Improving early childhood development in the context of the nurturing care framework in Kenya: A policy review and qualitative exploration of emerging issues with policy makers

Abstract

IntroductionThe Nurturing Care Framework (NCF) describes “nurturing care” as the ability of nations and communities to support caregivers and provide an environment that ensures children's good health and nutrition, protects them from threats, and provides opportunities for early learning through responsive and emotionally supportive interaction. We assessed the extent to which Kenyan government policies address the components of the NCF and explored policy/decision makers' views on policy gaps and emerging issues.MethodsA search strategy was formulated to identify policy documents focusing on early childhood development (ECD), health and nutrition, responsive caregiving, opportunities for early learning and security and safety, which are key components of the NCF. We limited the search to policy documents published since 2010 when the Kenya constitution was promulgated and ECD functions devolved to county governments. Policy/decision-maker interviews were also conducted to clarify emerging gaps from policy data. Data was extracted, coded and analyzed based on the components of the NCF. Framework analysis was used for interview data with NCF being the main framework of analysis. The Jaccard's similarity coefficient was used to assess similarities between the themes being compared to further understand the challenges, successes and future plans of policy and implementation under each of the NCF domains.Results127 policy documents were retrieved from government e-repository and county websites. Of these, n = 91 were assessed against the inclusion criteria, and n = 66 were included in final analysis. The 66 documents included 47 County Integrated Development Plans (CIDPs) and 19 national policy documents. Twenty policy/decision-maker interviews were conducted. Analysis of both policy and interview data reveal that, while areas of health and nutrition have been considered in policies and county level plans (coefficients >0.5), the domains of early learning, responsive caregiving and safety and security face significant policy and implementation gaps (coefficients ≤ 0.5), particularly for the 0–3 year age group. Inconsistencies were noted between county level implementation plans and national policies in areas such as support for children with disabilities and allocation of budget to early learning and nutrition domains.ConclusionFindings indicate a strong focus on nutrition and health with limited coverage of responsive caregiving and opportunities for early learning domains. Therefore, if nurturing care goals are to be achieved in Kenya, policies are needed to support current gaps identified with urgent need for policies of minimum standards that provide support for improvements across all Nurturing Care Framework domains.

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“…That said, in many ways it is more important and urgent that further implementation research is conducted to develop and test intervention strategies, potentially building on the potential of the childcare platform, to mitigate from some of these disruptions. In addition, these findings underscore the need for better research to characterise the childcare system, including the economics, policies and perspectives of key stakeholders involved, in and beyond Kenya(40,41).…”

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“…Five workshops were held with parents, community health teams, i.e., CHVs and CHAs, and their sub-County managers and Nairobi City County policy makers. Through a review of published literature, Kenyan ECD and child health policies ( 46 ), and discussions held with ECD, child health, and nutrition experts, we identified appropriate content for the intervention training and materials. The NGO partners in the study, Kidogo, who work to support and improve quality among informal childcare centers in Nairobi's informal settlements, shared key materials and childcare center assessment tools, which were adapted and included (see Supplementary Table 8 ).…”

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“…To date, a holistic nurturing care approach to children's health and development has not been embedded, globally, with rigour into policies and practices. Reviews of governmental services can highlight gaps and recommended actions, as has been demonstrated recently in Kenya (Abboah-Offei et al, 2022). This type of proactive action sets the stage for systems changes to ensure that children and families receive the support that enable them to reach their potentials moving forward.…”