Prescription to Play: Scaling Play through Bhutan’s Ministry of Health

• In Event: Global Parenting Interventions: Advances in Measurement and Scale Up

Abstract

Study Objective: To generate evidence of the effectiveness and implementation quality of a pilot program in order to inform the scale up of a playful parenting intervention in Bhutan

Background
Playful interactions with caregivers shape young brains. Yet many children, especially the most disadvantaged, miss out on such opportunities when caregivers lack the skills and motivation to play. In Bhutan, 26 percent of young children risk not reaching their developmental potential due to lack of appropriate stimulation, health and care in early childhood. (ECDAN, 2019) Save the Children’s Building Brains package was piloted in Bhutan in 2017 by the Ministry of Health (MoH) in two districts, Paro and Punakha. During implementation, evidence was collected around the effectiveness of the pilot program as well as strengths and challenges of implementation through the MoH to inform a possible path to scale.

Method
The evaluation of the pilot program used a mixed-methods design that included a randomized control trial (RCT) of caregiver behavior change and child outcomes, as well as a qualitative study of enablers and barriers to program implementation. For the RCT, Basic Health Units were randomly assigned the intervention or control group, and caregiver-child dyads were randomly chosen from village-level clusters (n = 420 dyads). The Caregiver Reported Early Development Index (CREDI), a parent-reported questionnaire developed by Harvard University for children aged 0-3 years, was used to measure changes in child development over time. (CREDI, 2018) The objective of the qualitative element of the study was to understand the perspectives of health workers and caregivers who were engaged in the program, and data collection was conducted immediately following completion of the program. Key informant interviews were conducted with health workers and their supervisors, and focus group discussions were conducted with caregivers.

Results
The program had a medium-to-large impact on children’s overall development. Scores on the CREDI demonstrated that the program had medium-to-large effects on children’s Cognitive, Language, and Social-Emotional development and a small-to-medium impact on children’s Motor development. The program was also successful in improving children’s home environments and stimulating interactions between caregivers and children. Qualitative analyses also found a positive impression of program impact, and stakeholders shared a view that there were several layers of benefit to the program: from child and caregiver to community and health system. Qualitative results made clear that the implementation of the program benefited from strong monitoring. Having staff available to consult and ask questions for implementation guidance was critical to success and must be sustained as the program is taken to scale.
Next steps
The highly effective Building Brains pilot will be scaled up to all districts in country from 2020 - 2022. The scale up project has adapted the International Fund for Agricultural Development (IFAD) framework, a widely-used approach for scale up that considers the drivers, spaces and pathways needed. (Cooley, L. and Linn, J.F., 2014)

Group Authors

"As per Anne Perdue please consider these flash talks as one session. They should either be accepted or rejected as a whole.

Flash talks should be ordered as follows: 1707093, 1705221, 1705962, 1707008, 1705220, 1705994, 1706107, 1706048"

Authors

• Karma Dyenka, Save the Children
  Presenting Author

• Tshetrim Tobgay, Save the Children - Bhutan
  Non-Presenting Author

• Thinley Dorji, Save the Children
  Non-Presenting Author

• Lauren Pisani, University College London (UCL)
  Non-Presenting Author

• Kinley Wangmo, Save the Children - Bhutan
  Non-Presenting Author

• Sara Dang, Save the Children
  Non-Presenting Author

• Nar Chhetri, Save the Children
  Non-Presenting Author