Implementation lessons from training, mentoring, and supervising community health workers to deliver a parenting program in rural Tanzania

• In Event: Strengthening ECD Monitoring: Psychometrics, Population Surveys, and Integrated Data Platforms

Proposal

Background: Parenting programs are well-established for improving early childhood development, but have not been widely scaled in many low-resource settings. A key challenge is ensuring an appropriate and effective the workforce to deliver these programs with fidelity, quality, and at scale. Community health workers (CHWs) are a promising cadre, given their established community presence and links to health systems. However, few studies have documented the journey and what it takes to prepare CHWs to deliver structured parenting interventions, such as context about CHWs’ initial skills, the processes and approaches used to train and support them, and how their competencies evolve through supportive supervision. This study addresses this gap by describing our experiences supporting CHWs to deliver Familia Bora (“Good Family”), a father-inclusive parenting program in Mwanza, Tanzania, and reflecting on our strategies to build their capacities as facilitators of this community-based parenting program.

Methods: Familia Bora is a weekly group-based parenting program that engages couples with a young children 0-2 years. The curriculum consists of 17 sessions that address multiple topics related to early childhood development, nutrition, responsive caregiving, gender, caregiver mental health, and healthy couple relationships. To evaluate Familia Bora, we designed a cluster-randomized controlled trial in 33 villages in Misungwi and Sengerema Districts in Mwana Region, Tanzania. We also embedded a mixed-methods process evaluation to generally understand how the program was delivered, identify implementation challenges and successes, and generate insights to inform program adaptation and scale-up. For this specific analysis, we focused on multiple data sources from our process evaluation that specifically focused on capacity building experiences of CHWs. First, we administered pre- and post-intervention surveys with CHWs to assess baseline capacities, knowledge, attitudes, and skills in delivering parenting content and other related aspects of their roles in the program. Second, we conducted in-depth qualitative interviews at midline and endline to capture CHWs’ experiences, challenges, growth, and reflections on supervisory support. Third, we systematically documented supervision and mentorship sessions, including audio-recordings from a sub-sample, to analyze the type of feedback provided, CHWs’ responses, and how supervision evolved over time. Fourth, we conducted structured observations of CHWs while they were facilitating group sessions to assess not only program fidelity, but also their facilitation skills, such as their ability to engage parents and children and promote responsive parent-child interactions. Finally, we drew on notes and reflections from our program team, collected during weekly meetings and ongoing discussions, to capture additional insights on implementation challenges, successes, and CHWs’ development. These complementary data sources allowed us to triangulate findings and show how our efforts in training and supportive supervision contributed to enhancing CHWs’ growing skills, confidence, and facilitation skills over time. With data collection ongoing and program completion scheduled for October 2025, this abstract presents preliminary findings and expected analyses ahead of the CIES conference in March 2026.

Results: Baseline data showed that CHWs had limited prior exposure to early child development. Most CHWs were accustomed to carrying out home visits focused on maternal and child health campaigns or supporting clinic-based services, such as nutrition counseling or vaccination outreach. Very few had experience facilitating structured group sessions, counseling parents about parenting practices, or guiding parents in interactive play or communication with young children. Early implementation highlighted these gaps, with CHWs initially struggling with facilitation skills, encouraging participation, and engaging both mothers and fathers from a gender-transformative perspective. Many struggled or lacked confidence in modeling playful interactions with children, counseling caregivers on responsive caregiving, or discussing sensitive topics relating to gender roles in childcare. Early observations also revealed challenges with CHWs following session guides, managing time, and maintaining participant engagement throughout the session. Over time, however, CHWs demonstrated substantial growth. Ongoing training and hands-on mentorship helped them build both technical knowledge and soft skills. By midline, CHWs demonstrated notable growth in content knowledge across all topics addressed in Familia Bora, and particularly in coaching caregivers on responsive caregiving and early learning. CHWs also grew more confident in guiding group discussions, encouraging active participation, and drawing connections across the lessons. Scaffolded and reflective mentorship was critical in empowering CHWs to identify areas for personalized improvement and take actionable steps. CHWs also reported personal and professional growth through their participation in Familia Bora. Many described pride in acquiring new knowledge about child development and in their ability to support caregivers and young children. Several noted that the program aligned well with their CHW roles and enhanced feelings of respect and recognition within their community. Others highlighted how the program taught them new skills that positively influenced their own parenting and strengthened relationships with their partners and children.

Conclusions: Findings from Familia Bora suggest that CHWs can be trained and mentored to deliver a structured, father-inclusive, group-based parenting program in rural Tanzania. With participatory training, supportive supervision, and data-informed feedback, CHWs can effectively counsel parents about various lessons pertaining to child development and family wellbeing, including responsive caregiving, early learning, gender equity, and healthy couples’ relationships. Achieving these outcomes requires consistent, tailored mentorship that addresses CHWs’ individual needs and within the constraints of low-literacy, resource-constrained contexts, along with ongoing monitoring and adaptive supervision to ensure fidelity and quality. Scaling parenting programs through CHWs will require not only ongoing evidence of feasibility but also investment in systems strengthening to ensure programs can achieve broad population reach, lasting impact, and sustainability.

Authors

• Joshua Jeong, Emory University

• Valencia Lambert, Emory University

• Gabriel Sangarara

• Julieth Joseph Bhoke, Tanzania Home Economics Organization (TAHEA MWANZA)

• Carina Wolfram Mayombo, Tanzania Home Economics Organization (TAHEA MWANZA)

• Alina Bhojani, Emory University

• Damas Joachim, Tanzania Home Economics Organization (TAHEA MWANZA)