title: Care Groups I: An Innovative Community-Based Strategy for Improving Maternal, Neonatal, and Child Health in Resource-Constrained Settings.
abstract: In view of the slow progress being made in reducing maternal and child mortality in many priority countries, new approaches are urgently needed that can be applied in settings with weak health systems and a scarcity of human resources for health. The Care Group approach uses facilitators, who are a lower-level cadre of paid workers, to work with groups of 12 or so volunteers (the Care Group), and each volunteer is responsible for 10-15 households. The volunteers share messages with the mothers of the households to promote important health behaviors and to use key health services. The Care Groups create a multiplying effect, reaching all households in a community at low cost. This article describes the Care Group approach in more detail, its history, and current NGO experience with implementing the approach across more than 28 countries. A companion article also published in this journal summarizes the evidence on the effectiveness of the Care Group approach. An estimated 1.3 million households—almost entirely in rural areas—have been reached using Care Groups, and at least 106,000 volunteers have been trained. The NGOs with experience implementing Care Groups have achieved high population coverage of key health interventions proven to reduce maternal and child deaths. Some of the essential criteria in applying the Care Group approach include: peer-to-peer health promotion (between mothers), selection of volunteers by mothers, limited workload for the volunteers, limited number of volunteers per Care Group, frequent contact between the volunteers and mothers, use of visual teaching tools and participatory behavior change methods, and regular supervision of volunteers. Incorporating Care Groups into ministries of health would help sustain the approach, which would require creating posts for facilitators as well as supervisors. Although not widely known about outside the NGO child survival and food security networks, the Care Group approach deserves broader recognition as a promising alternative to current strategies for delivering key health interventions to remote and underserved communities.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA hperry2@jhu.edu.
authors.forename: Henry
authors.initials: H
authors.lastname: Perry
authors.affiliation: ICF International (Maternal and Child Survival Program), Washington, DC, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Morrow
authors.affiliation: Food for the Hungry, Washington, DC, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Borger
authors.affiliation: Concern Worldwide/US, New York, NY, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weiss
authors.affiliation: Food for the Hungry, Washington, DC, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: DeCoster
authors.affiliation: Feed the Children, Oklahoma City, OK, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Davis
authors.affiliation: World Relief/Mozambique, Chokwe, Mozambique.
authors.forename: Pieter
authors.initials: P
authors.lastname: Ernst
mesh_terms: D000328:Adult; D002648:Child; D000067576:Child Health / Q000706:statistics & numerical data; D002662:Child Health Services / Q000706:statistics & numerical data; D003153:Community Health Services / Q000379:methods* / Q000706:statistics & numerical data*; D003150:Community Health Workers / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data; D011247:Pregnancy; D014838:Volunteers / Q000706:statistics & numerical data*