Scaling Prescription 2 Play in Bhutan

• In Event: Beliefs & Practices on Play in Bhutan & Rwanda 

Proposal

One assumption of many early childhood development programs is that caregiver behavior change will lead to changes in child development outcomes. At the same time, caregiver behavior change is only possible through the providers who deliver ECCD services—and the impact of the program on their knowledge and practices is often unexplored. This presentation will describe the program design of the Prescription to Play program in Bhutan, and present results on the influence it had on caregiver and service provider knowledge, beliefs and practices on parenting and play. Furthermore, this presentation will explore how this data influenced refinement of the program design at key phases as the program moved into national-level scale.

In 2019, the implementing organization and the Bhutan Ministry of Health agreed to nationally scale a pilot playful program that was piloted with success in 2017-2018 in two districts in the country. The Prescription to Play (P2P) program aims to improve child development outcomes by encouraging playful parenting, responsive care, and opportunities for early learning among caregivers. Caregivers are reached through government community Health Assistants (HAs), stationed at clinics and outreach posts around the country. Health Assistants were first trained on the role of playful parenting in early childhood development and ways to improve parenting practice. These HAs were then delivering individual and group sessions at their health posts.
National level scale up of the program was broken into two phases; Phase 1 included roll out to approximately 20% of districts using the scalable model from 2019-2021. Phase 2 brought the program to the remaining 15 districts, continued implementing in the first 5 districts, and included further elements to ensure the sustainability of the program.

This presentation will focus on how changes in health assistant knowledge and practice in turn influence caregiver knowledge and practices. From the service delivery side, pre- and post-training tests revealed improved health assistant knowledge of playful parenting, and observations of group sessions found that they were prepared and did well in covering the program content in the group sessions they delivered, in particular introducing and demonstrating new play approaches, explaining benefits for children and reviewing main messages. From the caregiver side, the phase 1 impact evaluation showed increases in caregivers awareness of the importance of play for child development, and their knowledge of child development and the role of the caregiver play and stimulation in promoting it in the districts where the P2P program was rolled out. We also observed increases in the availability of play materials in the home, the quality of mother-child interaction and stimulation, and the engagement of fathers in caregiving and stimulation. In this presentation, the Bhutan country team will present these results in detail to understand how beliefs and beliefs can be influenced through a government-led playful parenting program focusing on group and individual caregiver sessions.

Authors

• Sara Dang Dang, Save the Children

• Thomas Brown, Save the Children