Dominican Republic: Community-Based Child Health Program (ECOSAN)

In collaboration with the Ministry of Health, CRS, World Vision, USAID and the CHANGE Project, the Manoff Group established a community-based child health program in 43 communities in the Dominican Republic. The program philosophy, structure and materials are adapted from the successful AIN model developed in Honduras and applied throughout Central America and Africa.

The program focuses on preventing inadequate growth among all children under age two in participating communities. Program activities center on teams of community volunteers who weigh all children under the age of two to assess their growth, give tailored counseling to mothers, refer children for vaccinations, dispense micronutrients and refer sick children to health centers. Based on the weighing results and the responses to a few questions, the volunteers provide appropriate counseling to each mother or caregiver. The mother and volunteer negotiate one or two small changes in practices to enhance the child's growth and health. The counseling cards are an aid in the counseling and negotiation process.

The counseling cards were designed after qualitative research that included behavioral trials to ensure that the proposed new practices were feasible. The cards were pretested and revised. Twenty cards were developed. There are two diagnostic cards and negotiation cards for four age groups of children. These cover issues appropriate to each age group. In addition, there are four special cards to use as needed. They cover simple healthy recipes based on local foods, feeding a young child who is sick or lacks appetite, nutrition of the breastfeeding mother and other practices directly related to child nutrition status (hygiene behaviors, immunization status and micronutrient supplements). The volunteer begins counseling by noting how much weight the child has (or has not) gained in the past month, then selects the appropriate card for the age group of the child. Each counseling session (and the appropriate cards) are tailored to the specific needs of the child.