HIV and Child Development:
Two approaches to integrating ECD
Suzanne Andrews, 4Children USA
Case studies by:
Getachew Tefera, Childfund
Josephine Ferla, Catholic Relief Services
Why focus on early child development?
Millions of children under 5 years of age in low- and
middle-income countries (LMIC) are failing to reach their
potential in cognitive, language, and social emotional
development, which has implications for their
educational attainment, physical health, mental health,
social citizenry, and economic participation later in life.
For children affected by HIV, the risks are even greater.
HIV increases the risk of developmental delays
 HIV infection of infants and children is characterized by
either a progressive or static loss of previously acquired
developmental milestones with cognitive, behavioral and
motor manifestations. (Udgirkar & Tullu, 2003)
 For children affected by familial HIV, co-varying risks
include poverty, disrupted caregiving, malnourishment,
abuse and psychological trauma. Uninfected children are
more likely to not have their basic needs met, miss
developmental milestones, and become HIV positive
themselves (Van Rie et al., 2007).
Integrating ECD interventions and HIV clinical
care can improve developmental outcomes
Early stimulation and other ECD interventions for HIV-affected and
HIV-infected children have the potential to dramatically improve
development outcomes (Boivin, Bangirana, & Nakasujja, 2013).
2. Creating the conditions for HIV-affected children to not only
survive, but thrive requires integrated interventions early in life
that target the many risks to which vulnerable children are exposed
(Engle, Fernald, & Alderman, 2011).
3. Early identification and early treatment of pediatric HIV are critical
to improving both developmental and clinical outcomes for an HIVinfected child (Baillieu & Potterton, 2008).
1.
But how do we integrate ECD interventions and HIV clinical
care?
Two approaches to integrating ECD
1.
2.
ECD Centers with integrated health services: Health worker visits
and screenings, medication distribution and care plan for each
individual child.

Yekokeb Berhan, Ethopia

Presented by Getachew Tefera, Childfund
Clinic with ECD activities and messages: Child-friendly spaces,
volunteers providing key messages and early stimulation activities
with parents and children waiting for health services.

THRIVE, Tanzania

Presented by Josephine Ferla
Bringing Integrated services to ECD centers
Reflections from USAID’s largest OVC program
Yekokeb Berhan Program
for Highly Vulnerable
Children,
Pact/ Ethiopia
REPSSI 2015 Forum
“Care, Love and protect from
Infancy to Adolescence”
Sep 1-3,205
Zimbabwe
Delivery Approach
CSI/ Case Identified
Care and support plan
Service delivery at
HHs
Services provided by volunteers and
(HEW) health extension workers:
•Better parenting
•Health education
•HIV cases managed through referral
•Other referrals as needed
Service delivery at ECD center
•Medication
•Play
•Early stimulation
•Nutrition
•Follow up
Facilitating clinical outreach to HHs and ECD centers
INTEGRATION TO QUALITY ECD CLINICAL
SUPPORT
Coordination of Care
Bring key
stakeholders
together
Mobilize resources
to fill gaps
ECD Training
Health post/HEW
and ECD center
Community
mapping, resource
directory, MoUs
Refer children who
lack access &
follow up
Program adaptations or elements that facilitate ECD
clinical integration
Original design: Household visited by HEWs
• Adaptation: Program volunteers and HEWs,
initially providing home visits, provide
outreach to ECD Centers
• HEWs signed MOU with community
committee to regularly visit ECD centers,
provide health services and follow-up with
HIV positive children.
Results
• Increased enrollment and retention of HIV+
children.
• Children’s health outcomes improved.
• Children’s learning and development
improved.
• Children’s psycho-social well-being improved,
they are more assertive and connected to
community.
Quality assurance (Highlights for monitoring)
• Setting standards and procedures
–
–
–
–
–
ECD management guideline
ECD standards (minimum)
Continuum of care (HCT and palliative care)
Disclosure manual
Stigma and discrimination
• Monitoring mechanisms
– Supportive supervision
• Volunteers, community facilitators, project officers, project
coordinators, MERL officers, regional teams(INGOs) and key
government stakeholders
– Review meetings
• Volunteers-HEWs weekly meeting
• Regular monthly meeting of ECD management committee
Opportunities and lessons for ongoing efforts
• Opportunities
– Presence of ECD centers in diverse settings
– Government commitment for better health
• Policies, manuals, guidelines, directives
• HEWs deployment (financing)
– Community care coalition
– Replicable and adaptable
• Lessons
– Integrated approach is cost effective and promises better
results
– Facilitate leverage of knowledge, skill and other resources
Ah-hah Moment
Integrating health and ECD
programming has helped to identify
HIV+ children, and supported
enrollment and retention in pediatric
treatment.
Other services offered by the
program: shelter, nutrition, health
services, and parenting training for
caregivers also contribute to
improved child development
outcomes.
HIV and ECD integration in
Health Facilities
THRIVE project
REPSSI 2015 PSS Forum
“Care, Love and Protect from Infancy to Adolescence”
September 2015
Project Overview
•
THRIVE targets vulnerable caregivers and children under
five
•
Works in health facilities through RCH/PMTCT clinics
•
Works with local CBOs using community-based volunteers
•
Provides positive parenting messages in RCH/PMTCT clinics
•
Provides early stimulation activities in ECD spaces attached
to health/PMTCT sites
Early childhood development (ECD) interventions have the
most benefit for children who are the most vulnerable and
have a mediating effect on maternal mental functioning for
HIV-positive mothers (Allen, AB et al 2014)
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Delivery model (principles, rationale &
philosophical underpins guiding delivery)
17
•
Local partner works with Most Vulnerable Children
Committee to identify vulnerable children
•
ANC & PMTCT clinics are platforms to deliver Positive
parenting messages targeting children under five
•
Trained Community Based Volunteers are linked with the
clinics to provide parenting messages
•
ECD spaces are located in these platforms for early
stimulation opportunity
Program adaptations or elements that facilitate
ECD clinical integration
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•
Positive parenting messages include all aspects of child’s development
including breastfeeding, complementary feeding, immunization,
positive discipline, early stimulation etc. CBVs use the ANC platform to
deliver all integrated information to parents
•
Mid Term evaluation report has reported on increased attendance due
to routine visits of HIV positive caregivers; increased efficiency of
referrals to other services and increased effectiveness of medical
services for children; e.g., reduction in loss-to-follow-up
Quality assurance (Highlights for monitoring)
19
•
Parenting manual are used by trained volunteers to deliver parenting
messages
•
Beneficiaries’ attendance is monitored and followed through
registration book
•
CBVs follow up on interaction between caregiver and a child. Home
visits is conducted to few beneficiaries with specific needs. More
supervision and support take place during home visits
•
Quality Assurance forms are developed for observing CBVs when
conducting positive parenting education and provide feedback
•
Baseline, mid and end - line surveys conducted
Opportunities and lessons for ongoing efforts
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•
Health facilities are still a promising and sustainable
practice for integration of HIV and ECD
•
Increase home visit outreach and other platforms to
increase dosage
•
Conduct operations research to test effectiveness of
integration of HIV and ECD
ECD Spaces & PMTCT Clinics
Photos by Philip Laubner/CRS
Children can play and parents can learn how to stimulate
their child’s mind through the modeling of lead parents.
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Discussion Questions
1.
2.
3.
4.
What are the potential benefits to the clinic or
ECD center approach in terms of developmental
HIV outcomes?
What are potential drawbacks: gaps and
challenges that might need to be addressed
Three key recommendations for future programs:
Do you know of other projects integrating ECD
and HIV clinical care? Project, country,
organization?
Thank you!
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