Introduction
Care for child development is a WHO and UNICEF training package based on the best available research on child development. The training package is designed for trainers of trainers (TOTs) which takes two weeks and there is also a more basic course available which takes one week. Comprehensive approaches addressing children’s nutrition, health, and psychosocial development have been shown to be effective in enabling children to reach their full developmental potential. Research shows that caregivers and families are best placed to support children’s growth and development through daily activities and interactions. Therefore, providing guidance and support to families by health workers and counsellors results in improved responsive care practices. This course prepares caregivers to promote the healthy growth and psychosocial development of their children. Implemented on a wide scale, care for child development can have significant public health and social benefits, especially for those children and families who need it most. This blog captures lessons learned in a training event held as part of our British Academy funded project aimed at testing the feasibility of incorporating Care for Child Development into the Baby Friendly Community Initiative in rural Kenya.
Course duration
The course took place over two weeks and covered both theory and practical lessons. The first week 2nd to 6th July 2018 was spent on trainers of trainers (TOTs) being trained and having practical clinical sessions with children and caregivers in a health facility; Eldama Ravine Sub County Referral Hospital. Practical sessions took place in the neonatal clinic, pediatric ward, and in the outpatient department as well as in the Maternal and Child Health clinic. The TOTs were drawn from the national level as well as from Baringo County. Those from the Ministry of Health were drawn from the Nutrition and Dietetics Unit and Community Health Services. Those from Baringo County and Koibatek Sub County were drawn from the nutrition, ECD services, and community health services departments and also from Baringo Referral Hospital and Eldama Ravine Sub County Hospital. Additional TOTs – Community Health Extension Workers (CHEWs) were also picked from the 13 Community Health Units (CHUs) from Koibatek sub County. The second week 9th to 11th July 2018 was dedicated to training a CCD basic course to participants who were mainly community health volunteers (CHVs) from 6 CHUs. The TOTs had an opportunity to train participants who came in to undertake a three-day basic training on care for child development. The training in the second week was a replica of what happened in the first week, but this time facilitated by TOTs under the mentorship of the facilitators and Master Trainer. The theory part of the course covered the following topics: who is a caregiver, caring for the child’s development from conception up to two years and beyond, counseling the family and helping them to solve problems.
Course participants
The 27 TOT course participants by cadre included two trainees from the Ministry of Health – a senior officer from the Community Health Services and an Assistant Director of Nutrition and Dietetics Services. Participants from the Baringo County and Koibatek Sub County included the nutrition officers, community health services focal persons, directors of ECD services, child health focal persons and county and sub county referral hospitals’ pediatricians. Additional participants from the sub county included the sub county referral hospital medical officer in charge of health.
The thirty participants for the basic course were Community Health Volunteers (CHVs) drawn from six community health units in Koibatek Sub County.
Course Facilitators
There were five course facilitators drawn from Ministry of Health, APHRC, and Kenyatta University. The facilitators’ roles included, to: train participants by making Powerpoint presentations, coordinating and development of appropriate play materials, and overseeing group discussions. They also facilitated practical sessions by overseeing TOTs during clinical sessions as well as practical sessions in the pre-school and community. There was a Master Trainer from PATH who was to ensure that quality is maintained during training and practical sessions. In order to ensure that the training ran smoothly, there were two course coordinators from APHRC who were in charge of logistics. The course coordinators ensured that transport was available from the training venue to the health facility as well as mobilizing the community and pre-school administrators where practical sessions were conducted.
Training methods
As mentioned earlier, the training had two components, theory and practice. The theory part involved exposing participants into various participatory learning methods through: Power-point presentations followed by discussions and questions, individual exercises/and feedback, video exercises, use of photographs to enhance discussions, role plays, demonstrations and periodic evaluations on what participants had learned.
Before the start of the training participants had an opportunity to do a pre-test on their knowledge and understanding on care for child development. They also did a post-test on CCD after the training to establish whether there was a change in their knowledge on CCD as a result of the training. The pre-test was used to gauge their level of knowledge of the CCD concept and to assist facilitators in guiding participants during the training. All the participants showed an improvement in their post-test performances. The pre-test average score was 53% compared to the post-test average score, which was 65%. The findings indicate that there was a 12% improvement in the participants’ knowledge on care for child development after the training. Emphasis on the training was focusing on the importance of communication and play in relation to the child’s brain development.
The course also incorporated clinical sessions in outpatient, inpatient, and newborn units as well as in the community and preschools. Participants had an opportunity to demonstrate to caregivers, parents and teachers the importance of play and communication to children in relation to the various domains of development, language, physical, social, emotional as well as brain development.
Every morning before the beginning of the training, participants had an opportunity to highlight the key lessons learned from the previous day. Among the things reported cumulatively in relation to their learning from theory, and practical sessions include:
Learning from Theory
Participants reported to have learned the following from theory: that there is a strong relationship between counselling caregivers and children’s development. This according to them proved to be a great tool for CCD evaluation. The participants were amazed at how the first 56 days of a child’s life are important in brain development. Discovering that babies can see immediately after birth was a key lesson to the participants’ as there is a common misconception that children acquire sight a few months after birth. Learning about the importance of the first 1000 days of a child’s life is critical to a child’s development and that play and stimulation are important ingredients to child development was also highlighted as a key lesson. As was the fact that development of the child begins at conception and that as the baby continues to grow in utero it can be stimulated by talking to and touching for proper brain development.
Learning from Practical Sessions
Participants reported that: the practical sessions in the hospital played a critical role in exposing them to the real life counselling situation and they were able to meet children directly and talk to mothers practically, being able to explain to mothers what to do to stimulate their babies. The feedback session from the hospital showed that great lessons were learned including how to interact with caregivers of small children it also gave participants an opportunity to interact with caregivers and play with children. The theory teachings were very applicable in the field especially on the use of counselling cards and checklists. Mothers in the maternity ward got to learn that their infants hear, see and play right from birth and therefore they need to be stimulated through play, they also learnt to be responsive and sensitive to their children’s needs. Most mothers were not aware about how to provide care for child development to their children and had to be sensitized during the practical sessions.
Conclusion
The participants acknowledged the knowledge deficits regarding play, stimulation and responsive caregiving as a way of facilitating optimal child growth and development. It was also apparent that there exist common misconceptions that may hinder optimal child play, communication and interactions between caregivers and their children in the community. The CCD training was therefore seen as a great strategy for addressing the knowledge gap and the misconceptions among trainees, caregivers and by extension, the communities that they serve. In conclusion, care for child development when well executed is one of the most effective strategies to ensure that young children reach their full developmental potential and training the team members being included in our British Academy funded project in Kenya will likely have lasting impacts beyond the duration of the funded research project.
Lessons Learned
A key lesson learnt during the training was the need to engage the CHVs at the community level in future trainings. Additionally, trainings should be tailored for the CHV cohort i.e. content should be kept very simple. The current level of training was not always appropriate to the qualifications of a CHV in the Kenyan context. Furthermore, training materials and tools utilized should be summarized into a format that is simple and easy to grasp. It also emerged that the time allocated for practical sessions both in the health facility, community and preschool was not sufficient to enable traininees to master the skill of counselling caregivers and playing with children. It may be helpful to allocate more time for practical observations especially for CHVs since they are the people who end up doing the counselling to caregivers in the community and schools.
Authors: Teresa Mwoma, Esther Kinuthia, Milka Wanjohi and Peter Muriuki