From Uganda to Lebanon: Experiences with Integrating Early

Childhood Development, Health and Nutrition Programs

Presenters:

Inka Weissbecker, International Medical Corps (IMC)

Jennifer Burns, International Medical Corps (IMC)

Mary Helen Carruth, Medical Teams International (MTI)

Laura Peterson, Hands to Hearts International (HHI)

Early Childhood Development

• Early years of childhood form the basis of intelligence, personality, social behavior, and capacity to learn and nurture oneself as an adult.

• Health services/workers and providers play an important role in promoting development of young children.

• Focusing exclusively on targeted interventions such as health and nutrition without considering the holistic nature of ECD risks the hindrance of children’s complete growth and development

Adverse Childhood Experiences (ACEs)

ACEs include:

•multiple types of abuse

•neglect

•violence between parents or caregivers

•other kinds of serious household dysfunction

•alcohol and substance abuse

•and peer, community and collective violence

Early Childhood – roots of health

Toxic stress (Adverse Childhood Experiences) in childhood creates life-long consequences for a person's health and well-being. It can disrupt early brain development and compromise functioning of the nervous and immune systems.

In addition because of the behaviors adopted by some people who have faced ACEs, such stress can lead to serious problems such as alcoholism, depression, eating disorders, unsafe sex, violence, HIV/AIDS, heart disease, cancer, and other chronic diseases.

Times of exceptional stress?

The settings we all work in –

•Emergency & post-emergency

•Conflict & post-conflict

•Developing communities/economies

These are all times of great risk for increased family stress, abuse, violence, neglect, hunger, illness, mental health issues, etc…

Lira Child

Survival Project

Post Conflict Environment

In the Northern Uganda, post-conflict context, service provision is continually improving as the Ministry of Health and NGOs re-construct health facilities and provide health services at the community level.

Characterized by food insecurity, unreliable infrastructure, and a fragile family unit.

It is an important time to rebuild community resilience by strengthening the parent-child bond, developing and reinforcing positive caregiving practices to improve long term child health and well-being.

Early Childhood Development in Uganda Early Childhood Development (ECD) policy was

established in 2007.

Investment in ECD is low.

ECD services are primarily sector based. Health, education and social services are provided in different settings.

The Early Childhood Learning Framework developed for ages 3-6 years. As of yet, there is no framework for the ages of 0-3 years.

Project Location

Approaches to Promoting Positive ECD Practices

1) Group sessions by health staff and Peer Educators for patients waiting for services in health facilities and during immunization outreach

2) Before midterm Peer Educators worked in female/male pairs led group trainings in their communities to reach both men and women caregivers (8 - 3 hour weekly sessions)

3) After midterm Peer Educators delivered ECD lessons directly to caregivers in their homes (8 visits to cover each module)

Indicators to track ECD Impact Linguistic Learning: % of mothers who told a story, sang or named objects for their child at least 2 times per week

Responsive Feeding: % of mothers who report talking or singing to their child while feeding them

Physical Development: % of mothers who report helping their child walk, playing a lap game, massaging or rubbing them gently, or by giving them objects with which to play

Cognitive Stimulation: % of mothers who provide cognitive stimulation in the form of games such as “where are your eyes”, etc.

Findings from Focus Group Discussions

• Health Clinic staff reported giving ECD messages to 60-85% of their patients

• baby massage, breastfeeding, nutrition, baby cues, language and cognitive development and the importance of love and affection.

• They credited the ECD trainings with improved relations between staff and parents, increased use of HC services, and a decrease in using traditional healers.

• They also attributed outcomes such as: improved child and hygiene; greater affection between parent and child, with parents being more communicative and gentle with their child.

Findings from Focus Group Discussions

• Village Health Workers & Peer Educators reported giving ECD lessons to an additional 88 people each (avg.) – beyond their formal trainings that were documented

Findings from Focus Group Discussions

ECD trained parents: •“because of the good relationship I have established between me and my child she now understands me and listens to me and above all loves me more than before”•“children do not fear us anymore” •“whenever my child hears the sound of my bicycle while arriving home, she runs out to greet me.”

Findings from Focus Group Discussio

• One father indicated that the ECD trainings showed him that he had true value as a caregiver, something he had not seen before. This realization led him to come home at nights and not stay out drinking. At home he enjoyed the affection his child had for him.

Findings from Final Evaluation

Findings from Final Evaluation

Arenas of Positive Change

1. Relationship with the child

2. Relationship between parents

3. Health behaviors

Findings from Final Evaluation

• “Decreased family violence is an unexpected finding; attributed it to the ECD interventions. ECD peer educators (PE) did teach parents alternatives to violence when relating to their children and parents found them effective.”

• “It is not possible to determine the causal factors for this behavior change but we can say that in the non-ECD intervention community, men did not talk about their wives loving them more and they did talk about caning their children.” ~ USAID Evaluator, Sue Leonard

How ECD is related to protectionResearch has shown that six protective factors are linked to a lower incidence of child abuse and neglect:

• Nurturing and attachment• Knowledge of parenting and of child development• Parental resilience• Social connections• Concrete supports for parents• Social and emotional competence of children

WHO “Prevention Violence” report

Child maltreatment is in families that:

• Have difficulties developing stable, warm and positive relationships

• Have a poor understanding of child development, and therefore have unrealistic expectations about the child’s behavior.

• Do not show the child much care or affection

• Have a harsh or inconsistent parenting style, and believe that corporal punishment is an acceptable form of discipline

WHO “Prevention Violence” report 1. Opportunities for parents to

practice new skills

2. Teaches parenting principles rather than specific techniques

3. Teaches positive parenting strategies, including age-appropriate discipline

4. Considers difficulties in the relationships between adults in the family

SummaryECD offers the perfect in-road to address a wide variety of issues, and in particular, can promote safe, stable, and nurturing relationships between children and caregivers which are protective against neglect and abuse.

Benefits are lifelong foundation for > health, wellness and success.