The document discusses implications of incorporating knowledge about the first 1,000 days into health services in Cape Town. It summarizes current initiatives related to maternal, newborn and child health. Services already focus on nutrition, health interventions, and intersectoral collaboration. The document outlines opportunities to enhance antenatal care, emergency services, infant and child services, and links with NGOs and adolescents. Key focus areas are comprehensive care, parenting support, screening and referrals, interdisciplinary teams, and building community support networks. The way forward is to facilitate family dialogue and empower parents through a family-centered approach.

1. Group Discussion
1
1st 1000 days to City of Cape Town Health
What is new that has been learned?
What is already being done in the services we are providing (to pregnant women &
babies & others)?
What are we already doing but needs to be enhanced and how can that be done?
What are we not doing that needs to be incorporated in the services?
How can the new knowledge be incorporated into service provision to clients?
What barriers to implementation are anticipated?

2. 1st 1000 Days Initiative Roadshow
,
E Malek, J Giddy, V De Azevedo, M Hendricks
FIRST 1000 DAYS SERVICE IMPLICATIONS
15 April 2016

3. What are we already doing?

4. 1st 1000 days to City of Cape Town Health
Provincial Strategic Plan 2014-2019:
5 Provincial Strategic Goals
STRATEGIC GOAL 1:
Create opportunities
for growth and jobs
STRATEGIC GOAL 2:
Improve education
outcomes and
opportunities for
youth development
STRATEGIC
GOAL 3:
Increase
wellness, safety
and tackle social
ills
STRATEGIC GOAL 4:
Enable a resilient,
sustainable, quality
and inclusive living
environment
STRATEGIC GOAL 5: Embed good governance and integrated service delivery
through partnerships and spatial alignment
2015/09/16
4

5. Provincial Strategic Goal (PSG) 3
Inclusive, Safe
and Healthy
Communities
Resilient and
Healthy Families
Engaged and
Healthy youth
Safe and Healthy
Children

6. PRE-CONCEPTION,
PREGNANCY,
CHILDBIRTH
(1st 1000 DAYS)
POSTNATAL &
NEWBORN
DEVELOPMENT
(1st 1000 DAYS)
INFANT &
TODDLER
HEALTH &
DEVELOPMENT
(1ST 1000 DAYS)
YOUNG CHILD
HEALTH AND
DEVELOPMENT
(<60 MONTHS)
ADOLESCENT
HEALTH &
DEVELOPMEN
T
LIFE
COURSE
PROGRAMME
INTERVENTIONS
Nurturing Care and Responsive Parenting
Healthy
growth
and
developm
ent
1ST 1000 DAYS INITIATIVE: PROJECT DESIGN
6
Communication
strategy
Intersectorial
interventions
Health
Interventions
Adapted ,Slide presentation,. Pia Britto,UNICEF ,DOHaD conference November 2015
Nutrition
&
Health
Nurture,
Care
&
Support
Safety,
Protection
&
Stimulation

7. Go to Insert > Header & Footer > Enter presentation name into footer field 7
PSG3 Plan of Action for 2016/17
Deliverable Area/
Main focus
Activities Target
Transversal
Communication
strategy
Targeting commuters
and caregivers
(LSM 2 -4)
• Branding of taxis
• Interior messages in taxis
• 10 taxis
• 47 taxis
• Community radio sponsored interviews and talks on 9
radio stations in Metro and Rural areas • 30 sessions
• First 1000 day social media campaign
• Test the success of campaign with focus groups
(caregivers & recipients of messages)
Health Interventions
Adolescent and
antenatal health
services
Ante natal policy reviews
• BANC checklists (risk screening tool)
• Comprehensive health education package
• 2
• M & E, First 1000 days dashboard indicators against
performance targets
• Quarterly reviews
Adolescent programme
• STI screening campaigns(4)
• HCT & HCT couple campaign(2)
• Adolescent family planning campaign(including
condom distribution(4)
• 10000 clients
• 10200 clients
• 600000 condoms

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PSG3 Plan of Action for 2016/17
Deliverable Area/
Main focus
Activities Target
Intersectoral
Interventions
including
Drakenstein
First 1000 days Roadshows (Workshops and Dialogues)
Including PHC, CBS, NPO and other departments
• Metro
• Rural
• 4
• 5
Adolescent programmes
• Empowerment and Care programme
• Empowerment, Care and Cash programme
• 6000 clients
• 2400 clients
• Pilot Social Impact Bond
Seminar, Promotion, protection and support of Breastfeeding, • 1
Situation analysis – parenting programmes • 1
Drakenstein First 1000 day summit • 1
Intersectoral linkages (DOE,DSD,DOCS)
• PSG2 links with ECD
• Alcohol Harm Reduction prevention during pregnancy
• Intimate Partner Violence, play environments (CSIP)
• Stimulation and Play - Valcare Trust
Intersectoral resource mapping for referral and support
services of at risk clients

9. Transversal Communication Campaign Unique Identifier
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10. Important First 1000 Day Facts!
The brain grows to 80% of its full size by the age of 2 years!
The brain needs 3 essential elements to grow & develop well, just like a plant
The brain needs loving interaction with a caring adult to grow well
Brain structure is affected by toxic stress during pregnancy & childhood!
Harm to the brain is buffered by the consistent presence of a caring adult
Positive parenting builds confident children to do better at school & get jobs!
3 Key Time Periods
3 Key Elements
1 2 3
To grow the best
brain by
2 years…
…Start early in
Pregnancy
Start Caring for Your Baby Before Birth
1000 days
270 365 365
Pregnancy 1st year 2nd year
+ +
Nurture,
Care &
Support
Safety,
Protection &
Stimulation
Nutrition
& Health
What Every Family and Community Have a Right to Know:
Start Caring for Your Baby Before Birth

11. Implications and Opportunities

12. What to aim towards?
12
1st 1000 days to City of Cape Town Health
A vision for re-engineering Maternal
and child health services..

13. First 1000 Days Circles of Support
13
First 1000 days W Cape Transversal Communications Workshop 14 May 2015
While the pregnant woman is the environment of the developing fetus,
the community is the environment of the mother.

14. First 1000 days care contexts
First 1000 days W Cape Transversal Communications Workshop 14 May 2015 14

15. First 1000 days: Existing Health Service
Opportunities
1st 1000 days to City of Cape Town Health
Primary Health Care, MCH, Nutrition, Mental Health & Emerg services:
• Antenatal (BANC): Every pregnant woman & teen and partner/family
– IYCF
• Intrapartum (MOU’s): Every pregnant woman & teen and partner/family
- MBFI
• Postnatal (clinics): Every child and parent/caregiver/family
– Postnatal care
• Infant (0-2years): Every child and parent/caregiver/family:
- RTHB (well child), IMCI, “Surge season” process, etc
Other: Adolescent & FP services: Every teen and partner/family
Emergency services: Every pregnant woman and partner/family
15

16. 16
Nutrition and Health
• Protection from unwanted pregnancy
• Adequate Family planning and
pregnancy spacing (>2 years)
• Empathetic service providers
• Comprehensive Antenatal, Postnatal &
Well-baby Care (incl RTHB)
• Comprehensive Risk screening in
pregnancy
• Nutrition support for pregnant and
breastfeeding women
• Maternal Mental Health Care &
counselling services
• Referral and support services for
substance, smoking & alcohol abuse
• Birthing (intrapartum) care (incl HBB)
• Breastfeeding Support (clinic, family,
community & workplaces)
• Postnatal Care (incl KMC, high risk
services)
• Infant wellbeing risk screening &
Parent-Infant assessment
• Caregiver counselling (Infant Feeding,
Attachment, Parenting, RTHB, ECD)
• Nutritious complementary feeding
• Emergency care (IMCI: DD, ARI, SAM,
MSSN))
• Community IMCI: danger signs, SSS,
etc
• Partner, Family & Community support
in pregnancy & for parents/caregivers
• Social service support/referral (incl
birth registration, family and parenting)
Nurture, Care and Support
• Self care and wellness
• Mentoring / Peer support
/ group
• Recognising important
role of men and fathers
• Family/partner support
before, during and after
pregnancy
• Social support services
(eg CSG, SASSA, ECD,
CPS)
• Community support
during and after
pregnancy
• Consistent, attentive
caregiver arrangements
• Workplace support (mat.
leave, breastfeeding,
child care..)
• Empathetic counseling
• Substance, smoking &
alcohol intervention
services
• Emergency care
arrangements /
preparedness
Safety, Protection and
Stimulation
• Sensitive
parenting/caregiving
(responsive to baby’s
cues)
• Infant Wellbeing (Sense of
Safety & Wellbeing)
• Play, singing, story-telling,
dancing, book-sharing
• Care-giving and Parenting
support
• Social and community
support services incl ECD,
toy libraries
• Clean air to breathe (away
from smoke)
• Clean water to drink
• Hygienic practices (hand-
washing, sanitation)
• Child safety in the home
• Road & pedestrian safety
• Safe spaces to play
• Safe neighbourhoods
• Environmental support
services
• Community and Family
engagement and support

17. PRE-
CONCEPTION,
PREGNANCY,
CHILDBIRTH
POSTNATAL &
NEWBORN
DEVELOPMENT
INFANT & TODDLER
HEALTH & DEVELOPMENT
(1ST 1000 DAYS)
YOUNG CHILD HEALTH
AND DEVELOPMENT (<60
MONTHS)
ADOLESCENT
HEALTH &
DEVELOPMENT
FP & TOP
BANC
Peer counselling
IYCF & Breastfeeding
Maternal Mental
Health & Nutrition
Risk screening
CBS
PNC incl risk
screening
MSSN
Breastfeeding
support
KMC
CBS
GMP (RTHB)
EPI (RTHB)
IYCF (RTHB)
IMCI & SAM
Danger signs
CBS
GMP (RTHB)
EPI (RTHB)
IYCF (RTHB)
IMCI & SAM
Danger signs
CBS
School Health
Contraception
Sexual
Reproductive
Wellness (STD’s,
HIV)
Mental Health
LIFE
COURSE
PROGRAMME
INTERVENTIONS
Nurturing Care and Responsive Parenting
Healthy
growth
and
development
1ST 1000 DAYS INITIATIVE FRAMEWORK
Parenting information
& Preparedness
(conversations, skills)
Environmental Health
Community Safety
Road Safety
Parenting Support
& Skills
Environmental Health
Community Safety
Road Safety
Play & Development
(RTHB)
ECD
Environmental
Health
Community Safety
Road Safety
Play & Development
(RTHB)
ECD
Environmental Health
Community Safety
Road Safety
Education curriculum
to include parenting
information
Environmental Health
Community Safety
Road safety
17
Nutrition
&
Health
Psychosocial
support
Social Services
Prevent IPV
Places of Safety
Family/Community
support
Psychosocial
support
Social Services
Prevent IPV
Places of Safety
Family/Community
support
Psychosocial
support
Social Services
Places of Safety
Family/Community
support
Psychosocial
support
Social Services
Places of Safety
Family/Community
support
Psychosocial
support
Social Services
Prevent IPV
Places of Safety
Family/Community
support
Safety,
Protection
&
Stimulati
on
Nurture,
Care
&
Support
Adapted from UNICEF (Pia Britto)

18. Implications for Services
Antenatal Birth to 6
months
7 months to 2
years
General
Health &
wellness
Booking < 20weeks;
4 ANC visits;
PMTCT
Educate, screen / refer
problems of alcohol,
tobacco, drugs;
Psychosocial risk
screen & mental health
screen
Postnatal care
Safe Family Planning
PMTCT
Immunisations
Management of disease
(pneumonia /diarrhoea)
Developmental screening
Hand washing & hygiene
Immunisations
Management of disease
(pneumonia / diarrhoea)
Developmental screening
Hand washing & hygiene
De-worming
Adequate
nutrition
Balanced diet
Micronutrients
Optimal weight
Breastfeeding
counselling
Support Exclusive
breastfeeding
Growth monitoring
Prevent malnutrition
Breastfeeding
Complementary feeding
Micronutrients
Growth monitoring
Prevent malnutrition
Supplementary feeding
Stimulation
& Support
Psychosocial support
Parenting information
Promotion of caregiving
practices
Parenting information
Promotion caregiving
Early learning (home)
Birth registration, Child
Support Grant (CSG)
Promotion caregiving
Early learning (home)
Parenting information
CSG

19. Implications for CBS level
19
1st 1000 days to City of Cape Town Health
Basic First 1000 Days messages to be communicated / shared with CBS
partners
Training in MCH care & counselling (including parenting) for CCW’s
Referrals of mother’s & children with risk factors CCW support (home
visits) for example:
o Adolescents who are pregnant / mothers
o Newly diagnosed HIV infected women
o Adherence problems on ART
o Lack of support by family / partner
o Violence / trauma and requesting support
o Breastfeeding problems
o Bereaved and struggling to cope
o Depression / anxiety
o Parenting problems shared
o Drug and alcohol use and wanting to quit

20. Implications for Maternal Health Services
1st 1000 days to City of Cape Town Health
Optimising opportunities for Maternal Health during antenatal care..
Provide Comprehensive Antenatal Care:
o Early booking encouraged
o Empathic and compassionate attitude
o Competent BANC services:
 including health education re nutrition (pregnant woman and BF education)
o Maternal Psycho-Social risk factor screening
 Appropriate referral for both medical and psychosocial care & counselling
NB Mental health services, substance abuse services, support for pregnant teens
o Improve links with CBS – need more home visits
Parenting-Infant attachment support
o Establish Parent support groups starting in antenatal care (Use Club Rooms)
o Promote the role of fathers and men; optimise antenatal waiting periods & areas
o Discuss RTHB & Parenting during Antenatal care, Expand infant feeding counselling
20

21. 21
First 1000 days W Cape Transversal Communications Workshop 14 May 2015

22. Implications for Emergency Health Services
22
First 1000 days W Cape Transversal Communications Workshop 14 May 2015

23. Implications: Infant and Child Services
1st 1000 days to City of Cape Town Health
Infant and Child Health:
o Implement new Postnatal care policy (& continue IMCI, SAM, MSSN)
o Comprehensive integrated wellness care for children
o Promoting,protecting and supporting breastfeeding
o Optimising the use of the RTHB, which tracks wellness care :
 growth monitoring
 Immunization
 Vit A
 Deworming
 Key messages on nutrition, play, home treatement, danger signs
Care of Mothers, caregivers and fathers:
o Screening for psychosocial risk, basic counselling and referral
o Provide integrated care where possible (e.g women on ART)
o Parenting information & support (active) – links with NGO’s if needed
 Appropriate referral for psychosocial care
23

25. Partnering with NGO’s & ECD Services
25
First 1000 days W Cape Transversal Communications Workshop 14 May 2015
Supporting a child starts with
supporting a Mother
The First 1000 days Relationship Support
Tool “Ibhayi Lengane” (Ilifa
Labantwana)was developed as an add-on
to existing
home visiting programmes with the purpose
of enhancing the mother-child
relationship during the first 1000 days.

26. Implications: Adolescent and FP Services
1st 1000 days to City of Cape Town Health 26

27. Implications for all services
1st 1000 days to City of Cape Town Health
Facilitate family and community dialogue and links to support – build
relationships - not just provide information;
o Empathetic staff
o Strengthen “Communicator / Facilitator” roles
o Family-centred approach – focus on child-family interactions, not child alone.
(Children develop in context of relationships)
o Know services in your area (local resource directory/map)
o Be trained on parenting
Actively encourage Positive parenting (sensitive, non-intrusive, consistent,
assertive). Parents are an untapped resource. Build on child and family
strengths and abilities (rather than focus on only problems)
Trans-disciplinary teaming and staff support, include parents and family,
shared decision-making, links to other support services, mapping of community
resources
27

28. Way Forward
28
1st 1000 days to City of Cape Town Health
Health Interventions
Communication
Intersectorial
interventions

29. From Interventions to Packages and Platforms
Interventions are
Implemented by single sectors
Interventions need to
be packaged taking into
consideration the
unique set of risks and
adversities that define
complex environments & nurturing care
Delivery Platforms need to be
Identified for services
,Slide presentation,. Pia Britto,UNICEF ,DOHaD conference November 2015

30. Source: “The Essential Package”, Ilifa Labanthana
)
Promoting Integrated Service Models for 1st 1000 days (1)
30

31. Ref: UNICEF ECD Update Workshop, 2014
Promoting Integrated Service Models for 1st 1000 days (2)
31

32. Working with what we have
32
1st 1000 days to City of Cape Town Health
Help create awareness: share what we have and what we know: “5
loaves & 2 fishes” principle -
The First 1000 days: a unique and powerful opportunity to
facilitate changed life trajectories for children and society as
a whole
Optimise the Starting Points, “1st 1000 day Champions” (badges),
Roll-out training, use Resources (flashdrive),
Recognise and strengthen the networks, Improve service point
linkages
Partner & Engage (use/expand existing platforms eg ECD’s, Sub-
district MCH working groups, ISDMT’s, community dialogues, NGO’s)
Map resources and referral pathways

33. Using existing mechanisms
1st 1000 days to City of Cape Town Health
Provincial Clinical Governance structures :
• Paediatrics, Obstetrics, Mental Health, Emergency Care
• Metro Family Medicine Specilalists Forum, Nurses Forums
District service coordination mechanisms
• District Maternal /Child /Mental Health Forums
Regional Training Centre and sub-district trainers
Liaison structures
Partnering with local Municipalities
33

34. Some Action Points
34
First 1000 days W Cape Transversal Communications Workshop 14 May 2015
Know your service environment
Map of Social services & supportive counselling for referrals from
clinics Available Parenting Information and Support Programs
Local district/sub-district intersectoral liaison committees/structures
M&E: Know the relevant Indicators (MNCH&N Dashboard)
Health Promotion:
Health & Wellness in Pregnancy (1st 1000 Days IEC tick list)
Food security during pregnancy
Community components:
Prevention Intimate Partner Violence, Safe play environments
Pregnancy prevention & parental readiness/planning (DoE)
Child supervision (Road/Pedestrian Safety)
Community dialogues re data on pregnant women and infants at risk

35. Resources & Support
35
1st 1000 days to City of Cape Town Health
First 1000 Days Initiative Roadshow Resources
Roadshow presentations and videos (Flashdrive)
1st 1000 Day Trailer (16 slides) for staff orientation (Flashdrive)
1st 1000 Day Flyers (hand-out today)
1st 1000 Day Champion Badges (hand-out today)
1st 1000 Day related existing Health Promotion Materials (listed on Flashdrive) &
masterfile
Provincial support:
First 1000 Days = W Cape DOH OPEXCO Key Priority
First 1000 Day Initiative point persons: EXCO Chair: Hilary Goeiman; Parent Infant
Child Health & Wellness (1st 1000 Days PSG3 Intersectorial WG) Chair: Elmarie Malek
RTC Training on Empathetic skills, etc
Metro support:
Metro GSA planning a session on 1st 1000 Days Initiative
Metro 1st 1000 Day Point Persons: CoCT: Dr De Azevedo; MDHS: Family Medicine
Clinicians and District Paediatricians (Dr J Giddy, Dr M Hendricks, Dr T Wessels), other

36. Flyers & Badges & more..
36
1st 1000 days to City of Cape Town Health
Button Badges for Facility
Champions
Flyers (in 3 languages):
English, Afrikaans, Xhosa
Communication Campaign Key
messages combined pamphlet (to
follow)
W Cape Province Website (First
1000 Days launch radio-interview)

37. 1st 1000 days to City of Cape Town Health
Many things we need can wait. The child cannot.
Now is the time his bones are formed, his mind
developed. To him we cannot say tomorrow,
his name is today.
Gabriela Mistral
37