Gindegi Goron: Impact and Cost of an Integrated Early Childhood Development (ECD) Approach in Rohingya and Host Community in Cox's Bazar

• In Event: Integrated approaches in ECD

Proposal

Introduction

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.1 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.2 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.3 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 access to adequate stimulation, early learning, and protection from physical abuse are even further behind.

These challenges are further aggravated by emergencies such as climate crises, pandemics, and other regular disruptions to the lives of children and their caretakers. Children living in humanitarian contexts face the greatest challenges to experiencing sustainable, consistent, and adequate nurturing care, and funding support for these children is extremely limited (estimated < 3% of humanitarian aids goes to ECD). In crisis-affected areas, the established networks of care that normally protect the health, care and safety of the child are disrupted, and multidimensional needs for children are high. This makes the efficiency, resilience, and cost-effectiveness of remote, sustainable programs especially important.

Taking into account the lessons of COVID-19 and the increasing pivots into digital solutions, this presentation is an in-depth look into the educational potential of remote delivery models of ECD. The results presented in this series presents evidence from a randomized control trial conducted in Cox’s Bazar, Bangladesh (N=1,872) on delivering ECD, health and nutrition messages through both interactive voice recordings (IVR) and home visits delivered by local community health workers.

Background:

Globally refugees suffer for all kind of basic needs such as food, health, education and appropriate housing environment. Currently, Bangladesh is hosting 989,585 Rohingya refugees (GoB UNHCR Population Factsheet – July 2024) in 34 refugee camps of Cox’s Bazar where they are staying in a densely populated and unhygienic situation with lack of access to proper living facilities. Living in adverse conditions and exposure to violence has detrimental effects on children's health, development and well-being. In the Rohingya camps, the lack of accessible health centres and limited health care services increase the risk of poor development of children and mental health disorders among women. In addition, Covid-19 created an extra level of complexity in receiving in-person services in the camps where they are more in need of health and child development service. Parallelly, the host community is also affected due to the flow of the refugees in their area and their children are becoming more vulnerable in terms of their health and development. There is substantial evidence on the benefits of parenting interventions on the early childhood development (ECD) in low-and middle-income countries, however, there is scarcity of data on the impact of the remote delivery modalities of ECD interventions on the development of the refugee children. This presentation will highlight the implementation of Gindegi Goron, a remotely delivered interactive voice recorded (IVR) messaging program, and explore the impact of this program alongside the value-add of home visits combined with the IVR program on the developmental outcomes of the children in the Rohingya camp and the host community. The presentation will also highlight the costing research conducted by IRC’s Best Use of Resources team to assess the cost-efficiency and cost-effectiveness of each model.

Method and Analysis:

A randomized controlled trial was conducted in 3 Rohingya camps and 4 unions of host communities in Cox’s Bazar district to test the effect of a blended model of psychosocial stimulation comprised of IVR messages on the health, growth and development of children and the added value of home visits. A household survey was conducted by the International Rescue Committee (IRC) to screen the eligible households of lactating mothers having a child aged below 16 months and access to mobile phone. A total of 1872 sample (Rohingya=801 and Host=1071) participated in the study. The children were randomized into three groups under Rohingya and host sample: Treatment 1 (weekly IVR audio messages) ii. Treatment 2 (weekly IVR+ monthly home visits) and iii. Control. The intervention package was developed comprising of nutrition, health, hygiene, maternal mental wellbeing and ECD components. The intervention includes the blended model of audio messages, supportive phone calls by the facilitators and in-person home visits and will run for 6 months. The primary outcome variables are children’s cognition, language, and motor development, which was assessed using Bayley Scales of Infant & Toddler Development, version IV, and their behavior was assessed using Wolk’s Behaviour Rating Scale. The secondary outcome variables are children’s height, weight and mid-upper arm circumference (MUAC), home stimulation, maternal knowledge on parenting practices and their mental health.

The data was analysed using random-effects multilevel regression adjusting for baseline scores, child’s age, sex, household assets and maternal education.

Discussion:

The study fills an important gap in generating evidence on the remote delivery of ECD interventions in response to the need of children in emergency crises and would provide a unique opportunity of integrating ECD with general health care services in refugee settings.

Authors

• SM Rashedujjaman, International Rescue Committee

• Ahsan Mahmud, International Rescue Committee

• Syful Azam, International Rescue Committee (IRC), Bangladesh

• Katie Maeve Murphy, International Rescue Committee

• Cecelia Scheuer, International Recue Committee