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