1. Mother Care Groups Kenyan Context- Samburu District From Relief to Self-Reliance Nutrition and Food Security Department Alexandra Rutishauser-Perera arutishauser-perera@internationalmedicalcorps.org All content in this document is the property of International Medical Corps and should not be reproduced without prior written consent. 15 January 2012

2. History of the project Started in August 2009 : -Support of the Kenyan Government in providing HiNi activities. -Creation of Mother care Groups in each facility -Blanket Feeding activity since Sept 2011 for 5 months Currently funded by UNICEF (HiNi),OFDA (MCG) and WFP (BSFP) Total Pop: Samburu North and East: 91,688 hab.

3. Current state of the MCG Activity 25 health facilities and 12 outreach sites implementing HiNi activities 2,362 MCGs formed since the start of the project – Each of the 12 leader mothers visits 14 households every 2 weeks – 25,564 mothers receiving nutrition education from the lead mothers

5. Topics tackled MCGs have targeted education for behavior change in three modules covering a variety of topics including: - anemia prevention -early initiation of breastfeeding -diarrheal transmission, care and treatment -improved water sources and water purification -malaria transmission, prevention and recognition

6. Gathering of MCGs for Health Education through dramas

7. Results Preliminary findings from Dec 2011 KAP survey, in comparison to baseline data collected in September 2009 before the commencement of interventions, suggests the following: The proportion of mothers who sought ANC care while pregnant in Samburu increased by 23.3% (from 65.4% at baseline (n = 355) to 80.7% (n=849) in 2011). Mothers who sought ANC services from skilled health attendants increased by 19.3% (from 80.8% (n=223) at baseline to 96.4% (n=644) in 2011). 32.2% increase in Exclusive Breastfeeding up to 6 months (from 36% (n=317) at baseline to 47.6% (n=807) in 2011).

8. Results (2) 39.5% of the study population (n=841) had received health information on how to keep safe water at home. – Among those households, 58.8% (n=150) washed hands before feeding a child compared to 46.7% (n=119) among those who did not receive the health education = 12.1% improvement. – 59.6% (n=136) of those who received health education washed their hands after visiting the toilet compared to 28.1% (n=101) among those who did not receive the health education = 31.5% percent increase.

9. Constraints and lessons learned The severity of the drought in the area for the better part of the year meant mothers moved with their livestock to areas where groups were not present = higher number of defaulters from the group.  Ensuring a high number of groups to avoid rupture in health education messages. The level of education of the CHWs who are supervising the MCGs is sometimes low.  Regular theoretical and OJT training should be provided to CHWs. The program empowers women who are not always the main decision maker in the HH  Include men, grandmothers, leader’s groups

10. IMC Nurse in OJT Session with CHWs

11. Future of program A new proposal has been submitted to OFDA for the continuation of the project involving water and sanitation at health facility level:  A Nutrition Causal Analysis Assessment will be conducted at the beginning of the project to focus the health education topics on current priorities.  Pilot Men Care Groups will be implemented

12. Resiliency Improved behaviors most likely help reduce disease transmission and improve IYCF – addresses some underlying causes of malnutrition People who acquire additional knowledge get more status in their community – this added status motivates to increase future learning (in Samburu, mothers are requesting to learn more topics) Partnership with the government is compulsory in order to: 1) ensure that CHWs will follow regular trainings on ToT and health education 2) ensure that CHWs will continue following the groups after the departure of the supporting organization Explore involving the group in Income generative activities of their choice to ensure sustainability of the group

13. Thank You !

14. GOAL’s Use of Care Groups in SNNPR Ethiopia USAID Child Survival & Health project, Oct 2007 – Sept 2011, Awassa Zuriya and Boricha Waredas (Districts), Sidama Zone, SNNPR, Ethiopia: “Significant drought and food shortages in the last half [July 09 – Sept 11] of the project for a large segment of the beneficiary population”. Timing of project allows for assessing if results pre-drought were maintained. USAID Child Survival & Health project, Oct 2007 – Sept 2011, Awassa Zuriya and Boricha Waredas (Districts), Sidama Zone, SNNPR, Ethiopia: “Significant drought and food shortages in the last half [July 09 – Sept 11] of the project for a large segment of the beneficiary population”. Timing of project allows for assessing if results pre-drought were maintained. Covered area with 168K population with 1,640 Care Group Volunteers, 891 CHPs, and 60 HEWs. Covered area with 168K population with 1,640 Care Group Volunteers, 891 CHPs, and 60 HEWs. Interventions: Nutrition (25%), Diarrhea (25%), Malaria (25%) and Maternal/Newborn Care (25%). Care Group approach using Designing for Behavior Change [BEHAVE]. Interventions: Nutrition (25%), Diarrhea (25%), Malaria (25%) and Maternal/Newborn Care (25%). Care Group approach using Designing for Behavior Change [BEHAVE]. Final Evaluator: “Care Groups help communities to develop resilience. The behaviors that were fostered protected children.” Final Evaluator: “Care Groups help communities to develop resilience. The behaviors that were fostered protected children.”

15. Care Groups & Resilience Feb 2008 – July 2009: Pre-drought July 2009 – August 2011: Major drought Evidence of Resilience: Results maintained or improved for 10+ indicators during drought, including 21% underweight improvement during drought. Pre-drought Drought Under- weight: 9%  pre- drought; 21%  during drought