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Supporting Early Childhood Development in the Slums of Africa – Emerging Concepts

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Supporting Early Childhood Development in the Slums of Africa – Emerging Concepts …

Supporting Early Childhood Development in the Slums of Africa – Emerging Concepts

John H. Bryant,, Johns Hopkins University

CORE Spring Meeting, April 27,2010

Published in: Health & Medicine

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  • This is a rare intervention for the most needy. Keep up the good work!
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  • 1. Supporting Early Childhood Development in the Slums of Africa – Emerging Concepts John H. Bryant CORE-GROUP, Baltimore April 27, 2010
  • 2. Introduction
    • We have been working on the problems of Orphans and Vulnerable Children (OVC) in the Urban Slums of Africa for the past 6 years, using Nairobi, Kenya as our test site.
    • We began with fundamentals of primary health care (PHC), reaching every household, that had a child-under-5.
    • We had a fine relationship with the communities – sensitive, mutually respectful, learning together about what is necessary to keep the child healthy.
  • 3. Evolving patterns of child care
    • Now, we wish to invite you to join us in a journey we have been taking in the context of care of the OVC in the urban slums of Kenya.
    • While focused on the slum communities – and proceeding with implementation of PHC….. further advances in the science of early childhood development (ECD) were emerging.
    • So, let us proceed, step by step, as we came to understand these advances and absorbed them into our program.
  • 4. UN Habitat, Nairobi, from 2004
    • UN Habitat made a commitment in 2004 to the MDG of improving the lives of at least 100 million slum dwellers in Africa.
    • Senior Staff of UN Habitat were concerned that young children would be left out.
    • J. and N. Bryant were asked if they could help in the development of health care and social support for Orphans and Vulnerable Children (OVC) in the Urban Slums of Africa.
  • 5. UN Habitat, Nairobi
    • We said “Yes”, and were excited by the challenge.
    • Then we asked: “What will the budget be?
    • UN Habitat answered: “Zero, budget”!
    • Rather than saying – “no budget, no work!” --– this became a core challenge of the project.
    • It meant we had to seek our own resources.
  • 6. The Urban Slums of Africa
    • The realities.
    • About 1 billion people in the world live in slums. In Africa, about 70% of the urban populations live in the slums.
    • In the urban slums of Nairobi, 87% of households live in one room homes with no running water, no sanitation and no electricity.
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  • 11. Slum Up-grading in Kenya
    • UN Habitat and the Government of Kenya have agreed to work on upgrading of the slums of Kenya, beginning with Nairobi.
    • KENSUP – Kenya Slum Upgrading Program
    • It was decided that the work of Jack and Nancy on OVC of urban slums should begin in Nairobi in collaboration with KENSUP.
    • The communities selected for that purpose were Mlolongo , Sophia and Bondeni, 10,000 people, part of a larger settlement named Mavoko.
  • 12. Working with slum communities of Nairobi.
    • The plan was to develop health care programs for OVC in those communities, initially as a pilot project to then be expanded more widely.
    • However, one of the realities was that the existing governmental health system was largely facility-based and with limited community access to needed services . So it is with much of the slums of Africa!
    • Further reality – almost no budget.
  • 13. Mlolongo, Sophia, Bondeni
    • Our reality was that our task would not be to implement a well known health care system.
    • It would be to help the people of Mlolongo, Sophia and Bondeni to realize the things they could do to improve the health of their children.
    • This approach would be shaped so as to be applicable to other urban slums of the greater Africa, at modest costs!
  • 14. Mlolongo, Sophia, Bondeni
    • Mlolongo, Sophia and Bondeni have a Health Committee , a group who have been involved in some community surveys with UN Habitat and providing home-based care in the community for PLWA.
    • The Health Committee is lively, socially committed, interested in working with us, and understanding of the local social, cultural and economic issues.
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  • 16. Mlolongo, Sophia, Bondeni
    • The Health Committee helped us to organize a workshop to consider the activities the community would be willing to undertake.
    • There was a lively and socially open discussion.
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  • 24. The Workshop
    • The workshop was lively and interactive.
    • With our own broad experience in Primary Health Care, we were able to introduce them to aspects of PHC that they could pursue in their own households , while depending on back-up from the Government Health Centers and Hospitals.
  • 25. Project Areas to Initiate in Communities
    • Growth Monitoring
    • Immunizations
    • Hand Washing
    • Insecticide Treated Bed Nets
    • Nutrition –
      • Nutritional Supplements
      • Micronutrients
    • Home-based Care For People Living with HIV/AIDS
    • Caregiver-Child Attachments
  • 26. Evolving patterns of child care
    • Soon after the start of our project, I was asked by the AJPH to review an article focused on early childhood development.
    • The article involved concepts that were new to me, based on recent advances in the science of early child development (ECD).
    • The main reference: From Neurons to Neighborhoods – the Science of Early Childhood Development, NAS, IOM, 2000.
  • 27. Neurons to Neighborhoods
    • An explosion of research in the neuro-biological, behavioral, and social sciences has led to major advances in understanding the conditions that influence whether children get off to a promising or worrisome start in life.
    • These scientific gains have generated a much deeper appreciation of:
    • (1) early life experiences, as well as the inseparable and highly interactive influences of genetics and environment, on the development of the brain and the unfolding of human behavior;
  • 28. Neurons to Neighborhoods
    • (2) the central role of early relationships as a source of either support and adaptation or risk and dysfunction;
    • (3) the capacity to increase the odds of favorable developmental outcomes through planned interventions.
  • 29. Caregiver-Child Attachments
    • It is very important that the child has a relationship with the mother (or caregiver) that is nurturing, loving, protective, supportive, stimulating, encouraging – every day, week, month, for considerable time.
    • With that secure attachment , the child builds a foundation that includes a sense of self-worth, physical, social, cultural, cognitive development that prepares it to cope with this complex world into which it is born.
    • That can be beneficial for the child’s entire life.
  • 30. Loving Mother and Her Baby
  • 31. Caregiver-Child Attachments
    • But, let us say the child is neglected or abused, and lacks that secure attachment ; let us say that it is an insecure attachment
    • This can be disruptive and truly harmful, with lifelong consequences.
    • It can actually cause damage of the little one’s brain which is undergoing early maturation.
  • 32. Caregiver-Child Attachments
    • We are, of course, concerned about the many children in the slums who would not have parents or caregivers.
    • Importantly, there would be limited under-standing that children who are simply neglected, even if not mistreated , could be harmed by the lack of a nurturing caregiver attachment. Indeed, harmed for life!
  • 33. Caregiver-Child Attachments
    • So, we shared these ideas and problems with our Health Committee and they were truly excited by the knowledge, and deeply interested in taking steps to protect the children in Mlolongo, Sophia, Bondeni and beyond.
    • So they began teaching the community about this, and gaining widespread support from them.
  • 34. Community Health Workers (CHWs)
    • An important aspect of our Project has been the selection and training of CHWs.
    • These are women and men from the local communities who agree to visit every household on a regular basis, maintaining records on elements of PHC and caregiver-child interactions, and maintaining an information system that records and monitors the care of the children-under-5.
    • There are currently 2400 households with at least one child-under-5.
  • 35. Caregiver-Child Attachments
    • We are developing a diagnostic tool to be used by the CHWs in estimating whether the attachment is secure and loving, or insecure and neglectful.
    • They have actually been scoring households in terms of whether the caregiver-child attachment appears to be secure or insecure.
    • The CHWs take action accordingly, supporting the secure attachments, and encouraging correction away from insecure attachments.
    • Now let us tell you of some of their findings that surprised and impressed us.
  • 36. Caregiver-Child Attachments
    • They found that households where a child was malnourished was also a household in which the caregiver-child attachment was often insecure !
    • Actually, the literature in this field is quite supportive of these findings.
    • It is telling us that correcting childhood malnutrition may require more than feeding. Somehow, nurturing, loving care has to come alongside the feeding.
  • 37. Health and Child Development Information Management System
    • HCDIMS.
    • CHWs visit every household, collect information relating to the well-being of the children.
    • This is done monthly or bi-monthly, depending on the households.
    • They have a small data book in which they enter the data from every household.
    • The Project Secretary, Betty, is also a data clerk, and she enters into the computer the data from the CHW’s data books.
  • 38. Health and Child Development Information Management System
    • Computer-based OVC DATA
    • Each step of PHC – for each household
      • Weight for Age…Changing
      • Nutritional Supplementation
      • Malaria and Bednets
      • Handwashing
      • Oral Rehydration Solution
      • Home-based care of PLWA
      • Caregiver-Child Attachments
  • 39. Health and Child Development Information Management System
    • The nature of caregiver-child attachments
    • Initial assessment of attachment
      • 1 st visit
      • 2 nd visit
      • 3 rd visit
    • Changes in attachment?
    • Comments: doing well; she is now loving; no change – doesn’t understand; etc.
    • PHC Status and Caregiver-Child Attachment for every child recorded, with changes added as they occur.
    • HCDIMS – updated quarterly.
  • 40. Community Leadership!
    • One of the delights of this work has been the lively and effective involvement of the communities.
    • We have been careful to be involved in a sharing of thinking, planning and actions, and listening more than telling !
    • Racheal Nduku began as Secretary for the Health Committee. Excellent organizational skills and writing of minutes of our meetings.
  • 41. Community Leadership!
    • Racheal amazed us with her capacities for organizing activities, recording processes, and involving community members in these processes.
    • We advanced Racheal to be the Community Coordinator of the Project.
    • Here are some photos of Racheal and this work that she pursues.
  • 42.  
  • 43. Caregiver-Child Interactions
    • Racheal has taken special interest in supporting caregiver-child interactions.
    • She arranges local workshops in each of the communities, bringing together caregiver-child interactions that range from secure to insecure attachments.
    • Racheal is tracking those changes carefully, and recording changes as they occur.
  • 44. Caregiver-Child Attachments
    • Child’s relationship with primary caregiver begins even before birth
    • Plays critical role in development
    • Affects emotional, cognitive, social, physical development with lifelong impact
  • 45. Secure Attachments
    • Relationships that are nurturing, loving, and stimulating result in positive patterns
    • These children do better at school, at work, in relationships, and as parents
    • We call this “secure attachment”
  • 46. The Project – in Communities
    • Project Office in Mlolongo
    • Racheal, and her secretary
    • Computer, printer
    • Room for meeting with CHWs and community people
    • Shelves -- household information system
    • Walls with photographs, maps, and statements of visions, goals, hopes
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  • 51. Center On the Developing Child
    • An important resource relating to our work on caregiver-child interactions is the newly established Center on the Developing Child, Harvard University .
    • Director of the Center is Professor Jack Shonkoff, senior editor of the book -- From Neurons to Neighborhoods, National Academy of Science, 2000.
    • Professor Shonkoff invited J. Bryant to visit Harvard and share insights on challenges of addressing the needs of the developing child in the African urban slum context.
  • 52. Center for the Developing Child
    • Shonkoff emphasized emerging understandings of the needs and difficulties faced by the developing child .
    • In the broad fields of public health and the health care of children, particularly in developing countries, the emphasis so often is on child survival !
    • Shonkoff emphasized that child survival is not enough -- it is of critical importance that child development be included in priority concerns.
  • 53. Daystar University and ECD
    • Daystar University is located in downtown Nairobi, with another campus in a rural area.
    • A fine institution with strong faculty and cultural commitments to the needs of the people of Kenya.
    • One of the Departments of Daystar is that of Child Development.
    • That Department has become very interested in our work, and has invited Racheal’s involvement in the academic programs.
  • 54. Daystar University and ECD
    • She has been invited to give lectures to the students, and they have welcomed Racheal’s inviting the masters level students to visit our community slums sites as field work, which has delighted all of them.
    • I have been invited as a visiting professor to provide support for presenting the science base of ECD.
    • The relationship between Daystar and our project has become very positive, and it pleases us that the university is revising the Department to become the Child Development Institute .
    • Racheal is now enrolled as a student in the Child Development degree program.
  • 55. New Dimensions in Our Journey!
    • In the course of interacting with other scholars in related fields, an interesting and important dimension of ECD came to our attention.
    • Lancet: child development in developing countries series – three articles, 2007.
    • OVERVIEW -- 200 million children under 5 years fail to reach their potential in cognitive and socioemotional development because of poverty, poor health and nutrition and lack of early stimulation.
  • 56. New Dimensions!
    • These disadvantaged children are likely to do poorly in school, and subsequently to have low incomes, high fertility, and provide poor care for their children, thus contributing to intergenerational transmission of poverty .
    • Four causes: malnutrition, iron and iodine deficiency, and inadequate stimulation.
    • Governments and civil societies need to consider expanding high quality, cost-effective, ECD programs .
  • 57. Core Values
    • At the heart of our project has been the secure loving, supportive interactions of caregivers and children in family settings.
    • The product of those secure, loving interactions is a stable, maturing process whereby the children evolve as productive, creative members of families and society.
    • We now see the relevance of our work to the 200 million children under-5 across the world who are missing the loving stimulation that our children receive.
  • 58. Our Journey Continues
    • And so our journey continues, as we are alert to further advances in the science of ECD, and sensitive to how such advances can enhance the strengths of our project and how these might benefit children in the larger Africa.
  • 59.