A Care Group is a group of 10-15 community-based volunteer promoters who agree to regularly visit 10-15 of their neighbours and share behaviour change communication about health and hygiene.

A Care Group meets regularly with a trained extension or project worker for support, training and supervision and to discuss problems or successes encountered in their neighbourhood household visits. This is a cascade model based on Peer Education T.29. The model can be used with a variety of groups but is usually associated with mothers of young children with a focus on maternal and child health. Some programmes stipulate at least one pregnant or lactating mother as a criterion for the visited households. Others may include a household with children under two or five years. The trained mothers are role models in their community. They are chosen by neighbours based on various criteria, usually including basic literacy and numeracy to ensure accurate reporting and record-keeping. The number of households that they cover is kept low (10-15 households) so that volunteering does not become too time-consuming; it is expected that members will visit each of their assigned households twice monthly. The Care Group is also limited in size to facilitate effective interactive and participatory learning. The groups are usually provided with visual aids (such as flipcharts) to support their work. Care Group meetings should follow a specific structure and include objectives, Games T.15 or Songs T.47, trouble-shooting, learning about and trying out a new behaviour, exploring barriers and solutions and making a commitment to practise. The Household Visits T.18 can then follow a similar structure. Supportive supervision observing household visits and giving feedback should also be carried out.

Applicability

This method is used in development settings but can be adapted to acute settings in which more frequent visits may be needed and members may cover fewer households.

Do

• Work closely with the community to design and implement the Care Group approach

• Identify Care Group volunteers with the community, based on agreed criteria

• Meet regularly with the Care Group and provide supportive supervision

Don't

• Do not have too many volunteers in each Care Group

• Do not give each Care Group volunteer too many households to visit

• Do not neglect accurate record-keeping to monitor and evaluate the outcomes of the Care Group Programme

Practical Example

The Care Group approach has been used in over 28 countries in development and emergency contexts by different organisations and some governments. World Vision began piloting the Nurturing Care Groups (NCGs) approach with a WASH focus in Ghana in 2019. In two districts 108 NCGs were established reaching 75,000 people. The behaviours targeted through the leader mothers included ending open defecation and handwashing with soap at critical times. A 2021 evaluation revealed that the NCGs had a significant impact on indicators such as reducing detectible E. coli in drinking water from 32% to 8% and increasing the availability of soap from 34% to 84%. Access to basic sanitation only increased slightly (7 percentage points more than the control group), but there was evidence of improvements in animal penning and reduced stigma toward menstrual hygiene management.