Setting Our Agenda on Early Learning, Violence and Physical Environment: Care for Child Development

This article by the World Health Organization (WHO)/United Nations Children's Fund (UNICEF) discusses what the two organisations have learned over the last 10 years about how scalable health services for children aged 0-3 can be integrated with counselling parents to promote early learning. From the Bernard van Leer Foundation's Early Childhood Matters (pages 15 - 19), the article describes the development of a module for care for child development as part of the Integrated Management of Childhood Illnesses (IMCI) strategy.

Underpinning the development of the IMCI-embedded module was the thinking that interventions to promote growth and those to promote psychological development have an even greater effect when linked to each other and to recognition of the role of parents. "The Care for Development Module included recommendations to parents to support cognitive development (play), social-emotional and language development (communication), and responsive feeding, as well as breastfeeding and complementary foods." It was decided to focus on O-3-aged children through the delivery mode of both the healthcare system and community outreach. The prompting questions for health workers to use with families were "embedded into the feeding module to emphasize the value of responsivity both to a child’s feeding and to the child’s development..." with an emphasis on recommendations to parents rather than health screening. Information and recommendations for families to help them provide cognitive stimulation and social support to young children became part of the child health visit specified in IMCI. "WHO prepared not only the Care for Development recommendations, as part of the Counsel the Mother Card (PDF) - a translatable illustrated card on childcare for mothers, but also prepared advocacy materials (video and newsletter), technical seminars, training materials for the trainers of health workers, a facilitator’s guide for training of trainers, a checklist for a three-day training, and video training materials."

Four evaluations, in Brazil, South Africa, Turkey, and China, were undertaken prior to scaling up the project. Evaluations assessed health worker understanding and recall of materials, consultation behaviour changes in trained health workers and client satisfaction, home environment quality assessment, and the efficacy and appropriateness of counselling materials based on the Mother's Card. "These research studies have shown that the appropriate use of the Care for Development materials can have a significant impact on parenting behaviours and child development...", for example "highly significant differences in young children’s cognitive development, and in mothers’ understanding of the recommendations after home visits by a trained specialist....The results from all the studies are quite consistent: one can change health care providers' behaviours substantially with training, and when they are observed, in order to improve care for development. With additional training, the quality of the caregiver/ care provider interaction improved significantly and ...so did satisfaction with the care provider."

As a result of positive evaluation outcomes, WHO, UNICEF, and partners are promoting the integration of the Care for Child Development intervention into existing health systems in a number of countries. In addition, a 10-year materials review resulted in the following additions: "an increasing focus on the newborn... giving specific recommendations for the birth to one week period; new recommendations for dealing with maternal depression, and with children affected by the HIV/AIDS pandemic; recommendations addressing issues of child discipline, given growing concern about the dangers of harsh punishment and its wide usage in many countries; new suggestions for using books and pictures, where available; and specific suggestions for involving fathers." Also, because IMCI is not available in all countries, a new module was added that could be incorporated into any primary health care, rather than only IMCI.