Poster #78 - Creating a Monitoring and Evaluation Framework for Early Childhood Home Visiting: Central and Eastern Europe

• In Event: Poster Session 10

Abstract

The UNICEF Regional Office launched the Right of Every Young Child to Comprehensive Development and Well-being initiative for Europe and Central Asia (UNICEF, 2012) to address inequities in the health, development, care, and protection of young children in the region, which encompasses 21 countries, most created from the break-up of the Soviet Union and the former Republic of Yugoslavia. One approach with great potential in the region is home visiting.

Early childhood home visiting (ECHV) is a strategy used internationally to promote the health, development and well-being of pregnant women, infants, toddlers, and their families. In Eastern Europe and Central Asia ECHV services are available in most countries through their national health care systems, are typically implemented by primary health care centers within a community and use patronage nurses as home visitors. Although these services are universal, the systems are often overtaxed and underfunded. Nurses have large caseloads, and home visits are infrequent and narrowly focused on basic health monitoring. Other issues for development and well-being, such as responsive and nurturing care and early detection of risk and vulnerability, are not addressed adequately.

The UNICEF initiative identified a need for enhanced home visiting services, with a more holistic view of child health and well-being and incorporation of elements for family support, child development guidance, and positive parenting practices. Patronage nurses required additional knowledge, skills, and tools for the early identification of risks and needs, including children with developmental difficulties and children maltreated or exposed to violence, and for assisting families to secure early intervention and other needed social services. This enhanced model has been promoted as a progressive element to existing services; families with identified higher needs can receive additional supportive services. Although there is some evidence of this progressive approach being implemented in some countries in the region, a recent report (Gotsadze et al., 2020) detailed considerable challenges, including the lack of appropriate monitoring and evaluation (M&E) tools to track home visiting implementation and outcomes.

This poster will present the results of an effort to develop and pilot a common, simplified, and practically oriented M&E framework, one that includes performance measures for monitoring universal progressive home visiting service delivery and tracking progress against key child and family outcomes. The framework was developed from a literature review and feedback from UNICEF country offices to ensure country and cultural relevance. It is organized around five separate dimensions: system level supports, local health care structure, service delivery, visit content and experience, and outcomes (see figure).

The framework was piloted with one of the country offices, with results highlighting the role of the home visiting system in the success of M&E efforts, specifically training and workforce burdens of data tracking with the patronage nurses and differing priorities for program content and outcomes. The use of the framework was valued in its potential to give health care systems the ability to understand the reach of ECHV in its targeted populations and to seek support to continue these services.

Authors

• Emily Reznicek, Chapin Hall
  Presenting Author

• Jennifer P Baquedano, Chapin Hall at the University of Chicago and Erikson Institute

• Jon Korfmacher, Chapin Hall at the University of Chicago