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Session Submission Summary

Promoting Nurturing Care to Improve Early Childhood Development through Health and Nutrition Services

Wed, February 22, 9:45 to 11:15am EST (9:45 to 11:15am EST), Grand Hyatt Washington, Floor: Independence Level (5B), Independence F

Group Submission Type: Formal Panel Session

Proposal

The Nurturing Care Framework (NCF), launched in 2018, is a guide for multi-sectoral actors on improving early childhood development (ECD) outcomes by supporting families and caregivers to provide nurturing care for young children, with a specific focus in the first 1,000 days when a child’s brain is developing most rapidly. Nurturing care consists of five domains: health, nutrition, responsive caregiving, early learning, and safety and security. Integrated interventions that leverage existing health and nutrition services for promotion of other aspects of nurturing care, such as responsive caregiving, yield greater benefits. Momentum is growing for testing integrated approaches for improving ECD. A challenge has been how to begin to operationalize the Nurturing Care Framework and seamlessly integrate responsive care and early learning into on-going health and nutrition interventions. This panel features four experiences—spanning formative research, program design, and implementation research—in leveraging health and nutrition systems for improving ECD funded by USAID through the MOMENTUM Country and Global Leadership (MCGL) programming in Indonesia and USAID Advancing Nutrition’s programming in Mozambique, Ghana, and the Kyrgyz Republic.

In Indonesia, a case study was conducted to identify the needs and opportunities for delivering counseling on nurturing care at community health centers (Puskemas) and during community outreach during (Posyandu) visits in Manggarai Barat district. Influenced by human-centered design, the qualitative approach targeted caregivers, health workers, community kaders (community health workers), traditional birth attendants, and government officials. The case study examined the enabling environment for nurturing care, current counseling practices, including the utilization of the Maternal and Newborn Health (MNH) book, the impact of COVID-19 on service delivery, and referrals between Puskemas and Posyandus. Preliminary findings suggest inadequate knowledge among frontline health workers to counsel on responsive care and early learning, limited use of the MNH book, long wait times at antenatal care and postnatal care visits, and local myths on maternal and child feeding practices. Findings from this case study can inform the effective delivery of nurturing care through public health delivery platforms in Indonesia.

In Ghana, USAID Advancing Nutrition conducted a mixed methods study to identify opportunities for promoting optimal development in early childhood—especially between conception and three years of age—through the health and social welfare sectors. The study spanned three regions (Upper East, Eastern, and North East). The assessment aimed to understand the status of current support for ECD through these sectors and workforce competencies, and to identify opportunities to strengthen services. In total, we completed 70 key informant interviews, 26 observations at the point-of-service, and 316 competency assessments. This study indicated a positive landscape for strengthening support for ECD through the health and social welfare sectors. Features of that landscape include (1) the existence of relevant national tools, and (2) the willingness of health and social welfare workers and district-level stakeholders to do more to support children’s development. This includes strengthening services for all children through improved counseling and child-friendly spaces, and specifically for children with disabilities by supporting caregivers’ mental health. Further support is needed to fill gaps in knowledge and skills through workforce development strategies. Last, the government can improve accountability for ECD by integrating ECD indicators in national information systems.

In Mozambique, USAID Advancing Nutrition is supporting caregivers’ capacity to provide nurturing care to their young children by enabling the local consortium—Transform Nutrition (TN)—to deliver responsive care and early learning in community-based nutrition and sanitation and hygiene (SH) services delivered through peer groups and home visits. An impact evaluation on a random sample of 961 caregiver-child dyads (children zero to two years at baseline) from Nampula Province participated in this study. The Ages and Stages Questionnaire (ASQ-3) and the Global Scale for Early Development (GSED) were administered at baseline with an endline planned for early 2023. Study findings will indicate if the integration of responsive care and early learning has a greater effect on ECD outcomes compared to the nutrition/SH intervention alone. Results will also provide evidence on the feasibility, acceptability, and experience of integration. Finally, this study will provide evidence on validation of the GSED measure for program evaluations.

USAID Advancing Nutrition, with an external technical advisory group, developed counseling materials that can be integrated into existing child health, nutrition, or infant and young child feeding (IYCF) counseling packages. The technical advisory group, comprising an interdisciplinary team of experts in ECD, nutrition, and social and behavior change, developed the Responsive Care and Early Learning (RCEL) Addendum package, which includes illustrated counseling cards, training materials, and a guide for planning, adaptation, and implementation. It is flexibly designed for both individual counseling and group sessions. A mixed method design is underway to assess the feasibility, acceptability, and effectiveness of the RCEL Addendum to promote optimal early childhood outcomes in Ghana and the Kyrgyz Republic. The study includes multiple data collection components, including a pre-post survey design (N=478 caregivers of children ages 0 up to 24 months at baseline), focus group discussions, individual interviews, and pre-post training evaluations (N=822 health workers and 1,763 volunteers trained to date). While results of the studies are pending, they are expected to illustrate the feasibility of adapting the generic counseling cards to different country contexts, highlighting key points where adaptation was necessary. Results will also provide evidence on the feasibility of delivering the package, examining barriers and enablers to its effective implementation, such as the value of training and on-the-job coaching through supportive supervision. Last, endline results will provide evidence on the effectiveness of the package to support behavior changes related to RCEL practices among the study population (caregivers of children under two). Overall, the study offers insights into how such an integrated package may impact nurturing care practices, and ultimately ECD outcomes, in Ghana and the Kyrgyz Republic.

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