Reality of integrating Nurturing Care in health facilities: PATH’s experience in with the integration of ECD across four countries

• In Event: Roundtable Session (Tuesday I)
  In Refereed Round-Table Session: Nurturing care framework: lessons learned from developing and adapting integrated ECD programs

Proposal

During the early years of a child’s life, the health system offers the primary means to consistently reach young children and their caregivers in many low and medium income countries. But routine health and nutrition services tend focus on child survival, rather than promoting all-round child development. Seeking to better promote the thrive agenda for 0-3s in sub-Saharan Africa, PATH has been working over the past 5 years with health authorities at national and subnational levels in 4 countries to introduce, validate and expand integrated ECD programs through the health system.
The system’s based approach PATH has developed seeks to create an enabling policy and program environment while sustainably building ECD service delivery and measurement capacity into existing MCH, nutrition, and HIV platforms. The program looks to improve development outcomes and caregiving behaviors that are known to lead to better outcomes. Specifically, this is done by integrating monitoring of child development, counselling caregivers on age-appropriate play and communication, and referring and following up on children suspected of developmental delays. Community-based service providers also reach children and caregivers during home visits and structured play sessions in health facility waiting areas. To date, PATH has contributed to the comprehensive integration of nurturing care into 12 district health systems in Kenya and Mozambique. Both countries are in the process of scaling-up integration, ultimately reaching a population of at least 2 million by 2020.
Through this health systems approach, PATH works closely with policymakers, technical staff and civil society partners to align interventions with existing structures and resources, and to ensure that government is at the center of the ECD integration process. This presentation will describe and summarize PATH’s experience to date and offer examples of how ECD has been integrated into different elements of the health ecosystem, including national policies and technical documents from child health, nutrition, and HIV, M&E systems, health workforce capacity building, planning processes at different levels of the system, financing, and champion cultivation.
Initial results are highly encouraging. The Lancet’s landmark series on early child development and the May 2018 launch of the Nurturing Care Framework have turned a global spotlight on the need for ECD integration into the health system. This has propelled PATH’s work forward and greatly increased government and partner readiness to prioritize for the first time ECD during the early years. Program data is affirming the operational feasibility of ECD integration and pointing to improved service quality along with increased client satisfaction and self-reported improvement in nurturing practices in the home. A cluster randomized controlled trial is underway in Kenya that will significantly deepen the available evidence base for health system based ECD service delivery.

Author

• Matthew Frey, PATH