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GROUP CARE FOR THE FIRST 1000 DAYS (GC_1000): If it takes a village to raise a child, group care is the first step

Periodic Reporting for period 2 - 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)

Reporting period: 2021-07-01 to 2022-12-31

This project focuses 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. No evidence-based guidelines exist for health systems to establish and sustain this transformative model. Care in a group changes the user(s)-provider experience, encourages self-care, is empowering and enables end-users to learn to increase healthy behaviors for themselves and for their children. It breaks the vicious circle of poor quality and inadequate utilization of services by offering comprehensive antenatal and postnatal care that meets the needs of the end users, care providers and health systems by combining quality clinical care with health promotion and health information activities. The European funded project GC_1000 included demonstration sites in 4 low- and middle-income countries, as well as in 3 high-income countries in settings that serve the most vulnerable women and girls. GC_1000 will deliver group antenatal and postnatal care. The three aims of this project are:
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. analyze 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.
During the first 18 months of the project all necessary actions were undertaken within the consortium, countries, and the work packages to prepare the achievement of the three aims of the project. Second, the infrastructure for an effective operating, accessible and outreaching consortium was developed and implemented.

Work performed in reporting period 2:

To achieve the first aim, the country leads of the Netherlands, Belgium, Suriname, Kosovo, Ghana, South Africa and United Kingdom, in collaboration with the Work Package (WP) 2, 3, 4 and 5 teams, hosted stakeholders' engagement groups and regular country team meetings to advise, co-create and implement group care in each country.

The 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, we built the basic framework for site-specific protocols and adapted 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 RP2, a total of 242 health care workers were trained in 15 basic or advanced trainings, 20 in-country trainers were trained. In Ghana, 2 extra trainings were given related to working with the Check2Gether backpack. In almost all countries groups have started, adding up to 104 in total. Only in South Africa the first group will start in January 2023. In three countries (Kosovo, Netherlands, and UK) WP4 supported activities for upscaling.

To achieve the second aim, data collection and data entry were started. Collected data included observational data of groups and trainings, surveys of women participants, routine clinical indicator data and economic data. In addition, a series of workshops have been held online to guide and support country teams with data collection and analysis of qualitative data.

To achieve the third aim, we conceptualized the development of the blueprint in order to decide what to include in the lessons learned report. First concepts of in-country blueprints and implementation toolkit, including a planning guide and blueprint template, were presented to the consortium for feedback. Two draft manuscript for systematic reviews have been completed: on Clinical Outcome and on Maternal Satisfaction. A third review, on Lessons Learned, is being prepared.

WP1 activities were aimed at the coordination and monitoring of all activities in the work packages and countries, to ensure timely submissions of deliverables, achievement of milestones and alignment between work packages. Because of COVID-19-related delays, an amendment request for a six-month budget-neutral extension was submitted and approved by December 2022. Except for one milestone, the planned deliverables and milestones were achieved within the reporting period. The last milestone that had to be achieved (starting groups in every site) had been accomplished one month later, in January 2023.

Within WP7, a variety of disseminative output were developed and disseminated such as an animation on Group Care from the perspective of participants, an infographic brochure, social media posts, local television, songs, publications in scientific journals and conference presentations. An international Group Care conference with over 130 attendees was co-organized in the Netherlands, resulting in widespread dissemination and collaboration. Finally, Community of Practice (CoP) are being prepared that will be hosted by the IDP Network of the World Health Organization, free-of-charge.

Overall, it can be concluded that a six-month budget neutral extension was needed due to the short and longer-term challenges caused by COVID-19. Nevertheless, we executed most of our re-planned work during within the this second period of the project. WP teams, country teams and sites worked hard and collaborated creatively to solve challenges. Therefore, we are confident to successfully finalize the project in the third and last period of 18 months.
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 child birth.

So far, the implementation of Group Care has been successful in most but not all countries and settings. This helps us to understand mechanisms 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 results from this project will support countries to adapt, implement and scale up facilitated Group Care locally. 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.
Group Care in Suriname