Leveraging paraprofessionals and family strengths to improve coverage and penetration of nutrition and early child development services

Abstract

Children need to be protected in intergenerational networks, with parents who have positive mood, resources to feed their children, and skills to promote early childhood development (ECD). Globally, more than 200 million children are raised annually without these resources. This article reviews the potential contributions of increasing coverage and penetration of services for these children, challenges to achieving penetration of services in high risk families, the opportunities created by bundling multiple services within one provider, the potential leveraging of paraprofessionals to deliver care, and mobilizing communities to support children in households at high risk for negative outcomes. We end with a number of suggestions for how to ensure the equitable scale up of integrated ECD and nutrition services that take into account current global priorities, as well as coverage and penetration of services.

The effects of caregiver and household HIV on child development: a community‐based longitudinal study of young children

“…In southern African countries most affected by HIV, the complexity of family structures and models of caregiving matter. Children grow up in households where their needs may be met by a variety of individuals (Tomlinson et al ). HIV clusters in families, and those families affected by the disease also live in adverse circumstances often exposed to several other risk factors (Skeen et al ).…”

“…There is good evidence from a range of studies that interventions delivered by community health workers can reduce depression (Van Ginneken et al 2013) and child outcomes can improve in the context of community-based delivery of support to caregivers (Tomlinson et al 2014). There are also ongoing trials examining the impact of communitybased treatment of maternal depression (Lund et al 2015).…”

Effect of an early perinatal depression intervention on long-term child development outcomes: follow-up of the Thinking Healthy Programme randomised controlled trial

“…32 There is also growing evidence that inputs such as nutrition and stimulation interact in the production of child developmental outcomes 33 and previous trials in which depression treatment is combined with nutritional and parenting components are among the most successful. 33 It is hence possible that, in environments with multiple adversities (e.g. malnutrition, low social support, overall poor health), treating maternal depression alone may not be sufficient to address children's cumulative risk.…”

Investing in the foundation of sustainable development: pathways to scale up for early childhood development

“…107 Among many challenges is the already stretched health workforce, giving impetus to the movement to expand paraprofessionals (including community health workers) and families as resources to support nurturing care for children. 108,109 Technology can facilitate training, service delivery, data collection, and programme improvement. 110 …”