Prescription to Play: Scaling Play through Bhutan’s Ministry of Health

• In Event: Pathways to Scale for Playful Parenting Programs

Proposal

Playful interactions with caregivers shape young brains. Yet many children, especially the most disadvantaged, do not have exposure to such opportunities when caregivers lack the skills and motivation to play. The Prescription to Play (P2P) scale-up project in Bhutan builds on a successful pilot program implemented in two districts in 2017-18, and aims to improve young children’s play ecology with equity, by offering an intensity of services commensurate with the level of need. The project will institutionalize play in Bhutan’s health system and improve the motivation and ability of families to raise young children in playful homes.
At the health system level, playful parenting will be integrated in the Ministry of Health’s (MoH) Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program and the pre-service training for Health Assistants (HAs) at Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB). The project will be delivered by the HAs through all Basic Health Units (BHUs) and Outreach Clinics (ORCs). HAs will conduct monthly interactive group sessions (e.g. hands-on demonstration and practice) for caregivers and babies on play, health, safety and positive discipline and screen children for developmental delays. They will also provide individual counselling at the BHU/ORC for families with children with delays on play and responsive caregiving and refer those exhibiting severe delays to specialized services. HAs will be trained to refer families needing child and maternal protection to social services. The IMNCI focal persons consisting of both District Health Officers (DHOs) and Focal HAs will monitor the HAs and provide supportive supervision. The project will also advocate for administrative, financial and technical changes within the MoH to effectively institutionalize and monitor the project.
At the community level, the project will use a Social Behavior Change Communication (SBCC) strategy to develop a mass media campaign and community mobilization activities to generate awareness, demand and support for the project’s playful parenting sessions, engage community champions, and address beliefs and barriers related to masculinity, caregiving, early childhood and play. At the household level, the project aims to engage all influential household members, including fathers and grandparents.

The P2P project will be using qualitative and quantitative data to inform the multiple layers of programming throughout the project. The project’s Monitoring Evaluation and Learning (MEL) plan focuses on playful interactions between caregivers and children, changes in practice among the workforce to promote this behavior change, and government commitment to sustaining the intervention at scale. This presentation will focus on qualitative information gathered from SBCC activities leveraged to adapt the pilot program into the P2P national implementation plan, as well as initial quantitative findings from the baseline evaluation and mixed-methods data from the first quality improvement cycle.

Authors

• Karma Dyenka, Save the Children

• Lauren Pisani, Save the Children

• Sara Dang, Save the Children

• Kinley Wangmo, Save the Children

• Tshetrim Tobgay, Save the Children