Integrating ECD monitoring within the health system in low and middle income settings: a case study in Kenya

• In Event: Integrated approaches in ECD

Proposal

Integrating ECD monitoring within the health system in low and middle income settings: a case study in Kenya
Abstract
Authors: Margaret Nampijja, Linda Oloo, Brian Odhiambo, Evitar Ocheng, Silas Onyango, Paul Otwate, Nelson Langat, Charity Waweru-Mwangi, & Patricia Kitsao-Wekulo
Institution affiliation: African Population and Health Research Center, Nairobi

Background: In many sub Saharan African (SSA) countries, healthcare systems struggle to provide a complete package of child health and development (ECD)programs and many of them focus on improving health, nutrition, and do not monitor or provide other ECD nurturing care services to their communities. Integrating ECD monitoring services in health could be a pathway for governments to identify the contextual, socio-economic, and cultural barriers to optimal development in young children. Provision of holistic early childhood development services and monitoring of indicators is important for children. ECD services and monitoring in low-income countries have mainly focused on child health (morbidity, mortality, immunization) and physical growth (nutritional status) and limited attention has been paid to monitoring developmental milestones and other aspects of nurturing care (responsive caregiving, early learning, child safety and security) which also contribute to children’s wellbeing, educational outcomes and success in life. This project aimed to explore the existing ECD services and monitoring of indicators within the health system, existing gaps, and how ECD integration in the health system can be strengthened to optimize ECD outcomes in Kenya.
Methods: We conducted a qualitative study in Kenya to understand the knowledge, practices and experiences of health care providers and policy makers at the national and subnational levels (in two sub-counties (Korogocho and Viwandani) of Nairobi County in monitoring and supporting ECD within the health system. We held two workshops with stakeholders at national, county, sub-county and community levels (with community health volunteers [CHVs]), with a total of 60 participants across the two groups. The discussions from the workshops were recorded and notes taken. The data were analyzed qualitatively focusing on the key aspects i.e. which aspects of ECD are being monitored and supported, tools used, capacity, any challenges and gaps at different levels of the health system, and ideas on how full integration can be achieved, and opportunities for digitalizing ECD data monitoring that can be leveraged.
Findings: The information from the workshops revealed that there was a degree of monitoring and provision of ECD services within the health system at the different levels of the health system. These mainly focused on health specific aspects particularly child health (illnesses, and referral, immunization) nutrition (measuring weight and mid upper arm circumference); and reporting on children with disabilities. These aspects were monitored by CHVs and reported through the ECHIMS and relayed electronically to CHIMS for decision making. Key gaps included lack of monitoring developmental milestones, and limited focus on responsive caregiving, as well as feedback/advice to parents of children who had issues. CHVs lacked knowledge and skills in monitoring developmental milestones and detecting delay. They also mentioned the lack of tools for assessing developmental milestones. There was lack of clarity in referral and feedback pathways from the community to the health facilities as well as limited knowledge or connections on specialists to provide the needed support. Discussions revealed opportunities for use of digital technology to support monitoring of ECD indicators. The electronic community health information management system (ECHIMS) currently being used to capture routine health data at community level has a great potential to support electronic capture and reporting of ECD information at household level.
Policy makers and health managers recognized the need to include more ECD indicators particularly developmental milestones and the need to skill CHVs and other cadres to assess, advice and/or referral children with delayed developmental milestones. Policy makers also expressed the need to include developmental milestones and other aspects of ECD into the CHVs training curriculum and reporting tools, and the need to mainstream this at all levels. Health managers and policy makers were keen to strengthening the ECD integration into the health system, however, they mentioned that this would have budgetary implications.
Conclusion: Supporting the integration of ECD monitoring and support services into the mainstream health care system through joint efforts with policy makers, health care providers and community health volunteers is critical for optimization of ECD outcomes in the Kenyan context. This can be achieved through addressing the existing gaps in the system, and building on what has been achieved to date and leveraging the existing infrastructure such as the electronic health information platforms. The findings of this study inform the next steps i.e. co-designing a full integration model of ECD integration for Nairobi, and ultimately scaling it countrywide.

Authors

• Margaret Nampijja, African Population and Health Reserach Center, Nairobi

• LINDA AWUOR OLOO, African Population and Health Research Center (APHRC)

• Silas Odhiambo Onyango, African Population and Health Research Center (APHRC)

• Paul Wandera Otwate, African Population And Health Research Center

• Nelson Kipkoech Langat, African Population and Health Research Center (APHRC)

• Patricia K Kitsao-Wekulo, African Population and Health Research Center