Date: 28-07-2020

BLOG: Making the First 1,000 Days Count! - a Home Visiting Toolkit

The support that parents and other caregivers need to provide nurturing care in the first years of life is now recognized as essential by the international agencies such as the World Health Organization (WHO), UNICEF and the World Bank. In fact, nurturing care is a central tenet of what is required to achieve optimal development and is now understood as health, nutrition, security and safety, responsive caregiving and opportunities for early learning.

In 2018, ICDI with our Ethiopian partner organization, Education for Sustainable Development (ESD), started to promote an innovative, comprehensive approach to nurturing care, combining home visiting and  center-based programs. The approach supports playful learning and responsive parenting activities for children under 4 and their caregivers in seven communities in the Amhara region. This took form in the project ‘Making the first 1000 days count in Ethiopia!’.

The reasons behind a combination of modalities

We realized early on that not all families were ready to participate in center-based group activities such as in the Play Hubs or in other ECEC centers. This is because families, especially those living in rural areas, are often not aware of the importance of ECEC, or have very limited access or no access to services in their communities as they are living in remote areas far away from the services. Where services do exist –  they do not cater for the needs of the families with very young children. For this reason, we decided to offer a combination of modalities: we opened seven Play Hubs, and, at the same time, we developed a home-visiting program to reach the hardest to reach families and introduce them softly and slowly to the  center-based activities.

The Play Hubs are family-friendly  centers, located next to Health centers that are run in collaboration with community members, educators, and health extension workers. Here young children can play with toys and join educational activities and their parents can participate in workshops on child development, education, health, nutrition and parenting. Services can also connect with each other and reach out to the 'hardest to reach' families. The Ethiopian Play Hubs are inspired by and adapted from the European TOY for Inclusion program, of which ISSA is also a partner.

The home visiting program component of the project supplements the existing national health extension workers’ program that is supported by the Ethiopian government that mainly focuses on health and nutrition. Whilst the end goal of the home visiting program is that the most vulnerable families also become regular users of local services, home visits, if they are of good quality, serve an important purpose in helping parents to provide safe and supportive environments for their children. Our experience in ‘Making the first 1000 days count in Ethiopia!’ project is that the home visits are alerting parents to the importance of establishing healthy connections with their babies and of building loving, trusting and supportive relationships with their children. They are also reducing the stress parents and carers may experience in their parenting role by providing a listening ear, calm reassurance, support, and information. Over time, families and home visitors are building strong relationships that lead to lasting benefits for the entire family.

Home visitors reinforce and strengthen competences of caregivers

Due to the fact that home visiting that addressed needs beyond health is very new in Ethiopia, ICDI and ESD developed a new training on Early Childhood Development and home visiting with a particular focus on social and emotional development, brain development, engaged parenting, play and child abuse. The training was first provided by ICDI as a two-day training of trainers to ESD staff in 2018, and it was followed by a two-day follow-up workshop after piloting of the program with the home visitors also facilitated by ICDI. The training included exercises about how to communicate with the families, how to encourage parent-child interaction, how to create bridges between services, and how to promote the importance of social and emotional development among families and service providers.

As one home visitor stated: ‘We now look at children in connection to their environments and in their relationships. We can better support them in getting ready for school while we also make sure that both parents and children are happier and healthier.’

The development of the toolkit: a bottom-up and participatory process

We wanted to develop a toolkit that would be useful for the trainers, health extension workers and community facilitators who were embarking in this new role as home visitors, as well as for the parents. Our research began with a review of the UNICEF ECARO and ISSA - Supporting Families for Nurturing Care: Resource Modules for Home Visitors – an extensive toolkit that was really useful for us as a resource and inspiration. Besides this toolkit, we also reviewed materials developed by the experts in the early childhood field (the Center on the Developing Child at Harvard University, the LEGO Foundation, the World Health Organization). After this initial review, with the help of ESD and local ECEC experts, we needed to select the topics and contents we wanted to include in our toolkit and decide how to adapt them to the Ethiopian context.

Thus, we designed a need assessment tool to map the available services in the communities and to get a better idea of the approaches to child rearing and parenting practices within the communities. Parents were asked about their pregnancy, birth, breastfeeding, birth registration, their parenting practices, playtime of the baby, access and use of services.

The mapping highlighted that most women access prenatal and postnatal services, but often the quality of these services is not very good or they are not perceived as family friendly.

The majority of the interviewees reported the need for additional services in the community such as parent/toddler groups, family planning for men, home visits for mothers and children and training on child abuse. They also highlighted the need to improve children’s learning environments, specifically referring to creating safe and clean places for children to play, distributing play materials for children and opening childcare centers/daycares/nurseries. Based on these findings, we decided to emphasize the importance of play in the home environment in the home visiting program and to pilot the ECEC Play Hub model for group activities.

With regards to the quality of the relationship between mothers and children, 65% of the participants said that they did not have a good relationship with their baby while in the womb. This finding led us to including in the toolkit and home visiting program specific topics to help mothers (and fathers) understand the importance of the relationship with their baby starting from pregnancy.

Another important finding was that all mothers answered that they did not get any kind of advice concerning the importance of play. This is why we decided to include information about play and the brain, learning through play, play without toys and Do It Yourself Toys (DIY Toys), so that parents could make their own toys with things they already have at home. Our bottom-line is always: the important part of parent-child play is the bond and the interaction with the adult.

The Toolkit includes four parts, and you can read more about it and its key messages here. Part One and Two in English and Amharic are publicly available, but if an organization is interested in applying it, ICDI offers a training during which Part 3 and 4 are also shared and explored. Please feel free to contact us through icdi@icdi.nl

What’s next for the ‘Making the first 1000 days count!’ project?

After two years of the project, the fruits of our efforts of are becoming visible: seven Play Hubs were opened in the Amhara region and have already reached over 1600 children under 4, their carers and siblings. Over 400 vulnerable families took part in the home visiting program and 50 families received financial support to improve their income, take part in training programs and ensure a better future to their children. Finally, over 300 women with children under 4 or who are pregnant received support to access existing prenatal and postnatal services.

In the future, we would like to focus on upscaling this model by expanding to new regions in Ethiopia and engaging the local and national government in discussing systemic changes, which aim to recognize the importance of nurturing care in ECEC and the adoption our model on a national scale.

Written by Mariana Palazuelos and Giulia Cortellesi, International Child Development Initiatives – ICDI