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Integrating ECD in Tanzania one hospital at a time

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Early Childhood Development should be a health priority. Photo/Courtesy/ Pexels

The value of early childhood stimulation to overall development of children has gained from being just a concern of a few enlightened/polished parents to a public health priority. The bonds children experience in their first 1000 days of life and their learning experiences greatly impact their future cognitive, emotional, social and physical development.

Though early childhood development was the key theme of the World Health Summit organized by the WHO in Geneva in May 2018, it has continued to be a vital issue in subsequent meetings.

Studies have raised evidence that 80 percent of the human brain develops during the first 1000 days (since conception) of child’s life.

In Tanzania ECD is recognized in policies that guide education and rights of a child. However, these policies do not capture the entirety early childhood development aspects but rather focus on early learning i.e. preschools.

“Policies and guidelines in the health sector emphasize prevention of disease, treatment and nutrition. Stimulation does not equal prominence,” says Tabora regional medical officer, Gunini Kamba.

It is in Tabora region where Elizabeth Glaser Pediatric Aids Foundation (EGPAF) in collaboration with the Ministry of Health Community Development, Gender, Elderly and Children initiated a project that is shedding light on the gap and showing the promise from integrating stimulation in early childhood development services.”

“ECD vacant is very noticeable at our health facilities. Children get vaccination, treatment and their parents get information about nutrition; that is good. But, caregivers almost never get counseling about how to stimulate cognitive, confidence and communication development of their children,” said Josephine Ferla, EGPAF’s Malezi project senior manager.

The collaboration with EGPAF, MOHCDGEC, enlisted UNICEF that had CCD package.

“We adopted the UNICEF global CCD package to Tanzanian context including language. As the result, now we have training package for health workers and community volunteers who conduct home visits. With the available training they are equipped with skills to integrate early stimulation component with routine health and nutrition services to caregivers and children,” she adds.

EGPAF, implements ECD project, called Malezi through support from Conrad Hilton Foundation based in USA to integrate early stimulation in 49 health services at facilities in Nzega and Igunga in Tabora region.

The impact early childhood stimulation is hardly observable in short time span. But the evidence of it being practiced at health facilities and homes promises an attitudinal change that points to a result.

Walking into any one of the 49 Malezi supported facilities you are sure to notice a colorful wall or a corner that stands out a portion pasted in health facility from a nursery school.

“We have created a child friendly corner at our facility where children can have fun and play with their caregivers as they wait for other services,” says Sarah Kabea a nurse at St. Anna hospital.

At St. Anna’s hospital in Tabora municipal hand-made and bought toys cheer up children: a three year boy is running after a brightly colored ball, and another boy catches a ball made from rugs and socks.

Two infants sit beside two admiring mothers on straw mat, their small hands grabbing on the small ends of caped used plastic bags. They smile and let baby drool as they lift their little hands, jingling the miniature marbles in the plastic bottles.

“These are toys made from our own environments. We stock them according to age of our children. Each age have appropriate toys,” according Sarah.

“In group counseling session here, we provide evidence caregivers that creating games and toys and playing with their children is a universal approach to stimulate their receptive brains.”

After training by Malezi Saraha a nurse at St. Anna hospital counsels caregivers about many aspects of early childhood development, including age appropriate stimulation.

In two years, Malezi reached more than10, 000 caregivers with messages about early stimulation for their children.

Little Hadija curdle taciturnly on her mother’s lap. She is inactive. No smiling no playing. She is even unyielding when her mother tries to charm her by tickling her chubby brown cheeks.

“She is sick today. When I get home I will put her to bed straight,” says Amina Omari, 25, Hadija’s mother.

Fikira Abdallah, a community health worker brings a different method. Though a relative stranger to the infant the trained ECD health worker manages to cheer up Hadija with ease. She shakes the marble plastic bottle, the marble whooshing back and forth in the transparent bottle, giving a jingling sound. Hadija’s smug face now cracks smiley lines. Instinctively, she reaches out her little chubby hand to grab the bottle from Fikira.  Then laughs, her angelic eyes giving genuine elated sparkle as shakes the bottle now.

Looking at the smile on the little girl, Hadija’s mother turns to the Fikira, “Really!”

Fikira is one of the ECD trained community health workers (CHWs). They counsel caregivers at health facilities and homes in assigned localities in Tabora municipal about importance of and practices of early childhood stimulation to child development.

 “I get encourages when in I find that a caregiver has adopted some of the things we talked about in my initial visit,” says Fikira. Results of the project evaluation, as contrasted to the baseline finding show pronounced improvement in appreciation of ECD activities.

Number of caregivers seeking services from health provider if they suspect their children with developmental delay has increased from 76% to 96% during program implementation.

Findings show that parents interest in using homemade and purchased toys to play with their children in increasing in areas reached by the project. However there is less improvement in parents engaging their children in reading, looking at pictures and writing.

Early stimulation practices in the household also have improved in households compared to the beginning of the program

Unplanned positive results

In poor rural communities or underserved urban communities child stimulation which they understand as simply playing with children, may seem a matter of lesser agency in comparison to obvious health conditions such as disease or malnutrition.

CHWs home visits to mobilize for ECD and early stimulation serendipitously raked a number of little angels that were either facing severe malnutrition or ailments in the care of less informed or pessimistic caregivers.

Magreth Shija, a distant grandmother to Aggrey and Agrippina, who lost their mother to AIDS a year ago, volunteered to take care of them. She found a partner in the visitor that frequented her home to share tips about caring for the twins.

“They (twins) were devastated, malnourished to the point of hairless scalps and were not walking despite reaching an appropriate age. I was worried and my neighbors were worried too,” said Magreth Shija grandmother to Aggrey and Agripina at Kilabili village.

Now the twins play freely with Bibi (grandmother) who is more than willing to learn from Community health worker about how to care for them.

Some caregivers believe they already observe merits of stimulation. “I think my children make their decision more confidently because I let them talk freely and me about what they think,” says Eliwaza Simon a mother of four in Igunga.

In policy arena, at health facility level and in many homes, Malezi initiative marks the beginning of something that is for the better.

“By integrating ECD and stimulation in our health systems we are leaning to science. Our children will grow in a better environment. Once caregivers take interest in the early development of their children we hope that family health will improve,” says the regional medical officer in Tabora.

Additional Reporting by Mkama Mwijarubi