Yousafzai – PEDS background

This trial was designed because we found there was a real missing gap in addressing childhood interventions for the very young children from birth to two to three years of age. And the reason we found this was important was because there is so much, there is tremendous evidence from the neurosciences which tells us how we can modulate the quality of brain development in those early years and how is good to intervene early; and we know it’s the health worker who is the person most likely to be able to support families and very young children.  

And in many countries around the world like Pakistan. We also know that the risk factors that we are dealing with that cause poor development like malnutrition they are not only going to affect the physical well-being of the child but, the development of the well-being of the child.  

And so, the health worker is ideally placed to integrate all of the interventions to do with better health, better development and to serve that child more holistically. So, that was the rationale for it and we began in July 2009 and the partnership that we have is with the lady health workers who are government based community health workers.  

We wanted to implement a realistic intervention for them that they could integrate a child development module that complemented the health and nutrition services they already provided. So, we took the Care for Child Development module design by UNICEF and WHO, we adapted it and we’ve been training and supporting lady health workers to implement it over the last eighteen months.  

So, it’s an existing nationwide program in Pakistan. They provide very basic health care to mothers and children in rural communities and in disadvantaged and remote communities throughout the country; and like many other community health workers you find in India, in Bangladesh, in Kenya, they have probably a grade ten level of education. They are from the local community they serve and they have basic health care training and a very large workload.  

We give the lady health worker a baseline training of three and a half days, which is not very much and we provide them with an ECD supervisor or an ECD facilitator, who provides on the job, continue on the job training and mentorship; and the lady health worker will deliver this to a group of mothers in her own area once a month.  

And then she will do a follow-up home visit to that mother to see well, how the mother is getting on at home and do more individual counseling. So, the advantage of the group meetings is that the social interaction, the mothers get to see how children of different ages develop, see how different mothers work with their children, learn from each other so there is peer to peer learning and there is the social aspect, there is the… By using the groups I think we’ve created a demand in the community for early childhood development, so there is the message that’s spread; and then the home visit is the opportunity to really build the mother skills on one to one basis; and so the lady health worker is able to follow-up and she integrates that so she does that with health and nutrition.  

And now we’re beginning to see that mothers see these things linking up so the discussion on the development of the child and the activities is the focus point for talking about everything to do with the child. So, that’s how it works on the intervention side.