Protocol to develop sustainable day care for children aged 1–4 years in disadvantaged urban communities in Dhaka, Bangladesh

Abstract

IntroductionLack of safe, stimulating and health-promoting environments for children under-5 hinders their physical, social and cognitive development, known as early childhood development (ECD). Improving ECD impacts on children, and can improve educational attainment for girls, who often care for younger siblings, and employment prospects for mothers. Developing and evaluating the impacts of ECD programmes within childcare needs to assess a range of social, health, educational and economic impacts, including women’s empowerment.Children living in slums are at high risk of poor early development and holistic, sustainable interventions are needed to address ECD in these contexts. This study will be undertaken in Dhaka, Bangladesh, a city where over 8.5 million inhabitants live in slums. In collaboration with government, non-governmental organisations and communities, we are developing and testing a sustainable day-care model for low-income communities in Dhaka.Methodology and analysisA sequential mixed methods approach is being used in the study, with qualitative work exploring quantitative findings. Two hundred households with children under-5 will be surveyed to determine day-care needs and to assess ECD (parent-reported and direct assessment). The feasibility of four ECD measuring tools Caregiver-Reported Early Development Index, Measuring Early Learning Quality and Outcomes, The Early Human Capability Index and International Development and Early Learning Assessment will be assessed quantitatively and qualitatively. Qualitative methods will help understand demand and perceptions of day care while mothers work. Participatory action research will be used to develop a locally appropriate and potentially sustainable model of day care for under-5 children. A ward in the south of Dhaka has been selected for the study as this typifies communities with slum and non-slum households living next to each other, allowing us to explore potential for better-off household to subsidise day care for poorer households.Ethics and disseminationFindings will be published and inform decision makers at the national, regional and the local actors in order to embed the study into the policy and practice on childcare and ECD. Ethical approvals for this study were obtained from the School of Medicine Research Ethics Committee at the Faculty of Medicine and Health at the University of Leeds (ref: MREC16-106) and the Bangladesh Medical Research Council (ref: BMRCAIREC/20 I 6-20 I 9 I 250).

Co-creation and self-evaluation: An accountability mechanism process in water, sanitation and hygiene services delivery in childcare centres in Nairobi's informal settlements

“…Our study will add to the literature as both the users (parents) and providers (childcare managers) were involved in describing the building blocks of co-creation using two qualitative approaches; FGDs and workshops. The cocreation process output entailed (1) defining accountability to whom and for what?, (2) performing/action and information, (3) judging and assessing performance, (4) learning and adapting, the four steps were intended to lead to (5) a key outcome of meeting WASH needs of children in childcare centers. It was clear that FGDs and participatory workshop approaches for co-creating iSAMs were of great value, as the participants were beneficiaries of the output and had attribution in the process.…”

“…Many of the basic services are neither statutory nor compulsory, with limitations of finance, governance and a growing reliance on non-governmental organization (NGO), faith-based and private-for-profit led initiatives ( 3 , 4 ). As such, children under 5 years of age are among the marginalized and under-represented in access to services, including WASH service delivery in childcare centers ( 4 , 5 ), more so in informal settlements ( 6 , 7 ).…”

Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries

“…The inclusion of the non-health sector allows public health programmes to look for more creative ways of reaching urban poor communities. Exploring opportunities to co-opt non-health services into the response to health improvement and delivery of services provides many creative opportunities, for example, through schools,37 mosques,38 day-care centres39 as mechanisms for reaching the urban poor with messages of prevention, immunisation or nutrition campaigns or support for self-management. This reduces reliance on health workers giving health advice and attempting to stimulate individual behaviour change of the (proportionately few) patients that visit their health centres.…”

Co-creation and self-evaluation of informal social accountability mechanism process in water, sanitation and hygiene (WASH) services delivery in childcare centres in Nairobi’s informal settlements

“…Many of the basic services are neither statutory nor compulsory, with limitations of nance, governance and a growing reliance on NGO-led, faith-based and private-for-pro t initiatives (4)(5)(6). As such, children under ve years of age are among the marginalized and under-represented in access to WASH service delivery in the childcare centres (7)(8)(9), more so in informal settlements (10,11).…”