Partners’ Haiti Nutrition Security Program (Haiti NSP) began educating women and families about healthcare in some of the most poverty-stricken areas in Haiti in 2013. Haiti NSP’s Senior Technical Advisor, Dr. Altrena Mukuria, presented her findings for the role Care Groups play in exposing Haitians to nutrition and healthcare information at this year’s annual American Public Health Association (APHA) Conference on November 3, 2015 in Chicago, Illinois. The conference brought together more than 12,000 public health professionals and research experts.
Nearly one in every three Haitians does not have enough to eat, and women and children are especially vulnerable to the impacts of malnutrition. Dr. Mukuria’s presentation focused on the ways social capital can be used to decrease the levels of malnutrition in a community. Social capital is, “the network of relationships among people who live and work in a particular society, enabling the society to function effectively.” In other words, people in a community build relationships, and those relationships create economic growth and a stable society with free-flowing ideas and knowledge.
There are three levels of social capital- bonding, bridging, and linking. Bonding capital, often the strongest form of social capital, are the relationships a person has with friends and family. Bridging capital is the relationship between friends of friends, neighbors, and others that are just outside of the bonding relationships. Linking capital is the relationship between a person and a government official or political groups, community leaders, and others with resources.
Haiti NSP implements all three levels of social capital in the communities where it works. Bonding relationships traditionally reinforce social norms, which are often passed down through generations or shared among closely knit communities. This can have both positive and negative consequences. Knowledge is shared, but if the knowledge is not accurate, poor nutritional or social behavior can be reinforced and normalized, making it hard to counter-act. Information or behavior from outside sources often has trouble permeating those relationships.
Communities are typically untrusting of outside programs teaching new information. Haiti NSP overcomes this by having each community select its “Mother Leaders,” who have the responsibility to be educated by Haiti NSP volunteers about healthcare and nutrition. The Mother Leaders then share what she has learned with her own bonding relationships, such as close friends and families. Each Mother Leader also shares her knowledge with 10-12 other women, through monthly house visits. This activates bridging relationships. Since the Mother Leaders are already trusted and respected in their communities, they are able to create effective change.
To date, 162 care groups comprised of over 2,000 community-appointed Mother Leaders have provided trainings to over 20,980 neighboring women on breastfeeding, food choices and diet diversity, maternal and child health, small-scale gardening, cooking, and healthcare. As a result, exclusive breastfeeding during the first six months of an infant’s life has risen from 46 to 85 percent; pregnancy deliveries with a trained health professional have risen from 53 to 88 percent, and mothers are learning how to grow their own fruits and vegetables to improve the food security of their households.
Mother Leaders are already expanding their roles and thinking up with new ways to teach their neighbors. Two women decided it would be better to teach their neighbors about proper nutrition by actually showing rather than telling. These two women created a community nursery out of their vegetable gardens so the women under their care would come, see how to incorporate healthy foods into their families’ diets, and then be able to grow some for themselves.
Haiti NSP is also enforcing linking relationships in rural communities. Health centers are available, and they require that mothers come in for medical check-ups and to disperse nutritional resources. However, the centers frequently don’t have the supplies they need, so mothers stop coming. Haiti NSP has built up a reputation and a presence in the areas they work, so when Mother Leaders visit the centers, they ensure that the needed supplies are there and the women get the care that they need. This gives credibility to the Mother Leader program, reinforces the authority of the Mother Leaders among their community, and requires the health communities to be accountable for their responsibilities.
Haiti NSP also runs grandmother, father, and youth groups, educating and engaging the entire family. Grandmothers are particularly important because they are seen as holding the knowledge for tradition and cultural practices. If someone is resistant against the lessons a Mother Leader is teaching, she can ask a grandmother to come talk to the person. More than half of Haitian women have their first child before the age of 21, making it important to focus education and behavior change not only pregnant and lactating women, but also on youth and adolescents between 15 to 20 years of age, in order to have an impact on the next generation.
Edited by Mary Henkin