OVERVIEW OF CATHOLIC RELIEF SERVICES
PROGRAMMING
History/Background of CRS’ Work in Ghana
CRS has operated in Ghana since 1958 with the goal of
improving the quality of life among the poor and the most
vulnerable and helping victims of natural and man-made
disasters. The choice of beneficiaries is based on the
agency’s mandate to alleviate suffering and its commitment to
work for the poorest of the poor. These are most often women
and children in food insecure households in rural
communities where the major income generating activities
are rain-fed farming and agro-processing.
History/Background of CRS’
Work in Ghana Cont.
To achieve its goal, CRS/Ghana acts as a
service and support agency for programs
and projects, which are implemented by the
Catholic Church, the Government of Ghana
and its various ministries, departments and
agencies, and other religious and non
religious and non-governmental
organizations that pursue common
development goals.
History/Background of CRS’ Work in
Ghana Cont.
CRS/Ghana has interventions and programs in
several development sectors, including Education,
Health, Water and Sanitation, HIV/AIDS, Safety Net
Initiatives, Peace-Building and Conflict
Transformation, and Agribusiness.
The three regions in the northern most part of
Ghana are cited in the Ghana Poverty Reduction
Strategy II as the regions experiencing extreme
poverty.
History/Background of CRS’
Work in Ghana Cont.
These are also the regions with the highest levels
of malnutrition and stunting among children,
highest child morbidity and mortality rates, lowest school
enrollment and completion rates, especially among girls,
highest adult illiteracy levels, and the regions with the most
recurrent cases of guinea worm and other water-borne
diseases. As such, in pursuit of CRS’ global determination
to reach out to the “poorest of the poor”, CRS/Ghana made
a just decision since 1987 to focus its limited resources in
the three northern regions, in all its 34 districts.
History/Background of CRS’ Work in
Ghana Cont.
Working with local church ,government partners, and other
NGOs, CRS/Ghana supports development through specific
activities or programs as outlined below.
School Feeding provides hot meals for pre and primary
school children and take home rations for girls to promote
enrollment, attendance and retention of school aged pupils.
School Health Education Program (SHEP): Recognizing the
link between health and school attendance, SHEP promotes
appropriate hygiene practices, teaches health education
and provides children with deworming tablets twice yearly
History/Background of CRS’
Work in Ghana Cont.
• Quality Education Improvement Program
(QEIP): Improving educational attainment in
target schools through improved quality of
primary education using methods and activities
that are proven to yield results.
• Water and Sanitation: Improving access to water
and sanitation facilities for participating
communities by providing technical and
infrastructural support in addition to improving
hygiene practices by training community based
water and sanitation committees.
History/Background of CRS’ Work in
Ghana Cont.
Agribusiness: Increasing incomes and yield for rural farmers
producing selected crops by adding value and facilitating
marketing linkages
Peace building: Supporting five satellite peace centers
throughout Tamale Ecclesiastical Province with training and
inputs to mediate and transform conflicts in selected
communities.
Leprosy Support: Providing targeted hospitals materials and
support to improve the care of leprosy patients.
History/Background of CRS’ Work in
Ghana Cont.
• Health Sector: Child Survival: The Child
Survival program relies on four key
objectives namely:
– Improving key household health and nutrition
behaviors among mothers of young children
– Improving accessibility of health services to
rural communities
– Improving quality of health services
– Increasing utilization of health services
History/Background of CRS’ Work in Ghana
Cont.
INAAM (INTERGRATED NUTRITION ACTION AGAINST
MALNUTRITION)
This focuses on rehabilitating undernourished children by
using quick impact and assets-based approaches at both the
community and facility level. These approaches include:
Focused Nutrition Intervention (FNI): Facility based treatment
of severe child under-nutrition
Child Survival Assistance/Targeted Food and EducationEducational support and appropriate food inputsPositive
Deviance (PD)/Hearth Approach-Assets based approach that
utilizes community based resources to rehabilitate
undernourished childrenCentral to the above stated programs
is the fact that they all hinge on the behaviour attitude and
situations of people.
History/Background of CRS’ Work in
Ghana Cont.
CRS merely facilitates a process to aid the
communities/beneficiaries to change their attitudes or
behaviours towards a particular action or inaction, which
when not checked might generate into situations that
negatively affects one or more sectors of their lives.
These will then further exasperate an already declining
status of wellbeing. Thus cardinal to the successful
implementation of all these programs is the effective
participation of partners and beneficiaries in accepted
behaviour change strategies aimed at improving an
identified negative, harmful and sometimes life
threatening situation.
WHAT IS BEHAVIOUR CHANGE
COMMUNICATION (BCC)??
In the context of CRS’ work, we describe BCC as the
development of interventions that best empower
communities to identify problems, evolve solutions and
mobilize resources and skills to address the problems.
In the design of BCC strategies, CRS is guided by the
Academy for Educational Development’s (AED’s) BEHAVE
Framework. BEHAVE employs easy-to-use tools based on
principles of behavioral science to make four strategic
decisions:
WHAT IS BEHAVIOUR CHANGE
COMMUNICATION (BCC)??
Cont
• Who the primary target groups are that should
be reached with BCC
• What actions should be taken to change
behaviour
• what the psychosocial, structural, or other
determinants and factors are that make the most
difference in the target group’s choice to act
• What strategies will be effective in addressing
those determinants and factors?
Once a BCC strategy is determined, it is further scrutinized
and categorized into the following 3 main purposes.
Instruction: This is communication designed to improve skills
e.g. how to wash hands, or brush teeth, how to prevent
guinea worm infection, how to breast feed exclusively
Advocacy: Communication for removing environmental
constraints e.g. socio-cultural factors or norms that affect
hygiene promotion and education, exclusive breast
feeding, high taxes that make mosquito nets too
expensive for people to buy.
Promotion/Counseling: -Communication designed to change
ideational factors e.g. knowledge, attitudes (belief &
values), perceived risks, social influence, emotions etc.
School Health Clubs
• School health clubs have been formed in
all SHEP schools. It comprises of a
membership of twenty pupils-10 boys and
10 girls with 5 pupils each selected from
primary 2 to 5 who have expressed
interest and enthusiasm in promoting
personal and environmental hygiene
issues.
Roles
•
•
•
•
•
Supervise and encourage school cleanliness
Help make the school an attractive place through proper
landscaping
Promote gardening and tree planting
Monitor and help implement the school health education
program through assisting teachers during regular
inspections, games and drama etc.
Look after food cleanliness of food vendors in the school/
Supervise and encourage food vendors to promote the
safety of food sold to pupils by vendors on the school
compound
Roles
•
•
•
•
Ensure that water used in the school is clean and safe
and that children adopt clean methods in its usage
Help eliminate mosquito breeding places in/near
school
Make up health quizzes and health checklist and try
them out/Conduct quizzes and institute the use of a
checklist to improve upon the knowledge base and
bring about positive behavior change in their peers
Carry out any other related school health activities as
may be determined by the school health teacher in
consultation with the rest of the staff...
COMMUNITY SCHOOL HEALTH
MANAGEMENT COMMITTEES
• As a way of linking and improving community
involvement in School Health activities;
Community School Health Management
Committees have been formed and trained in all
CRS/SHEP schools/communities.
CRS BCC STRATEGIES
CRS’ program activities are focused on supporting
communities to become actors of their own
development rather than being passive recipients of
information. School children and community members
are supported with knowledge and analytical skills
through life skills based education and rights based
approaches and trainings to enable them assess their
situation, analyze the causes of the problems identify
and develop appropriate responses and actions
based on their community specific needs towards
solving these problems.
The key BCC strategies/activities most frequently employed
are:
INSTRUCTION - Communication designed to improve skills
e.g. how to wash hands properly with soap
Hygiene and sanitation education
•
•
•
•
•
Nutrition education
Environmental education
Sensitization
Demonstration
Development and use of Health guides and other
teaching/learning materials
• Wall/pocket calendars
• Posters
• Child to child
• ADVOCACY - Communication for removing environmental
constraints
• Community sensitization and meetings
• Trainings
• Health Talks
• Radio Broadcast
• Drama
• Focus group discussions using appreciative inquiry-best
practices.
• Handouts
• Incentives-wheel barrows, hand washing containers
• Child to child
Promotion/counseling -Communication designed to change
ideational factors e.g. knowledge, attitudes etc.
• Drama, role play
• Quiz Competitions
• Health campaigns
• Health walks/circle of assessment
• Games
• Posters
Monitoring to enforce desired behavior change: CRS has
designed monitoring tools for the program and this is to
enforce hygiene behavior. One remarkable feature of the
program is that Community members assist in personal
hygiene inspection, health talks and children growth
monitoring activities.
Social Mobilization: This brings together all feasible and
practical intersectoral social allies to raise people’s
awareness of and demand for the behaviour change being
sought; to assist in the delivery of resources and services;
and to strengthen community participation for sustainability
and self reliance. The above is done through regular
meetings with GHS and GES officials and sensitization of
selected communities to discuss roles and responsibilities of
the specific program.
Capacity Building/Training: BC is a highly sensitive and
difficult activity CRS provides both the facilitator and the
beneficiary with rigorous training to appreciate each other’s
role in this joint venture. Furthermore behavioral science is a
dynamic field of study with new findings published every so
often. CRS deems capacity building as absolutely crucial to
the successful implementation of any BCC.
PRA/PLA Tools: To aid the identification of problems, design
appropriate BCC and to ensure active participation of
community members in the process, various participatory
approaches are employed
Participatory Hygiene and Transformation Tools (PHAST):
knowledge and tools from PHAST methodologies are
adapted for various BCC strategies across all sectors in
the development of relevant and appropriate target
strategies.
Appreciative Inquiry: Recognizing that beneficiaries have a
lot of potential and a assets CRS usually employs AI to
build on these local-based assets in the development of
appropriate BCC strategies.
Regular review/Assessment meeetings: BCC strategies are
constantly reviewed to ascertain its relevance, impacts
and acceptance by beneficiaries. These reviews and
assessments are usually conducted with expert
consultants in BCC and behavioural science.
Establishment/ Working through Structures: For continuity
and sustainability CRS and partners (GES/GHS/Community)
has put in place structures to make its BCC strategies more
effective. Some structures established within beneficiary
communities include:
•School Health Clubs
•Community School Health Management Committee
•Community food Management Committees
•Mothers Clubs
•Watsan Committees
•Community Volunteers attached to outreach clinics
•Regional and district GES/CRS Partner supervisors
In addition to these CRS-established structures, CRS also
works with already government established structures such as
SMC/PTAs, Regional and District SHEP coordinators,
Environmental officers, District water and Sanitation Teams
(DWSTs), Community Health Nurses, District Health
Management Teams (DHMT) Assemblypersons, area Council
/unit Committee members, chiefs, religious leaders magazias
and other community leaders.
IMPACT ACHIEVEMENTS
PERCENTAGE OF PUPILS WHO DEMONSTRATE AND
PRACTICE APPROPRIATE HYGIENE BEHAVIOUR
Baseline
2003
2006
(Target)
2006
(Achieved)
42.8%
47.8%
79%
Percentage of pupils in program schools who
consume de-worming medication twice per year
Baseline 2003
0
Target 2006
85
Achieved 2006
86
Indicator
# of Girls enrolled in
program Schools
Baseline
2006
44,388
Target
2006
Achieved
2006
48,827
53,700
# of Pupils enrolled
in Program schools
(boys&girls)
150,145 157,650 171,240
% increase in
attendance of pupils
(boys & girls)
24.6
50
59.3
Indicator
% increase in girls’
attendance
Baseline
2006
Target
2006
Achieved
2006
24.5
55
83
% of teachers in
program schools
78.0
effectively planning their
lessons
% of teachers in
program schools using
19.7
pupil-focused
instructional practices
-
97.0
-
62.4
Indicator
% of teachers in
program schools using
effective classroom
management
techniques
% of teachers in
program schools using
improvised TLMs in
teaching
% of Communities
active in School
decision-making
Baseline
2006
Target
2006
11.0
-
39.0
-
35
50
Achieved
2006
50.3
71.5
65
Indicator
% of Communities
implementing
activities/projects to
improve quality of
education
Baseline
2006
Target
2006
Achieved
2006
27
53
93
Nutritional Status of Children under 5 years
STUNTING DISTRICT
BASELINE
2004
MID-TERM
2006
Moderate
Severe
Moderate
Lawra
Lawra
East Mamprusi
19.6%
7.6%
21.8%
11.2%
3.7%
19.7%
Severe
Moderate
East Mamprusi
16.7%
25.3%
7.4%
15.4%
18.9%
7.7%
Severe
Saboba
Saboba
Moderate
Bongo
24.8%
15.9%
Severe
Moderate
Severe
Bongo
Wa
Wa
11.8%
20.9%
20.3%
9.3%
8.5%
16.9%
Nutritional Status of Children under 5 years
WASTING DISTRICT
(Indicator)
BASELINE
2004
MID-TERM
2006
Moderate
Severe
Moderate
Severe
Moderate
11.7%
2.9%
8.3%
7.2%
16.0%
10.7%
1.5%
5.0%
1.5%
8.9%
2.1%
0%
Lawra
Lawra
East Mamprusi
East Mamprusi
Severe
Saboba
Saboba
Moderate
Bongo
11.5%
10.3%
Severe
Moderate
Severe
Bongo
Wa
Wa
2.5%
12.6%
3.8%
0.9%
6.7%
0%
Indicator
Exclusive Breast
feeding at 6
months
District
Baseline Mid-term
2004
2006
Lawra
12.4%
64.0%
East
Mamprusi
22.4%
52.4%
Saboba
12.0%
85.7%
Bongo
16.2%
85.7%
Wa
17.0%
25.0%
Usage of Household Latrines
Year
# of
Communities
Household
Latrines
Family
Size
2005
7
70
420
2006
13
494
2,964
2007
19
500
3,000
SUCCESS STORIES
• 1. Adaboya School/community: The School Health Club
action plan had contribution of shea nuts as an activity.
All children willingly contributed and money used to
purchase 10 cartoons of soap and the rest used to buy
shares in the Bongo Community Bank
• 2. Feo SHEP Club constructed a urinal whilst community
provided coaltar for painting. School Health Clubs
engaging in income generating ventures like basket/hat
weaving to support SHEP activities
SUCCESS STORIES
• 3. SHEP Club members asking for land from opinion
leaders for farming purposes to sustain the program
• 4. SHEP teachers integrating the program into capitation
grants by adding provision of soap to their School
Performance Improvement Plan
• 5. As a result of effective animation, the communities of
Langbinsi and Namangu in the East Mamprusi district have
evolved a good maintenance strategy ( by employing
young girls who keep registers of money collected on water
fetched) by collecting token amount of money on each
bucket of water collected and saving it at the bank to yield
profit. Use of the money to purchase spare parts for
maintenance
SUCCESS STORIES
• 6. A Community Health Volunteer through her active
involvement in CRS health program by working with
nurses and keeping of good records, finally gained
admission into the Nursing school
• 7. Mothers (lactating and pregnant) attend clinics regularly
even though food incentives given has ceased
• 8. Mothers of malnourished children are learning from
mothers of well-nourished children how to combine locally
available food commodities to ensure that their children
grow strong and healthy
CHALLENGES
•
•
•
•
•
•
•
•
Post –intervention assessment
Dissemination of information to the larger
community
Target and coverage (scope)
Ineffective coordination among stakeholders
(NGOs and District assemblies)
Volunteerism fatigue (motivation, migration,
etc)
Lack of clear-cut policy directives e.g. SHEP
Enforcement of bye-laws
Inadequate funding
LESSONS LEARNED
•
•
•
•
•
•
•
Collaboration /consultation with key partners helps in
synchronizing activities
For greater impact and success involves direct
beneficiaries in programme planning information and
assessment.
Capacity-building is a key tool
Behaviour change is a process – it takes time to see
the impact
Hardware and Software leads to total behaviour
change (improved health)
Total coverage enhances behaviour change
“A good cloth sells itself”. Here good work promotes
itself
Thank You
•CRS Tamale