Since 2014, PATH has been working in Mozambique and Kenya to test tools adapted from the Care for Child Development package (WHO, UNICEF, 2012) with government community health workers (CHWs). In both countries it was the first time that CHWs were introduced to developmental monitoring and counseling. The eventual objective was to integrate ECD content into existing government tools provided to CHWs, and this was achieved to different degrees in both countries.
PATH had designed and tested a standalone CHW ECD package—training manual, pictorial job aids, and mentoring tool drawing on the Care for Child Development—in southern Mozambique in 2016. A competency-based mentoring tool was the first CHW tool to check for the quality of counseling during household visits, as existing CHW tools only checked for clinical competencies. Assessment results indicated that trained CHWs were able to effectively deliver developmental monitoring and counseling during their household visits.
As the next step, PATH supported integration of relevant ECD content into several national tools, such as CHW training manuals and supervision tools. It also developed and validated extra pages on child development, nutrition, and postnatal care for the CHW flipchart, and co-created relevant content for a CHW app with a partner NGO, the Malaria Consortium. Finally, PATH supported the pilot of a CHW ECD indicator and CHW data dashboards in one province, with the intention to inform MOH adoption of such tools in the future.
Current restructuring of the community health subsystem in Mozambique has put this technical work on hold. However, PATH is actively supporting the relevant technical working groups and, through these efforts, has been able to advocate for the new CHW mandate to include ECD. The updated CHW curriculum (currently in testing) includes content on developmental monitoring, counseling, and community-based rehabilitation of children with disabilities.
In Kenya, PATH has also started implementation with adapted Care for Child Development materials, but added playbox sessions in health facility waiting rooms under the Community Health Promoter (CHP) portfolio, since CHPs regularly support health services at the facility. (See more information in the Evolution of Approaches and Tools and Child Health sections.)
This pioneering work was used by PATH to provide inputs into the Kenya Community Health Policy, which explicitly describes the CHP role in promoting Nurturing Care for ECD and to successfully advocate for the introduction of an ECD indicator in the CHP Log Book. PATH has also actively supported the MOH and UNICEF in the design of the national Nurturing Care for ECD module for CHPs (currently being piloted) and worked with the Siaya Community Health Team to integrate developmental monitoring and counseling into the CHP supportive supervision checklist. Additionally, two mobile apps have been tested with ECD content sourced by PATH.
More recently, human-centered design work has allowed for co-creation of more sustainable solutions for CHP delivery of ECD services. Namely, CHPs are now expected to deliver ECD activities by drawing on the Mother Child Health Handbook content. PATH and the Siaya Country Health Management Team co-created an SOP, a training manual, and a mentoring tool that prepares CHPs to do just that. Initial assessment of this approach indicated some increase in developmental monitoring and counseling on age-appropriate play activities by CHPs during household visits; however, it is clear that building CHP skills will require more effort.
