Periodic Reporting for period 3 - GC_1000 (GROUP CARE FOR THE FIRST 1000 DAYS (GC_1000): If it takes a village to raise a child, group care is the first step)
Periodo di rendicontazione: 2023-01-01 al 2024-06-30
This project focused on in-depth understanding and a systematic development of acceptable, feasible and sustainable strategies to integrate group care into health systems for antenatal and postnatal care during the first 1000 days. Group care is evidence-based, transforms the delivery of maternal, newborn and child health care, reduces inequities in services utilization, improves the quality of services and makes a significant positive impact on the health and wellbeing of mothers, families and children. The European Union-funded project GC_1000 included demonstration sites in 4 middle-income countries, as well as in 3 high-income countries in settings that serve the most vulnerable women and girls. The three aims of this project were:
1. Implement group antenatal and postnatal care in selected demonstration sites in collaborative ways that set the groundwork for sustained service delivery and possibilities for scaling- up;
2. Analyse within country data that emerge from the implementation process to create country-specific blueprints for scale-up.
3. Use cross-country synthesis to develop a global implementation strategy toolbox for the adaptation, implementation and scale-up of facilitated group care within the first 1000 days, particularly to reach the most vulnerable groups of women and girls globally.
1. Implement group antenatal and postnatal care in selected demonstration sites in collaborative ways that set the groundwork for sustained service delivery and possibilities for scaling- up;
2. Analyse within country data that emerge from the implementation process to create country-specific blueprints for scale-up.
3. Use cross-country synthesis to develop a global implementation strategy toolbox for the adaptation, implementation and scale-up of facilitated group care within the first 1000 days, particularly to reach the most vulnerable groups of women and girls globally.
To achieve the first aim “Implement group antenatal and postnatal care in selected demonstration sites in collaborative ways that set the groundwork for sustained service delivery and possibilities for scaling- up" the country leads of the Netherlands, Belgium, Suriname, Kosovo, Ghana, South Africa and United Kingdom, in collaboration with the Work Package leads, hosted stakeholders' engagement groups and regular country team meetings to advise, co-create and implement group care in each country.
Next, Rapid Qualitative Inquiries (RQIs) were completed in all countries. Based on the RQI, the sites were provided with an overview of important impeding and facilitating factors for the implementation. An overview of medical and psycho-social care needs and implementation challenges was created that were countries and/or site specific. Also, based on their analyses of the RQI, each country team received an overview with recommendations for adaptations per site in their country. The recommended adaptations for each country were structured according to surface structure adaptations and deep structure adaptations.
Based on the adaptations, a basic framework was built to support and create site-specific protocols and adaptations of training and implementation materials to fit the cultural and health system guidelines for each country. In recruited sites, key clinicians and other staff were identified and trained for Group Care facilitation. At the end of the project, in all countries, more than 200 health care workers were trained. Overall, 46 in-country trainers were trained. In Ghana, 2 extra trainings were given related to working with the Check2Gether backpack. In all countries groups had started. In the 32 participating sites in total 210 antenatal groups, 19 postnatal groups and 12 continuous groups (antenatal and postnatal) were carried out.
To achieve the second aim “Analyse within country data that emerge from the implementation process to create country-specific blueprints for scale-up, ” data was collected using a variety of methods. Collected data included observational data of groups and trainings, surveys of women participants, (focus group) interviews with health care providers, national healthcare data and economic data. In addition, a series of workshops were held to guide and support country teams with data collection and analysis of qualitative data.
All data collection was finished and analysed. Data collection was used to capture the situational context (RQI, WP2), and strategies for adaptations (WP3). Data on experiences, outcomes, lessons learned, process and costs of implementation in the first five groups in each site or country was collected and analysed to develop the country specific blueprints, evaluation and toolkit (WP4, WP5 and WP6). Data on sustainability and scale-up was collected until the end of the project (WP4).
To achieve the third aim “Use cross-country synthesis to develop a global implementation strategy toolbox for the adaptation, implementation and scale-up of facilitated group care within the first 1000 days, particularly to reach the most vulnerable groups of women and girls globally”, the blueprint and lessons learned report was guided by a planning guide and blueprint template. At the end of the project the cross-country synthesis resulted in an implementation strategy Toolkit designed for a global audience, 7 country Blueprints and a Manual for the Rapid Qualitative Inquiry (RQI) of Context.
A variety of communication activities were undertaken during the project such as social media posts, local television, local newspapers/magazines, songs, and conference presentations. An international Group Care conference with over 130 attendees was co-organized in the Netherlands, resulting in widespread dissemination and collaboration. The GC_1000 consortium also contributed actively to an international conference on Group Care in low- and middle-income countries worldwide in Kenya in 2024.
The toolkit and other materials resulting from this project can be downloaded from the project website: www.groupcare1000.com. The website also contains the link to join our Group Care Community of Practice.
Next, Rapid Qualitative Inquiries (RQIs) were completed in all countries. Based on the RQI, the sites were provided with an overview of important impeding and facilitating factors for the implementation. An overview of medical and psycho-social care needs and implementation challenges was created that were countries and/or site specific. Also, based on their analyses of the RQI, each country team received an overview with recommendations for adaptations per site in their country. The recommended adaptations for each country were structured according to surface structure adaptations and deep structure adaptations.
Based on the adaptations, a basic framework was built to support and create site-specific protocols and adaptations of training and implementation materials to fit the cultural and health system guidelines for each country. In recruited sites, key clinicians and other staff were identified and trained for Group Care facilitation. At the end of the project, in all countries, more than 200 health care workers were trained. Overall, 46 in-country trainers were trained. In Ghana, 2 extra trainings were given related to working with the Check2Gether backpack. In all countries groups had started. In the 32 participating sites in total 210 antenatal groups, 19 postnatal groups and 12 continuous groups (antenatal and postnatal) were carried out.
To achieve the second aim “Analyse within country data that emerge from the implementation process to create country-specific blueprints for scale-up, ” data was collected using a variety of methods. Collected data included observational data of groups and trainings, surveys of women participants, (focus group) interviews with health care providers, national healthcare data and economic data. In addition, a series of workshops were held to guide and support country teams with data collection and analysis of qualitative data.
All data collection was finished and analysed. Data collection was used to capture the situational context (RQI, WP2), and strategies for adaptations (WP3). Data on experiences, outcomes, lessons learned, process and costs of implementation in the first five groups in each site or country was collected and analysed to develop the country specific blueprints, evaluation and toolkit (WP4, WP5 and WP6). Data on sustainability and scale-up was collected until the end of the project (WP4).
To achieve the third aim “Use cross-country synthesis to develop a global implementation strategy toolbox for the adaptation, implementation and scale-up of facilitated group care within the first 1000 days, particularly to reach the most vulnerable groups of women and girls globally”, the blueprint and lessons learned report was guided by a planning guide and blueprint template. At the end of the project the cross-country synthesis resulted in an implementation strategy Toolkit designed for a global audience, 7 country Blueprints and a Manual for the Rapid Qualitative Inquiry (RQI) of Context.
A variety of communication activities were undertaken during the project such as social media posts, local television, local newspapers/magazines, songs, and conference presentations. An international Group Care conference with over 130 attendees was co-organized in the Netherlands, resulting in widespread dissemination and collaboration. The GC_1000 consortium also contributed actively to an international conference on Group Care in low- and middle-income countries worldwide in Kenya in 2024.
The toolkit and other materials resulting from this project can be downloaded from the project website: www.groupcare1000.com. The website also contains the link to join our Group Care Community of Practice.
Antenatal and postnatal care services need to undergo transformation to provide quality care ensuring that women, babies, and families thrive as well as survive during pregnancy and childbirth.
During this project the implementation of Group Care has been successful in all countries and settings. This project helped us to understand mechanisms on how to transition from a traditional model of service provision (provider-to-user) to Group Care, and what is needed for sustainability and scaling up. The deliverables of this project will support countries to adapt, implement and scale-up facilitated Group Care locally. Consortium members contributed to (inter) national campaigns to disseminate findings and resources and have indicated to continue to do so beyond the project period. This is important, because Group Care has been shown to improve uptake of health services, reducing the inequities in access and appropriate use, and to contribute to short-and-long term health gains for mothers and babies during the first 1000 days.
During this project the implementation of Group Care has been successful in all countries and settings. This project helped us to understand mechanisms on how to transition from a traditional model of service provision (provider-to-user) to Group Care, and what is needed for sustainability and scaling up. The deliverables of this project will support countries to adapt, implement and scale-up facilitated Group Care locally. Consortium members contributed to (inter) national campaigns to disseminate findings and resources and have indicated to continue to do so beyond the project period. This is important, because Group Care has been shown to improve uptake of health services, reducing the inequities in access and appropriate use, and to contribute to short-and-long term health gains for mothers and babies during the first 1000 days.