Integrating early stimulation and responsive caregiving into health systems

• In Event: Roundtable Session (Tuesday I)
  In Refereed Round-Table Session: Nurturing care framework: lessons learned from developing and adapting integrated ECD programs

Proposal

The Nurturing Care Framework (NCF) recognizes the critical role multiple sectors play to create an enabling environment to protect, promote and nourish child growth and brain development. In particular, the framework advocates for inter-sectoral collaboration, especially with the health sector because of its unique reach of children under three years.
This presentation will focus on the adaptation process of aligning global early childhood development materials implemented through health services in two countries in Asia and Africa. The Building Brains materials were developed to guide group and individual sessions on early stimulation and responsive care that could be implemented by any sector.
In Ghana, through USAID’s Maternal and Child Survival Program (MCSP) existing country-level health and nutrition activities were leveraged to improve interaction between caregivers and young children ages 0 to 3. More than 1500 Community-based Health Planning and Services (CHPS) staff and volunteers were trained to deliver the ECD technical package. Early stimulation and responsive caregiving materials were reviewed and adapted to be contextually relevant as well as adjusted to fit for delivery through health facilities, mother-to-mother support groups and other social groups. The adaptation process involved consultation and collaboration with key stakeholders, a technical advisory group, focus groups with health workers and caregivers. Mixed method evaluations designed to document changes in health worker knowledge, implementation fidelity, and changes in caregivers’ responsive relationships with their children are ongoing.
In Nepal, the Ministry of Health’s Female Community Health Volunteers (FCHVs) were trained to deliver the Building Brains package. Through a cascade model, FCHVs were trained to deliver parenting group sessions during mothers’ group meetings and integrate individual counseling on early stimulation in their routine home visits. The FCHVs conducted the Building Brains sessions in addition to nutrition and health sessions. Frontline NGO workers were trained to monitor and support the FCHVs. Local illustrations of the global Building Brains materials were created. The package was implemented for five months and then reviewed and improved by a working group composed of Save the Children staff and Tuki, the local implementing partner. The materials and implementation plan were improved during the review by increasing the frequency of the group sessions, creating a separate fathers’ group, developing a flip chart and designing a poster provided to each home. At the end of the project, a final review of the Building Brains content was done through implementation feedback from frontline NGO workers. Using a simple rating mechanism, each early stimulation activity was rated and refined to improve program implementation strategies. Activities using common materials, such as cloths or cups were most highly rated.
The integrated programming undertaken in Ghana and Nepal demonstrates how global materials can be contextualized and improved through a participatory process, and implemented through health and nutrition services.

Authors

• Romilla Karnati, Save the Children

• Caroline Dusabe, Save the Children

• Sara Dang, Save the Children