In Mozambique and other countries where PATH works, mothers and other caregivers are learning the skills to support their children’s physical, cognitive, and emotional growth. Photo: PATH/Svetlana Drivdale.
Investing early so children survive and thrive
“How do you know your child is growing well?” a peer educator asks a group of mothers waiting to be seen at a clinic in Mozambique.
Waiting times can be long at health clinics, but these mothers and their children are engrossed. Pointing to a chart illustrating child developmental milestones, the peer educator says: “At three months, a child should be able to hold his or her head upright.” She adds, “Reaching for toys helps children build neck strength.”
After the talk, mothers help babies reach for colorful bottle shakers, while toddlers pull homemade rag dolls and toy cars from a play box. While the children play, unaware they are helping their young bodies and minds grow, the peer educator counsels the women one-on-one about the importance of play and shows them age-appropriate activities they can do at home.
The window of opportunity
The foundation of health and well-being is laid early in life, especially from conception until a child’s second birthday. The damage from poor health, undernutrition, and developmental delays during this time can be irreversible.
Exposure to HIV and poverty exacerbate these early deficits, jeopardizing not only children’s development, but the physical and emotional capacity of caregivers to offer high-quality care. As a result, hundreds of millions of children worldwide suffer from chronic health problems, do poorly in school, and fail to realize their full productive potential as adults.
But this period also represents a window of opportunity, when early childhood health and development interventions can give children the foundation to thrive. To that end, PATH adapted a UNICEF/World Health Organization training package, called Care for Child Development, and tailored it to a number of African settings.
By focusing on this window of opportunity, we’re helping to shape children’s long-term physical, cognitive, and emotional health and break the cycle of poverty.
Intervening across the continuum of care
Integrated early childhood development encompasses a range of interventions—nutrition, health, care that is responsive to a child’s needs, and healthy stimulation of body and mind. It starts with the health of a woman during pregnancy; supports her through the care of her baby; and follows both her and her child through the early stages of growth.
"We have reduced the maternal deaths. We have also reduced the neonatal and children's deaths. So it is a great impact."
PATH works across this continuum of care—making sure women get regular prenatal care, infants are born safely, and babies get the best health, nutrition, and early childhood development services. We integrate early childhood development efforts into the touch-points where women and children intersect with their local health systems, both in the clinic and at home. We work with government health services to train community health workers, nurses, and specialists to incorporate new skills in nutrition, tracking developmental milestones, and counseling caregivers.
By helping clinicians and families anticipate and respond to children’s health, nutrition, and developmental needs—and recognize when milestones aren’t being met—we are imparting the skills needed to intervene early so children can develop to their fullest.
Partnering is key
PATH’s early childhood development portfolio includes foundation, corporate, and US government–funded projects in Kenya, Mozambique, and South Africa. In each country, we partner with national and local governments, United Nations agencies, civil society organizations, and communities to tailor our approach, maximize reach, and ensure the work endures.
At each community and health service touch-point, we aim to:
- Improve health care and nutrition services for mothers and children.
- Strengthen screening and referral systems to detect and address problems in child development.
- Provide caregivers with the skills to stimulate their children’s physical, cognitive, and emotional growth.
The importance of play
Building a child’s self-confidence, relationships with others, and language, cognitive, and motor skills are all parts of helping a child thrive. Play is one critical way that children develop the range of skills they will need to be successful later in life.
Play with homemade toys helps children develop skills they will need to be successful later in life. Photo: PATH/Svetlana Drivdale.
Because people in resource-scarce environments often have limited leisure time, our approach is to help parents and other caregivers meet children’s need for play and interaction in ways that are easy to incorporate into daily life. During clinic play-box sessions and home visits, health care workers demonstrate how to make toys from recycled materials and teach games that help children reach and stand, talk and learn. Caregivers are also taught to incorporate conversation and play into their routine activities.
Many dedicated parents don’t realize just how much of a difference these simple activities can make in their children’s lives. One mother said of the play box: “It affected me, because there are several things that I now know about a child’s development, such as what a child is capable of doing at certain times of growth.”
A boy named George
The integrated early childhood development approach is eye-opening for clinicians as well. Lispher Oichi, a physiotherapist at Yala Subcounty Hospital in Kenya, discovered how effective it is while working with a toddler named George. At nine months, George could not sit or hold up his head on his own.
Lispher observed George and his mother interact, using concepts Lispher learned from PATH’s adapted training on Care for Child Development. She noticed poor bonding and communication, and asked George’s mother specific questions related to caregiving and nutrition. Then she worked with the mother on a plan to improve her caregiving.
Within two months, George was able to hold up his head, sit with limited support, and make his first attempts at walking. His mother was cuddling him and making the regular eye contact he needed to feel secure.
“My original training did not focus on trying to understand the reasons behind poor development by talking to caregivers,” Lispher said. “I also did not know that simple toys produced in the community could be used to stimulate children so effectively.”
Surviving and thriving
Over the course of two years, PATH-supported community health workers in Mozambique and South Africa made more than 170,000 home visits, educating mothers about safe pregnancy and childbirth, nutrition, and the developmental needs of young children. Thanks to their efforts, women are coming to clinics earlier in their pregnancies. More are exclusively breastfeeding their infants and giving their young children opportunities to learn.
This work is also saving lives: Fewer babies have severe malnutrition or diarrhea, and fewer mothers are dying from complications in pregnancy and childbirth. In one South African district, PATH helped reduce the number of maternal deaths by 65 percent in just one year.
PATH has also contributed to significant drops in newborn mortality in supported regions of South Africa and Mozambique. In one of district in Mozambique, newborn mortality fell from 16 deaths per 1,000 births to 3 deaths per 1,000 in two years.
“An empowered citizen is able to look after himself,” said Nombusa Mamela, director of district community–based health services for the Department of Health in South Africa. “PATH has been able to encourage people to articulate their own health needs to know what they need to seek and where to get it. We have reduced the maternal deaths. We have also reduced the neonatal and children’s deaths. So it is a great impact.”