Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya

Abstract

BackgroundGlobally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya.MethodsThis mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted.ResultsIn total, 129 childcare centers were identified −55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention.ConclusionImplementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed.

The feasibility, acceptability, cost and benefits of a “communities of practice” model for improving the quality of childcare centres: a mixed-methods study in the informal settlements in Nairobi

“…Here we report the findings of objective 3 covering the final evaluation of feasibility acceptability, benefits and costs of the co-designed model. The codesign process is described in Oloo et al ( 29 ) and the findings on the factors influencing the quality of childcare centres are presented in Nampijja et al (awaiting publication). In this study, we aim to test the feasibility, acceptability, benefits and the cost of a co-designed CoP model on the centre quality, and the knowledge and skills of the centre providers and CHVs.…”

“…Following our initial mapping exercise, we categorised childcare centres as: (i) faith-based run by and often located within religious institutions, (ii) centre-based, small centers often run small centres often run by NGOs or private organisations, (iii) home-based run from within a resident’s (predominantly women) own house with limited facilities or training, and (iv) school-based attached to a primary school. Following the mapping of childcare centres and co-design workshops with local government, community health teams, parents and childcare centre providers, school-based centres were excluded from the intervention implementation ( 29 ). This allowed the intervention to focus on the lowest quality and least supported home-based, and small centres (faith-based and centre-based).…”

“…Following the initial mapping ( 29 ) we conducted baseline assessments of 68 centres (16 Korogocho and 52 Viwandani). All were invited to participate in a six-month pilot of the intervention and all accepted.…”

“…Given the poor quality of childcare centres in LMICs particularly in impoverished settings due to lack of resources, lack of skills on the part of the childcare centre providers and absence of clear guidelines to regulate centre-based childcare, our programme of research aimed to support the improvement of the quality of centre-based childcare in line with the WHO’s nurturing care guidelines ( 7 ). The intervention was co-designed by centre providers, community health teams, parents, local and national government and is described in detail in a sister paper ( 29 ). This study aimed to assess the feasibility, acceptability, cost and benefits of the CoP intervention for improving the quality of childcare centres.…”

Editorial: Day-care for healthy child development and wider social and economic gain in urban areas in low- and middle income countries

“…First, a survey of childcare centers examined the quality and key drivers of quality in childcare centers in the Nairobi slums, with poor caregiver knowledge and practices being the major barrier ( Nampijja, Langat, Oloo, Okelo et al ). The second paper describes a successful codesign process with center owners, NGOs, and lay community members to develop a community of practice approach to improving day-care center provider skills and practice ( 17 ). In the third paper, with implementation led by government-supported community health volunteers (CHVs) and supervised by community health assistants (CHAs), with training from an NGO with expertise in childcare (Kidogo), the intervention was found to be feasible and showed potential to improve the knowledge and practices of the center providers ( Nampijja, Langat, Oloo, Amboka et al ).…”