Building Brains: Evidence from Bhutan and Ghana

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

Proposal

Save the Children (SC) has developed the Building Brains approach to support children’s cognitive development from birth. The Building Brains approach focuses on early stimulation and responsive caregiving messages and is designed to be integrated into existing early childhood development services delivered through any platform (e.g., health, nutrition, child protection). This presentation will focus on evaluations of implementation fidelity and impact of the Building Brains approach in two different contexts: Ghana and Bhutan.
Both countries are implementing the Building Brains approach through existing health system networks. In collaboration with Ghana Health Services, the program has been adopted and implemented by Community-based Health Planning and Services (CHPS) staff and volunteers in two districts of Ghana. To support eventual roll-out of the program at scale, the Building Brains approach was delivered to community health workers through a national training cascade. In Bhutan, Save the Children partnered with the Ministry to Health to adapt and implement the Building Brains approach in two provinces in the country. In this context health workers and volunteers were trained directly by Save the Children.
Methods
Quantitative and qualitative methods were used for evaluation in both sites. In Ghana, health workers were interviewed for their perceptions of the appropriateness and sustainability of delivering early stimulation services in their communities. In addition, quantitative data were collected to investigate changes in caregiver behavior and child development. Caregivers were interviewed before and after programming began in order to estimate changes in early stimulation and responsive care practices as well as children’s development. In Bhutan a randomized control trial was designed to measure the impact of the Building Brains approach in target communities. Qualitative data were also collected during the post-test to better understand implementation fidelity and health workers’ perceptions of the program.
These studies use similar instruments to capture information from health workers and caregivers. The qualitative interview tools focus on health workers’ perceptions of the benefits and challenges of implementing the Building Brains program, and the specific items have been adapted to fit the national context. Both studies use a similar caregiver questionnaire to measure caregiver-child interactions and health and demographic characteristics. Finally, both studies use Harvard University’s Caregiver Reported Early Development Instruments (CREDI) to measure child development.
Results
Results of these two studies will speak to successes and challenges of implementing integrated early childhood development programs in one African and one Asian context. Results of the quantitative evaluations will provide evidence about the changes found with target beneficiaries, with results of the RCT in Bhutan providing particularly rigorous evidence of the impact of the Building Brains program. These data will be complemented by qualitative data which speaks to health workers’ experiences implementing the program. Implications for future programming and scale up will be discussed.

Authors

• Sara Dang, Save the Children

• Lauren Pisani, Save the Children

• Romilla Karnati, Save the Children

• Caroline Dusabe, Save the Children