Community-based organizations’ experiences, successes, and challenges in using Care for Child Development – Reports from Tanzania and Zambia

• In Event: Roundtable Session (Tuesday I)
  In Refereed Round-Table Session: Community-based and multi-sectoral ECE programming

Proposal

Introduction to Care for Child Development (CCD)
Scientific evidence and international consensus confirm the crucial development that occurs in the earliest years of life, particularly from birth to age 3. The Care for Child Development (CCD) (WHO/UNICEF 2013) program has been used and tested widely as a low-cost, high-impact resource to build the knowledge and skills of parents and caregivers in providing nurturing, responsive, and stimulating care to their infants and toddlers.

Implementation of CCD
CCD has been found to be effective when delivered through government systems such as healthcare workers (A.K. Yousafzai, J. Obradović, & M.A. Rasheed, 2016). However, there is limited research on the implementation and effectiveness of CCD through community structures, such as community-based organizations (CBOs). This is especially important in many African countries where, despite policy commitments to early childhood development (ECD), national and district level budgets and plans have often not included services for families to effectively support the development of their children from birth to age 3. In many countries, CBOs and other civil society groups have come together to respond to the needs of families with young children, and provide services and support to improve the developmental potential of the most vulnerable.

Program intervention
Firelight believes that, due to their grounding in and understanding of their own communities, CBOs are uniquely positioned to work with the key actors in a child’s life: family, school, local institutions, and government agencies. Since 2012, Firelight Foundation has been partnering with and funding CBOs in Tanzania, Zambia, and Malawi to develop, strengthen, and expand programs and services for early childhood development. Aggregate process and outcome data indicated that children from birth to age 3 were often being ineffectively served, if at all.

Thus, in 2016, Firelight offered CBO partners in Tanzania and Zambia the opportunity to build their capacity in and pilot the CCD curriculum in their communities. Seven CBOs from Tanzania (Mwanza) and seven from Zambia (Lusaka, Central and Copperbelt provinces) participated in the capacity building process led by the Madrasa Early Childhood Program – Kenya, who are Master Trainers in CCD. The training approach was structured on a cascading model, where Master Trainers train and mentor Trainers, and then Trainers train and mentor CCD counsellors. The capacity building process was carried out over a year and included iterative cycles of training, mentoring, and implementation, with feedback loops at every step. CBO partners were encouraged to implement the CCD program as appropriate in their community, integrating it where relevant their existing health, community development, and ECD programs and services.

Evaluation of CCD implementation in Tanzania and Zambia
In early 2018, a mixed method, multi-site study was carried out in Tanzania and Zambia to assess progress and document learnings made by CBOs in implementing CCD. The aims were to assess outcomes CBOs achieved in their communities, as well as surface deep learnings from CBOs around their experiences, decisions, successes, and challenges in implementing CCD. The evaluators reviewed documents, administered structured surveys, and conducted key informant interviews and focus group discussions. Respondents included primary caregivers who received CCD programming from the CBOs, CBO staff who had been trained as CCD counsellors or Trainers, and other CBO leadership involved in the implementation and integration of the CCD program at the CBO. Both quantitative and qualitative analysis were guided by the study objectives. Where appropriate, progress assessment results were compared with findings from a baseline conducted in 2016.

Results
The findings from the progress assessments revealed important gains made by Tanzanian and Zambia CBO partners in improving play-related materials and activities, child care, as well as the participation, knowledge, and practices of primary caregivers at the household level. Qualitative findings indicate that the program thrived because it filled a critical gap in programming – the birth to age 3 group – who had not been effectively served by common center-based ECD interventions serving preschoolers. However, challenges remained, including an important gap in the involvement of fathers and other male caregivers.

The implementation of CCD by the CBOs was examined according to four dimensions of program implementation fidelity: adherence, exposure, quality of program delivery, and participant responsiveness. The progress assessment confirmed that CBO partners were using varied approaches in their implementation of CCD – which enabled them to reach and influence a larger number and range of caregivers, but made it difficult to gauge program quality and systematically assess adherence and ‘dosing’ (how much exposure families got to the CCD intervention). The findings also indicated challenges around the sustainability of CBO-led CCD implementation, particularly in the context of the requirements to be certified as a CCD Trainer who is able to train counsellors independently, or to become a Master Trainer who can train other Trainers.

Lessons learned
The findings from this progress assessment indicate that there is great promise in the capacity of CBOs to implement CCD to reach the youngest, most vulnerable children in their communities. CBOs are often already effective in assessing needs; mobilizing communities, advocating and counselling; developing or adapting and delivering services to children and families in greatest need; and advocating for systemic change. CCD capacity building builds on these capacities in CBOs by providing targeted and tested tools and resources that CBOs can use to empower parents and caregivers to optimize the development of their children in the earliest years of life – right from birth, setting the foundation for lifelong development, learning, and wellbeing.

However, we recognized that substantial consideration must be given to two key areas:
1- How do we balance the need to adapt interventions to local contexts with the need to have an agreed-upon minimum standard of implementation in order to ensure quality and adequate ‘dosing’? We found that while CBO partners appreciated having flexibility and independence in implementation, they also needed further guidance around program implementation – for example around how to establish selection and graduation criteria for target families, or determining the frequency and duration of home visits.
2- How do we establish, from the start, a training and implementation strategy that can be sustained long after the completion of external funding and capacity support.? These includes establishing systemic support to CCD structures in terms of the recruitment, training, and retention of Trainers and counsellors.

We seek to discuss these two key areas with colleagues at CIES, and will be working with our CBO partners to explore, answer, and address these questions and concerns in the coming years.

Authors

• Beatrice Matafwali, University of Zambia

• Ronald Goodluck Kimambo, Firelight Foundation

• Sadaf Shallwani, Firelight Foundation