Early Nurturing Care- Basic Foundation for Building a Nation

Currently the number of children 0-3 years of age is estimated at about 13 million in Ethiopia. Majority of these children are not getting proper nurturing care. The main cause for the problem of children deprivation of proper care and support is low awareness and knowledge of the importance of early brain development and responsive care giving among in low-literacy and low-income rural communities in Ethiopia. 

We are proposing two effective knowledge delivery mechanisms, namely 1) Learning Through Play (LTP) and 2) early Audio-visual early brain development education program that fit rural, low-income and low-literacy communities where there is underdeveloped infrastructure to improve parents’/caregivers’ knowledge, skills and practices of proper nurturing care to bring about positive change in physical, linguistic and social-emotional development of more than 100,000 young children over the coming 5 years.

A 2016 CCFC study of a rural district in Ethiopia showed that only 31.5% and 51.5% of children 0-3 years of age attained normal expected levels of cognitive and social-emotional skills (CCFC, Final Evaluation Report of Saving Brains Project, 2016) as majority of these children are deprived of early stimulation, adequate nutrition and play.

There are two major factors for lack of proper and adequate nurturing care for young children. First, there has been a lack of knowledge of good parenting practice on the part of parents/caregivers. Second, there has not historically been an adequate enabling environment to support holistic programs aimed at supporting comprehensive child development.

With regard to the former, we will work towards improving the knowledge and skills of parents on proper nurturing of young children through two complementary innovative knowledge delivery mechanisms 1) Learning Through Play (LTP)- with pictorially illustrated successive stages of child development and 2) community-led participatory audio-visual early brain development education program.

With regard to the latter, we are proposing to support Federal Ministry of Health on how to integrate proven social, emotional, and cognitive child development initiatives into the existing health extension worker platform at scale.

We will work directly with at least 95,000 parents (caregivers) and 200 health extension workers to improve the holistic development of about 100,000 children 0-3 years of age in low-literacy, low-income rural communities in Oromia Regional State of Ethiopia for the coming 5 years. We will involve mothers and fathers (female and male caregivers of children) in community conversation, orientation and training on proper nurturing care for young children. We will take into account the existing cultural norms and child-rearing practices in the communities while working with them.  In collaboration with Ministry of Health, we will provide training and job aid (on early brain development and comprehensive nurturing care) to health extension workers (HEWs) so that they can continuously provide technical support to parents through home visits and HEWs-Community platforms.  The knowledge delivery mechanism to parents (caregivers) in rural, low-literacy communities, wherein there is underdeveloped social and technological infrastructure will improve parents’/caregivers’ knowledge, skills and behavior in child-rearing, which in turn address the developmental needs of their children bringing about a positive and measurable change on the children’s physical, cognitive, language and socio-emotional development.

We will use two solutions to address the developmental needs of young children: 1) improving knowledge and skills of parents on nurturing care, 2) support strengthening national early childhood development system.  

For the first solution, there are the following two complementary knowledge delivery mechanisms. 

1. Learning Through Play (LTP):  which are pictorially illustrated showing the successive stages of child development with descriptions of simple play activities to enable parents easily understand age appropriate care and supports for children 0-3 years of age. LTP Calendars was originally developed by the Hincks-Dellcrest Centre and Toronto Public Health Department based on the works of Judith Evans and Ellen Ilfeld, and Dr. Bea Ashem. The Learning Through Play (LTP) program and materials including the Calendar and guidelines for parent group leaders and health promoters were new to Ethiopia and they were translated into the local language and illustrations were adopted to the local context. We have tested and demonstrated (from 2014-2016) the LTP Calendars that have been found to be effective in bringing about significant change in knowledge and skills of parents (caregivers) in Ethiopia. We want to scale up the LTP program.

2. Audio-visual early brain development education program: A community-led, participatory approach will be applied in producing and disseminating educational films (videos). The audio-visual education program on early brain stimulation, child nutrition and play will be used to facilitate discussions and learning among parents in order to enhance adoption of best practices for early brain development. The videos will be locally produced involving model mothers and fathers who are already using best practices in early childhood care from within the area. Trained Health Extension Works will disseminate the video messages to parents using small portable PICO projectors that use batteries (once fully charged the battery can be used for 8 hours) in rural areas or places that have no electricity.

For the second solution, we will closely work with Ministry of Health to build the technical capacity of Early childhood development (ECD) Workforce (mainly Health Extension Workers /HEWs by developing and equipping them with ECD training modules, guides, supervision tools, child development measurement, and other job aids incorporating LTP.  CCFC is one of the members of the National ECD Technical Working Group, led by Ministry of Health and Technical Working Group has already started working on improving ECD materials that can complement the LTP program in near future. 

Our solution uses a more effective way of knowledge delivery (using Learning Through Play and audio-visual) and takes less time to improve parents’ knowledge and skill on proper nurturing of their children and utilization of basic maternal, newborn and child health services.

It changes gender stereotype in child care and promote the equal participation of fathers and mothers in child parenting. It is a ground breaking parental educational practice to be applicable in rural, low-literacy communities with its suitability to cultural context of the target communities based on scientifically proved and field tested evidences suitable for the local context (in rural low-literacy communities).

The innovation will bring various experts (psychologists, health experts, nutritionist, community health workers) to work together to wards holistic development of young children (physical, cognitive, language, social and emotional development).

The innovation will accelerate early child development impact at scale through better nurturing care for and protection of young children.

Our innovation is effective knowledge delivery mechanism that can transform in knowledge, skills and practices of early childhood development in rural, low-income and low-literacy communities in Ethiopia.

It uses two innovative complementary knowledge delivery mechanisms that constitute our innovation

1) Learning Through Play (LTP):- It applies LTP calendars which are pictorially illustrated descriptions of simple play activities that promote caregiver-child attachment to enable caregivers easily understand successive stage of child development with interactive activities to provide the right interventions (care and support) at right time for children 0-3 years of age to enhance early brain development.

2) Audio-visual education program: This increases outreaches for disseminating early brain stimulation, maternal (caregivers’) and newborn health (child nutrition, infection prevention and  combating harmful traditional practices using participatory, locally contextualized educational films (videos) and portable devices (Pico Projectors) and other audiovisual materials to facilitate discussions and learning among parents in order to enhance adoption of best practices of maternal and newborn health in remote and hard to reach rural communities.

Our activities will focus on training and counselling caregivers and health extension workers using effective on knowledge delivery mechanism to improve parents’/caregivers’ knowledge, skills and behaviour in child-rearing or practicing proper nurturing care for their young children. Trained Health Extension Works (HEWs) will disseminate nurturing care messages contemporary knowledge and building upon indigenes knowledge) to parents using LTP and small portable PICO projectors that use batteries (once fully charged the battery can be used for 8 hours) in rural areas or places that have no electricity. The HEWs will also provide advice to caregivers through home visits. This will lead to change in knowledge and skills of caregivers in early child development and healthy pregnancy and birth and will challenge/combat existing harmful traditional practices. Improved in knowledge, skills and practices of caregivers will contribute to a positive and measurable change on physical, cognitive, language and socio-emotional development of children 0-3 years of age. 

We will compare baseline and post-intervention child development assessments (Ages and Stages Questionnaires or Kilifi Developmental Inventory and MacArthur Child Communicative Development Inventory) to measure child growth and development.          

We are currently serving about 11,520 children and 9,680 of their caregivers through early childhood care and development (nurturing care) programs. We intend to serve 20,100 children and 19,350 caregivers (parents) in one year.  We will work directly with at least 95,000 parents (caregivers) and 200 health extension workers to serve (improve the holistic development of) about 100,000 children 0-3 years of age in five years.

The overall goal is to improve holistic development (physical, cognitive, linguistic and socio-emotional development) of young children (0-3 years of age). 

There are two specific goals:

1.To improve developmental outcomes for children- increasing proportion of children achieve normal gross /fine motor skills, cognitive function language ability and socio-emotional capacities

 2. To improve home environment for children-  improving caregivers’ (mothers’, fathers’ or guardian’s) knowledge and practices on proper parenting, improved nurturing, early stimulation, child protection (safety, sanitation and hygiene).

Our approach will be part of existing national health extension system of Ethiopian Ministry of Health (MoH) to effectively scale it up. CCFC will support the MoH to spearhead the capacity building of the early childhood care (ECD) workforce by developing and equipping them with ECD training modules, guides, supervision tools, child development measurement, and other job aids incorporating Learning Through Play (LTP), and by delivering training for LTP Master Trainers and ECD workforce members.

There are two major barriers: financial and cultural barriers. Financial barrier is related to funding constraint. We need fund especially for the first three years for training, Learning Through Play material production and audio-visual message production and dissemination.

The cultural barrier is related to existing harmful traditional beliefs and practices that hinders the development of young children in the target rural communities. This requires effective behavioral change communication to change peoples perception and improve their awareness about early child development.

We will demonstrate the effectiveness of our approach in changing the lives of children and silicate fund from interested donors to replicate and scale up our solutions.

We will use effective community conversation (CC is used as an effective knowledge and information delivery mechanisms and behavior change communication.  At the end of CC sessions, the participants will draw recommendations and action points that they will take as an assignment to implement.

There are 2 full-time staff, 1 part-time staff, and 3 other field-level staff who will work in the communities (parents).

Lemma Asfaw (me, lead) hasMaster of Science (M.Sc.) and attended different international and regional trainings in program development. He has 24 years of experience in designing, planning, directing and implementation, monitoring and evaluation of development programs including early childhood care and development and health projects. Lemma is currently member of the national (Ethiopia) Early Childhood Development Working Group and Early Childhood Development Research Advisory Board which is coordinated by Ethiopian Federal Ministry of Health. He has been overseeing the piloted project on early childhood development implemented from October 2014-September 2016 in Ethiopia.

Professor Tirussew Teferra is expert in Early Childhood and Development. Prof. Tirussew worked as Researcher for National Research Project on Early Childhood Education and Co-Director for longitudinal research project on Early Psychosocial Development. He has been teaching at Addis Ababa University in early intervention, developmental psychology, psychopathology, and counselling on early childhood care and development over the last 23 years. He will be a Co-Project Leader for the solution and will be responsible for providing technical support to the project team on the implementation of innovative approaches related to early childhood development. 

Atsenash Gossaye is Public Health Specialist. She has over 14 years of extensive experience in program development and management with a focus on maternal, newborn and child health programs. Mrs. Atsenash was manager for the piloted project.  As a Project Manager, he will make sure the scaling up the project (the solution) by identifying best approaches and integrating the project with existing health extension system.

We are partnering with the local nonprofit organization called Bole Bible Baptist Church Child Care & Community Development (BBBC). BBBC assigns staff in the communities to facilitate community conversation (one of behavioral change communication methods) that contribute to raising awareness of parents about early childhood care and development.

The products are Learning Through Play (LTP) calendar and audio-visual (video). The LTP calendar, which will be printed and distributed to parents will be used by caregivers as a guide to provide age-appropriate nurturing/responsive care for their children. The audio-visual (video) will be used by Health Extension Workers (HEWs), early child development and health workforce are hired and managed by Ministry of Health, to disseminate early childhood care development messages to caregivers. The video and PICO projectors will be provided to HEWs to enable them disseminate information to parents in rural areas. For the first three years the LTP calendar, video and PICO projectors will be provided free of charge and in the subsequent years (year 4 and 5), the products will be among public health model through government funding to avail the products in the forms of hard copies for LTP calendar and electronics copies (CD, VCD) with multiple language of video massages to the users. 

The impact of the products in terms of delivering knowledge to caregivers and changing knowledge, skill  and behavior of caregivers on nurturing care was proven to be effective in improving holistic development young children. Return for investment is high. For every $1 spent on early childhood development interventions, the return on investment can be as high as $13 (Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential, World Health Organization 2018).

We will solicit fund from interested donors (presenting our proposal and evidence based track records on early childhood care and development intervention and impacts) for the first three years of our work as we need fund for training of caregivers and early child development workforces (health extension workers) and production and distribution of our products (LTP and video) free of charge.

Christian Children's Fund of Canada (CCFC) and SickKids Center for Community Mental Health (formerly known as The Hincks-Dellcrest Center) have already documented and proved that LTP materials can be used in different countries including in Ethiopia in hard copies for low-literacy, low-income rural communities, and given that if these products are produced in terms of digital way it can attract new caregivers (guardians), teachers, health promoters, and other parents to buy the materials.

We will advocate that the Government to allocate budget for the production and distribution of the products starting the 4th years of our intervention.

The demand for the LTP calendar will increase as the awareness of the users’ increases. The production economics (cost of the product) will be in line with ability of the users (about $2.5 USD/pc of a product (LTP calendar). The product will be supplied locally- private sector (publishers, day care centers, KGs), social enterprises /national organization specializing in social enterprise) being the delivery channel to reach the target users beyond the period of funding.

We are applying to Solve for two reasons. First, we hope that Solve can link us with potential donors who may be interested in our solution to improve physical, cognitive, linguistics (communication), social and cognitive development of young children. 

Second, we hope that Solve can link as with inventors and business communities who can supply communication technology device like PICO projectors (high resolution with durable batteries- once charged to serve longer hours)  to enable disseminate audiovisual massages to rural communities where they have no access to electricity or TV. 

Thus, we are seeking support from Solve give us opportunity to have access to a platform where we can show our innovative solution to funders and business communities. 

Ministry of Health (MOH) of the Ethiopian Government is one of key partner for this initiative and it has committed to collaborating with CCFC to replicate and scale the solution. MoH is responsible for managing health facility-based health workers and HEWs, who will provide counseling and education to parents on LTP.

The SickKids Center for Community Mental Health (formerly known as The Hincks-Dellcrest Center) is also key partner responsible for providing technical support in revising and adapting LTP materials (calendars and guides) and in designing child development assessment tools.