Background

The period from pregnancy to 3 years is when children are most susceptible to environmental influences. Negative factors reduce the capacity of families and other caregivers to protect, support and promote young children’s health and development. Commitment to early childhood development can be the catalyst to enable children to thrive, and thereby transform health and human potential. Children need to develop to their full potential. They need nurturing care – the conditions that promote health, nutrition, security, safety, responsive caregiving and opportunities for early learning.

Scientific evidence shows that children who lack nurturing care as part of early childhood development (ECD) may be less healthy, grow poorly, learn less and complete fewer grades at school. They may have difficulties relating confidently to others and earn less as adults. Responsive care and opportunities for early learning are essential components for early childhood development. The mental health and wellbeing of care givers are also critical factors. Investing in these interventions can result in a triple dividend – with health, social and economic benefits – for people now, for their future and for the next generation.

Globally, the Nurturing Care for Early Childhood Development (WHO, UNICEF, World Bank and partners) is recommended as a framework for helping children survive and thrive to transform health and human potential. Early childhood development covers children aged 0–8 years. The Nurturing Care Framework focuses on the period from pregnancy to age 3 because it is scientifically proven that this is a very sensitive period for brain development. Components of nurturing care includes good health, adequate nutrition, responsive care giving, opportunities of early learning and security and safety.

The Government of Nepal has prioritized the early childhood development as an important agenda but is implemented mainly through the Ministry of Education. Nepal has made great strides in expanding access to pre-primary education with enrolment rate having increased from 12 per cent in 2000 to 86 per cent in 2017. Reports show that children who are in pre-primary education are much more likely to be developmentally on track in foundational early literacy and numeracy skills than children missing out on that opportunity. According to a nation-wide survey conducted in 2014, children aged 3 to 5 years attending early childhood education programs in Nepal were 17 times more likely to be on track in their foundational early literacy and numeracy skills even after excluding the effects of numerous socio-economic factors.

The global strategies guide to invest in well-coordinated policies and services with multi sectoral involvement for early childhood development. The National Planning Commission has developed the National ECD Strategy for Nepal with the goal to ensure equal opportunity for overall development during early childhood period to all children by 2088 BS. The strategy guides for involvement of stakeholders at federal, provincial and local levels and all relevant stakeholders including MoHA, MoWCSC, MoE, MoHP, MoFAGA, MoF.

The period of maximum development i.e. the first 3 years in life, the children are in contact with the health sector more than other sectors. As mentioned earlier, the health sector, specially the maternal, newborn and child health programs have been working to improve the health of newborns and children, but the concept of ECD needs to be discussed more widely and integrated within the health programs.

The Family Welfare Division (FWD) initiated discussions for strengthening the role of MoHP for ECD. An assessment was undertaken including consultation with key stakeholders. The assessment report recommends for need of involvement of different sectors as well as resource allocation and capacity building of program managers as well as service providers. A sensitization program and one workshop were also organized by the Family Welfare Division to identify the opportunities for integration of ECD components within the MNH services. The ECD component has also been included in the Community-based Integrated Management of Newborn and Childhood Illness clinical protocol updated in 2021.

Therefore, the FWD aims to develop guidelines for integrating the concepts of ECD within the health services for pregnancy and childhood. This proposal has been submitted to provide technical assistance to FWD and WHO to develop national guidelines for integration of early childhood development guidelines in health services.

Objectives:

The general objective of this assignment is to develop a national guideline for identification and integration of early childhood development in MNCH services. The specific objectives are as follows;

1. To define and develop the program implementation modality
2. To develop package of care by level of health services and beyond health sector
3. To identify requirements for implementation of interventions
4. To develop and establish the coordination for ECD

 

Methodological approach

The guideline on integration of ECD in MNCH services will be developed in close collaboration with FWD and WHO. Consultations will be done with all other major stakeholders during the process. Following processes will be undertaken for developing the guideline and providing technical assistance;

1. Formation of a Technical Working Group (TWG) including all stakeholders (led by FWD)
2. Inception meeting to initiate the process of developing the guideline
3. Desk review of national and global documents on ECD and integration of key elements of nurturing care framework
4. Desk review of national policy and programme documents including policy framework, strategies, assessment reports etc.
5. Discussion with ECD experts from various sectors: health, nutrition, education
6. Preparation of the first draft of the ECD guideline that includes;
7. Significance of ECD in children’s overall development, health and education
8. Age appropriate activities and care regarding physical, social, emotional and linguistic development for children (0-5 years) from pregnancy to delivery, birth to 24 months, 24-36 months, 36-48 months and 48-60 months;

• Care from parents/ family: regarding care, health, physical and psychological development, nutrition
• Care from health sector by level of care (HP, PHCC, hospitals)
• Care from other sectors (day care, kindergarten): include care, nutrition, health, development and education

iii. Age appropriate activities and care care for children (6-8 yrs): from 60 to 96 months regarding physical, social, emotional and linguistic development;

• Care from parents/ family: regarding care, health, physical and psychological development, nutrition
• Care from health sector by level of care (HP, PHC, hospitals)
• Care from other sectors like education (school): include care, nutrition, health, development and education

1. Organize workshop to share the first draft and get the feedback from stakeholders including 1-2 provinces
2. Incorporate feedback and revise the draft for finalization
3. Share the draft guideline for technical review from subject experts
4. Organize final meeting to share the final ECD guideline. Develop a two day orientation package based on the final guideline.
5. Facilitate in one batch of orientation organized by FWD.

Partner: WHO Nepal

Duration: December 2022 to July 2023