lesson 3: maternal nutrition - care group...

Lesson 3: Maternal Nutrition

Care Group Orientation

Promoter Lesson Plan

Module 1 of 5

70

Care Group Orientation

Table of Contents:

Lesson 1: Introduction to Care Groups9

Lesson 2: Teaching Techniques17

Lesson 3: Mother Leader Responsibilities28

Lesson 4: Watching for Change and Monitoring Groups39

Lesson 5: All Children Have Value50

Lesson 6: I Can Change!58

Lessons 1-6 Pre and Posttest67

Lessons 1-6 Pre and Posttest ANSWERS69

Lessons, stories, and activities in the Care Group Orientation Lesson Plan are meant to complement the information provided in Care Group Orientation Mother Leader Flipchart.

Understanding the Lesson Plan

Each lesson begins with objectives. These are the behavior, knowledge and belief objectives that are covered in the lesson. Make sure that each of these objectives is reinforced during the lesson. There are four types of objectives. Each is described below.

Behavior Objectives: Most objectives are behavioral objectives written as action statements. These are the practices that we expect the caregivers to follow based on the key messages in the flipchart.

Knowledge objectives: For example, we want mothers to be able to name the danger signs as well as the five ways that diarrhea-causing germs are transmitted. These are facts that the caregivers must memorize during the lesson, using the pictures as a reminder.

Belief objectives: We know that beliefs and attitudes affect our practices. Many times it is a persons inaccurate belief or worldview that hinders them from making a healthy behavior change. In this module we are reinforcing the belief that change is possible. We also have a lesson devoted to discussing child value.

Behavioral determinant objectives: Behavioral determinants are reasons why people practice (or dont practice) a particular behavior. There are eight possible behavioral determinants as identified in the Barrier Analysis[footnoteRef:1] surveys done in each region. The surveys identify the most important determinants for each behavior. By reinforcing the determinants that have helped the doers (caregivers in the community already practicing the new behavior) we are able to encourage the non-doers (caregivers who have not yet tried or been able to maintain the new practices). We also help non-doers (caregivers who are not practicing new behaviors) to overcome obstacles that have prevented them from trying or maintaining the practice in the past. Behavioral determinants will be more prominent in future modules. [1: See http://barrieranalysis.fhi.net for more information.]

Under the objectives, all of the materials needed for the lesson are listed. The facilitator should make sure to bring all of these materials to the lesson. In Lesson 5, we introduce the idea of an Activity Leader who will focus on the needed materials for Module 2. See below for more information.

Each exercise (section of the lesson plan) is identified by a small picture. Pictures are used to remind non-literate Mother Leaders of the order of the activities. For example when its time to lead the game the lesson plan shows a picture of people laughing as if they are enjoying a game (see below). The pictures in the lesson plan help to cue Mother Leaders of the next activity. Review the descriptions below for more information.

The first activity in each lesson is a game. Games help the participants to laugh, relax and prepare for the lesson. Some games review key messages that the participants have already learned. Some games promote the belief objectives. Make sure that everyone participates in the games.

Following the game is the attendance and troubleshooting section. All facilitators will take attendance. The troubleshooting questions only apply to facilitators (promoters) training others.[footnoteRef:2] The promoter follows up with any difficulties that the Mother Leaders had teaching the previous lessons. Refer to the role play in Lesson 4 for more information. [2: In the Tubaramure program, paid staff are called promoters. The role of the promoters is to train Mother Leaders to facilitate lessons with their neighbors. A few exercises, noted above, are only for promoters and do not need to be used by the Mother Leaders when sharing with their neighbors.]

Next the facilitator opens the flipchart to the first picture of the lesson. He or she reads the story printed on the back of the flipchart, adding more details and descriptions as desired.

The story in each lesson is followed by discussion questions. These questions help the facilitator to find out the caregivers current practices (related to the lesson). This section is marked by the A (ask) in the ASPIRE method.[footnoteRef:3] This section is meant for discussion, not for teaching. Be sure to let everyone voice their opinions [3: For more information about the ASPIRE method review Lesson 2.]

The second, third and fourth picture in each lesson are for teaching the key objectives of the lesson. After turning to the second flipchart page [the S (Show) - in ASPIRE], ask What do you see in this picture? Let the participants respond and describe what they think the flipchart pictures are telling them.

Next, explain the key messages written on the back of the flipchart. The key messages also appear as captions on the flipchart pages. Be sure to explain each picture using the additional bullets printed on the back of the flipchart (or in the lesson plan). The lesson plan also contains additional information for the trainer. The additional information does not need to be discussed during the lesson unless it directly relates to questions by the participants.

After the fourth picture of the lesson, is an activity. Activities are hands-on exercises to help the participants understand and apply what they have learned. Most of these activities require specific materials and preparations.

Beginning in Module 2, an activity leader is responsible to organize materials for the Lesson Activity. The Activity Leader for Module 2 is elected in Lesson 5. The Activity Leader meets with the facilitator ten minutes before each lesson to discuss the needed materials for the next lessons activity. The Activity Leader is responsible to talk with the others (Mother Leaders or neighbors) during the Attendance and Troubleshooting to organize the materials needed for the next meeting, asking them to volunteer to bring the items. The facilitator will lead the activity, but the Activity Leader will support her by organizing the volunteers and aiding the facilitator as needed during the activity.

After the activity, the facilitator completes the P-I of the ASPIRE method. The ASPIRE method is used to reinforce participatory methods of teaching. It is explained in detail in Lesson 2.

In the probe section the facilitator asks if there are any obstacles that may prevent the caregivers from trying the new practices. They discuss these obstacles and then move to the next section.

The facilitator informs the caregivers of ways to overcome the concerns that are mentioned. The facilitator gives more information or a different perspective to help the caregivers understand how to move forward.

Next is Practice and Coaching. This section is required for the training of Mother Leaders. We want to make sure that they understand the material and can present it to others. In this small group activity, the promoter can observe and coach those who are having difficulty.

Finally the facilitator completes the R-E of the ASPIRE method.

The facilitator requests a commitment from the Mother Leader (or caregivers) to begin practicing the new practices they have discussed. If they agree, the caregivers should make a verbal commitment. It is up to the caregivers to make a choice. They should not be forced to make a commitment if they are not ready.

The last section is where the facilitator examines the Mother Leader (or caregivers) practices based on the teaching from the last lesson. The facilitator encourages them to try the new practices they have not yet done.

All lessons follow the pattern described above. Lessons can be adapted as needed to fit the needs of your care group. Lessons should not exceed two hours in length although some lessons may take longer than others. The suggested time for each section is listed below.

Section name

Time needed for this section

Game

Attendance and Troubleshooting

Story and Ask (picture 1)

Show and Explain (picture 2)



Activity

Probe

Inform

Practice and Coaching

Request

Examine

10 minutes

5- 15 minutes

10 minutes

5 minutes

5 minutes

5 minutes

15 minutes

10 minutes

5 minutes

20 minutes

2 minutes

15 minutes

2 hours

Acknowledgements

Hanold, Mitzi J. (2009) Care Group Orientation Mother Leader Lesson Plan. Washington DC. Food for the Hungry (FH), made possible through support provided by the Office of Food for Peace, Bureau of Democracy, Conflict, and Humanitarian Assistances, and the U.S. Agency for International Development under the terms AID-FFP-09-00004-00. The opinions expressed herein are those of the author and do not necessarily reflect the view of the U.S. Agency for International Development.

Many thanks to our illustrators [insert the local illustrators name], Ocatvio Gonzales and Petra Rhr-Rouendaal. Editors include Carolyn Wetzel (FH), and Mary Hennigan (CRS), Deanna Olney (IFPRI). For questions or comments, please contact the author at [email protected].

Lesson 1: Introduction to Care Groups

Caregivers will be able to describe the program goal: all parents will take actions to help their children grow tall, strong and healthy. That is, infants and children will not die of malnutrition and preventable diseases before age two, but be healthy and strong.

Mothers will have good nutrition and health while pregnant and give birth to healthy infants.

Caregivers[footnoteRef:4] will be able to prepare healthy foods for their children to grow tall and strong. [4: The term caregivers refers to all beneficiaries who care and support children in the Tubaramure program (Promoters, Mother Leaders, beneficiaries and their families). ]

Caregivers will prevent, identify and manage childhood diseases.

Caregivers will keep water, food, and bodies clean to prevent illness and disease.

Caregivers will be able to name the Tubaramure partner organizations: Food for the Hungry, International Medical Corps, CRS (Caritas) and USAID.

Caregivers will be able to describe those who will be reached with the health messages: pregnant women and infants less than 24 months.

Caregivers will be able to explain why the Tubaramure program is targeting pregnant women and children less than 24 months.

The largest increase in malnutrition (poor nutrition) occurs in the first 24 months of life.

By targeting this age group, we will see the greatest reduction in child sickness and death.

If children survive the first two years of life and grow well, they are more likely to be healthy for many years in the future.

Caregivers will believe that change is possible.

Materials:

1. Attendance Registers for Mother Leaders

2. Care Group Orientation Mother Leader Flipchart for the promoter and each Mother Leader

Lesson 1 Summary:

Game: Getting to Know You

Attendance

Share the story and ask about the women about their beliefs about change: Healthy Children.

Show pictures and share key messages on flipchart pages 6-11: The Tubaramure Goals, Reaching Mothers and Children, and Tubaramure Partners.

Activity: Tubaramure Song

Probe about possible barriers

Inform them of possible solutions to the barriers

Practice and Coaching in pairs

Request a commitment

1. Game: Getting to know you 10 minutes

1. Ask Mother Leaders to talk to the woman sitting next to them to find out about their family (how many children, how old are they, what are their names, etc). Finally, ask what they hope to learn from being a Mother Leader.

2. In a large group, ask each Mother Leader to introduce her neighbor until everyone has been introduced.

2. Attendance 5 minutes

1. Take attendance, marking the attendance sheet for those who are present and those who are absent.

Healthy Children (Picture 1.1) 10 minutes

3. Story

Read the story on page 4 of the flipchart.

The story explains how the Tubaramure program changed the old womans community.

The story is set in the future. It describes the changes seen by the old woman. It describes how women will talk about the Tubaramure program many years from now.

The old woman says, Of all my children, your father was the strongest child. My other children were often sick and lacked energy. I was pregnant with your father when the Tubaramure program began. Because of the Tubaramure program, the community made changes that helped children to grow. Children were born healthy and were sick less often. Children grew taller and stronger than those born before the program. Today, children do not struggle, but are healthy and strong in the first years of life.

4. Ask

Read the questions on page 4 of the flipchart.

Ask the first questions to review the changes that occurred in the story.

Ask the last two questions to encourage the women to discuss how the program goal might change life in the community? Encourage the women to think about how healthy children might make life easier for the parents. Would it affect their productivity, their finances, and their happiness?

Encourage discussion. Dont correct wrong answers. Let everyone give an opinion. This page is for discussion, not for teaching.

After the participants answer the last question, move to the next flipchart page by saying, Let compare your ideas with the messages on the following pages.

What problems existed when the old woman was having children? How did it change?

Are children in your community healthy? Why or why not?

How would life be different if all children were healthier and stronger?

Tubaramure Goals (Picture 1.2) - 5 minutes

5. Show:

Ask the caregivers to describe what they see in the pictures on page 7.

What do you see in these pictures?

6. Explain:

Share the key messages using flipcharts pages 6 and 7.

Use the captions on the flipchart to remind you which images represent each point.

Children will grow tall.

Caregivers will be able to prepare healthy foods for their children to grow tall.

Healthy foods allow bones to grow and lengthen.

Children will be strong.

Caregivers will be able to prepare healthy foods to strengthen their bones and muscles.

Children will have more energy and strength.

Children will be healthy.

Mothers will have good nutrition and health while pregnant and give birth to healthy infants.

Caregivers will be able to diagnose illness and get help quickly.

Caregivers will be able to help their children when they are sick to overcome the illness.

Caregivers will keep water, food and bodies clean to prevent illness.

Are these goals important to you? Why or why not?

Additional Information for the Trainer

Infant Mortality

The infant mortality rate (death rate) in Burundi is 101 deaths out of every 1,000 live births[footnoteRef:5] (for infants less than one year of age). In more developed countries infant mortality rates are between 5-10 infant deaths out of every 1,000 live births. [5: http://www.unicef.org/infobycountry/burundi_2774.html]

The Tubaramure program will not only increase health, but also help to reduce the numbers of deaths in infants and children.

Reaching Mothers and Children (Picture 1.3) - 5 minutes

7. Show:



8. Explain:



To help children grow, we will share messages with pregnant women and mothers with children less than 24 months.

Like a bird that protects her eggs in a nest, infants and children need protection and special care in the first two years of life.

During the first two years children are most vulnerable to sickness and death.

Healthy two year olds are more likely to grow up into healthy adults.

For five years Tubaramure staff will train Mother Leaders with skills to help children grow tall, strong and healthy.

After five years, you will be well known in the community for the work you have done.

You will be able to see a change in childrens height, strength and health.

By continuing to train others, even after the program is over, you will be able to share these life-changing skills with others in your community and region.


Malnutrition

The greatest increase in malnutrition occurs between 6 and 24 months of age. Six months marks the age when most mothers add foods to the infants diet. It is during this time that infants begin to experience diarrhea more frequently. Frequent diarrhea often results in malnutrition.

Tubaramure Partners (Picture 1.4) - 5 minutes

9. Show:



10. Explain:



This program is your program. You are the ones who will help children to grow tall, strong and healthy.

With your experience, talents, and time we will be able to see changes.

The Community Development Committee will support you with their wisdom and advice when problems arise.

There are several other organizations helping you to reach your goal: USAID, Food for the Hungry, Caritas, and International Medical Corps.

All of these organizations are working with you to help children to grow tall, strong and healthy.

Together they will provide training and advice for five years so that you will have the skills and knowledge to improve child growth.

11. Activity: Tubaramure Song - 15 minutes

Below is a song which describes the goals of the Tubaramure program.

We will take action so that our children will grow

Tall strong and healthy.

With good food and care, and good hygiene our children will grow

We can do it, we can change our community

I can change and I can help my neighbors to change

Tubaramure is our future, a strong and healthy future

We will take action so that our children will grow

Tall strong and healthy.

Practice the Tubaramure Song with the Mother Leaders.

Sing it several times so that they learn the words.

Challenge the women to learn the song and share it with those who ask about the program.

12. Probe 10 minutes

? Do you agree to work with the Tubaramure staff to reach this goal? Is there anything that might prevent you from helping the community to reach this goal?

Ask mothers to talk to a woman sitting next to them for the next five minutes. They should share any personal concerns that they have about the program goals. Together they should try to find solutions to these worries and problems. After five minutes, ask the Mother Leaders to share what they have discussed.

13. Inform 5 minutes

Help find solutions to their concerns. If a woman offers a good solution to another womans concern, praise her and encourage others to consider this solution.

Possible concerns:

14. Practice and Coaching 20 minutes

1. Give each Mother Leader a Care Group Orientation Mother Leader flipchart. Ask them to share the teachings they have learned with the person sitting next to them using the first two flipchart pages.

2. They should try to teach the person next to them in the same way that they promoter used the flipchart to teach them.

3. After ten minutes, ask the women to switch roles. The other Leader Mother will share the teachings from the third and fourth pages of the flipchart.

4. The Promoter should watch, correct, and help the Mother Leaders who are having trouble.

5. When everyone is finished, answer any questions that the mothers have about the materials, or todays lesson.

15. Request 2 minutes

? Are you willing to commit to working with the Tubaramure program to help children grow tall, strong and healthy?

Ask each mother to say aloud the commitment that she is making. For example, I commit to working with the Tubaramure partners so that children grow tall, strong and healthy, or I commit to reaching pregnant mothers and mothers of children 23 months or younger.

Lesson 2: Teaching Techniques

Mother Leaders will be able to share the flipchart messages using ASPIRE with someone else in the Care Group.

Mother Leaders will be able to explain the meaning of each step in ASPIRE, the method for effective facilitation.

Mother Leaders will be able to ASK about current practices without judging or criticizing participant answers.

Mother Leaders will be able to SHOW the lessons three flipchart pages and explain the key messages for each image.

Mother Leaders will be able to PROBE to find out obstacles or problems that might prevent a mother from trying a new practice.

Mother Leaders will be able to INFORM a mother, giving alternative ideas or suggestions to help them overcome the obstacles that are mentioned.

Mother Leaders will be to REQUEST a commitment from another mother after each lesson.

Mother Leaders will be able to EXAMINE the commitments of a mother from the last meeting to find out if she has fulfilled her commitments.

Caregivers will be able to identify the different parts of the lesson with the appropriate pictures.

Mother Leaders will believe that they can be part of the change in others lives (change agent).

Materials:

1. Attendance Registers

2. Two copies of the role play at the end of this lesson

3. Care Group Orientation Mother Leader Flipchart

Lesson 2 Summary:

Game: Making Eyeglasses

Attendance

Share the story and ask about the methods used for teaching others: Teaching for Change

Show pictures and share key messages on flipchart pages 14-19: Ask and Show, Probe and Inform, and Request and Examine.

Activity: Role Play with ASPIRE





Examine beliefs related to the goals of the program

1. Game: Making Eyeglasses 10 minutes

We will begin with a game.[footnoteRef:6] I will show you how you can make eyeglasses. You have to follow my directions. If you follow them, just as I say, you will make a pair of eye glasses with your hands. Lets work together to see if you can make them. [6: The game is used to demonstrate that people need to SHOW us how to make changes, not just educate about change. This game can be substituted with another game as needed. However, make sure that the new game includes the same learning lesson. ]

I will tell you what to do, but you must do it on your own. I wont answer questions, or tell you if you are doing it right. You must listen.

Explain the following steps.

1. Press and hold the tips of your thumb and first finger together on each hand. Your fingers should form two small circles on each hand.

2. Keep your fingers pressed together. Now touch the two circles together from each hand so that they are joined in front of you.

3. Next touch your remaining six fingers under your chin, so that the palms of your hands are facing away from you.

4. Keeping your fingers under your chin, move the palms of your hands towards your eyebrows, until you can lay your thumbs across your eyebrows.

? How did you do? Lets try it again. This time I will SHOW you.

Read the same instructions again. Answer questions. Help those who are having trouble. Show them with your hands what they should do for each step.

? What can we learn from this exercise? Encourage discussion.

People learn best when they can see and hear how to do a new thing.

People learn best when they practice the new thing with someone who has done it before.

In our program we will be sharing new skills and new practices. We have to show them and help them to practice the new skills.

The best way to be a new teacher, is to commit to doing the practice yourself first. Then you will know how to instruct others.


1. Take attendance, marking the attendance sheet for the Mother Leaders who are present and those who are absent.

2. Then mark the Mother Beneficiary attendance sheet, reading off each Mother Beneficiaries name and marking their attendance based on the Mother Leader report.

Story: Teaching for Change (Picture 2.1) 10 minutes

3. Story:


The story describes teaching techniques used in the Tubaramure program.

The great granddaughter says, How did the community change? The community selected Mother Leaders. I was chosen as a Mother Leader. I met with a promoter and learned new things. Then I began to share messages with my neighbors. I told stories and asked questions about my neighbors lives. I encouraged my neighbors to try new things. I also made changes at home.

4. Ask


Ask the first question to review the story.

Ask the second question to find out their beliefs about the effectiveness of these methods.

Ask the last question to find out their willingness to teach this way.



How did the Mother Leader help the women change?

How do these things help others to change?

Do you think you can teach this way?

Ask and Show (Picture 2.2) - 5 minutes

5. Show:



6. Explain:



The word ASPIRE will remind you what to do.

Each letter in ASPIRE represents one step that will help you to be a good teacher.

A in ASPIRE stands for ASK.

We should remember to ASK mothers about the practices that they are doing related to the lesson.

This will help us to know what to teach.

If we are teaching about hand washing, we can ask each woman, how often do you wash your hands?

S stands for Show.

Each lesson will have about four flipchart pages.

We show them the flipchart page and ask them to describe what they see.

Then we explain the meaning of the pictures.

Each picture is explained on the back of the flipchart.

The main points are also written on the picture page.


The Ask

If the facilitator discovers during the ASK phase that all of the learners are already practicing the new behavior, the facilitator does not need to spend much time explaining the behavior and giving reasons for change. Based on the learner responses during the ASK phase, the facilitator will adapt the teachings so that it is relevant to the learners current behaviors and experiences.

If some of the message points are shared by a learner during the story and discussion, the facilitator can refer back to this discussion. For example the facilitator might review the message and then say, This message was already explained by Jeanine during the discussion, instead of re-teaching the same message again. This reaffirms the learners and acknowledges information that is already known by the learners.

Probe and Inform (Picture 2.3) - 5 minutes

7. Show:



8. Explain:



P and I are the next steps in ASPIRE.

P in ASPIRE stands for PROBE.

After you have shown all four pages of the lesson, ask about obstacles that may prevent the families from trying the new practice.

For example, Is there anything that might make it difficult for you to cover your food to keep out the flies?

Listen to the concerns that the women mention.

I in INSPIRE stands for INFORM.

Suggest ways that the caregivers can overcome the problems that they mention.

For example, You said that you need to purchase fabric to cover your pots. Could you use reeds to weave a lid instead?

Request and Examine (Picture 2.4) 5 minutes

9. Show:

Ask the caregivers to describe what they see in the picture on page 19.


10. Explain:



R and E are the last two steps in ASPIRE.

R in INSPIRE stands for REQUEST.

Ask the caregivers if they would like to commit to trying the new practice.

For example, We learned about covering foods. What will you commit to do now?

Ask the mother to say out loud what she has decided to do.

It is her choice; we will not force mothers to change.

E in INSPIRE stands for EXAMINE.

Ask the women about the commitments that they made at the last meeting.

Have they done the things that they committed to?

For example, At our last meeting, you said you would go to the clinic. Did you go?

How do you think these steps will help you to be a good teacher?

Additional Information to the Trainer

Commitments

Many studies have shown that if learners make a verbal commitment in front of others, they are more likely to remember the commitment and actually follow-through on the commitment.

By allowing the learners to make their own commitments, we allow them to take responsibility and set goals that are relevant to their own experience.

The facilitators role is to make it easy for others to proceed through the process of change. Reminding and helping them follow-up on their commitments is one way of achieving this goal.

11. Activity: Role Play 15 minutes

1. Ask each Mother Leader to look at Lesson 3 in her Care Group Orientation Mother Leader Flipchart. Ask her to look for each of the small ASPIRE pictures in the flipchart? (Where is the ASK image? Where is the SHOW image? Where is the PROBE image?)

2. Explain to the Mother Leaders that the small images are clues to help them remember what to do next when they are teaching.

3. When they begin teaching, they will use these small images to help them follow the ASPIRE method.

Now lets watch a role play to see what happens when a Mother Leader visits a mother in her home. This role play takes place after several lessons have been taught. We will focus on the last four steps the P-I-R-E steps.

4. Ask for two volunteers to act out the role play at the end of this lesson with you.

5. Give one copy of the role play to each volunteer. For a low-literate audience, you might also consider asking one literate volunteer to read the role play. Each volunteer should listen and then act out each sentence after it is read. Adapt as needed.

6. After the role play is over, read the discussion questions below.

? What did you see in this role play?

7. Encourage discussion. Add any of the following points that are not mentioned.

a. The Mother Leader often repeated what the mother said in a different way (paraphrasing). This helps to clarify and confirm what the mother has said.

b. The Mother Leader did not force the mother to make a commitment. She mentioned the benefits of adopting the practices.

c. The Mother Leader integrated ASPIRE into the discussion.

Probe: What do you think about this lesson? Is there anything that might make it difficult for you to only give breastmilk for the first six months?

Inform: The nurse at the health post can read the growth chart and show you that the child is growing well.

Request: Would you be willing to commit to exclusively breastfeed your infant until six months, and then begin slowing adding foods?

Examine: You said that you would commit to putting the newborn child to the breast immediately after she was born. Did you do that?


? What do you think about these ideas? Is there anything that might prevent you from using the ASPIRE method and sharing with others?

Ask mothers to talk to a woman sitting next to them. They should share any personal concerns that they have about the lesson. Together they should try to find solutions to these worries and problems. After five minutes, ask the Mother Leaders to share what they have discussed.


Help find solutions to their concerns. If a woman offers a good solution to another womans concern, praise her and encourage others to consider this solution.

Possible concerns:


1. Ask Mother Leaders to share the teachings they have learned today using the first two flipchart pages. They should share with another woman in the care group using the ASPIRE method.

2. Tell each Mother Leader to ask, What do you see here. What do you think it means? before they explain each picture.

3. Then after the woman has responded, clarify any misunderstandings and explain what this picture means for the health program in our community.

4. After ten minutes, ask the women to switch roles. The person they are sharing with should practice using the next two pages of the flipchart.


6. When everyone is finished answer questions that the mothers have about todays lesson.

Additional Information for the Trainer:

Lessons 2, 3, and 4 are for the training of Mother Leaders. You may choose not to share lessons 2, 3 and 4 with the neighbor groups. However, sharing all lessons may encourage greater support from the community.


? Are you willing to commit to using the APSIRE method with your neighbors?

Ask mothers to give a verbal declaration that they will use the ASPIRE method every time they share with others.

16. Examine 15 minutes

Ask each Mother Leader one-on-one about their commitments from the last meeting:

At the last meeting what was your commitment?

How are you feeling about this commitment? Have you shared it with others? How did they respond?

Have you shared the messages you learned with others?

Role Play: Using A-S-P-I-R-E with a Neighbor

Additional Information for the Trainer: This role play will only be used with Mother Leaders and does not need to be shared with neighbor groups.

Setup: The promoter will act as the Mother Leader and sit together with the two volunteers (Mother and Mother-in-Law) during the role play.

Explain: The Mother Leader is sitting with a mother in her home. She has just shared messages about breastfeeding with the mother and her mother-in-law. (That is, she has already ASKED about current practices and SHOWN all three flipchart pages.) Listen to how the Mother Leader uses the last four steps of the ASPIRE method. The woman that is mentioned in the discussion is the Model Mother, or mother who follows the recommended teachings.

Mother Leader: What do you think about this lesson? Is there anything that might make it difficult for you to exclusively breastfeed for the first six months of your childs life?

Mother-in-Law: I have heard from your story that the Model Mother gave her child only breastmilk until he was six months old. Then at six months she added foods. I have never heard such teaching before.

Mother to Mother-in-Law: You are right; we have never heard such teaching. Its true that infants dont need other foods or drink before they are six months old. Even some women in our villages wait to give food until the child is six months old.

Mother-in-Law: Yes. Some women say that giving food earlier gives the child diarrhea.

Mother Leader: So it sounds like although many mothers give foods early, some wait to give foods to prevent the child from getting illnesses.

Mother-in-Law and Mother: Yes

Mother Leader: What do you think? Do you think it is possible that waiting to give foods or drink might prevent illness?

Mother: It may be true. I have heard your teaching and the story of the Model Mother. She is very wise and her children are much stronger than the other mothers. How can we be sure that our children are growing well with just breastmilk?

Mother Leader: The nurse at the health post can read the growth chart and show you that the child is growing well. Would you be willing to commit to trying to exclusively breastfeed your infant until six months, and then begin adding foods?

Mother: Yes, it is possible. We will talk to our family and make a decision with them before your next visit.

Mother Leader: Okay. I will ask you at my next visit. Now lets examine what you have done since my last visit. You said that you would commit to putting the newborn child to the breast immediately after she was born. Did you do that?

Mother: Yes, I made the commitment and I followed through. Look. She is very strong and healthy now.

Mother Leader: That is wonderful. You are trying new things. I can even see that you child is happy and healthy too.

Mother-in-Law and Mother: Thank the Mother Leader for coming.

Mother Leader: Schedule a time for her next visit, thanks the woman and leaves.

Lesson 3: Mother Leader Responsibilities

Mother Leaders will meet with the promoter (in the care group) once every two weeks to learn a new lesson.

Mother Leaders will commit to being a role model; making healthy changes in their home and modeling healthy practices to others.

Mother Leaders will share a new lesson with their neighbor groups[footnoteRef:7] once every two weeks. [7: Neighbor groups represent the beneficiaries who are reached every two weeks by the Mother Leaders.]

Neighbor groups consist of at least four and not more than 12 pregnant mothers or mothers with children less than 24 months.

Once each month the Mother Leaders will teach her neighbors all together in one large group (neighbor group). At the second monthly meeting, she will teach in each neighbors home (household visit).

During each household visit, Mother Leaders will share two messages from the Picture Cards.

The Picture Cards have messages that are specific to pregnancy and the monthly development of the child. These messages will help mothers to adopt healthy practices relevant to the childs growth.

Before each lesson, Mother Leaders will ask each neighbor about the familys health.

Mother Leaders will report new pregnancies, maternal deaths and deaths of children less than 24 months back to the promoter at each meeting.

Materials:


2. Picture Cards for each Mother Leader

3. One extra copy of the role play


Lesson 3 Summary

Game: Hello Hello

Attendance

Share the story and ask the womens feelings about being a Mother Leader: A Family that Brought Change

Show pictures and share key messages on flipchart pages 22-27: Teaching Mother Leaders and Neighbor Groups, Asking about the Familys Health, and Sharing Message from the Picture Cards.

Activity: Role Play with the Picture Cards





Examine commitments from the previous lesson

1. Game: Hello Hello 10 minutes

1. Ask the Mother Leaders to stand in a circle.

2. Select one Mother Leader. Ask her to walk around the outside of the circle and tap someone on the shoulder.

3. The tapped person walks the opposite way around the circle, until the two women meet. They greet each other three times by name.

4. The two Mother Leaders then walk quickly back to the open spot, walking in opposite directions around the circle. The person who fills the spot first is the winner.

5. The other Mother Leader then walks around the outside of the circle and chooses someone to tap.

6. Repeat the game until everyone has had a turn.

Now that we are energized, lets begin todays lesson.




Story: A Family that Brought Change (Picture 3.1) 10 minutes

3. Story:


This story gives some reasons why the old ladys husband was proud of her new responsibilities.

The old lady says, I remember when I was chosen to be a Mother Leader. My husband was so proud. He said, In our community, the sound of crying is often heard. Children are always sick and struggle to survive. Soon our community will be filled with laughter. Children will be healthy and strong. I am so proud that you were chosen to bring change.

4. Ask


Ask the first question to review the reason why the Mother Leaders husband was proud of her role as a Mother Leader.

Ask the second question to discuss the beliefs and thoughts of the Mother Leaders and their families about the new responsibilities.



Why was the old ladys husband proud of his wife?

What does your family think of you working as a Mother Leader?

Teaching Mother Leaders and Neighbor Groups (Picture 3.2) - 5 minutes

5. Show:



6. Explain:



Mother Leaders will learn a new lesson every two weeks and share it with their neighbors.

Mother Leaders will meet in the care group with the Promoter every two weeks.

Every two weeks Mother Leaders will learn a new lesson.

Mother Leaders will share the messages with their neighbor groups (4-12 women).

Each month, the Mother Leader will share one lesson in a group and one lesson in each home.

Once a month the Mother Leader will share the new lesson in the neighbor group.

Once a month she will share the new lesson at each home.

During each household visit, Mother Leaders will share two messages from the Picture Cards.

This allows her to share with other family members in the household.

Asking about the Familys Health (Picture 3.3) - 5 minutes

7. Show:



8. Explain:



Ask about the health of the family.

At the start of each lesson, the Mother Leader will ask about the familys health.

She will refer families to the health center to treat illnesses mentioned.

She will take questions to the Mother Leader Care Group.

Mother Leaders will listen for births, deaths and new pregnancies for women in the group and their children under 24 months.

Report mother or child death and new pregnancies to the promoter.

The promoter will share this information with the local clinics and Ministry of Health.

This will help the clinics to understand the health needs of the families in the community.

This information will also help the Mother Leader Care Group to understand the needs of the families in the community.

Sharing Messages from the Picture Cards (Picture 3.4) 5 minutes

9. Show:



10. Explain:



The Picture Cards have five pages.

Each page gives specific messages based on the age of the child or month of pregnancy.

The first page is for pregnant women in the first seven months of pregnancy.

The second page is for pregnant women in the last two months of pregnancy and for infants up to five months of age.

The third page is for children six to eight months.

The fourth page is for children nine to eleven months.

The last page is for children 12 to 23 months.

Find the age of pregnancy or the age of the child on the cards.

Share two or three messages from the appropriate Picture Card at each household visit.

11. Activity: Role Play 15 minutes

1. Ask for three volunteers to act out the role play at the end of this lesson with you. Give one copy of the role play to each volunteer.

2. For low literate audience, you might also consider asking a literate volunteer to read the role play. Each volunteer should listen and then act out each sentence after it is read. Adapt as needed.

3. After the role play is finished, ask the discussion question below.

What did you see in this presentation?

4. Encourage discussion. Add any of the following points that are not mentioned:

a. The Mother Leaders explains that she is a volunteer that will be visiting every two weeks.

b. She reminds the neighbor of the program goals.

c. She begins by asking about the familys health.

d. She refers families to the health center to treat illnesses mentioned.

e. At the end of the lesson she gives two messages with the Picture Card.

What do you think will help the Mother Leader to be a successful Mother Leader?

5. Encourage discussion. Add any of the following points that are not mentioned.

a. She is willing to learn new things and come to all of the trainings.

b. She communicates easily with others. She listens and respects others.

c. She helps others to try new practices.

d. She is committed to continue helping mothers even after all the training is complete.

e. She believes that change is possible and encourages other mothers to believe too.


? What do you think about these ideas? Is there anything that might prevent you from completing all of your responsibilities?

Ask mothers to talk to a woman sitting next to them for the next five minutes. They should share any personal concerns that they have with these messages. Together they should try to find solutions to these worries and problems. After five minutes, ask the Mother Leaders to share what they have discussed.


Help find solutions to their concerns. If a woman offers a good solution to another womans concern, praise her and encourage other mothers to consider this solution.

Possible concerns:



2. Tell each Mother Leader to ask, What do you see here. What do you think it means? before they explain each picture.

3. Then after the woman has responded, clarify any misunderstandings and explain what this picture means for the health program in our community.

4. After ten minutes, ask the women to switch roles. The person they are sharing with should practice using the next two pages of the flipchart.


6. When everyone is finished answer questions that the mothers have about todays lesson.


? Are you willing to make a commitment to the teachings you have heard today? What is your commitment?

Ask each mother to say out loud a new commitment that she will make today. Each mother can choose the commitment that is most important to her.

For example: I commit to meeting my neighbors every two weeks and being a role model to others. I commit to coming to the care group meeting twice a month and making changes in my life. I commit to asking about the families health at each meeting.


Ask each Mother Leader one-on-one about their commitments from the last meeting:


How are you feeling about this commitment?

Have you practiced the ASPIRE method since the last meeting?

Role Play: Visiting the Neighbor Groups (Asking about Family Health and the Picture Cards)


Setup: The promoter will act as the Mother Leader. She is standing outside the door of one of her neighbors. Inside the house the Mother and Mother-in-Law are sitting.

Explain: The Mother Leader is coming to visit one of her neighbors.

Mother Leader: Greetings to you and your family. Is this a good time to talk? Would your husband or others in your family like to join us?

Mother: My husband is not here. But my mother-in-law is here with me. She will listen too.

Mother Leader: As you know I am an elected community volunteer, a Mother Leader, and I have been receiving training to help families raise healthy children.

Mother: Yes. We are very glad that you have come.

Mother Leader: I am a volunteer. I dont receive any money from the program. I volunteered to visit the neighbor groups every two weeks so that we can learn together. I believe that we can help bring change to the community so that our children will be tall, strong and healthy.

Mother: Yes I have heard of this program.

Mother Leader: Yes. (pause) How is your family; are you and your children well?

Mother: My youngest child has a fever.

Mother Leader: Have you taken him to the clinic?

Mother: Yes, and I received some medicine this morning. He seems to be getting better.

Mother Leader: Good. Make sure to give all the medicine that the clinic described. If the child doesnt improve, you should return tomorrow. How is the rest of your family?

Mother: The rest of us are healthy.

Then, at the end of the lesson

Mother Leader: Now that we have finished the lesson, I want to remind you of some health messages for your children. How old are your children?

Mother: The youngest is 6 months and the next is 3 years old.

Mother Leader: Our program focuses on children under age 2, so I can share health messages only for your youngest children.

Mother Leader: For a child 6 months of age, you should begin giving one or two spoonfuls of thick, soft porridge once or twice a day after breastfeeding. After the infant begins to accept the porridge, begin giving four large spoonfuls of porridge three times a day after breastfeeding.

Mother: How do I prepare the porridge?

Mother Leader: The picture shows that the first porridge includes a mashed staple like manioc mixed with oil until it thick and easy for an infant to swallow. This will help the child to grow.

Mother: I will try it this week and see if he likes it.

Mother Leader: Yes try to give him four spoonfuls three times a day after breastfeeding. At our next meeting, I will share more messages to help you add new foods.

Mother: Yes your teaching is good. I will try the porridge to see if he will take it.

Mother Leader: Our next meeting is with all the neighbors under the tree in the village center on Wednesday morning. Are you coming?

Mother: Yes I will come.

Mother Leader and Mother exchange greetings and end the meeting.

Lesson 4: Watching for Change and Monitoring Groups

Mother Leaders will watch for changes in the health of their neighbor groups and the health of their own children.

Mother Leaders will look for positive changes in child illness.

Mother Leaders will look for positive changes in child growth.

Mother Leaders will look for changes in height and strength.

Mother Leaders will share changes that they see with the promoter including information from vital events at each meeting.

Care Groups will celebrate the small changes that they see every few months.

Mother Leaders will watch the pregnancies and the age of the children in the neighbor groups to make sure they are reaching the most vulnerable to malnutrition (pregnant mothers or women which children 23 months or younger).

Mother Leaders will watch the size of their group making sure that they do not go over 12 neighbors in each group.

Care Group Leaders will believe that change is possible.

Materials:

1. Attendance Register

2. Three copies of the role play at the end of the lesson.


Lesson 4 Summary:

Game: Fruit Salad

Attendance

Share the story and ask about the groups ideas for monitoring change: Watching Child Growth

Show pictures and share key messages on flipchart pages 30-35: Waiting for Changes in Family Health, Watching Neighbor Groups, and Sharing Progress with Others.

Activity: Role Play Reporting





Examine commitments from the last meeting

1. Game: Fruit Salad 10 minutes

1. The Promoter divides the Mother Leaders into three to four groups. Each group is given a fruit name such as oranges, papaya and bananas.

2. Mother Leaders then sit in chairs (or on mats) in a circle. The Promoter stands in the center of the circle and shouts out the name of one of the fruits.

3. All of the women in this fruit group must change places with one another. The Promoter tries to take one of their places as they move, leaving another Mother Leader in the middle without a seat.

4. The new Mother Leader in the middle shouts another fruit name and the Mother Leaders in this fruit group must all change places with each other.

5. If someone says, fruit salad all Mother Leaders have to change seats.

Now that we are energized and ready for our lesson, lets begin!




Story: Watching Child Growth (Picture 4.1) 10 minutes

3. Story:


The story describes how one care group decided to monitor the progress of the Tubaramure program in their community.

Our care group began to watch (monitor) our childrens growth. We wanted to see if the changes we made were helping our children. We began taking our children to the health clinic every three months to have them measured and weighed. Pregnant women went every three months to the clinic to have their belly measured. We were encouraged. Even small changes helped our children to grow. It encouraged us to keep working.

4. Ask


Ask the first two questions to review the messages from the story.

Ask the last question to encourage the women to brainstorm other ways they can watch for change in the community. Leader Mothers are not required to monitor change. However, if they understand the goal and begin looking for improvements, it will encourage them to continue the work.



Why did the women decide to watch their childrens growth?

How did watching growth encourage them to continue?

What are some other ways you can watch for change?

Watching for Changes in Family Health (Picture 4.2) - 5 minutes

5. Show:



6. Explain:



We can watch for changes in the health of the families in our neighbor groups.

Changes in the number of child illnesses.

Changes in the height of children.

Changes in the strength of children.

We can encourage our neighbor groups to look for change too.

We can combine the information from all Mother Leaders and look for changes. In these pictures the number of children with diarrhea has decreased.

Tubaramure staff will also measure changes and share this information with us.

How will we know if the change is good?

If sickness decreases, it will encourage us. We have made improvements.

If height and strength do not change or go down, we need to keep working and make changes in our homes.

Watching Neighbor Groups (Picture 4.3) - 5 minutes

7. Show:



8. Explain:



Mother Leaders will work with one group of 12 mothers.

If groups have fewer than 12 mothers, the Mother Leader can include more mothers in the group.

Groups should have no more than 12 mothers.

Women who are not pregnant and do not have children less than two years will graduate from the program.

In order to reach our goal we must focus on pregnant mothers and mothers with children less than 24 months of age.

Women with older children will graduate so that new mothers can join the neighbor groups.

Mother Leaders can continue to volunteer, sharing with their neighbors even if they are not pregnant or do not have children less than 24 months.

Why are these things important?

The childs future health is affected by his nutrition and strength in the womb and in the first two years of life. Neighbor group members must graduate so new mothers can also receive training.

Small groups make it easier for the mothers to see the flipcharts and learn.

Additional information for the trainer:

Graduation

When children turn 24 months old, the mothers must graduate from the program, unless they are a Mother Leader. Mother Leaders are encouraged to continue volunteering.

Neighbor mothers will graduate but may continue attending care group meetings once a month, if they would like. Graduated neighbor mothers will not receive home visits and their attendance will not be tracked on the Care Group Registers.

Sharing Progress with Others (Picture 4.4) 5 minutes

9. Show:



10. Explain:



When we see change, share it with others.

Share stories of change with our partners.

Share stories of change with the Ministry of Health.

Share stories of change with the Community Development Committee.

Share stories of change with other mother groups in the community.

Sharing will encourage us to continue.

We need to celebrate the small changes that we see every few months.

It may take many years to reach our goal of all children growing tall, strong and healthy.

We need to celebrate the small changes to encourage us to keep going.

11. Activity: Role Play


1. Ask for three volunteers to act out the role play at the end of this lesson with you.

2. Give one copy of the role play to each volunteer.

3. For low literate audience, you might also consider asking another literate volunteer to read the role play. Each volunteer should listen and then act out each sentence after it is read.

4. After the role play if finished as the following questions.

? What did you see in this presentation?

5. Encourage discussion. Add any of the following points that are not mentioned by the mothers:

a. Mother Leaders are responsible to report the attendance of the women in their groups at each care group meeting.

b. The Promoter asks about problems with the meetings, and helps the mothers to find solutions.

c. If there are problems encouraging a new practice a few suggestions are given:

Ask other Mother Leaders what they have done to help mothers change.

Speak with other members in the household about the new practices.

Have caregivers who are practicing the healthy practice come and share their experiences with the mother.

Seek support from community leaders regarding the new behaviors.

d. The Mother Leaders should report changes in the numbers of women in their group as well as any new births, deaths or pregnancies that occurred among their group members.


? What do you think about these ideas? Is there anything that might stop you from watching for change in the community?



Help find solutions to their concerns. If a woman offers a good solution to another womans concern, praise her and encourage other mothers to consider using this solution when they talk with others.

Possible concerns:



2. Tell the Mother Leaders listening to the message that they should give one objection to the lesson; one reason that they think this message would be difficult for them.

3. The Mother Leaders sharing the message should try to help the women overcome this obstacle.

4. After ten minutes, ask the women to switch roles. The other Leader Mother will share the teachings from the next two flipchart pages.






For example: I commit to watching for change in the growth of my children. I commit to making sure that only pregnant mothers or women with children less than 24 months join the neighbor group meetings. I commit to watching the number of women in my group so that my group is always full.


Ask each Mother Leader one-on-one about the commitment that she made at the last meeting:


How are you feeling about this commitment?

Have you practiced using the Picture Cards with others? How did they respond?

Have you asked your neighbors about their family health at each visit?

Role Play: Reporting to the Care Group

Additional Information for the Trainer: This role play will only be used with Mother Leaders and does not need to be repeated with neighbor groups. The underline, slanted text explains the actions of the actors. The words in normal font should be said aloud.

Setup: You need three volunteers each with a copy of the role play. The volunteer Mother Leaders should sit in a small circle in front of the Promoter (just as they would sit in a care group meeting). The Promoter should be sitting with an attendance register and pen on her lap. A flipchart is sitting nearby.

Explain: This role play is a care group meeting between the promoter and a group of Mother Leaders. After the attendance each week, I will ask about the family health any troubles you have had in your groups. We will begin following this example at our next meeting.

The promoter greets all of the Mother Leaders.

Promoter: Lets begin with attendance.

Promoter looks at his register and calls the name of the first Mother Leader (Mother Leader 1).

Mother Leader 1: Yes I am here.

The promoter makes a mark in the register. He then calls the name of Mother Leader 2.

Mother Leader 2: Yes




Mother Leader 3: She could not make it to todays meeting.

The promoter makes a mark in the register. The promoter then turns to the Mother Beneficiary List in his register for Mother Leader 1.

Promoter: Lets review the attendance and health of women and children in your neighbor groups.

The promoter calls the name of Mother Leader 1.

Mother Leader 1: We had a group meeting on Wednesday and ( she lists 10 Mother Leaders names) attended. I met with everyone except Anne-Marie. She was away visiting relatives. So I did not see her. She returned this week. I will teach both lessons to her during the next two weeks.

Promoter: You visited all mothers, except Anne-Marie. You plan to teach her both lessons at your next meeting.

The promoter makes 11 marks on the register.

Mother Leader 1: Yes. There are no new births, deaths or pregnancies for the women in my group.

Promoter: You said that none of the women in your group had any new health events to report.


The promoter looks at her register and calls the name of Mother Leader 2. Promoter: Please tell me the names of the women who came to your meeting.

Mother Leader 2: I met with all of my neighbors (she lists eight names).

The promoter makes eight marks on the register.

Promoter: You taught lessons to all of your mothers. What about Agathe? You did not mention her name.

Mother Leader 2: Agathe has moved away. She no longer comes to my meetings.

The promoter makes a mark on the register next to Agathes name.

Promoter: You only have eight neighbors in your group now since Agathe has left.

Mother Leader 2: Yes.

Promoter: Do you have any new births, pregnancies, or deaths to report?

Mother Leader 2: Yes, Chantal is pregnant.

Promoter: Chantal is pregnant. Ok I will mark that on the register. Is there anything else to report?

Mother Leader 2: No, that is all.

Promoter makes a mark on the register.

The promoter calls the name of Mother Leader 3.

Mother Leader 3: I asked all of the women to come to one meeting together. Only half of them came.

Mother Leader 3: You know that it is your responsibility to visit each mother. If it is difficult for all of them to come to one meeting, then you need to meet with them one-on one. You must make sure that you teach all of the mothers that you are given.

Mother Leader 3: Yes. I know.

Promoter: Please tell me which neighbors attended.

Mother Leader 3 lists four names of women from her neighbor group.

The promoter repeats the names of the four women and makes three marks in the register.

Promoter: Do you have any new births, pregnancies or deaths to report?

Mother Leader 3: No there are no changes in the health of my neighbor group. Promoter: Ok. No changes.

The promoter makes a mark in the register.

Promoter: Lets talk after the lesson about meeting with the rest of your neighbors. I can help you with some ideas for meeting with the mothers. It is important that you visit all mothers.

Mother Leader 3: Yes. Let us talk after the lesson. I do not want to be replaced.

Promoter: Ok, we will talk at the end of the lesson. Now that we have taken attendance, tell me about your meetings. How did your visits go? Did the women understand the teachings on exclusive breastfeeding?

Mother Leader 1: Many people here believe that water and other foods must be given to the infant when they are born.[footnoteRef:8] Some mothers did not want to commit to changing their ways. They found the teaching very difficult. [8: Adapt or insert other common harmful beliefs or obstacle to breastfeeding from your barrier analysis findings.]

Promoter: You were teaching about breastfeeding and some mothers had trouble accepting the message. What did you do?

Mother Leader 1: I told them that it was okay if they did not feel ready to make a commitment to exclusive breastfeeding. I told them that I would continue meeting with them, and that they could talk to other mothers and make a decision later.

Promoter: (Speaking to Mother Leader 2 and 3) Did any of you have these troubles?

Mother Leader 2: Yes, one mother in my group is giving water and other foods to her infant before it is time. So I asked about the health of her infant. Her infant had been very sick. I asked her to try breastfeeding only to see if her infants health and weight improves. She said she would try it.

Promoter: So, you asked the mother to try out the new practice, and see if the babys health improved. That is a very good idea. [Turning to Mother Leader 1] You may consider giving this same advice to the woman you mentioned the next time that you meet.

Mother Leader 1: Yes I will try that. I will also see if I can get other mothers who exclusively breastfeed to talk with her. When she hears from these mothers and sees the health of their infants, she may be ready to listen.

Promoter: You may also speak to the others in her household, the mother-in-laws and the husband if they will listen. Once the whole family understands it may be easier for the mother to try something new.

Mother Leader 3: Yes. That is good. Several other family members joined the meeting that I had with the mothers. It was very helpful.

Promoter: [To Mother Leader 3] Yes, it is very good that you are encouraging others to join. [To the group] Any other problems?

Mother Leader 2: The mothers that I met with were very happy with this information. They said that it was so good and they wished that they had known sooner.

Promoter: Good. Yes, as we continue to share with women in our community, we hope that they too will share with their neighbors and that many children will be healthy and strong. Ok. Lets begin the lesson.

Lesson 5: All Children Have Value

Caregivers will believe that all children are unique and valuable; none are born with more value than the others.

Girls and boys both have value and should be equally cared for and loved.

The first born and the last born both have value and should be equally cared for and loved.

A child from the poorest family and a child from the wealthiest family both have value; both should receive equal care and love.

Caregivers will believe that it is important to promote value and equality for all children including male and female, first born and last born, rich and poor, healthy and the weak.

Caregivers will be able to recognize inequality in the community.

Mother Leaders will identify an Activity Leader to help solicit help for the lessons in Module 2.

Materials:



Lesson 5 Summary:

Game: Memory


Share the story and ask about the current beliefs about child value: First and Second Born Children

Show pictures and share key messages on flipchart pages 38-43: Each Child is Unique and Valuable, Special Care for Those We Value, Showing Equal Value to All Children.

Activity: Showing Value





Examine commitments from the previous lesson

1. Game: Memory 10 minutes

1. Ask the women to stand in a circle.

2. Starting with one woman, she must make a statement and indicate part of her body.

3. The statement should not match the action that she doing. For example she says, This is my nose, when pulling on her ear.

4. The woman standing next to her must repeat the phrase and action and then add another phrase and action of their own.

5. Continue going around the circle with each woman saying and doing the actions from everyone before them and adding a new one.

6. If someone forgets or does the wrong thing, they should sit down.

7. The last woman standing is the winner.

Now that we are energized, lets begin reviewing your work over the last two weeks.

2. Attendance and Troubleshooting 15 minutes

1. The Promoter should fill out the attendance sheets for each Mother Leader following the role play model from Lesson Four.

2. Promoter asks if any of the Mother Leaders had problems during their meetings with their mothers. Promoter problem solves with the mothers, helping to solve troubles they are having, and asking other Mother Leaders for advice.

3. Promoter asks about maternal deaths, child deaths or new pregnancies in the neighbor groups. Promoter records new events on the attendance sheet.

4. Promoter thanks all of the mothers for their hard work and encourages them to continue.

5. Explain that you would like a volunteer to help organize the Activities in the next six lessons. The volunteer will be called the Activity Leader. She will be responsible to coordinate the supplies and preparations for the activities in the next module. She will make sure that each volunteer brings one or more of the needed items for the lessons activities. She will come to each of the meetings ten minutes early so the promoter can give her the list of needed items and explain the activity for the next lesson. The Activity Leader will then ask for volunteers who are willing to bring the needed items during the Attendance and Troubleshooting section. She will also assist the promoter during the days activity. A new Activity Leader will be elected after she has completed the flipchart.

6. Ask the new activity leader to come ten minutes early to the next meeting and you will explain her to prepare for Lesson 1 of Module 2.

Story: First and Second Born Children (Picture 5.1) 10 minutes

3. Story:


The story describes a family that values some children over others in the family.

There was a family with four children. The caregivers gave special care to the first and second born. The third child was a girl who was very small at birth and often sick. The fourth child was born with a deformity. The parents favored the first and second born. They gave them special care. The last two children were neglected. The third child died before her fifth birthday. The last child lived, but had health troubles throughout his life.

4. Ask


Ask the first question to review the practices of the caregivers in the story.

Ask the second question to find out if the mothers believe this is a good or bad practice.

Ask the last question to find out how common this practice is in the community.



Why didnt the family value the last two children?

Did they have good reasons to value some children more than others?

Do people here value some children over others?

Each Child is Unique and Valuable (Picture 5.2) - 5 minutes

5. Show:



6. Explain:



Each child is unique.

Each childs looks different from all others.

Each childs personality is different than all others.

Each childs abilities are different than all others.

Each child has value.

Each child has a future in which they can do great things.

Since each child is unique, they are able to bring new ideas, experiences and opportunities to the community.

Like a seed in the earth, each child is born with the desire to live and grow.

Why do people in this community value children?

How have you seen people show value to children?


Value of Children

Caregivers may value children for many different reasons. Reinforce the positive beliefs mentioned by the participants.

If you see a discrepancy between the beliefs of the caregivers (children are valuable) and the actions of the caregivers (few caregivers show or demonstrate value), then ask the caregivers why this happens. Is there a reason why people have certain beliefs but do not act on them?

If the value of children is low in the community, consider ways to encourage a greater appreciation for them. If caregivers do not value children, it will be less likely they will commit to making changes to help them.

Special Care for Those We Value (Picture 5.3) - 5 minutes

7. Show:



8. Explain:



We give them foods to grow strong.

We give special portions of food to our children to ensure they get sufficient food and nutrients.

We bathe and keep them clean.

We set aside time to bathe our children because we take special care of the things we value.

We encourage them.

We praise them when they are doing well.

We encourage them when they have troubles.

We gently discipline our children when they do wrong because we love them and want them to learn.

We use money to care for them.

We save money to meet our childrens food, clothing, and health needs.

When we value children, we care for them the same as (or even better) than we care for ourselves.

Do people in this community give children special care? Why or why not?

Showing Equal Value to All Children (Picture 5.4) 5 minutes

9. Show:



10. Explain:



When we value all children, we give them equal care.

We do not favor some children and neglect others.

Provide equally for all children.

If we feed some children better because they are favored and neglect others, we are not showing equal value.

If we let some children suffer because we do not favor them, we are not showing equal value.

If we only send one child to school and not the other, we are not showing equal value.

How does unequal care affect child health?

11. Activity: Showing Value 15 minutes

1. Ask the mothers to identify which children in the community do not get equal care. Responses may include the disabled, the youngest children, female children, etc.

2. Ask the mothers to identify practices that can help to show equal value. For example, how can they change the way they care for these children to show they are equally valued. How could they care for them in a new way that shows value?

3. Encourage the women to try some of these new practices this week to help show equal value to all children.


? What do you think about these ideas? Is there anything that might stop you from believing that all children are created with value and deserve equal care?



Help find solutions to their concerns. If a woman offers a good solution to another womans concern, praise her and encourage other mothers to consider using this solution when they talk with others.

Possible concerns:

Mothers may mention that other family members may disagree with these principles. Encourage them to share the teachings and flipchart pictures with their family members and discuss these new ideas.



2. Tell the Mother Leaders listening to the message that they should give one objection to the lesson; one reason that they think this message would be difficult for them.

3. The Mother Leaders sharing the message should try to help the women overcome this obstacle.

4. After ten minutes, ask the women to switch roles. The other Leader Mother will share the teachings from the next two flipchart pages.






For example: I believe that all children were created with value and commit to caring for all of my children equally. I commit to discussing these ideas with my spouse. I commit to giving my child special portions of food. I commit to changing my beliefs about the value of children.


Ask each Mother Leader one-on-one about the commitment that she made at the last meeting. At the last meeting what was your commitment? Have you followed through with your commitment during the last two weeks? How?

For example:

Did you ask each of your neighbors about the familys health at your last visit?

Were you able to report on the attendance of each woman in your neighbor group at your last meeting?

Are all of the women in your group either pregnant or have children less than 24 months of age?

What will you do if one of the mothers stops attending the neighbor meetings?

Lesson 6: I Can Change!

Caregivers will be able to explain one way in which they have started a new practice (or changed) during their life.

Caregivers will be able to explain at least three things that help people to make changes in their lives.

Caregivers will be able to name three reasons that they have confidence in their ability to change.

Caregivers will be able to reflect on their lives and identify which of their own behaviors or attitudes they would like to change.

Caregivers will believe they are able to make changes with their current skills, knowledge and abilities.

Caregivers will believe that change is possible.

Materials:

1. Attendance Register

2. Several strips of fabric to use as blindfolds

3. Care Groups Orientation Mother Leader Flipchart

Lesson 6 Summary:

Game: Blindfold Walk


Share the story and ask about the womens confidence in their ability to change.

Show pictures and share key messages on flipchart pages 46-51: Thinking about Change, Things That Help Us to Change and Believe That You Can Change.

Activity: The Confidence Ruler



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lesson 3: maternal nutrition - care group...

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