Strengthening nurturing care through national health systems: Ahlan Simim Health-ECD integration in the Middle East

• In Event: Evidence from integrated ECD-Health interventions in conflict-affected contexts

Proposal

Prolonged stress and adverse experiences during a child’s early years - particularly between birth and age five - can have negative impacts on children’s development. Fortunately, nurturing care and early childhood development (ECD) interventions can have a significant effect on reducing harmful effects of adversity, allowing children to learn, grow, and thrive. National health systems present a critical entry point for reaching young children and caregivers, offering untapped opportunities to promote holistic services.
The context in Jordan underscores opportunities and challenges for alignment between national health systems and ECD programs. A 2022 UNICEF Syria Crisis Humanitarian Situation report called attention to 1.6 million children in Jordan who face grave risks to their health and development. In Jordan, 83% of mothers access postnatal healthcare and 86% of children ages 12-23 months receive vaccinations. However, approximately 39% of children are not developmentally on track. As standard protocol, health clinics offer wellness checks about physical growth, vaccinations, hygiene, breastfeeding, and diet, but they have not addressed other key areas related to children’s cognitive growth, behavior, and social-emotional wellbeing.
Through the Ahlan Simsim initiative, the International Rescue Committee (IRC) and the Ministry of Health (MoH) in Jordan partnered to co-develop and launch a new ECD-Health Integration Program aiming to improve caregiver knowledge to support children’s holistic development and strengthen the existing national health services. The program equips nurses and midwives in health clinics to deliver age-targeted inclusive ECD tips to caregivers to support children’s social emotional development and early learning.
Between August 2022 and February 2023, the IRC and MoH trained 112 nurses/midwives to implement this program. The program launched in 19 health centers, and has since expanded to 103 health centers, representing roughly 20% of centers across Jordan. The team aims to further refine and expand the program in 2023 and 2024.
Mixed methods implementation research conducted by the IRC and NYU’s Global TIES Center showed key findings that shape future iteration and improvement of this model. This research included baseline and endline surveys with 209 caregivers, structured observations of 184 well-child visits, surveys with 36 midwives/nurses, and qualitative interviews with 15 nurses/midwives and 37 caregivers. Key findings include:
Midwives/nurses see the importance of Ahlan Simsim ECD tips, but struggle to find time to use them during short visits with caregivers and children and their competing priorities.
More supportive supervision and capacity building activities are needed for nurses/midwives to effectively use the tips during well-child visits.
Caregivers are satisfied with services provided by midwives/nurses, but midwives/nurses often struggle to convince caregivers to adopt ECD practices especially if their advice conflicts with advice from family members.
The MoH is exploring adding ECD tips to checklists for well-child visits, to make them a clear part of visit protocols and remind midwives/nurses to use them.
In this presentation the IRC will share the program design and learnings from implementation research in Jordan and monitoring data from adaptations of this intervention in Iraq and Northeast Syria.

Authors

• Heidi Rosbe, IRC

• Maram Yousef Shahin, International Rescue Committee

• Manar Mohyddein Shukri, International Rescue Committee

• Ragheb Ra'fat Fityan, International Rescue committee

• Mohammad Nasser Al-A'abed, IRC

• Kate Schwartz, Global TIES for Children, New York University

• Phoebe Sloane, International Rescue Committee

• Sharon Kim, New York University