MEDAIR's alignment with CHS helps make communities more resilient
South Sudan has a sporadic and inconsistent phone network inaccessible in many parts of the country. Radios and televisions are rare. Villages are spread out and isolated. The ability to share messages with the population of South Sudan is severely hindered by the lack of infrastructure and difficult terrain. This context creates a challenging situation for Medair as it works to not only provide services but to also encourage change and build resilience at the household level.
To address these difficulties, Medair operates the Care Group Model (CGM) to complement its primary healthcare, nutrition, WASH, and psychosocial activities, helping to ensure services are paired with relevant behaviour change to improve health outcomes. A Care Group (CG) is “a group of 10 to 15 volunteer community-based educators who meet regularly with project staff for training, supervision, and support. CGs are distinguished by the ongoing relationship among members as well as each volunteer’s responsibility to teach individuals in the households outside of the meeting, thus multiplying the impact of the training. Volunteers belonging to a CG provide greater peer support, develop stronger commitment to health activities, and find creative solutions to everyday challenges by working as a group, as opposed to individual volunteers working independently."* The volunteers are referred to as “lead mothers”. They regularly bring together a group of neighbours (or visit each woman at home, depending on the subject) to learn about targeted health, nutrition, and hygiene topics.
The positive behaviours targeted by Medair include vaccinations, health-seeking behaviour, postnatal care, skilled delivery, family planning, handwashing with soap/ash, safe excreta disposal, safe water, and Infant and Young Child Feeding practices (IYCF), among other topics identified quarterly based on the season and which behaviours need to be changed to reduce morbidity and mortality. Frequent Knowledge, Practice, and Coverage (KPC) surveys monitor and report on the effectiveness of the CGM.
Medair began working in Maban County in 2012 in response to the influx of Sudanese refugees. At the conclusion of the project at the end of 2017, there were 40 CGs, 467 Lead Mothers (volunteers), and 6,180 direct beneficiaries. The changes in community health practices addressed by the CGs are evident in the KPC surveys. Exclusive breastfeeding increased from 54.1% in 2014 to 99% in 2017 whilst safe handwashing practices improved from 47% to 74% over the same time period. The practice of safe water storage also increased from 38.3% to 85.4%, whilst coverage of children fully vaccinated almost reached the 85% target in October 2017 compared to 64.3% in January 2016. The reduction of diarrhoea prevalence from 47% in June 2014 to 21.8% in October 2017 is an impressive decrease and a good example of the impact Medair’s programming has had in Maban. An indication of the effectiveness of the CGM alongside the provision of basic services in Maban is that indicators fell below emergency levels, allowing Medair to hand over the project to development partners in December 2017.
In 2015, Medair introduced the CGM in Renk. Currently there are 77 CGs operating throughout the former Renk County with 896 Lead Mothers (volunteers), although a new registration was ongoing as of February 2018. There have been various improvements in behaviour throughout the sectors. There has been positive change in the number of deliveries with a skilled birth attendant (SBA) from 27% in 2016 to 58% in 2017, as well as an encouraging increase in the number of people using latrines, from 44.6% in 2016 to 72.5% in 2017. The KPC survey also measured an improvement in handwashing practices. The population of Renk is very spread out and fluid with many people transiting through the county. This makes the implementation of CGs even more challenging; however, progress is being made and those who leave Renk carry with them the knowledge they have gained through their participation in CGs.
CGs are especially effective in developing community engagement in the process of recovery and empowering people to build on their existing capacities. A CG participant in Renk explains: “We are just housewives and mothers here. We’ve never been to school because of the war. When Medair gave me training, I realised that I had a real value to my household. I can keep my family from getting sick. I never knew before that I could make such a difference.”
CGs are community-based, cost-effective, and sustainable. Medair plans to continue implementing and strengthening the CGM to ensure communities are informed on the importance of these positive behaviours.
Commitment three of the Core Humanitarian Standard states: “People in crisis can expect that they are not negatively affected and are more prepared, resilient, and less at-risk as a result of humanitarian action.” The CGM aims to prepare communities and build resilience through positive behaviour change messaging and encouragement.
Medair’s work in South Sudan is made possible with support from EU Civil Protection and Humanitarian Aid, US Agency for International Development, UK aid from the UK Government, Swiss Agency for Development and Cooperation, Swiss Solidarity, SlovakAid, and generous private donors.
This content was produced with resources gathered by Medair field and headquarters staff. The views expressed herein are those solely of Medair and should not be taken, in any way, to reflect the official opinion of any other organisation.
* “The care group difference, a guide to mobilizing community-based Volunteer Health Educators” - World Relief Core