In collaboration with the Ministry
of Health (SESPAS), CRS, World Vision, and USAID, the
CHANGE Project is establishing a community-based child
health program in 43 communities in the Dominican Republic.
The program philosophy, structure and materials are
adapted from the successful AIN model developed in Central
America.
The program focuses on preventing inadequate growth
(a proxy for malnutrition and infections) among all
children under 2 in participating communities. The adequate
growth of these children is assessed monthly by a group
of trained community volunteers. Based on the weighing
results and the responses to a few questions, the volunteers
then give appropriate counseling to each mother or other
caregiver. The mother and volunteer negotiate one or
two small changes in practices that should enhance the
child’s growth and health. The set of counseling
cards is an aid in the counseling and negotiation process.
The Dominican cards were designed on the basis of in-depth
qualitative research that included behavioral trials,
so that the program could feel quite confident that
suggestions to the mothers were feasible. The cards
were carefully pretested and revised in the summer of
2003.
The set comprises 20 cards organized as follows. There
are two “diagnostic” cards and “negotiation”
cards for each of four age groups of children. These
cover issues appropriate to the age group. In addition,
there are four special cards that are used as needed.
These cover simple healthy recipes based on common foods,
feeding a young child who is sick or lacks appetite,
nutrition of the breastfeeding mother, and other practices
directly related to child nutritional status (hygiene
behaviors, being up-to-date with vaccines and micronutrient
supplements). There are “references” to
these special cards on the other cards.
The cards contain few if any words, so their use depends
principally on an understanding of their organization
and the drawings. The volunteer begins counseling by
noting how much weight the child has (or has not) gained
in the past month, then uses the cards for the appropriate
age group. If the child gained adequate weight, the
volunteer uses only the first of the two diagnosis cards
to understand current practices and the first of the
negotiation cards to probe possible improvements in
practices. If the child has not gained adequate weight,
the volunteer uses both diagnostic and counseling cards
for the age group. In either case the volunteer uses
the appropriate special cards.
Volunteers in the Dominican Republic were trained between
October 2003 and January 2004.
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