Nurturing Care Implementation: Regional Perspective

1. Nurturing Care Implementation: Regional Perspective Kenya PaediatricAssociation -2019 Annual Scientific Conference 9th – 12th April, 2019 – SarovaWhitesands, Mombasa, Kenya Theme: Beyond Child Survival – A Holistic Approach to Child Health

2. Overview Of The Presentation • Overview of Science of Early Childhood • What is Nurturing Care • Current country engagement in nurturing care • Challenges and innovative approaches to nurturing care programming • Seizing Opportunities • About Africa Early Childhood Network (AfECN) Najma Rashid_ KPA Scientific Conf2019

3. The Science of ECD:The interaction of genes and experience shape the developing brain • The brain develops a genetic blueprint in the embryo/fetus that establish the broad strokes of development • The environment modifies this blueprint during critical periods of development RESPONSIVE CAREGIVING (interactions with adults) is the active ingredient Najma Rashid_ KPA Scientific Conf2019

4. Sensory, language and cognitive functions are dependent on early experiences between conception to 2 years Cell division and migration Najma Rashid_ KPA Scientific Conf2019

5. The importance of caregiver-child interactions “Every time a parent speaks to a young child, it sparks something in the child; it’s stimulation to the child. It forms brain connections”. - Dr Pia Rebello Britto, neuroscientist, UNICEF senior advisor on ECD Responsive caregiving • Quality interactions between adults and young children Najma Rashid_ KPA Scientific Conf2019

6. Nurturing care is a set of conditions for a whole society child centered approach to strengthening societies • Nurturing children means keeping children safe, healthy and well nourished, paying attention and responding to their needs and interests, encouraging them to explore and providing them with opportunities to learn. • In order for caregivers to be able to provide nurturing care, they must be secure, economically and socially, participate in social networks, be empowered to make decisions in the best interest of the child, and affirmed in the important role they play in the lives of the children in their care. Najma Rashid_ KPA Scientific Conf2019

7. What are the ingredients children need to have the best start in life – Nurturing Care • Poor nutrition stunts brain growth • Brain development requires protective, caring environments • Poverty major driver of developmental delay in children • Early stimulation is critical for later brain learning • Neglect fails to provide stimulation essential for brain function • Abuse results in elevated levels of cortisol which is toxic to brain cells Health/nutrition Physical environment Early learning Protection Responsive Caregiving Najma Rashid_ KPA Scientific Conf2019

8. There are multiple entry points to strengthening the enabling environment that young children develop Caregivers’ capabilities Enabling policies Empowered communities Supportive services Najma Rashid_ KPA Scientific Conf2019

9. Country Engagement in NC Mozambique: • A comprehensive approach- integrating NC in into antenatal consultations (counseling on bonding with baby and stress reduction), childbirth care (the new neonatal approach to IMCI includes developmental monitoring, counseling on responsive care and early stimulation), and during the postpartum consultation (screening for maternal depression and counselling) • Integrated in nutrition programs and pre-service training of CHWs as well as in their job aids. Najma Rashid_ KPA Scientific Conf2019

10. Country Engagement in NC- Cont Zambia: • Embraced the launch of the 2016 Lancet series on ECD and the Nurturing Care Framework, however, national data on the domains of responsive caregiving and opportunities for early learning are very limited. • finalizing the integration of the NC framework into the relevant policies and guidelines for Reproductive Health, Child Health and Nutrition. • Promoting intervention of Caring for the Child’s Healthy Growth and Development in coordination with several ministries and partners. Najma Rashid_ KPA Scientific Conf2019

11. Country Engagement in NC- Cont Ethiopia: • ECD included in the Government’s annual workplan for 2018 • Established ECD technical working group consisting of different partners, programmes/directorates and representatives of various ministries. • A research advisory council established a working group that is collaborating with universities, focusing on child development. • Developed messages for mobile phones targeting mothers with children and established better day care services where NC (stimulation) is integrated • Plans underway to conduct CCD TOT to build capacity of the TWG to advance ECD agenda Najma Rashid_ KPA Scientific Conf2019

12. Country Engagement in NC- Cont Malawi: • Developed a multi-sectoral ECD policy, with the Ministry of Gender, Disability and Social Affairs as lead agency • Good coordination supported by having shared strategies for implementation, strong leadership, prioritizing ECD, partnership building, capacity building, joint quarterly supervision visits, planning and reporting. Najma Rashid_ KPA Scientific Conf2019

13. Country Engagement in NC- Cont Tanzania: • The focus is on building capacity of health management teams at regional and local level, create master trainers in communication for development, and train CHWs, community leaders and volunteers. • The idea is to integrate nurturing care into the existing policies and guidelines for RMNCH, TB, Family Planning, PMNCT and nutrition rather than create parallel approaches. Health staff are trained in early stimulation and health facility are being reorganised to have child friendly corners. • Conducted National advocacy and established ECD National Task Force (devt. NC strategy for Tanz) Najma Rashid_ KPA Scientific Conf2019

14. Country Engagement in NC- Cont Zimbabwe: • Zimbabwe has not yet formally adopted the Nurturing Care Framework, but some components are addressed through the nutrition programme, civil protection, social welfare and the Ministry of Primary and Secondary Education. • Focus on reducing stunting and a pediatrician at a hospital has been providing rehabilitation services that include play and counseling for young children recovering from severe acute malnutrition. • A multi-sectoral module for nutrition in health facilities and communities for children under age 2 has been developed • Plans to establish a multi-sectoral technical working group to develop a national ECD policy Najma Rashid_ KPA Scientific Conf2019

15. Challenges and Innovative Approaches to Implementing NC • Working together across sectors and agencies • Financing • Integrating NC into existing services • Building and sustaining provider capacities • Identifications and involvement of champions- National and Local (first ladies…) • Exploring indigenous parenting practices • Using special health and nutrition events and mobile technologies • Setting up research mechanisms to generate evidence • Use regional/ global advocacy to enhance national commitments (e.g. letter from WHO to government to strengthen country action, ECSA, CSO Forum) • Establish a functional secretariat that supports the TWG and coordinates all stakeholders. • Leverage resources across donors and fund activities across sectors. • Review /adjust workflows of services and workloads of facility and community-based health providers • Train facility and community-based health providers in their local health facilities and provide Supportive supervision to sustain the quality of service • Transforming Health Facility Waiting Rooms and paediatric consultation !!! • Integrating NC in Universal Health Coverage Opportunities Najma Rashid_ KPA Scientific Conf2019

17. AfECN is a regional civil society network that brings together stakeholders to advocate for the rights of young children VISION All young children in Africa grow up in a safe, healthy, stimulating and happy environment; able to thrive and achieve their full potential MISSION To serve as a platform for the promotion of excellence and collaboration in protecting children's rights, influencing policy and practice through advocacy, strengthened partnership and sharing of experience and knowledge. EST 2015 Africa Regional ECD Network Najma Rashid_ KPA Scientific Conf2019

18. AfECN works to achieve 4 strategic goals Enhanced Advocacy Strategic Partnership Knowledge Generation and Dissemination Improved Practice Najma Rashid_ KPA Scientific Conf2019