CARE Inhambane ECD Programme (Funded by The Hilton Foundation)

Some reflections on training home visitors to give practical and

emotional support
November 2014
CARE Mozambique
Introduction
I can say I am married but not really as I havent seen my husband for
some years. He went to work in South Africa The thing that is most
heavy is to do it all alone. It is me who has to farm so we have food,
me who has to make all the decisions for the children. It is heavy to be
alone. Caregiver, Funhalouro, Mozambique
The burden of child caring alone and the stress it causes is at the core of the
CARE ECD programme, presently running in Inhambane, Mozambique. The
participatory needs assessment we conducted with caregivers and service
providers before we began the programme highlighted the fact that women
most often carry sole responsibility (whether their partners have migrated or
not) for their children. The worry about everyday needs, the heavy burden of
producing food from largely unproductive farms and the complexity of large
(often polygamous) families results in high levels of anxiety and depression
amongst most caregivers.
A review of research conducted by Richter and Naicker (2013) gives evidence
that parent support programmes can reduce stress and increase confidence
in the context of ECD. There is also evidence that home visiting can improve
caregiver well-being (Weiss and Klein, 2006; Paulsell, Avellar, Sama Martin &
Del Grosso, 2010). We also have clear guidance on how home visits should
be conducted. Dawes, Biersteker and Hendricks (2012) report that, A home
visiting approach is able to reach very vulnerable families (p11) but that it is
most effective if the visits are frequent and the relationship between
participant and programme staff is stable, warm, supportive and uncritical.
The practitioner who visits needs to be skilled in communicating and working
with caregivers and there needs to be direct interaction between the home
visitor and the children and caregivers.
In early 2014, as the CARE ECD programme began, about 150 home visitors
were selected by nine communities in the two districts of Homoine and
Funhalouro in Inhambane Province, Mozambique. The home visitors selected
ranged in age from 20 to 70 and included both men and women. The women
are called Masungukate (one who advises in the local Xitswa language) and
the men, Masungudhoda1. They have each been assigned 5 or 6 families with
children under 5 to visit2. Our challenge was to make sure that their training
took into account all the requirements described by Dawes, Bierstecker and
1

We have used the two names interchangeably in this article but in all cases we are talking
about both the men and women.
2
The families were identified as vulnerable through a wealth-ranking process.

Hendricks in the paragraph above. In addition we also needed to train them to

use, authoritative, simple information on topics requested by parents,
attractive materials for guidance and referral to and assistance in accessing
related services3 (Richter and Naicker p35), all of which are important
components of a parent support programme.
This document describes some of the lessons we have learned as we have
undertaken the training of the Masungukate and Masungudhoda.
The dominance of information giving
The first training took place in mid-2014 and introduced the Masungukate and
Masungudhoda to the idea of home visiting. The drawings below, taken from
the training materials, describe The six things to do on a home visit.

They mention other important components such as Assistance with material needs, whether
economic, housing, employment or discrimination, and help to overcome structural barriers to effective
parenting (p 35). The CARE programme has a component that deals with the practical needs of
families through a livelihood project that focuses on improved farming practices and loan and savings
clubs.

The main reason for using visuals that model behaviour was because most of
the Masungukate and Masungudhoda cannot read. The visuals were
developed through a participatory process with potential beneficiaries and
Masungukate to reflect the local reality. Much time was spent during the
training interrogating the details of these drawings because we wanted
Masungukate and Masungudhoda to copy the behaviour they saw. For
example, drawing number 2 shows the Masungukate listening while the
caregiver speaks.
But when we observed the Masungukate and Masungudhoda on their initial
home visits it became clear that they were relying heavily on imparting
information rather than being supporters or friends of caregivers. Many of
them did not ask how the caregiver and child were but began to read from the
information guide we had given them. Many of them were not listening at all
but telling.
On reflection, we realised that the only experience the Masungukate had of
education was the banking model (Freire, 1970) where facts are delivered
3

into empty vessels. Also the only other home-visiting programme

encountered by them is one where health visitors deliver messages, on
malaria prevention, for example. They were merely copying what they had
seen. We knew that one-off trainings are not effective so we had already set
up a process for mentoring each of the Masungukate, but we did not realise
how much work we would need to do on helping them build relationships with
the caregivers.
It was especially important for us that we get this right because one of the
basic tenets of the strategy we wanted to use was that most families want to
do the best for their children but cannot always achieve this because the
context works against them. The extract below from our strategy document
explains this in more detail.
The WHO document on ECD (2007b) makes a very important point.
The nurturant qualities of the environments where children grow up, live, and
learn matter the most for their development. Families want to provide for
their children, but they need support from community and government at all
levels. (p 3 and 4, my emphasis)
The key words in relation to the ECD strategy for the Inhambane project are the
words Families want to provide .
Why this is an important point to highlight in this document is that working from an
assumption of deficit or what is sometimes called a welfare or service approach
allows for a patronising and preaching tone, a giving of messages that often
alienates participants in a project and reduces their self confidence in their ability to
raise their children adding to their already high levels of anxiety and depression. The
idea that families want to provide but need support to do this, can inform the
content and the approach of the intervention. It can inform the style of material
developed, the kinds of training activities used, the style of facilitation in training, style
of interaction of the Masungukate
Extracted from the strategy document used to inform CAREs Inhambane ECD
project: 20 October 2013

Further training sessions were held to emphasise the fact that friendship and
support are more important than imparting information. We used role-play a
lot to help the Masungukate look at the difference between being a teacher
and being a friend. Apart from role-play, we found that teaching the
Masungukate and Masungudhoda the Motivational Interview format described
by Miller and Rollnick (2002) very useful. The approach encourages the
Masungukate to express empathy with the caregivers, build self-efficacy
through affirmation and to explore new behaviours through critical reflection.
We have started noticing that the idea of two-way communication and support
is slowly being understood and adopted. We were very excited when a group
of Masungukate created the song below to celebrate what they had learned in
the training.
We Masungukate dont come to change the rules of your home.
4

We Masungukate come to exchange experiences.

We will help each other to take care of our children.
It is worth noting that we would not have picked up the issue of informationgiving rather than supporting if we had not been mentoring the
Masungukate and Masungudhoda by joining them in home visits.
Mentoring and reflective supervision
Each village group of Masungukate has their own ECD facilitator (trained by
CARE but from a local CBO). ECD facilitators make regular home visits with
the Masungukate. This is followed by a reflective discussion where the
Masungukate chooses an element of their practice that needs improvement or
an issue related to the particular family to focus on in the next few visits.
In addition, the Masungukate and Masungudhoda meet in a learning circle
once a month with their ECD facilitator to share learning stories. These stories
include successes and discussion of barriers to change in the families they
visit. They all choose something to work on with their families at this learning
circle and report on it at the next meeting. It is important to us that the
reflective supervision process is congruent with the entire ECD programme
strategy as it is built around a relationship for learning (Hawkins and Shohet,
2000). The relationship between the ECD facilitators and the Masungukate
and Masungudhoda is not based on a didactic approach but on a reflective
approach, similar to that which the Masungukate have learned to build
between themselves and the caregivers they visit.
It is also important that the process asks the Masungukate to reflect on their
feelings about the work they are doing. The Masungukate, as members of the
community face the same stresses as the caregivers they visit. They have to
cope with their roles as advisors within a context of their own deep poverty
and inability to give their children what they know they need. Research (De
Saxe Zerden, Zerden, Billinghurst, 2006) shows how the emotional toll can be
huge on home visitors especially in a context where they can most often not
change the context that has led to the distress they have to deal with in the
families they visit. In this context supervision and mentoring based on a
relationship that includes time to talk about feelings is essential if the
Masungukate are to continue to be motivated to make a difference in the lives
of the caregivers they visit.
Conclusion
We are documenting the process of change in understanding and behaviour
in the Masungukate and Masungudhoda and in the caregivers they visit. This
is being done mostly through a qualitative research process that involves
frequent focus group discussion and interviews with them and caregivers.
We are also continuing with our mentoring of Masungukate and
Masungudhoda as they continue to mentor the caregivers they visit. What we
have all learned so far is that we need to work alongside each other, to
observe with empathy and to listen to each other as we help each other take
care of our children.
5

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