1. ARNE
Nurturing Young Children: CARE India’s Early Childhood Care
and Education Approach by Geeta Verma
I. Setting the Foundation:
For all children, learning begins at home and in the community in which they are raised. A
rich and stimulating environment, along with sufficient nutrition and health provisions in
childhood contributes to better child development , and thus increasing the likelihood of an
individual breaking the cycle of poverty. Researchers have shown that infancy and early
childhood are critical periods for brain development – deficits during this time have lifelong
impacts. It is observed that mo re than 200 million children worldwide fail to reach their full
developmental potential (Grantham-McGregor et al, 2007). The important factors to poor
developmental outcomes include lack of nutrition including maternal nutrition, social and
cognitive stimulation, and maternal depression. Therefore it is essential that child
development program have an approach that combines nutritional, health and social/cognitive
stimulation and education to improve child development status, contributing to improved
long-term outcomes. To ensure holistic development of children, engagement at all levels -
home, community or preschool education centre - are critical. Interventions across the world
largely engage with one or two level and inter-linkages are seldom formed at ground level.
Considering this, CARE, an international development organization working in India
through its Girls’ Education Program is addressing the challenges of early childhood
development among vulnerable communities especially schedules castes and tribes. CARE,
as an organization, emphasizes that working with selective sectors or target groups will have
limited effects on the children. Therefore, CARE in India developed an approach for Early
Childhood Development (ECD), which makes it essential to integrate different development
domains, such as health, early stimulation ,education, nutrition, economic development, and
protection etc. so that all needs of the child are met. To address domains, the model suggests
five levels of intervention, targeting: (1) the individual child, (2) the caregiver/family; (3)
child care settings; (4) the community; and (5) the wider policy environment with a focus on
engaging with health and education policy environment. As stated above and shown in
diagram below, five domains of engagement that are necessary for helping young vulnerable
children to survive and thrive are(1) food and nutrition; (2) child development, inclusive of
physical (gross and fine motor development), cognitive (language and sensory development)
and socio-emotional (addressing psychological and emotional development); (3) health (4)
economic strengthening; and (5) child protection. Due to uniqueness of five domains and five
interventions, the model is called ‘5x5 model’. It is also referred as ‘essential package’ for
early childhood development.

2. .
The ‘5x5’ approach is currently being piloted in Korba and Janjgir districts of
Chhattisgarh, India. CARE is working closely with varied stakeholders e.g. government
departments (Women & Child Development, Health & Family Welfare, Panchayat and Rural
Development), local non-governmental organizations, and community etc. to address the
holistic needs of 0-6 years of children. This is a three-years pilot project that uses strong
‘double comparison model of assessment’ and random control, where pre and post test result
of both intervention and control sites will be compared to measure the impact and outcomes.
Results will help in advancing advocacy around inter-linkages of services for holistic early
childhood development.
II. Understanding the Operational Approach to Address Five levels and Five domains of
Early Child Development
Early Childhood Development 5x5 approach provides the broad framework as well as space
to contextualize services as per context, culture and needs of the children. The section below
describes the package and contextualization as per needs of marginalized children of
Chhattisgarh, India.
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3. The Five domain areas are:
1. Food and Nutrition
For children to be nourished and healthy, food plays a vital role specially the period between
birth and three years. As evidence shows, children belonging to this age are most vulnerable
to the permanent effects of stunting as well as to a number of negative cognitive outcomes
due to malnutrition (Walker et al, 2007). Therefore, 5x5 package of ECD proposes that every
child should have access to timely, sufficient and nutritious meal as per his or her age. To
address malnutrition and stunting amongst young children in India, interventions are
strengthening government nutrition services though additional focus is on timely delivery of
ready-made food mix to children, pregnant and lactating mothers. Community orientations
are being taken up to ensure that pregnant mother gets adequate and nutritious meal, since
such behaviours are influenced by social customs and cultural practices, not so much by
poverty. Even in most marginalised communities, the right to breastfeeding is affected by
family power structure. Hence fathers and grand parents are also engaged in monthly
meetings so that they help in fulfilment of breastfeeding right. Engagement at community and
system level also ensures that all children attend centre and receive nutritious hot cooked
meal daily. In this relation, the food menu is changed periodically. Formative research of
project suggested that caregivers in rural setting do not have access to correct knowledge that
affect the practices related to child development. Parenting education, therefore, is identified
as a critical intervention. At village level, monthly meeting is being instituted where
challenges around exclusive breastfeeding, supplementary and complimentary feeding,
identification of malnourishment and ways to address malnutrition discussed regularly.
2. Child Development (Stimulation and Preschool Education)
Brain research has established that between birth and age of eight, and more so under six
years old, a young child’s brain undergoes enormous growth as neural connections are
constantly formed that provide the foundation for language, reasoning, problem solving, and
social skills. As with deficiencies in nutrition that may cause life-long detriments,
deficiencies in cognitive stimulation and/or emotional bonds during these early years can
have lifelong negative effects on the child. The impact is severe amongst children living in
marginalised communities. To ensure that parents and caregivers provide required
stimulation experiences and opportunities from early stage on, CARE India has developed a
‘developmentally appropriate stimulation and preschool education curriculum’. The
curriculum ensures that caregivers provide appropriate stimulation at home and preschool
education at centre that are age appropriate. To facilitate appropriate practices related to care
and education, facilitator, Aaganwadi workers (AWWs), are trained through continuous
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Key Assumptions
 Interdependency of Developmental domains -Focus on one domain & not on
other/s may lead to lopsided child development
 Maternal and child rights to education, health, nutrition, safety, security are
critical
 Early interventions best for most vulnerable (compensate for negative
experiences & deprivation)
 Economic strengthening interventions provide direct benefits to children

4. trainings and on-site coaching. The training focuses on enhancing their knowledge and skills
in facilitating a child’s cognitive, language and social development, and their ability to deal
with varied emotions, while parents are oriented on how to provide age appropriate
stimulation to the child at home. The ECD program is also ensuring children transit to formal
school settings smoothly.
3. Health
In India, malnutrition of children is linked with conditions and infectious diseases that could
be life-threatening such as: diarrhoea, respiratory infections, anaemia. Therefore, the package
focuses on preventive mechanisms, at community and family levels to address common
illness of children. Growth monitoring, vaccination and records of vaccination are promoted
as essential. Basic preventive systems for safe water and sanitation practices in home and
child care setting is being given emphasis to address infection amongst children. Under
health, focus is also on improving maternal health as it has direct impact on the child status,
therefore anti natal check- ups, supplementary nutrition (consumption of IFA and vitamin A)
is promoted. Inter -linkages are being established with health and child development
departments to improve health services at community level. Community is also oriented
towards their role towards health provisions and building their agency. Material depression is
identified as another focus area therefore focus is on building awareness on this issue.
4. Economic Strengthening
Poverty is a major hurdle for parents, guardians, and early childhood caregivers alike in every
marginalised community. Lack of resources equally affects young children and their needs. In
Chhattisgarh, a formative search was also conducted to understand economic opportunities
and challenges at family level and it was found that most families have inadequate awareness
about nature and entitlement provisions (CARE, 2011). To address this, CARE is working
with families through self help groups to improve their livelihoods and family resources to
meet children’s needs. For this purpose, families are educated about government schemes and
related entitlements, along with this, linkages are formed with government departments to
ensure they receive timely entitlements. This study also helped in designing the interventions
around livelihoods and engagement with Self Help Groups.
5. Child Protection
CARE is using child rights framework to understand and address issues at all levels of
intervention. The approach has also influenced project design as well as monitoring
mechanism. At intervention level, identification of vulnerable children, linking them with
existing resources such as legal aid and community mediation, and training of community
service providers on child rights are taken up. The child’s safety is considered critical for
holistic development therefore caregivers are being oriented and educated on abuse, violence
and safety issues otherwise adverse impact it may have on children development. Hence, a
safety network in the form of Mother’s group is being built, in each village, to ensure
children are safe and secure.
Five Levels of Intervention and impact:
The essential package outlines that ECD impact should be seen at five levels therefore
they need to be targeted through various interventions. The details are as follows:
1. The Individual Child
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5. The primary beneficiary of the 5x5 model is the individual child and the impact is being
observed at child level in terms of nutritional and developmental status, which is further
understood by that on girls and on boys (or “by sex”). The impact is also understood by
children’s social background for comparative reasons.
2. Caregiver/Family
The development of child is highly dependent upon the status of his/her health, nutrition and
a stimulation experience, the child receives. Quality of care depends on the knowledge and
skills of his/her primary caregiver. To address this, skills and knowledge building of
caregivers (parents including fathers), is identified as critical area of engagement. Generally,
fathers are not encouraged to be part of child rearing, even government program in India do
not encourage such practices. Essential package in India emphasises that father’s engagement
is important for child development. Moreover, to encourage investment on children in poor
households, interventions are designed to enhance family income. It is believed that such
intervention will lead to increased investment on child in terms of resources as well as
parents’ engagement.
3. Childcare Settings
Child Care settings have been established in the form of ‘Aaganwadi centre (AWC)’ by the
government though these centres primarily target nutrition and health needs of children and
mothers. Using existing child care setting as an initial point of intervention within a
community allows for increased access to caregivers, households, and individual children.
Hence, focus is on revitalization of AWC where thrust is also on promotion of appropriate
preschool education to 3-6 years old by having appropriate play and learning materials,
enriching classroom experience and capacity building of government outreach worker called
“aganwadi workers” (AWW) around curriculum and methodology. Aaganwadi workers are
further trained to build community and Aaganwadi linkages. AWC further provides an
excellent community gathering point for community meetings, preschool education, and
health services. Therefore AWC is being promoted as a forum for discussion on local and
regional policy, planning, monitoring, etc.
4. Community
Under the 5x5 model, capacity building at the community level and mapping of available
resources is a major focus of intervention. AWC centres act as platform for community
training, through government outreach worker (AWWs), and training of Self Help Groups to
address economic issues where SHGs are trained to facilitate linkages with government
schemes to ensure that the community has access to resources. To engage with community,
AWC is being promoted as a structure to orient parents, family, mothers groups and other
community members about child development and breaking myths around many child
development practices. Mothers’ group is promoted as a safety network and child
development monitoring group in the village that work with centre to support and to address
challenges faced by centre or outreach worker.
5. National Policy
Any improvement in services for young children at the centre or community level will be
short-lived without an accompanying change in state or national policy to give child health
and development greater recognition and financial support. Hence, the ‘5x5 model’ is
advocating to various ministries for improved ECD curricula, budget allocation, trained and
qualified personals to fulfil the rights of very young children.
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6. Thrust
Age appropriate
development, especially
school readiness, of the most
vulnerable, marginalised
children in the 0-6 yrs age
group
Thrust
Age appropriate
development, especially
school readiness, of the most
vulnerable, marginalised
children in the 0-6 yrs age
group
Focus on 0-6 age group
Address the “whole” child
Foster the critical link between
Education and development
Promote gender equity
Enable empowerment of
families and communities
Reach out to the most excluded
CARE India’s Thrust and Approach
III Concluding Remarks
In India, essential package or ‘5&5 approach’ is greatly guided by field realities hence
research and evaluation is critical component which has been guiding the implementation.
For example, at the beginning of the project, a formative research was conducted to
understand the child development practices and perceptions of caregivers and community.
The study aimed to understand local good practices and challenges as well, the results helped
in shaping and refining essential interventions within 5&5 framework. As a result, major
thrust of project is on care and development and protection domain as that required
understanding and skills at all levels. Study also informed that no efforts were made in the
past to address these domains thereby community and government functionaries did not have
much understanding on how such domain is essential for health development of the child.
Later on, a baseline study was carried out to assess knowledge, skill and impact at the level of
child, caregiver and settings, community etc. Baseline results have informed content of
training package, community manual, information and communication materials and
monitoring framework.
Essential Package or ‘5x5 model’ is currently being implemented in selected
geography of India and El Salvador to understand its impact at the level of children. The
project is in second year of implementation and end line result will be available in early 2014.
At the point, base line and end line results will be compared to understand the magnitude of
impact on child, caregivers and care giving settings and the results will also be available for
dissemination. Meanwhile, larger constituency of supporters and partners is built for holistic
approach to Early Childhood Development in the country.
Bibliography:
Grantham-McGregor, Sally, et al ( 2007) ‘ Developmental potential in the first 5 years for
children in developing countries, Lancet; 369: 60–70.
CARE (2011) ‘Understanding Child Development Practices in Chattisgarh: A formative
research’, unpublished.
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7. CARE (2012) ‘ A Baseline Study of Early Childhood Development Project’, conducted by
GfK Mode-Delhi, unpublished.
Walker, Susan P, et al (2007) ‘Child development: risk factors for adverse outcomes in
developing countries’ Child development in developing countries 2, Lancet ; 369: 145–57.
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