Evidence from integrated ECD-Health interventions in conflict-affected contexts

Group Submission Type: Formal Panel Session

Proposal

The first five years are the most important in a child’s life. Not only is it the most critical for early nutrition and growth, but it is also during this period that the brain grows most quickly and is most responsive to the outside world (Black et al., 2016). In 2018, the WHO, UNICEF and the World Bank launched the Nurturing Care Framework to call attention to the variety of inputs required to ensure children’s holistic, healthy development (World Health Organization et al., 2018). Recent global estimates find that 75 percent (181.9 million) of 3-4-year-old children living in low- and middle-income countries are not receiving adequate nurturing care (McCoy et al., 2022). On average, 33 million 3-4-year-old children are wasted and 79.8 million are stunted. These indicators are far from achieving the Sustainable Development Goals set for young children’s nutrition, but progress toward indicators for other aspects of child development are even further behind. On average, 163.7 million children are not experiencing adequate maternal stimulation and 165.2 million experience physical punishment from caregivers. In addition, all indicators demonstrate the inequality in children’s access to nurturing care, with those from poorer families and countries less likely to receive these critical inputs than their wealthier peers.
There is an increasing amount of evidence that health and nutrition interventions can become even more effective when paired with early childhood development messages. A meta-analysis of 21 interventions in low- and middle-income countries which focused on improving nutrition and stimulation for young children, found that enhancing stimulation improved children’s cognitive development more than nutrition services on their own (0.09 standard deviation effect size for nutrition interventions, compared to 0.42 standard deviations for stimulation) (Aboud & Yousafzai, 2015). In addition, longitudinal data from Jamaica found that stunted children who received both nutrition supplements and stimulation weekly over a two year period had higher developmental scores than groups who received only one of the two interventions (Grantham-McGregor et al, 1991). Children who received the nutrition intervention alone had the weakest cognitive outcomes at the time of the study (children approx. 2-years-old), and a longitudinal analysis of children’s outcomes found no effect of the nutrition intervention on children’s cognitive development in adolescence, while the effect of stimulation was still present when the children were 17-18 years old (Walker et al., 2005). In summary, current evidence suggests that interventions combining cognitive stimulation with nutritional inputs are the most effective for supporting children to develop to their full potential, including developing the cognitive skills that will enable them to participate critically in their communities.
Integrated ECD programs are also attractive from a systematic and financial perspective. Health system integration has been identified as a key entry point for the expansion of ECD services for children living in low and middle-income countries due to the relatively broad coverage that has been achieved by health systems over the past 30 years and the existing mandate to serve young children (Black et al., 2016). However, health systems and frontline workers are often overburdened by competing initiatives from various governmental and non-governmental actors, and demands have only increased since the onset of the COVID-19 pandemic (Nores & Fernandez, 2018).
Children living in humanitarian contexts face the greatest challenges to experiencing adequate nurturing care, and funding support for these children is extremely limited. In crisis-affected areas, the established networks of care that normally protect the health, stimulation and safety of the child are disrupted, and displaced, exhausted parents are less able to provide the nurturance and care that their children need (World Health Organization et al. 2020). It is the combined effects that occur in such settings which contribute to poor outcomes for children. This makes the efficiency and effectiveness of integrated programs especially important. However, the high need across multiple sectors in humanitarian contexts presents additional challenges for quality implementation of ECD services.
This proposal is for a two-part series sharing evidence from integrated ECD-health programs implemented in low-and middle-income countries. The first panel will focus on integrated ECD programs in development settings, and the second will focus on implementation in humanitarian contexts. All papers presented in this series represent original research from organizations implementing ECD models that focus on responsive caregiving, playful parenting strategies, and positive discipline techniques. Delivery modalities range from technology-assisted messaging to home visiting, all with links to health and nutrition systems or programs.

The second panel consists of three papers presenting evidence from integrated ECD-health programs in humanitarian settings. The first paper presents evidence from a randomized control trial conducted in Cox’s Bazar, Bangladesh (N=1,892). Researchers from icddr,b investigated the impact of a program delivering ECD, health and nutrition messages through both interactive voice recordings (IVR) and home visits, delivered by local community health workers. The second paper is a qualitative study aimed at understanding the barriers and enablers for Save the Children’s Building Brains model implemented in humanitarian settings. Data include information from a series of 20 in-depth, semi-structured interviews in 17 countries, and highlight the challenges with visibility and feasibility in humanitarian settings. The third paper is a mixed-methods implementation research study from Jordan. 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, which trains nurses and midwives in health clinics to deliver vital age-targeted ECD information to caregivers on topics ranging from feeding, safety, and how to interaction with children in ways that support children’s social-emotional development and early learning. Results showcase successes and challenges of integrating ECD into the national health system and have informed program adaptation for scale-up.

Sub Unit

• Early Childhood Development SIG

Chair

• Lauren Pisani, The Palladium Group

Individual Presentations

• Championing Nurturing Care in Crises: deploying caregiver-based interventions to improve child development outcomes in humanitarian settings - Emily Weiss, Save The Children International; Sara Dang Dang, Save the Children; Filipa de Castro, Save the Children

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