The Program

Young children in Bangladesh face multiple risks that can prevent them from developing to their full potential. Low birth weight is estimated to affect 22% of newborns in Bangladesh, 36% of children under 5 are severely or moderately underweight, and 41% of children under 5 are stunted (UNICEF 2015). In response to this situation, Save the Children implements an ECD program targeting children younger than 3 and their families to support holistic child development. As a result, over the course of 15 visits to a community clinic or through receiving home visits, parents learn effective practices related to health, nutrition and early stimulation that support their child’s healthy development. The program is built on a collaborative partnership with the Ministry of Health and Family Welfare in Bangladesh. The partnership was formalized through a Memorandum of Understanding (MOU) after Save the Children shared positive results of a rigorous pilot study of this program. Program components include:

  • Training frontline government health, nutrition, and family planning service providers in early stimulation and holistic child development over 4 days with a curriculum focused on integrating nutrition and early stimulation messages in visits with parents of young children. 
  • Frontline service providers conducting monthly home visits or one-on-one community clinic counseling sessions with participating families to advise them on effective parenting practices.
  • Giving each community clinic a set of materials that include child development cards, which frontline workers distribute to families. Child development cards are divided by child age (e.g., pregnancy to birth, birth-6 months, 6-12 months, 1-2 years and 2-3 years) and visually depict the activity that parents are encouraged to conduct with their child including health, nutrition and early stimulation activities focused on language, communication, and play.
  • Monitoring program implementation at community clinics and through home visits.
Challenges

The Integrated Child Development Program Team faces several challenges to program implementation including:

  • The frontline government workers have demanding job duties and some saw the early stimulation component as an extra burden in their already full work schedule. In signing an MOU with the Ministry of Health and Family Welfare, Save the Children was able to guarantee access to frontline government service providers for training and by collaborating with ministry officials at all levels, from central to local, government buy-in was enhanced, thereby improving service delivery.
  • Some parents had a difficult time envisioning the benefits of the early stimulation activities since the impact is not easily visible in the short-term. In response, one father and one mother, each of whom was respected throughout the community, were identified to work as motivators and help generate interest and support for the program with eligible parents. Fathers' support for the program proved essential in ensuring family participation, but was difficult to obtain given their income-generating responsibilities.
  • Finally, monitoring the impact by observing parent-child interactions at home was difficult. Monitoring and evaluation is conducted both by frontline government service providers and Save the Children staff, which increases the program’s ability to get into homes.
 
Success Factors

A few key factors related to program success included:

  • Assuring government buy-in and support from the beginning. This was possible in part due to the rigorous evaluation results that were obtained during the pilot study. These results helped to motivate government officials and secure their commitment in implementing the program. 
  • Formalizing the relationship through an MOU.
  • Working with government officials at all levels from central to local and from senior to more junior roles. Staff turnover at central and district levels can be high so ensuring that there are clear communication channels at multiple levels can mean that program activities continue despite a change in staffing at the ministry.

Resources

Parenting Cards

These are sample child development cards from Save the Children's early childhood program in Bangladesh.
Save the Children Bangladesh
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