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Scaling up an Early Childhood Development Intervention by Integrating into Health Services in Bangladesh

Principal Investigator: Dr Helen Baker-Henningham, Bangor University

In two recent effectiveness trials, we demonstrated that parent-training sessions conducted by government health workers, as part of their existing duties, in primary health care clinics in rural Bangladesh leads to large benefits to the development of disadvantaged young children (Effect size = 0.84-1.3SD on cognition). In those trials, the research team trained and supervised the health workers (HWs). For the intervention to be implemented at scale, we need a feasible and effective model for the training and supervision of clinic health staff using the supervisors and trainers of the Ministry of Health (MOH). Through this project, we will work with the technical staff of the MOH to i) develop and evaluate technical guides for training and supervision of government supervisors, ii) develop and evaluate tools for monitoring the quality of implementation at scale and iii) evaluate the effectiveness of the training using two measures: observed quality of parent-training sessions and parenting practices of participating mothers. We will also measure HWs’ job satisfaction and burn-out.

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Update Wednesday 1st November 2017

The evidence-based home visiting early childhood intervention ‘Reach Up’ was previously adapted for Bangladesh and four trials of individual play sessions at home or in clinics with specially employed staff found benefits to child development. Integrating into government health services is a promising approach to going to scale, however, there is scarce evidence of its effectiveness. In Bangladesh, the government delivers primary health care through health clinics across the country. We recently modified the intervention for clinic staff to deliver as part of routine work, including fortnightly play sessions with small groups of mothers and children. We evaluated the model in two randomised trials, and found large benefits to the development of disadvantaged young children.

Having developed an effective model, the next step is to develop the implementation strategy in collaboration with the Ministry of Health and assist them in using it. Most research does not continue to this stage but it is critical to going to scale. We will investigate whether the supervisors employed by the Ministry of Health can provide the necessary training and supervision of the health workers (previously provided by the researchers) to run a high-quality programme. The long-term goal is for the Ministry of Health to integrate the programme into routine services.

Objectives: 1) To assess the ability of the Bangladesh government health care services to integrate an adapted version of Reach Up into community health clinics, including training and supervising health workers, 2) To produce tools to assist going to scale including training manuals for supervisors and inventories to assess the quality of the parenting sessions conducted by health workers and validate them with direct observations, 3) To assess the fidelity of the intervention through the observations of the quality of the parenting groups run by health workers and assess the impact on home stimulation in a small randomised trial.

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