Model adaptation to support caregivers during the First 1000 Days of life in the West Bank, Occupied Palestinian Territory

• In Event: Highlighted Session: Caregiver wellbeing in the context of COVID-19: evolving strategies to assess and respond to an evolving global crisis

Proposal

The World Health Organization’s Nurturing Care Framework recognizes poor mental health of caregivers can negatively impact early childhood development. In West Bank, Palestinian communities face complex challenges and increased risk for poor mental health. Awareness of postnatal depression (PND) is low and screening for PND is unavailable to vulnerable communities without health clinics.
From 2017–19, a cluster randomized study was conducted in 26 communities in West Bank, to test the effectiveness of integrated package includes behavioral change communication on health and nutrition for the First 1000 Days to pregnant (PWs) and postpartum women through, early childhood stimulation in addition to psychosocial support to the mothers. The integrated package was delivered to the Intervention Group by trained CHWs during scheduled home visits, which begin during pregnancy until the infants’ first birthdays.
Edinburgh Postnatal Depression Scale (EDPS) was used to assess mothers in both study arms between 4–6 weeks postpartum, and repeated when the infant reached 12 months of age.
Additionally early child development and attachments scales were also assessed as main indicators for mothers’ mental health and proper interaction with her child.
Based on the evidence of this successful intervention, WV scaled up this intervention to include another 1858 mothers located in more than 100 communities.
Process and Results:
The scale up of the integrated package that started that in October 2019, was interrupted due to COVID 19 pandemic, and since the country was in complete lock down, the CHWs were unable to proceed with the HHs visits and PHC centers were almost closed.
In response to this, and the fact that the onset of any type of crisis can lead to significant increases in population-wide psychological distress, and specifically among pregnant and lactating mothers, WV technical team worked urgently and developed an adapted package using online platforms.
To ensure quality implementation the assigned CHWs went through a set of relevant trainings:
• Proper use of online platforms
• WHO COVID 19 online basic training for health workers
• Advanced psychosocial support using online platforms, mainly on stress management guidelines and practical skills to help cope with stress during COVID-19.
Support was originally provided to 1858 mothers through online closed groups and individual sessions, at a later stage the support was extended to another 1853 mothers. All mothers were provided with general PSS, 133 showed signs of distress and received intensive individual support and were recovered, 28 had postnatal depression, 18 were recovered and 10 of them were referred for more specialized support.
97% of the targeted mother confirmed that they have benefited and are satisfied from the provided services and the platforms used.
ECD and caregiver survey data were also collected and will be analyzed soon, Web links were used to collect the needed data from the targeted mothers.
Recommendations:
• The maternal mental health service gap is a known need in West Bank. It’s evident that CHWs support is crucial specifically in times of crisis.
• Proper investment, proper and timely shift to appropriate platforms in times of crisis is critical.

Author

• Hana Rabadi, World Vision international