A Tale of Two Programs for Parents of Young Children: Independently-Conducted Case Studies of Workforce Contributions to Scale in Bhutan and Rwanda

Abstract

Two case studies of parenting programs, aiming to improve parenting practices and child development outcomes, and implemented by Save the Children/Ministry of Health/Khesar Gyalpo University in Bhutan and Boston College/University of Rwanda/FXB in Rwanda, respectively called Prescription to Play and Sugira Muryango, were conducted by an independent research and learning group. Implementation research focused on the workforce, a crucial but little-studied element determining the success of programs going to scale. Mixed methods were used to examine their training, workload, challenges, and quality of delivery. Health assistants in Bhutan and volunteers in Rwanda were trained for 10–11 days using demonstrations, role plays, and manuals outlining activities to deliver to groups of parents (Bhutan) or during home visits (Rwanda). Workers’ own assessments of their delivery quality, their confidence, and their motivations revealed that duty, confidence, and community respect were strong motivators. According to independent observations, the quality of their delivery was generally good, with an overall mean rating on 10 items of 2.36 (Bhutan) and 2.44 (Rwanda) out of 3. The facilitators of scaling for Bhutan included institutionalizing training and a knowledgeable workforce; the barrier was an overworked workforce. The facilitators of scaling for Rwanda included strong follow-up supervision; the barriers included high attrition among a volunteer workforce.

Using Implementation Research to Inform Scaling of Parenting Programs: Independently Conducted Case Studies from Zambia and Bhutan

“…Previously used observational methods for assessing workforce delivery quality were applied along with survey and in-depth interview methods [18]. The CARE reporting guidelines for the implementation of early childhood development programs were used [19].…”

“…Based on previously published measures of delivery quality [16,18], qualities found to be important in changing parenting practices are listed. Ten qualities concern specific activities related to active teaching/learning, known as behavior change techniques [12].…”

“…The structured survey consisted of 20 questions with sub-questions [18]. It included demographic variables (age, sex, years of education, years of experience); workload for this program and for other duties; training and supervision; confidence in delivery; perspective on own work; and the 20-item Caregiver Knowledge of Child Development (CKCD) Inventory with 10 items on child development and 10 items on stimulating parenting practices (Ertem, 2007) [20].…”