1. The Integrated Care Group Model Supporting the Burundi Ministry of Health to deliver quality health communication at scale Gwyneth Cotes, Health Support Unit

2. Community Health Workforce in Burundi Emerging from 13 years of conflict, Burundi has limited experience in developing a community health workforce The MOH is developing a community health strategy, and holding elections for Community Health Workers in each village CHWs receiving insufficient training and support through uncoordinated efforts As a result, basic preventive and curative health services are not readily available at the community level

4. Strategic Health Communication Effective behaviour change communication: Is multi-channeled ; understanding and adoption increases with the frequency and types of contacts used to disseminate them (dose effect). Involves negotiation ; caregivers feel their child’s particular situation has been taken into account Can be expanded to scale (Source: Victora, C.G., Fenn, B., Bryce, J. Kirkwood, B.R. Co-coverage of prevention interventions and implications for child survival strategies: evidence from national surveys. Lancet 2005, Volume 366, Issue 9495, Pages 1460-1466).

5. Mabayi District Child Survival Program: The integrated Care Group model Baseline assessment found low coverage of key household health behaviours The Care Group Model was identified as a powerful strategy for community mobilization for widespread behaviour change suitable to the context of Mabayi District. The project staff structure was recognized to be unrealistic for the MOH to maintain after the life of a donor/NGO project. Source: Philip Wegner, Concern Worldwide

6. Basic Description of a Care Group Care Groups are different from typical “Mother’s Groups” in that each volunteer is responsible for regularly visiting 10-15 of her neighbors, sharing what she has learned. Goals are set for the group as a whole, encouraging volunteers to support one another Household visits are targeted to the primary child caregiver, usually a mother, but all family members are invited to participate in the home visits A Care Group is a group of 10-15 volunteer community health educators who meet regularly with a group leader for training, supervision and support.

7. Magbontho Village School

9. Preliminary results 305 Care Groups formed as of October 2011, made up of 3,010 volunteers 74% of households with children <5 years of age or women of reproductive age have received at least one household visit by a Care Group Volunteer per month in the previous quarter (June-August 2011). Health facility staff (Titulaires) hold monthly training sessions for Community Health Workers at the health centre Workload for CHW is approximately 12-15 hours per month, 6 hours for health facility staff (usually shared by two staff members) Traditional and integrated Care Group models have achieved similar levels of functionality thus far, in terms of regularity of meetings and reporting Qualitative mid-term assessment found evidence that household practices are already beginning to change.

10. Future programming implications With the CGVs serving as “relays” for the CHWs, CWB’s Integrated Care Group Model has been identified in national-level discussions as a promising model for implementing a realistic community health worker strategy in Burundi. Need to address issue of incentives for CHWs and Care Groups Lobby for inclusion of CHW in performance-based financing Roll-out of Community Case Management is important for motivation of CHW Integrate C-HIS data into district HIS system Strengthen the link between community representatives (COSAs) and health facilities Ensure a viable exit strategy is in place

11. Acknowledgements: Alyssa Davis, Health Advisor, Concern Worldwide Burundi Jennifer Weiss, Health Advisor, Concern Worldwide US Rosalyn Tamming, Head of Health Support Unit, Concern Worldwide Thank you!