Over the last decade Zimbabwe has made noteworthy progress in reducing both underweight and wasting in children under the age of five years, however one in four children in Zimbabwe is stunted. The rate in the decline of the number of children stunted still falls short of meeting the World Health Assembly target, and it goes without saying that effective, innovative community-based strategies are required by the government and development partners to accelerate the rate of stunting reduction. This paper presents experiences from using the Care Group approach for promoting improved maternal, infant and young child nutrition (MIYCN) and care based on lessons from the Amalima program, a seven-year United States Agency for International Development (USAID) Office of Food for Peace intervention. The Amalima program has been promoting Care Groups as a community and family centred approach to improve maternal and child nutrition in Zimbabwe. Care Groups are an innovative community-based strategy that has been rolled out as part of the Amalima program activities in four food and nutrition insecure districts in Zimbabwe. The final programme evaluation suggested the program succeeded in increasing the exclusive breastfeeding rate and reducing levels of nutritional stunting among children under two years. In the present discussion paper, we present the key lessons learned and strategies we believe may have contributed to making Care Group implementation effective; we highlight the modifications that we made in Care Group implementation to ensure a context appropriate approach; and we discuss how Care Groups can be integrated into the Ministry of Health and Child Care structure. The critical factors for successful Care Group implementation have been grouped into five broad categories: conduct formative research; ensure context specific approaches & adaptive management; leverage on social capital and cohesion; invest in human capital; prioritise quality assurance & reviews.

Objectives Amalima, a USAID Development Food Aid Program (2013–2020) led by Cultivating New Frontiers in Agriculture, supported Zimbabwean communities in Matabeleland North and South to improve food security and nutrition. In 2016, Amalima developed Indoda Emadodeni (IE), a behavior-change campaign which trained local men as Male Champions (MC) and aimed to increase their involvement in childcare, domestic chores, and support for women's participation in Amalima. Methods The IE pilot occurred in six wards in Tsholotsho and Bulilima districts from April to October 2016, involving 60 MC aged 25–67. Each MC recruited ≥ 10 male peers and hosted monthly sessions, where men discussed IE behavior change topics (i.e., men's roles in child feeding and care, household chores, and support for women in Amalima), followed by team-building soccer matches. In December 2016 during an Amalima supplementary food distribution, 100 mothers in Amalima with children < 2 years old, half with husbands in the IE pilot and half not, were randomly selected for a questionnaire about their husbands’ practice of the 12 IE target behaviors. The 12 IE behaviors in the cross-sectional questionnaire were organized by category 1) child feeding and care, 2) support for women in Amalima, and 3) household chores. Behaviors in each category were ordered and scored from poor to ideal. Each behavior was worth 1–4 points, with a total possible score of 30. An independent t-test was conducted to compare mean scores between the two groups of women sampled for the questionnaire. Results The average age of women sampled was 27.7, with a range of 17–45 years old. Most women had three children, with at least one < 2 years old. The average score among women with husbands in the IE pilot was 21.3 and the average score among women in the control group was 16.6, representing a significant difference (p value = 0.013). Conclusions These results suggest that men's participation in the Indoda Emadodeni pilot supported their improved practice of the IE target behaviors, including child feeding, care, and domestic chores. Male change agent-focused behavior change approaches, like Amalima's Indoda Emadodeni, offer a promising opportunity to increase male participation in childcare and domestic chores. Funding Sources Funding for the Amalima Development Food Aid Program was provided by the US Agency for International Development.