tag Archives: “behavior change”

80% Volunteer Labor + 90% Behavior Change = 6,522 Children’s Lives Saved

I wanted to share some of the findings with you from our latest evaluation of a Care Group project, Food for the Hungry’s USAID-funded child survival project in Mozambique.   If we could prevent all child deaths today in the whole world for a full 7 hours, we would save 6,472 lives.  That’s the equivalent of what this Care Group project in Mozambique achieved using 80% volunteer labor.  And we estimate that about 90% of FH’s input into the system through this project was through behavior change — promoting changes at the household and community levels, but also using community mobilization to increase  health system utilization.   Now we need to scale up this remarkable approach so that more countries can meet Millennium Development Goal #4.

The project was evaluated by Dr. Henry Perry of Johns Hopkins University.  (I highly recommend Henry if you are looking for an experienced child survival consultant.)  We will eventually post the final evaluation document to this website, but in the meantime, here are some of the highlights from that evaluation:

  • The project saved an estimated 6,522 lives of preschool children.  We estimated lives saved using the LIST.  It was heartening to see how many parents were saved from this grief.  To see the coverage changes that brought about these lives saved, click here.
  • We measured time input by everyone involved in the project and found that 80% of the work was done by community volunteers, and 97% of the work was done by community-level staff and volunteers.  Communities are helping themselves out of their poverty using Care Groups.
  • Largely due to the fact that people were mobilized to help their neighbors voluntarily, the cost per life saved was only $464 – less than a third of the average cost per life saved in CSHGP child survival projects (and that average is very cost effective).  The total cost per beneficiary per year was only $2.75.
  • We are growing more and more interested in measuring the effects of the Care Group model on gender-based violence.  In this project, respect between husbands and wives, and for woman as leaders, increased: 61% of Leader Mothers (Care Group Volunteers) who served as the main volunteers in the project said that their husbands respected them more now (at final evaluation).  64% said their community leaders respected them more, 25% said health staff at the clinics respected them more, and 100% said other women and mothers respected them more now.  This may be a part of the reason that spousal abuse appears to be much lower now among these Leader Mothers (3%) as compared with other women in their communities (34%).  And spousal abuse of all mothers of young children appears to have decreased during the project (from 69% in 2004 [when it was measured as part of a LDM study] to 34% in 2010) … but more needs to be done. Leader Mothers also said that they respected their husbands more now, so mutual respect is growing.  (In Mozambique as a whole, about 55% of women said that they thought it was okay for a man to hit a woman.)
  • Malnutrition (underweight) decreased by 34% in communities where FH worked for only 15 months.  In the other project area, malnutrition dropped 22%.  The final KPC showed statistically-significant, positive changes in consumption of many different food groups.
  • Insecticide treated net use increased from 35% to 80% in the first project area, and from 16% to 89% (in only 15 months) the other project area.  While these have been available to mothers who show up for prenatal care, community mobilization is what got the mothers to the health facility.

On Monday of this week, I had a good talk with Dan Heath, the author of Switch, the #1 organizational and behavioral change book on Amazon.com right now. (I highly recommend it!)  He saw the narrated presentation on Care Groups on this site and said that he was “blown away” by the results.  We are too, and hope that you will tell your colleagues about the approach.   As Dan said, “You know you have a winning horse … and you need to let that horse run.”

Tom Davis, MPH

Senior Director of Program Quality Improvement

Food for the Hungry

Care Groups: Using the Power of Social Networks

I’ve been reading a host of exciting books on social networks and social network theory lately:  Linked, Connected, etc.   We are not talking about Facebook here, but the networks that we find in all communities and countries, regardless of their internet connectivity.  Findings presented in Connected show that we have a measurable influence out to three degrees — our friends’ friends’ friends — in our social network.  There are more and more studies showing how behaviors and outcomes spread through networks including cigarette smoking/cessation, obesity, and even happiness.   New findings in social network theory are driving changes in many domains including genetics, behaviorism, health promotion.

As I’ve read these books, I’ve become increasingly convinced that one reason we are seeing such amazing results in behavior change using Care Groups is that we are utilizing the power of scale-free social networks.  By having beneficiary mothers choose “their” Leader Mother (who does health promotion with them), they are more likely to be choosing one of the “hubs” in their social network — someone who is in a much better position to convince them to make healthy changes.  Also, with the structure put in place by Care Groups, there are fewer links to traverse between any two given mothers, so communication and persuasion is enhanced.   The mothers who serve as connectors between mothers are also more likely to be practicing healthy behaviors, and so healthy behaviors are more likely to be spread.  If  a Leader Mother — who is more often than not a hub — hears about a positive story of a mother using ORS, for example, she is more likely to transmit that information to other mothers with which she is connected (since it is in tune with her beliefs and experience) than she is to transmit a story about ORS “not working.”  Certain types of information (e.g., pro-exclusive breastfeeeding info) is preferentially transmitted through the social network, and that’s important when you are going against the prevailing cultural practice.

I am convinced, however, that we could be doing a lot more to harness the power of social networks for child survival and community health if more of us understood the latest findings and developed the tools needed to better understand the networks that we are dealing with and our effect on those networks.  Findings from modeling on immunization strategies, for example, show that we could dramatically decrease the number of people who we need to immunize to stop an epidemic if we focused on people’s acquaintances (who are more likely to be hubs) in a given community.  Given that behaviors also flow through these social networks, it would make sense that focusing more on those hubs (and using them to influence others) should make behavior change happen more quickly and at lower cost.  Doing some social network analysis can also help us to know who in the broader community to target and who has the most influence on mothers and their child survival behaviors.  (See this article on breastfeeding and social networks in Bolivia, for example.)

If you are new to social networks, I recommend these videos on social network theory and acquaintance immunization.
[youtube=http://www.youtube.com/watch?v=tLiZRwF9cVc&w=480&h=385]

[youtube=http://www.youtube.com/watch?v=5BdQxvHtMIQ&w=480&h=385]


Efficient Immunization Approaches to Avoid Epidemic Spreading

Tom Davis, MPH

Chairman, CORE Group Board of Directors

Director of Health Programs, Food for the Hungry

The Care Group Buzz

Care Groups:  Pulling Mothers Together

Welcome to Care Group Info! I’m Tom Davis, Chairman of the Board, CORE Group, and Director of Health Programs for Food for the Hungry.  The CORE Group is THE network for people who work in community health, and the CORE Group has been instrumental in documenting this approach and getting the word out to others.  If you are looking to learn more about methods to reach the poor with lifesaving information at low cost, you’re in the right place.  Care Groups have been around now for 12 years, but recently they have been gaining a lot more attention by international NGOs and multilateral organizations.  If you are new to Care Groups, I recommend you watch the narrated presentation we have posted.  If you are more of a reader, download the manual.

I learned about Care Groups 12 years ago from one of the original developers of the approach, Dr. Pieter Ernst in Mozambique.  (The other main collaborator on the methodology is Dr. Muriel Elmer, formerly with World Relief.)  In Food for the Hungry, we began using them at that point and have used them in many settings in the world (most in Africa) since then.  When — with World Relief — we started to gather information on the results of Care Groups and compared them to other child survival projects, we realized that this was a very special approach that deserved a lot more attention — hence the website.

For example, in our Care Group project using Care Groups in Mozambique (sponsored by USAID), we have seen a 42% drop in malnutrition (underweight) in only 2.5 years.  The cost per beneficiary there is a mere $3.60 per beneficiary per year.  By doing Lives Saved Analysis (using the Bellagio Lives Saved Calculator — the same one used in the Lancet Child Survival Series), we found that for only $305, we could save the life of one child.  This is about 1/4 of the cost to save life for a typical (and very cost-effective) USAID funded child survival program.

As I have read more of the literature on networks, persuasion, community-based social marketing and other disciplines, I have more and more hypotheses about the power of Care Groups and why they are successful.  But these are mostly hunches at this point.  What we do know is that they work.  What we need to do now is to better explore why they work, under what conditions they work, and how to convince policy makers to scale up the approach where it has been effective..

In future posts, we can discuss some of the possible reasons for Care Groups’ success.

Tom Davis

Chairman of the Board, CORE Group

Dir. of Health Programs, Food for the Hungry