Can community volunteers bring about sustainable behavior change? Tom Davis, Chief Program Officer of Food for the Hungry, says yes, and shares why he thinks Care Groups are the answer.
Care Groups are peer-based, health promotion programs that seek to drive behavior change and improved health outcomes in low-resource communities. Davis, a leader in the Care Groups space, recently published an exciting new study evaluating the model’s impact in Mozambique.
Find out more in the following Q&A, as well as in our newly released case study on Care Group Programs, the latest component of our toolkit for donors interested in child survival. In this case study, we describe the Care Groups in Mozambique that achieved an estimated 30% decrease in under-five mortality over five years. The estimated cost per child life saved is less than $500.
Why are Care Groups a great investment?
Care Groups establish local, sustainable community groups that can outlast the four or five years that project funding is available. In addition to being sustainable, they are cost-effective: Care Groups can bring about large and rapid health and nutrition changes in communities at very low cost.
Recent estimates have found that the cost per life saved in some Care Group projects was one-third of that of more traditional models. One reason for this is that Care Groups draw on the power of thousands of community volunteer women who work with small neighborhood groups of their peers to bring about life-saving changes in parental practices such as use of oral rehydration serum for children with diarrhea, hand washing with soap, and exclusive breastfeeding.
Behavior change seems so difficult. How do Care Groups succeed in changing behavior?
Care Groups both take advantage of – and strengthen – the social ties amongst neighbors. Since the Care Group Volunteer is often selected by her peers, the woman selected is more likely to be a “hub” in her social network.
Recent scientific studies show that behaviors spread more quickly through these social networks and that these “hubs” can have a profound influence on the opinions, beliefs, and behaviors of their neighbors. Tina Rosenberg, Pulitzer Prize-winning author of Join the Club, calls this positive effect of peers the “social cure.” Atul Gawande in a recent New Yorker article talks about how this repetitive contact by peers and others you trust is one of the best ways to bring about adoption of new ideas and practices.
What about relying on volunteers? The traditional thinking has been that poor people cannot or will not volunteer their time on a regular basis unless they receive some sort of monetary or material incentives that will offset the time required for volunteering. What have you found with Care Group Volunteers in your program?
We find this to be an outdated view of people’s motivations in developing countries. Many people used to believe that people moved up lockstep in Maslow’s Hierarchy of Needs, only advancing to motivations like self-actualization and respect/esteem after they had most of their physiological and safety needs met. Food for the Hungry’s experience in Mozambique was different. In that project, Care Group Volunteers contributed more than 2.4 million hours of volunteer service over five years. Rather than the volunteer duties being a burden on these women, 96% of the volunteers continued to volunteer each year despite a complete absence of monetary incentives.
In operations research conducted in June 2010, we asked Care Group Volunteers why they served as volunteers. The overwhelming response in focus groups was that they gained respect from others. When we asked in a follow-up survey, “Who respects you now that did not before you became a Care Group Volunteer?” our results were the following:
- 61% of women said that their husband now respected them
- 48% said their parents or husbands’ parents
- 64% said community leaders
- 41% said their extended family
- 25% said health facility staff
- 100% said other women/friends
By giving these women opportunities to gain mastery and find purpose in their lives, they gain respect from others, and derive a lot of satisfaction from their volunteer role. This is in alignment with what we have been hearing from people, such as career analyst and bestselling business writer Daniel Pink, reporting on the latest findings concerning motivations and performance. Our findings in Mozambique are not unusual. A recent survey of 11 of the 26 organizations using Care Groups found that over 106,000 Care Group Volunteers are currently active in the world serving an estimated 1.2 million families with young children without receiving monetary incentives.
What’s in store for the future?
Operations research is being conducted to look at:
- how to better reach other people who influence mothers (e.g., husbands and grandmothers);
- how to increase mothers’ overall level of motivation (e.g., by treating depression and reducing domestic abuse); and
- how to combine Care Groups with Savings Groups.
Food for the Hungry and other organizations implementing the Care Group model are also testing peer educator models – such as Cascade Groups – that have a structure similar to the Care Group model, but focus on promoting changes in education, livelihoods, and disaster risk reduction. The governments of Burundi and the United States are also currently considering scale-up of the Care Group model to a national level in Burundi.
Care Groups: Another Tool for Taking Action
The Care Group model is a low-cost, community-derived solution that relies on the power of peers as the driving force behind behavior change and better health outcomes in multiple scenarios. For example, we first mentioned this model in our guide to investing in malaria control programs, and now we see it successfully applied to child survival and nutrition. Visit our Child Health Toolkit to learn more and take action.