Can home visits for early child development be implemented with sufficient coverage and quality at scale? Evidence from the SPRING program in India and Pakistan

Frontiers in Nutrition

Nutrition

Shamsa Zafar¹  Nazia Parveen²  Shumaila Saleem²  Siham Sikander³  Assad Hafeez⁴  Jolene Skordis⁵  Sarmad Aziz⁵  Zelee Hill⁵  Atif Rahman⁶  Bilal Iqbal Avan⁷  Seyi Soremekun⁷  Betty Kirkwood⁷  Reetabrata Roy⁸  Divya Kumar⁹  Gauri Divan⁹  Kamal Kant Sharma⁹  Deepali Verma⁹ 

[1] Fazaia Medical College, Air University, Islamabad, Pakistan;Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan;Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan;Institute of Population Health, University of Liverpool, Liverpool, United Kingdom;Health Services Academy, Islamabad, Pakistan;Institute for Global Health, University College London, London, United Kingdom;Institute of Population Health, University of Liverpool, Liverpool, United Kingdom;London School of Hygiene and Tropical Medicine, London, United Kingdom;London School of Hygiene and Tropical Medicine, London, United Kingdom;Sangath, Goa, India;Sangath, Goa, India;

关键词: early child development;    home visits;    implementation;    process evaluation;    community health workers;    community based agents;    India;    Pakistan;   

DOI  :  10.3389/fnut.2023.1152548

 received in 2023-01-27, accepted in 2023-03-27,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionThere is limited evidence from low and middle-income settings on the effectiveness of early child development interventions at scale. To bridge this knowledge-gap we implemented the SPRING home visiting program where we tested integrating home visits into an existing government program (Pakistan) and employing a new cadre of intervention workers (India). We report the findings of the process evaluation which aimed to understand implementation.Methods and materialsWe collected qualitative data on acceptability and barriers and facilitators for change through 24 in-depth interviews with mothers; eight focus group discussions with mothers, 12 with grandmothers, and 12 with fathers; and 12 focus group discussions and five in-depth interviews with the community-based agents and their supervisors.ResultsImplementation was sub-optimal in both settings. In Pakistan issues were low field-supervision coverage and poor visit quality related to issues scheduling supervision, a lack of skill development, high workloads and competing priorities. In India, issues were low visit coverage - in part due to employing new workers and an empowerment approach to visit scheduling. Coaching caregivers to improve their skills was sub-optimal in both sites, and is likely to have contributed to caregiver perceptions that the intervention content was not new and was focused on play activities rather than interaction and responsivity - which was a focus of the coaching. In both sites caregiver time pressures was a key reason for low uptake among families who received visits.DiscussionPrograms need feasible strategies to maximize quality, coverage and supervision including identifying and managing problems through monitoring and feedback loops. Where existing community-based agents are overstretched and system strengthening is unlikely, alternative implementation strategies should be considered such as group delivery. Core intervention ingredients such as coaching should be prioritized and supported during training and implementation. Given that time and resource constraints were a key barrier for families a greater focus on communication, responsivity and interaction during daily activities could have improved feasibility.

【 授权许可】

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Copyright © 2023 Hill, Zafar, Soremekun, Sikander, Avan, Roy, Aziz, Kumar, Parveen, Saleem, Verma, Sharma, Skordis, Hafeez, Rahman, Kirkwood and Divan.