Improved Child Development Outcomes among 0-5 Years Old Children from Scaled Up, Multisector Programming in Armenia – Program Evaluation

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

Proposal

More than 12 percent of children under five (CU5) in Armenia do not reach their age-appropriate development milestones. Anemia among CU5 is of public health concern, and in some regions the prevalence is up to 50 percent. Malnutrition continues to remain as an unresolved issue in Armenia. Both health care service and parental care practices mainly focus on child physical needs and growth, neglecting the need for psycho-social development counselling, screening and stimulation. Effective parenting in combination with quality primary health care and pre-school education can ensure that children reach their developmental potential in Armenia.
World Vision Armenia adapted the health and nutrition program for CU5, and implemented a multi-sector, four-year early childhood development (ECD) program across 200 communities in Armenia during 2014-2018 to improve CU5 development and nutrition outcomes.
Methodology: In total, 3,084 CU5 from 14 Area Programs (APs) participated in the final evaluation. Through quantitative and qualitative research methods we measured household socioeconomic characteristics, nutrition, learning support, attendance to early childhood development structures, child disciplining practices, and age-appropriate growth and development. The adapted Multi–indicator Cluster Survey tools and ECD index, child anthropometry, focus group discussions, key informant interviews with key stakeholders were used to measure program relevance, effectiveness and impact, cost-effectiveness and sustainability.
In 14 APs, the ECD program interventions included: behavior change communication (BCC) targeting parents for improved child care, nutrition and early stimulation practices, and capacity enhancement for quality primary healthcare (PHC) and preschool education services. We strengthened CU5 caregivers’ skills through trained community cadres, ensuring around ten BCC interactions for each parent, enhanced and supervised the PHC staff and pre-school teachers for quality services.
Findings: The integrated ECD Program demonstrated statistically significant improvements in CU5 growth and development. Stunting was reduced by 10%, with increase in minimum meal frequency practice among children 6-23 months old. Children aged 3-5 years demonstrated better development outcomes in physical and learning domains. The percentage of fathers of children 6-59 months, promoting child development at home, increased by almost 10 percent, and small, but statistically significant change (3%) was detected in children 6-59 months, with whom adult household members engaged in four or more activities to promote learning. The positive discipline practices significantly improved among parents with 6-59 months old children (only non-violent discipline, psychological aggression, physical punishment). There were strong associations between ECD outcomes and maternal education (Chi2 p<0.01) and number of siblings in the household (>3). The program was cost-effective compared to other age group programs due to leveraging on existing health and nutrition programming platforms.
Conclusion: The multi-sector, integrated ECD program, implemented at scale proved to be effective in promoting child growth and development. The program needs to be further adapted, enhanced and validated for effectiveness in reaching out and improving the most vulnerable children’s outcomes.

Authors

• Karine Abelyan, World Vision International

• Viktoria Sargsyan, World Vision International