Reality of integrating Nurturing Care/ ECD in health facilities: PATH’s experience in measuring integration of Nurturing Care/ ECD across three countries

• In Event: Highlighted session: Nurturing care framework: building evidence for program implementation and effectiveness_session I

Proposal

The Nurturing Care framework responds to the commitments in the UN Sustainable Development Goals by integrating across key five key components of early child development; good health, adequate nutrition, safety and security, responsive caregiving and opportunities for learning. In most low-resource settings, facility-and community-based primary health care workers may be the first and only service-providers to have regular contact with children and their caregivers during the early years (0-3). PATH’s approach to ECD has therefore focused on the integration of ECD interventions, messages, and activities into health system “touch-points”. The most essential touch points are during: antenatal care, childbirth, postnatal care, growth monitoring, immunizations, prevention of mother-to-child transmission of HIV, routine child health services, peer support groups and home visits by community health workers (CHWs) and community-based organizations (CBOs). PATH integrates ECD into both facility-and community-level health services through capacity building of service providers and supervisors. PATH supports the creation of an enabling environment at national and subnational levels for integration of ECD interventions into health service delivery guidelines, tools, and training and supervision processes.
Tanya Lalwani, PATH ECD MEL Lead, will present on PATH’s experience in measuring integration of nurturing care across three countries, Mozambique, Kenya and Zambia. PATH’s measurement approach hinges on several evaluation and operation studies that measure results across its theory of change including, coverage and quality of services, improvement in caregiver practices and ultimately child development outcomes. In the three countries, integration of ECD content into routine health services has demonstrated to improve overall perception of quality of these services by caregivers. In Maputo Province, where PATH has been implementing an innovative integrated ECD program at scale for several years, it conducted a qualitative assessment of play sessions that are held in health facility waiting areas to make them more child-friendly and provide an additional opportunity to counsel caregivers on ECD. Assessment results suggested that caregivers perceived improvements in the waiting experience—and in overall quality of service delivery. Caregivers also felt more motivated to return for follow-up visits, which has implications on retention in services and reduction in loss to follow-up. In addition, integration of ECD content has improved the performance of health service providers. Also in Maputo Province, PATH demonstrated that agentes polivalentes elementares (APEs—community health workers) who were trained to integrate ECD and nutrition content into their home visits and community activities have greater job satisfaction, their visits are more appreciated by caregivers. The panelists will also share continued challenges in implementation across the countries, including those related to collecting and using quality ECD data at the facility levels, and sharing patient data with the community health workers. Finally, she will present how PATH is addressing these implementation realities and has applied the resulting evidence for quality improvement and in its ECD programming.

Author

• Tanya Lalwani, PATH