PROSHAR Care Group Modules
In Bangladesh, a large percentage of households live in poverty, food insecurity at the national level is extremely high and exacerbated by high food commodity prices, and poor maternal health and low child nutrition are persistent problems. The goal of ACDI/VOCA and PCI’s 2011-2015 USAID funded Title II program Program For Strengthening Household Access to Resources (PROSHAR) was to reduce food insecurity among vulnerable populations. PROSHAR activities revolved around three key strategic objectives: income and access to food of poor and ultra-poor households improved (SO1); health of pregnant and lactating women and children under 5 (SO2); and improved institutions and households prepared to respond effectively to shocks (SO3).
Activities and reach: Within SO2, the major MCHN platform for improving health and preventing malnutrition among mothers and children was the Care Group Trio (Trio) model. The Trio model was designed to leverage the role that fathers and in-laws play in decision-making related to health and nutrition behaviors - mothers as the primary caregivers, fathers as the primary supporters of mothers as well as the purchasers of household food and health services, and in-laws as the primary advisors on maternal and child health and nutrition. By endline, PROSHAR had enrolled 22,101 pregnant women (PW) and 4,282 lactating women (LW) under the MCHN interventions and reached a total of 24,651 children (12,169 girls and 12,428 boys) through the nutrition intervention with its focus on growth monitoring and promotion (GMP) activities. Care Group Volunteers alone reached an estimated 74,533 adults who influenced maternal and child health care and nutrition in their households.
Results: The Trio model - composed of Care Groups and complementary father and in-law groups - led to remarkable behavior change results across the program in health and nutrition outcomes and care seeking behaviors. By endline, outcomes included significant increases in the proportion of mothers taking vitamin A and folic acid during pregnancy and mothers that reported attending four or more antenatal care visits. Similarly, chronic malnutrition rates of ever-married women considerably declined. Infants and toddlers receiving a minimally acceptable diet increased from a baseline value of 29 percent to 39 percent, and the proportion of children who were exclusively breastfed under six months of age grew significantly from 41 percent to 74 percent. Moreover, the prevalence of overall stunting and underweight children significant declined. Other outcomes include a significant improvement in the percentage of households with access to water at hand-washing facilities, and a significant increase in seeking treatment from a trained health care provider for a child with acute respiratory infection (ARI).
Additionally, a qualitative Trio assessment at endline suggested improved interpersonal harmony as families developed common goals around healthy pregnancies and children; improved understanding among fathers around the health and nutrition of their children beyond providing financial resources; improved knowledge among grandmothers and desire to support and encourage their daughters-in-law; and improved decision-making among mothers around issues directly impacting themselves or their children.