Angelica Francisco—a Maternal & Child Health (MCH) nurse in the maternity ward of Carapira Health Center—knows that the early stages of a child’s life impact their development, and that caregivers begin setting the foundation for their future before the child is even born and continue doing so from the first moments after birth. She also appreciates the opportunities afforded to her in a maternity ward. Mothers spend at least 24 hours in the ward and have their companions to support them throughout, which offers a significant opportunity for counseling and equipping them with skills to provide the best possible care for their newborns.
In Nampula, Mozambique, a team of dedicated health professionals, decision-makers, and their partners embarked on a human-centered design (HCD) activity in late 2022, to optimize the promotion of early childhood development (ECD) in health services. Through collaborative efforts with MCH nurses, the team co-created solutions that focused on integrating ECD counseling into maternity wards.
Together, the team established a set of steps for the nurses to promote ECD through their interactions with caregivers and their companions, starting with the first moments after birth and ending with the last moments just before the mother and baby are discharged. This design was aligned with PATH’s Primary Health Care (PHC) strategy to provide integrated services at key contact points.
The interventions were tested for 6 weeks in maternity wards within four health facilities in Monapo District, Nampula Province, including Carapira Health Center, Monapo Sede Health Center, Itoculo Health Center, and Monapo Rio Health Center.
Key findings
As the weeks progressed, the team observed a transformation in mothers’ and companions’ experiences in maternity wards and their perceptions of the importance of ECD. The transformation was measured by comparing baseline and endline data. At baseline, only 38 percent of the mothers and their companions reported that they received counseling on two target ECD practices (talking to the newborn and providing baby massages). By endline, that number increased to over 90 percent.
“The nurse explained that a child is like a computer, he 'records' everything he learns when he is a child,” one mother in Monapo Sede Health Center stated. She represents just one of the mothers whom the Nampula MCH nurses counsel daily to instill the value of early communication with newborns.
Prior to the intervention, most caregivers saw talking to the newborn as a way to assess if the child is healthy and to help them become familiar with their family members. No caregivers talked about how talking promotes learning at baseline; however, thanks to the nurses' counseling, 68 percent of caregivers at endline mentioned that communication stimulates the child's language and intelligence.
Also, over 70 percent of caregivers at endline (compared to 14 percent at baseline) were able to demonstrate baby massage steps. This learning was supported by a revised job aid, where massage steps were aligned with typical newborn exam steps. This alignment was suggested by the MCH nurses during the HCD process, as a way to help them remember the massage steps better. The need for alignment with other practices was not at all obvious when a massage poster was originally designed and even approved by the Ministry; as such, it illustrates the power of HCD to discover and resolve barriers to real-life applications.
Encouraging interventions that target fathers
Fathers’ participation in childcare is associated with better maternal and child health outcomes and better child development. Helping fathers engage with the child during pregnancy and straight after birth is particularly effective as fathers are more open to learning during these life-changing events. However, inviting and engaging fathers in maternity wards is not common, and therefore represents a missed opportunity.
Through the HCD process, fathers started gaining a foothold in the maternity wards. At the start of the intervention, no fathers were seen in maternity wards and no specific messages were directed towards them, according to mothers. As the weeks passed, the nurses began concerted efforts to invite the fathers to join their counseling. By endline, over 50 percent of the mothers reported nurses addressed specific messages to the father—especially as it concerned holding and talking to their babies from birth.
Nurse Atija Antonio invites fathers to participate at discharge counseling in her maternity ward, and asks them to hold and greet their newborns. Itoculo Health Center, Monapo district, Nampula province. Photo credit: PATH
The project team was delighted to witness the growth in knowledge about caregiving practices and see that the solutions were effective. However, the interventions would only be considered successful if they were sustainable. The nurses engaged in the human-centered design found counseling on ECD to be an acceptable and viable intervention to incorporate in their daily routines, and committed to doing so beyond PATH’s intervention in the district:
“Even without the support of the project, it is an asset for the MCH nurses and for the caregivers. The MCH nurse gives advice to avoid development delays and parents pay attention.”— Nurse Angelica
The success story of this project in Nampula, Mozambique is a testament to the transformative power of human-centered design. The use of HCD exemplifies current global PATH strategy where inclusive innovation and community engagement are key agents of change. It also reflects PATH Primary Health Care strategy, where people are put at the center of our approaches and receive integrated care at key points across the life stage.
