Testing an Implementation Strategy for Scaling Out Evidence-Based ECD Home-Visiting in Rwanda: Successes, Challenges, and Lessons Learned

• In Event: Pathways to Scale for Playful Parenting Programs

Proposal

Background: Rwanda has one of the highest rates of stunting (38%) in all of sub-Saharan Africa. This reality is in strong contrast to its ambition to be an upper middle-income country by 2035. Rwanda is invested in addressing stunting and similar indicators of underdevelopment in children, and recognizes that affordable, scalable, and effective interventions that address early childhood development (ECD) are needed to advance the prospects of vulnerable children (Britto et al., 2017). Since 2007, the Sugira Muryango father-engaged home visiting program to improve child development and reduce violence has undergone two pilots (Betancourt et al., 2018; Barrnhart et al., 2020) and an effectiveness trial (Betancourt et al., 2020) with a 10,000 household expansion program underway to test strategies for sustainment while maintaining quality and fidelity to evidence-based components.

Approach: Innovative approaches are needed to sustain and scale evidence-based programs as they move from effectiveness trials to systemwide scale out. As such, in order to reach 10,000 households using a government-supported workforce, an evidence-based implementation strategy, the Promoting Lasting Anthropometric Change and Young Children’s Development (PLAY) Collaborative, will be used to engage local stakeholders and frontline providers and supervisors to ensure quality improvement and sustainability. The PLAY Collaborative utilizes a multilevel implementation strategy drawn from Interagency Collaborative Teams (Hurlburt, Aarons, Fettes, Willging, Gunderson, & Chaffin, 2014) and the IHI Breakthrough Learning Collaborative methodology (IHI, 2003) that engages stakeholders across the layers of the ecology of ECD delivery in Rwanda in order to reinforce knowledge sharing and problem solving, and strengthen intervention oversight, creating a community of practice amongst ECD stakeholders.

Methods: Evidence-based approaches regarding the PLAY Collaborative process, collection of run chart data and use of Plan-Do-Study-Act (PDSA) cycles, including root cause analysis and Impact-Effort Matrices, will be discussed as targeted ways for anticipating, identifying, solving. and tracking problems. Specifically, these approaches will be used to address anticipated challenges regarding father engagement (i.e. attendance) in Sugira Muryango sessions and attendance of stakeholders at weekly PLAY Collaborative meetings where study updates will be shared and micro-ECD trainings carried out. The scaling of solutions and their contribution to quality improvement will be highlighted.

Discussion: Quality improvement strategies that are low cost, easy to implement, and measurable are of immense interest to policy makers and governments as they seek to scale programming while maintaining fidelity to evidence-based approaches. A discussion of successes and challenges will be shared including lessons learned for future implementation phases.

Authors

• Jordan Farrar, Boston College

• Jean Marie Havugimana, FXBX Rwanda