Process evaluation of integrated early child development care at private clinics in poor urban Pakistan: a mixed methods study

Abstract

BackgroundIn poor urban Pakistan, private GP clinics lack adequate services to promote early child development (ECD) care. A clinic-based contextualised ECD intervention was developed for quarterly tool-assisted counselling of mothers.AimTo explore the experience and implementation of ECD intervention by the private care providers and clients, for further adaptation for scaling of quality ECD care, at primary level private healthcare facilities in Pakistan.Design & settingA mixed methods approach using quantitative records review and qualitative interviews at poor urban clinics in Rawalpindi and Lahore, Pakistan.MethodQuantitative data from study-specific records were reviewed for 1242 mother–child pairs registered in the intervention. A total of 18 semi-structured interviews with clinic staff, mothers, and research staff were conducted at four clinics. The interviews were audiorecorded and transcribed verbatim.ResultsDistrict Health Office (DHO) support allowed transparent and effective selection and training of clinic providers. Public endorsement of ECD care at private clinics and the addition of community advocates promoted ECD care uptake. Clinic settings were found feasible for clinic assistants, and acceptable to mothers, for counselling sessions. Mothers found ECD counselling methods more engaging compared to the usual care provided.ConclusionIn poor urban settings where public health care is scarce, minimal programme investment on staff training and provision of minor equipment can engage private clinics effectively in delivering ECD care.

Is integrated private-clinic based early child development care effective? A clustered randomised trial in Pakistan

“…In Pakistan, there has been limited reported experience of using ASQ-3 to measure all five domains of child development. 30–32 Similarly, clinic-based measurement of child development has not been tested before. In the present study, the caregiver responses were supplemented by on-site observation by a trained assessor.…”

“…The process evaluation has shown that clinic-based delivery of ECD care is feasible for providers, and acceptable for mothers and families living in poor urban localities. 30…”

“…In conclusion, contextualised ECD care, when delivered by non-specialist staff at GP clinics in poor urban localities, can effectively reduce the developmental delays during the first 12 months of child life. The effectiveness and feasibility 30 of ECD care at GP clinics indicates a possibility of scaling the intervention in other parts of the country.…”

Family-centered Approach to Monitoring Children’s Development in a Paediatric Outpatient Setting: Feasibility Study From Pakistan

“…A study from Pakistan in private outpatient clinics with mothers of young children found that counseling focused on promoting development were more engaging and helpful than the usual/standard care provided by paediatric consultants [15]. However, the programme was funded through a research grant and scale-up of the innovation will likely remain dependent on philanthropy for further implementation.…”

A Family-Centered Intervention to Monitor Children's Development in a Pediatric Outpatient Setting: Design and Feasibility Testing

“…The majority of the ECD and disability research and programmatic work in Pakistan is community-based in the public sector with scarce evidence of collaboration from the private health sector. A study with private outpatient clinics with mothers of young children found that counseling focused on promoting development were more engaging and helpful than the usual/standard care provided by pediatric consultants (20). However, the program was funded through a research grant, and scale-up of the innovation will likely remain dependent on philanthropy for further implementation.…”