In Kenya, Beatrice Oyugi is helping children reach their full potential

Decades of research have shown that children’s early experiences in life have lasting effects on their health, education, and success in adulthood. In fact, the first one thousand days of a child’s life are a crucial period for brain development. What does it take to provide them with nurturing care during this time? Beatrice Oyugi knows.

Beatrice is a dynamic public health professional with a passion for creating lasting change. As the manager and regional technical advisor of PATH's Early Childhood Development (ECD) Program in Kenya, she leads with expertise honed over an illustrious 18-year career in the field.

Beatrice's journey began at the Kenya Medical Research Institute (KEMRI), where she played a pivotal role in HIV prevention for preteens and teenagers. Among her achievements, Beatrice stands out for developing evidence-based interventions that have not only transformed lives but have also been embraced on a national and regional scale, contributing to a significant reduction in HIV rates in Kenya.

Her ability to turn research into actionable solutions has been the hallmark of her career. Beatrice's unwavering commitment to public health and her proven track record make her an invaluable leader within PATH, where she continues to drive impactful change in early childhood development. Her work is not merely a profession but a calling, and her dedication inspires those around her to make a meaningful difference in the lives of children and families.

Working for several organizations over the years, Beatrice says she gained tremendous experience and understanding of how health systems are structured and how services are delivered to different populations. “That understanding gave me an edge and aroused my interest in working to strengthen the health systems, and that is how I enrolled for a master's degree in public health, because I realized that's where my passion was,” Beatrice says.

Beatrice joined PATH in 2014 as an ECD field officer, where she settled seamlessly into supporting the Siaya County government to integrate Nurturing Care for Early Childhood Development (NCfECD) into the health system. Nine years later, she has grown into her current position, where she oversees PATH’s ECD work in Kenya, particularly supporting the national government and the 14 counties of the Lake Region Economic Bloc to lead and invest in ECD.

“We have developed training packages for different cadres of staff, adapting and contextualizing them to fit into the health systems. I have built the capacity of health managers at county and subcounty levels and supported them to train frontline health workers including clinical health providers and community health promoters on how to integrate nurturing care for early childhood development into routine maternal and child health programs such as antenatal care, maternity, child welfare services, and general pediatric care,” she says.

For Beatrice, her passion working in ECD is personal, and for a good reason. For starters, she is a proud mother of three, and she admits that “motherhood has been the best gift that life has offered me.”

“It's one thing that I have given my very best, and it gives me great satisfaction looking at my children now, and who they are becoming,” she says. This backdrop has fueled her passion and goal in helping children live healthier and fulfilling lives.

“The period from pregnancy to age 3 scientifically is the most critical for overall human development, because that period lays a foundation for health, well-being, and learning and for productivity throughout a person's life,” says Beatrice.

“Scientifically,” she adds, “that is the period when the brain develops most rapidly. At that point in time, the brain is overly sensitive to inputs from the environment, meaning that it can take on so much from the environment and it is entirely dependent on the environment.”

According to Beatrice, at the center of ECD is the understanding that the growth and development of a child’s brain and how well it develops is intrinsically dependent on the caregiving environment. Some of the critical questions to be answered include: Who cares for the child? How are they caring for the child? Is the child able to access the resources that would help them to develop optimally?

“So, you realize by the time the child is 3 years of age, up to 80% of the brain is developed, and that it's upon this that future development and learning will take place,” she says.

“Therefore, supporting early childhood development is about ensuring that children get the best start in life. At the center of ECD is the caregiver—the one who takes care of the child. For children to develop optimally, their caregivers require support too. They need to be equipped with knowledge and skills to provide responsive care to their children,” she adds.

Beatrice indicates that her work involves supporting governments to implement the five components of the nurturing care for early childhood development framework. The first component is good health. This is about the health of the mother from preconception through pregnancy and lactation, and the health of the baby while in the womb, at birth, and during the first years of life. “A mother should access pre-conception care, antenatal care, skilled delivery and postnatal care, and babies should receive scheduled vaccines, growth monitoring, and sick child consultation,” says Beatrice.

The second component of the nurturing care for ECD framework is adequate nutrition, supporting maternal nutrition from preconception through pregnancy and lactation and ensuring the baby’s nutritional needs, ranging from exclusive breastfeeding during the first 6 months of life to diversified complementary feeds from 6 months on.

Beatrice asks, “During breastfeeding is the mother getting enough nutrients that would support her own health and the health of the baby? And then post-delivery, how is the mother supporting the nutritional needs of the child? And is breastfeeding exclusive as recommended for the first 6 months?”

The third component is responsive caregiving. According to Beatrice, “This refers to a caregiver who is sensitive and responsive to the needs of the child. Sensitivity means they can identify the needs of the child, while responsivity means they can respond in a manner that is matched to the child’s need.”

The fourth component is safety and security of the child. “This involves making the child feel secure and safe, and ensuring an environment where the child and the caregiver are free of violence, toxic stress, depression, neglect, and the like.”

The final component is providing opportunities for early learning. Beatrice says that learning begins at birth. The child needs to explore the environment freely and to interact with things around them, as learning happens through play. A child needs someone to constantly stimulate them, to speak, to explain to them the environment and what is happening. When that is done, the child learns so much, especially at this time when the brain is sensitive and depends on inputs from the environment.

“So early childhood development, the work that I am very passionate about, is about giving children the best start in life. Scientifically, this sets them on a positive trajectory for health, development, and productivity that lasts a lifetime,” says Beatrice. She adds that nurturing care for early childhood development enables children to develop executive function skills early in life that help them to become resilient and eventually productive adults in society.

To date, through Beatrice’s work and efforts, and in collaboration with other key stakeholders, the government in Kenya at national and subnational levels has revised relevant policy documents, guidelines, and tools to integrate nurturing care for early childhood development into maternal and child health programs. Some of these documents include the Newborn, Child, and Adolescent Health (NCAH) policy 2018, Kenya Community Health policy 2020–2030, Smart Start Siaya Strategic Plan 2020–2025, Integrated Management of Newborn and Childhood Illnesses (IMNCI) guidelines, Mother and Child Health Handbook 2020, and several Ministry of Health registers. Beatrice is also a member of the national team that is working to update the Kenya integrated ECD policy and the Nurturing Care for ECD Advocacy strategy.

In Siaya County, where PATH has been supporting integration of ECD into the health system, Beatrice’s efforts have led county and subcounty teams to be trained as trainers in integration of nurturing care for early childhood development into the health system. These government trainers have in turn trained up to 80% (687) of clinical providers employed by the government and 100% (2,148) of community health promoters to integrate the five components of nurturing care into their clinical consultations and household visits, respectively. This has translated into about 350,000 children and their caregivers benefiting from the project.

Joel Milambo, Siaya County’s focal person for community health services, says that PATH has been instrumental in supporting the county government to integrate nurturing care for early childhood development into primary health care.

“Beatrice has been the face of this work. Her technical guidance has helped us to institutionalize nurturing care for early childhood development. She has ensured that the government engages in every step of this work, facilitating co-creation sessions at various levels, and ensuring that government leads. We are confident that this work will be sustained within our government systems,” adds Joel.

In addition, to facilitate sustainability of services way beyond the project lifeline, Beatrice has technically supported the health system at higher levels by equipping 52 county and subcounty teams with knowledge and skills to provide post-training support to trained providers through targeted mentorship and supportive supervision.

“I have also equipped county and subcounty teams with the skills and tools to ensure quality of integrated nurturing care for early childhood development programs through mentorship and supportive supervision. This post-training support is integrated into their routine supervision structures to ensure sustainability,” says Beatrice.

Beatrice has also advocated for political goodwill and government leadership with county governors and executive teams, where she has conducted numerous meetings to sensitize them on the rationale for investing in ECD. “As we speak now, we have seen county governors giving directives that ECD must be budgeted for and integrated into county development plans as a priority program,” says Beatrice.

Undoubtedly, Beatrice’s work has not gone unnoticed. She is currently the chair of the Early Childhood Development Network for Kenya, which is a network of organizations ranging from grassroot to national to international players within the ECD space.

“I chair the Board of Directors, and we deliberate on issues around ECD. We advocate for coordinated action amongst non-state actors as we engage with governments at national level, at the Council of Governors, at the subnational levels, through regional economic blocs, and at the county levels, for government leadership and investment in ECD,” adds Beatrice.

The PATH Kenya ECD project, through Beatrice’s leadership, recently piloted a group-level parenting intervention program in collaboration with the United States Agency for International Development (USAID) Nuru Ya Mtoto project. The pilot project focused on improving positive parenting skills and mental well-being of adolescent girls and young women enrolled in the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative. The results of the pilot showed improvements in knowledge and skills in responsive caregiving, relationships, and mental wellbeing among adolescent girls and young women. The PATH-led USAID Nuru Ya Mtoto project implements the DREAMS initiative as the main approach to bring HIV prevention services to vulnerable adolescent girls and young women in Homa Bay and Migori counties.

Beatrice has also been collaborating with PATH’s Living Labs project, using human-centered design to refine the nurturing care ECD model, drawing from lessons learned from implementation over the years. Through human-centered design, Beatrice and the team are working with users including health management teams at county and subcounty levels, clinical providers, community health promoters, and caregivers to co-create solutions that improve quality of services, are feasible within the health system, and are impactful in improving caregiving practices.

Editor's note: As of 2023, Beatrice Oyugi is no longer with PATH. We remain grateful for her important contributions to health equity.