Cnhf hsrc mel newsletter 3 april 2013


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In this issue of the newsletter we feature a situational analysis
from PATH focusing on the integration of ECD services in Nyanza
Province, Kenya; we introduce more team members working on
Hilton Foundation-funded projects; we go up close with the Firelight Foundation and the work they are doing; we begin a series
on the ‘Nutrition and Nurturance of Young Children’ with a companion piece on breastfeeding; and we discuss what we can and
can’t learn from before and after measures in evaluations.

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Cnhf hsrc mel newsletter 3 april 2013

  1. 1. Page 1Newsletter 3 April 2013 We would like to showcase each of the five countries in which the Hilton Foundation and implementing partners are working—Kenya, Malawi, Mozambique, Tanzania and Zambia. In this newsletter, PATH shares a brief description of a situational analysis focusing on the integration of early childhood development services in the Nyanza province of Kenya. INTRODUCTION: The Government of Kenya has operationalized the National Plan of Action on Orphans and Vulnerable Children (OVC), which seeks to strengthen the capacity of families and communities to support OVC. Policy and service standard guidelines outline the development of a comprehensive and coordinated implementation strategy to meet the needs of children 0–8 years. As a result, Kenya has witnessed dramatic improvements in areas such as the use of insecticide-treated nets, immunisation coverage, and reduction in infant and under-five mortality. The prevalence of HIV has also declined. However, there has been little improvement in certain areas: of children’s health and wellbeing e.g., the prevalence of stunting has remained almost constant. AIM: In order to understand the state of ECD, health, nutrition, and poverty alleviation support and services being offered in institutions and community- based settings and the capacity of service providers, PATH’S I-ECD Project conducted a situational analysis in the three districts of western Kenya’s Siaya County: Siaya, Bondo, and Rarieda. METHODOLOGY & SAMPLING: Altogether 83 key informants were interviewed., including community health volunteers/workers (CHVs/CHW), social workers, village elders, community-based organizations (CBOs), preschool teachers, and Ministry officials at the provincial and district level. KEY FINDINGS: Enabling environment for ECD and care of vulnerable children Most key informants were not aware of the existence of the national policy on ECD and the National Plan of Action on OVC. General services provided by CBOs for children 0-5 years and their caregivers CBOs offer services related to health (preventive and referral), economic support (income-generating activities [IGAs]), nutrition (infant and young child feeding and providing food supplies and micronutrient supplements), and education (buying of school uniforms and paying school fees). ECD services provided to children 0-3 years There is little sensitization of parents and caregivers on the importance of learning through play in a child’s early years. Moreover, parents consider ECD to be synonymous with preschool. “Most of the parents do not know the importance of taking their children to ECD centres before joining primary.” (Preschool teacher, Bondo) Situational Analysis Kenya Situational analysis on integrating early childhood development services in Siaya County, Nyanza Province, Kenya In this issue of the newsletter we feature a situational analysis from PATH focusing on the integration of ECD services in Nyanza Province, Kenya; we introduce more team members working on Hilton Foundation-funded projects; we go up close with the Fire- light Foundation and the work they are doing; we begin a series on the ‘Nutrition and Nurturance of Young Children’ with a com- panion piece on breastfeeding; and we discuss what we can and can’t learn from before and after measures in evaluations. Newsletter 3 April 2013
  2. 2. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS Page 2Newsletter 3 April 2013 Educational services provided to children 3-5 years Preschools are often dilapidated and do not provide a child- friendly environment. Each preschool had 75-165 children and 1-3 teachers with the corresponding teacher:child ratio ranging from 1:25 to 1:60. Children walk between ten meters to three kilometres to get to preschool. Some children aged 3-5 years do not attend preschool because their caregivers cannot afford fees and school uniforms. Other caregivers keep children at home to take care of younger siblings or do household chores. “As early as 5 years, children are assigned household duties.” (CBO leader, Siaya) Health care services provided to children 0-5 years and their caregivers The most common early childhood diseases are malnutrition, diarrhoea, malaria, pneumonia, measles, and skin conditions. Nutrition services provided to children 0-5 years Vulnerable children are sometimes left in the care of aged grandparents who cannot meet their nutritional needs. Quite often, a small quantity of food needs to be distributed among a large number of dependents. Child protection services Child protection is the sole responsibility of parents and guardians. They are assisted by the provincial administration through the chiefs, assistant chiefs, and village elders to ensure that each child is given proper care and that action is taken against child abuse. “The environment is not safe; where there is poverty; safety of children is not a priority. In one case, a child was left to play near a pond and ended up drowning.” (CBO leaders and social workers, Siaya) Vulnerable children and children affected by HIV/AIDS Key informants defined vulnerable children as those who come from poor families, or children with ailing parents and guardians - including those affected by HIV/AIDS. Some vulnerable households receive KES. 2,000 (~US$24) bi-monthly via a Government of Kenya cash transfer program. Some CBOs support vulnerable children as well, although service provision to these children is scanty and fragmented. Vulnerable children often feel humiliated because of their poor economic situation at home. “Children with disability suffer a lot; some are hidden in the homes.” (Social workers, Siaya) “Grandparents are everyday taking up parental roles; this has affected the care and support the children receive since most of the caregivers are elderly.” (Ministry official, Bondo) Economic support for caregivers and guardians of vulnerable children Caregivers engage in income-generation activities (IGAs) such as kitchen gardening, bee-keeping, and rearing livestock. However, not all families and vulnerable children are reached through IGAs. Data collection and management Some CBOs have good systems for collecting and tracking data, although the capacity for rigorous monitoring and evaluation (M&E) is lacking. CHALLENGES:  Community attitudes toward ECD, the poor quality of preschools, and lack of sensitization on the rights of children are barriers toward age-appropriate care and stimulation of children.  Poverty, community beliefs, and lack of capacity of service providers are major barriers toward accessing health care services.  CBOs often have limited capacity to deliver services, as well as organizational challenges and limited capacity in proposal writing and fundraising to solicit funds from donors. RECOMMENDATIONS  Support organizational capacity building of CBOs; improve the capacity of CBOs to deliver health, nutrition, ECD, and poverty alleviation interventions.  Give special attention to vulnerable children and children with special needs.  Reach children 0–3 years at home through home visits, parenting workshops, etc.  In addition to home visits, use preschools as an entry point for reaching children 3–5 years with ECD, health, and nutrition services at the community level. IMPLICATIONS FOR PROJECT DESIGN  Work with caregivers to improve their knowledge, skills, and practices in major aspects of child development—including learning through play, safe spaces for play, and child rights.  Work with relevant partners to strengthen preschools— including materials development and sensitization of caregivers on the importance of preschool.  Through partnership with relevant ministries, support caregivers to carry out IGAs to improve their economic wellbeing and instill a saving culture through entrepreneurship.  Integrate ECD agenda in relevant forums to share experiences, success, and challenges. Teresa Mwoma RESEARCH Fernald, L. et al (2012). Socioeconomic gradients in child development in very young children: Evidence from India, Indonesia, Peru and Senegal (2012). Proceedings of the National Academies of Science of the USA. Children’s development shows gradients by socioeconomic status as early as 3 months of age. Children from better-off homes have higher development scores. Statistical analyses show that these gradients are due the fact that poor children don’t grow as well because of poor nutrition and they receive less home stimulation.
  3. 3. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS Page 3Newsletter 3 April 2013 INTRODUCTIONS Damaris K. Wambua is the Early Childhood Development (ECD) Specialist based in Child- Fund Kenya’s National Office. She is responsi- ble for coordinating ECD and for giving tech- nical support to 51 community organizations affiliated to ChildFund Kenya and 7 grant- funded implementation projects. Damaris is providing technical support to the Hilton Foundation project from the national office. She has over 8 years of experience in community development work. Damaris holds a Bachelor of Education degree in Early Child- hood Development from Kenyatta University and is currently work- ing towards a Masters degree in Education Planning at the Univer- sity of Nairobi. Elizabeth Kamau is Kenya’s Program Director with responsibility for all ChildFund pro- grams, implemented by 51 local partners and under 8 grants in 24 counties, reaching 1.2 million children. She coordinates, manages and gives support to the work of 61 staff. Elizabeth will provide managerial support to the Hilton Foundation project. Her experi- ence of 20 years is in community develop- ment work. Elizabeth is a founding member of one of the largest networks in Kenya, the Girl Child Network (GCN). She has a Mas- ters in Criminology from the University of Wales, College of Car- diff, UK. Rachel Maris-Wolf is the Project & Grant Man- agement Specialist supporting the Hilton Founda- tion project from ChildFund International’s head- quarters. Her background is in community devel- opment; community health; intercultural service, leadership, and management; and international education with over 5 years overseas experi- ence. Rachel has been with ChildFund for 7 years. She holds a B.A. in French from Mount Holyoke College and an M.A. in International Education from the SIT Graduate Institute. Francis Lwanda is the Monitoring and Evalua- tion Coordinator for Africa at ChildFund Inter- national and is based in Addis Ababa. He has 13 years of NGO experience between CARE and ChildFund, working on youth empower- ment. With experience in Asia and Africa, Francis has applied M&E and social accounta- bility methodologies and approaches in vari- ous sectors including education, social pro- tection, health services quality improvement, SRH, and nutri- tion. Victoria Dunning is t he Vice President for Pro- grams of The Global Fund for Children (GFC), with oversight of an annual $4.5 million global grants portfolio supporting community-based organiza- tions. She has been instrumental in defining and developing GFC’s GrantsPlus capacity-building grantmaking model, its accompanying metrics framework, and the streamlined Grantee Path- ways to Success - “GPS” – grants management systems and analytics. Victoria has a MPH from Columbia University and a BA from Mount Holyoke College. Apart from English, she speaks French, Spanish, Wolof and Swahili. Emmanuel Otoo is a program officer at the Global Fund for Children (GFC), responsible for the Africa and Middle East regional pro- gram, supporting 81 grassroots organizations in 19 countries. Emmanuel has managed a number of integrated corporate social devel- opment programs for organizations such as Plan International, African Development Fund/Government of Ghana, UNDP, and ILO/ IPEC. His work with Free the Slaves was featured on CNN’s Free- dom Project. Emmanuel holds an MSW, an executive MBA in pro- ject management, and a Bachelor’s degree in Sociology. Susan McCallister has 15 years of experience editing material at Hesperian, as senior editor/ project coordinator of the current edition of A Book for Midwives, and production manager for Helping Children Who Are Deaf. She is cur- rently leading the development of the book and supplemental materials for the Helping Children Live with HIV project. Prior to joining Hesperian, Susan designed and helped run a library-based adult literacy program in one of the Bay Area's poorest com- munities. Sarah Shannon has led Hesperian since 1996, providing editorial oversight on, amongst oth- ers, Where Women Have No Doctor, A Health Handbook for Women with Disabilities, Help- ing Children Who Are Blind, and Helping Chil- dren Who Are Deaf. Prior to joining Hesperian, Sarah trained health workers in refugee com- munities in Honduras, and co-founded an NGO in El Salvador to train residents in financial and small busi- ness skills. Sarah served on the Global Steering Council of the People’s Health Movement from 2004–2012.
  4. 4. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS Their goal was to understand how capacity level affects the implementation of the EP and if smaller CBOs could easily adapt the EP to their programming. In August 2011, Firelight provided feedback to both Save the Children and Care on year one of the validation process. The re- vised EP was tested with the same four partners. In the second validation phase (May–August 2012), each organization continued to imple- ment their programs using the revised EP and also completed baseline and endline data collection using the Comprehensive Checklist (CC). A minimum of 15 households served by each organization was included in the data collection process. The objective was to gauge any changes at the household and child levels and to ascertain if CBOs found the CC useful. While all four partners found the CC cumbersome to use, they all intend to continue using the EP in their ECD programming. Firelight’s approach to ECD work Firelight believes CBOs are well positioned to help co-ordinate between and among government and other key stakeholders and to integrate interventions within services so as to increase the effectiveness of parents and government services, and fill the gaps in social safety nets as needed. Firelight’s grant from the Hilton Foundation focuses on enhancing CBO organizational management and strengthening program de- livery in order to improve developmental outcomes of children 0-3 years of age and the school readiness of children 4-5 years of age. Fire- light will pursue these goals by (1) resourcing and building the capacity of each of the 16 CBOs selected in three countries for participation in the project; (2) supporting CBO delivery of support and services to young children and families; and (3) generating knowledge on the attrib- utes and competencies of CBOs to deliver quality programs of support. Page 4Newsletter 3 April 2013 UP CLOSE WITH THE FIRELIGHT FOUNDATION Firelight’s approach and philosophy The mission of the Firelight Foundation is to improve the well-being of children made vulnerable by HIV, AIDS and poverty in sub- Saharan Africa through supporting grassroots organizations. Firelight's approach to grantmaking is child-centered, family- focused and community-based. Firelight’s involvement in testing the Essential Package Firelight participated in the validation of the Essential Package (EP) from 2010 to 2012. They selected one high-capacity community- based organization (CBO) and one smaller lower-capacity CBO in both Zambia and Malawi to assist with testing. Key learnings are expected to emerge from several sources: 1. Country-level learning circles facilitated by Lead Partners; 2. Peer-learning exchanges between Firelight funded grantee-partners; and 3. Data collection by Firelight Foundation on individual child development levels using ZamCat. Firelight plans to generate knowledge about CBOs and their successful work by:  Articulating a set of learning questions to be answered during the three-year initiative;  Documenting effective program models;  Analyzing and synthesizing the information gathered into useful knowledge products;  Gathering and publishing information on CBO action for improving the lives of young children and;  Participating in at least two major conferences. The country and organizational implementers are: Malawi: The Lead Partner is Namwera AIDS Coordinating Com- mittee (NACC) and all the CBOs are located in the southern re- gion, close to NACC’s current areas of operation in Mangochi. Tanzania: The Lead partner is Tanzania Home Economics Associ- ation (TAHEA), located in the Mwanza area, which is near Lake Victoria. Zambia: The Lead partner is Mulumbo Early Childhood Care and Development Foundation (MECCDF), which is located near Lusa- ka, and one partner is located in the Copperbelt region. Some Firelight Team Members: Peter Laugharn became the Executive Director in July 2008. Previously he was the Executive Director of the Bernard van Leer Foundation. Before that, Peter worked in a variety of roles for Save the Children USA, with a great deal of experience on Africa. As Save the Children's Deputy Director in Mali, Peter helped develop the "Village Schools" model. A graduate of Stanford and Georgetown Universities, Peter holds a Ph.D. in education from the University of London. Currently a member of the Council on Foundations International Committee, Peter is also co-chair of the Inter-Agency Task Team on Children and HIV and AIDS, and past chair of the Coalition for Children Affected by AIDS. As a Program Officer at Firelight, Kristen Molyneaux works with grantee-partners in Zambia and Tanzania. Kristen joined Firelight in April of 2012 after completing her Ph.D. in Educational Policy Studies - Comparative International Education at the University of Wisconsin- Madison. Kristen was a Peace Corps Volunteer in both Uganda and Cape Verde and has been an education consultant in Burundi and Mozambique. Mia Schmid joined Firelight in 2011 as a Grantmaking volunteer and a year later was promoted to Program As- sistant. She works closely with a Program Officer to main- tain the Lesotho, Malawi, South Africa, and Zimbabwe portfolios. During her undergraduate years, Mia studied abroad with the School for International Training in Ugan- da. She graduated in 2010 with a BA in International Studies from the University of Denver.
  5. 5. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS Page 5Newsletter 3 April 2013 Nutrition and Nurturance of Young Children: Breastfeeding Nutrition (feeding) for young children during foetal and infant development is one cornerstone of human development. The other is nurturance, the loving responsive interaction and care provided by one or more devoted and engaged parents who fall literally “in love” with their baby . Although breastfeeding and eating other foods when weaned come naturally to mothers and babies, neither can be left entirely to chance. Breastfeeding requires that babies are put to the breast immediately after birth so they can express their innate capacity to latch onto the breast and suck vigorously to stimulate the mother’s milk flow. Mothers must be rested, comfortable and patient to enable her “let down” (oxytocin) reflex to release milk, and her baby to get and remain attached to the breast through sucking. The World Health Organization (WHO) and UNICEF have produced guidelines for Baby Friendly Hospital Practices1 to ensure sucking immediately after birth and a good start to breastfeeding as well as Breastfeeding Counselling2 materials to assist health and community workers and mothers to overcome common problems that can upset optimum nutrition and the happy exchanges of eye contact, communication and love that occur during feeding. Exclusive breastfeeding is best for babies for the first 4-6 months of their life. Exclusive means that babies should not be given any other liquids or foods, including water. Breastfeeding is best “on demand” (recall Traditional Practices that Promote Early Child Development from the last Newsletter) and babies also enjoy using the breast as a pacifier. Babies engage in “non-nutritive sucking”, or pacification, when they are stressed and when trying to cope with their newly developing physiological and psychological regulatory capacities (for example, when they are tired). This sucking has been shown to help the baby ‘regulate’ and thus promotes development. Mothers establish and stabilize their milk supply better if they rest after birth. This can be done by “bedding in” – mothers and babies lying and sleeping together and letting the baby feed whenever he or she wants. Many traditional cultures have customs during which the mother and baby are secluded together for two or more weeks, and the mother is relieved of her usual work by relatives so her and the baby can be together and establish their relationship, including breastfeeding. This is one of the reasons why social support for women from partners and family is important for infant feeding and mother and child health and wellbeing Women often introduce formula milk in a bottle and other foods earlier than f4 months because they think the baby is not getting enough breast milk. This conclusion is based on the fact that infants cry more between 6-12 weeks. But infants cry more also because their crying vocalization matures and they are better able to express discomfort, not only because they are hungry. Unfortunately, the introduction of formula, pap and other foods creates a vicious cycle – the baby sucks less vigorously on the breast and the mother produces less milk, making the baby more dependent on non-breastmilk feeds. In future Companion Pieces, we will discuss infant crying and active and responsive feeding of weaning food to young children. 1 2 ADVANTAGES OF BREASTFEEDING Breastfeeding  Helps bonding and development  Helps delay a new pregnancy  Protects mothers’ health Breastmilk  Costs less than artificial feeding DANGERS OF ARTIFICIAL FEEDING  More allergy and milk intolerance  Increased risk of some chronic diseases  Overweight  Lower scores on intelligence tests  May become pregnant sooner  More diarrhoea and respiratory infections  Persistent diarrhoea  Malnutrition Vitamin A deficiency  More likely to die  Increased risk of anaemia, ovarian and breast cancer Mother  Interferes with bonding WHO Breast feeding Counselling Participant Manual  Perfect nutrients  Easily digested Efficiently used  Protects against infection
  6. 6. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS The opinions and views in the newsletters are those of the HSRC team involved in the Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS and do not neces- sarily reflect the views or opinions of the Conrad N. Hilton Foundation as a whole or any of the twelve implementing partners. Page 6 30440 Agoura Road Agoura Hills, California, 91301 USA 818.851.3700 750 Francois Road Intuthuko Junction Cato Manor, Durban, 4001 South Africa +27 31 242 5400 Newsletter 3 April 2013 What can and can’t we learn from before and after measures? Following on from the last issue, most partners have set up their M&E plans such that measurement is made before the intervention starts and after it ends, with the intention of concluding that the difference between the baseline and endpoint measures is due to the effect of the intervention. These measures might be of individual children, families, households, villages or organizations. The difficulty with before and after assessments is that changes can occur independently of the intervention. For example, even if the intervention was not implemented, the per cent of children achieving an appropriate developmental milestone will increase simply as a consequence of the children getting older. Families may find sources of support other than the intervention, etc. The challenge is to design an evaluation which isolates change specifically associated with the intervention. Randomized Control Trials (RCTs) are designed to do this. The children, households or organizations are randomised to receive the intervention or not and this has the effect of evening out extraneous influences. But RCTs are expensive and require specialized personnel to design and run them. Because procedures need to be standardised across children, households or organizations, they may hinder the usual operations of agencies working to help children and families. How then to isolate the impact of an intervention without conducting a RCT? It is not possible to fully isolate the effects of interventions on many outcomes, but certain approaches to before and after assessments are better than others. The key is to select appropriate measures. Two types of measures help isolate the impact of the intervention: 1. Measures which are unlikely to change in the absence of intervention, and 2. Measures which change in predictable ways in the absence of intervention An example of the first type is participants’ knowledge of the progression of children’s developmental milestones. Although knowledge levels may well change over time, it is unlikely that they will change rapidly in the absence of intervention. Therefore, if knowledge is higher after the intervention than it was at baseline, it is reasonable to assume that the improvement is a result of the intervention. An example of the second type is children’s growth. Predicting the growth of an individual child may be difficult, but for groups of children, growth curves are available that have been established from measures taken from many children. If, relative to the growth curve, the average growth of children in the intervention group improved over the period of intervention, it is not unreasonable to argue that this may be a result of the intervention. With both types of measures, evaluators must be careful to question if there are other influences which are occurring simultaneously with the interventions, and which may also contributed to differences between before and after measures. If other changes are occurring simultaneously, isolating impact will be difficult without a control group. Take home points:  RCTs disentangle intervention related and non-intervention related change  If an RCT is not possible or desirable, select measures which are, either a) unlikely to change in the absence of intervention, or b) change in predictable ways in the absence of intervention  Always look out for influences which may be affecting the selected pre- and post-measures The World Health Organization commits itself to promoting early child development Using a total institutional approach involving many departments, the World Health Organization (WHO) in January 2013 convened a meeting, with external stakeholders, entitled Nurturing Human Capital along the Life Course: Investing in Early Childhood De- velopment to consider state-of-the-art evidence, effective interventions, tools and indicators, and successful strategies for getting programs to scale. Key messages from the meeting include that there are two important periods for interventions to overcome early ad- versity and encourage human capital formation. These are (1) Prenatal-3 years of life by ensuring the health and nutrition of parents- (especially mothers) to-be, and the promotion of nurturing early care environments for young children, and (2) Adolescence and precon- ception by ensuring supportive transitions into adulthood and preparing the next generation of parents.