Cementing Partnerships: Applying a Network-Mapping Tool in Tajikistan

BackgroundTo promote early childhood development (ECD), we require information not only on what needs to be addressed and on what effects can be achieved but also on effective delivery methods that can be adapted to local context. We describe design, implementation, and evaluation of a complex intervention to strengthen nurturing environment for young children.MethodsStudy participants were pregnant women and their children from birth to 2 years. We used design and redesign, implementation, and evaluation approaches for the study. We co-created curriculum and delivery plan with stakeholders, based on the theoretical framework, findings from formative research, and our preliminary work. We recruited 656 pregnant women and newborns, 326 (49.69%) from intervention and 330 (50.30%) from the control group. We conducted a cluster randomized controlled trial to evaluate the program’s effectiveness. The outcomes of children were assessed at 12 and 24 months.FindingsAt recruitment, study participants from both the study arms were similar in sociodemographic characteristics. We conducted 6,665 home visits, 25 toy-making workshops, and 65 caregiver-meetings. The initial examination of program data revealed gaps in quality and coverage of interventions. The intervention was redesigned based on feedback from stakeholders in community meetings. At recruitment, participants in both study groups had similar socio-demographics. We conducted 6,665 home visits, 25 toy workshops, and 65 caregiver meetings. Initial program data showed intervention quality and coverage gaps, leading to a redesign program based on community and stakeholder feedback. Post-re-designing, session quality improved, with program coverage rising from 32 to 98%. Male participation in home visits increased from 4.3 to 32.65%, and data errors reduced from 270 to 140 per month on average. At 24 months, program showed moderate–mild impact on ECD – cognitive (0.31, 95%CI: 0.13–0.48), language (0.2, 95%CI: 0.01–0.39), and socioemotional-development (0.19, 95%CI: 0.01–0.37), moderate effect on home-environment and mother–child interaction. 96% of women initiated breastfeed within one-hour of delivery, and exclusive-breastfeeding rate of 89.80%.InterpretationsThe study provides an evidence-based community centered ECD curriculum and implementation strategies to enhance service providers, and caregivers’ knowledge and skills for promoting ECD in low-resource settings with the potential to scale within existing Government Program.FundingThe trial was funded by the Saving Brains Round 5 Initiative of Grand Challenges Canada (Grant no. SB-1707-05084), and we are grateful for their ongoing support through online sessions and orientation workshops. The trial was also supported by the Indian Council of Medical Research (File No: 5/7/1693/CH/Adhoc/RBMCH-2020).

Section: Discussionmentioning

confidence: 99%

Design-redesign, implementation, and evaluation of effectiveness of maternal nutrition and responsive parenting program on child development at 2 years of age from rural India: a cluster RCT

Gaidhane,

Khatib,

Telrandhe

et al. 2023

“…Muhamedjonova et al ( 17 ) discuss integration of a MEL network mapping tool into a program in Tajikistan designed to shift the delivery of support for vulnerable children from institutional care, in publicly run Baby Homes, to family-based care, supported by Family and Child Support Centres. Mapping networks available to caregivers helped the team to monitor the way caregivers sought and used available support.…”

Section: Tools and Methods That Combine Measurement Of And For Changementioning

confidence: 99%

“…At the program level, the team gained a greater understanding of how their intervention's theory of change unfolded in practice, and program staff gained awareness of the value of systematic and regular review of practices. At a more general level the results both “ brought to life ” and “ add[ed] an extra dimension ” [( 17 ), p. 8] to Bronfenbrenner's Ecological Systems Theory (EST) ( 18 ), by identifying the need to structure support in a more networked rather than a nested distribution. The authors quote Neal and Neal ( 19 ) in this regard, pointing to an insight potentially relevant to policy design in similar contexts.…”

Section: Tools and Methods That Combine Measurement Of And For Changementioning

confidence: 99%

Measurement for Change: Reflections from innovators' experiences with monitoring, evaluation, and learning systems for Early Childhood Development

Laat

Radner²,

Holding³

et al. 2023

In this review paper, we explore how on-the-ground Early Childhood Development (ECD) innovators are using monitoring, evaluation, and learning (MEL) systems to guide the design and implementation of ECD programs, as well as how MEL systems can influence policy and support the achievement of impact at scale. We reflect on articles in the Frontiers series “Effective delivery of integrated interventions in early childhood: innovations in evidence use, monitoring, evaluation, and learning.” The 31 contributions to the series reflect the breadth and depth of complexity that characterizes ECD, including global geographic spread, with studies from Asia, Europe, Africa, and Latin America and the Caribbean. Our synthesis finds that integrating MEL processes and systems into the fabric of a program or policy initiative can broaden the underlying value proposition. Specifically, ECD organizations sought to design their MEL systems to ensure programs fit the values, goals, experiences and conceptual frameworks of diverse stakeholders, so that participating makes sense to all. For example, formative, exploratory research identified the priorities and needs of the target population and frontline service providers, and informed the content and delivery of an intervention. ECD organizations also designed their MEL systems to support a shift of accountability toward broader ownership: They included delivery agents and program participants alike as subjects rather than objects, through active participation in data collection, and by providing opportunities for equitable discussion of results and decision-making. Programs collected data to respond to specialized characteristics, priorities and needs, embedding program activities into existing day-to-day routines. Further, papers pointed to the importance of intentionally involving a variety of stakeholders in national and international dialogues to ensure that diverse ECD data collection efforts are aligned and multiple perspectives are considered in the development of national ECD policies. And, several papers illustrate the value of creative methods and measurement tools to integrate MEL into a program or policy initiative. Finally, our synthesis concludes that these findings align with the five aspirations that were formulated as part of the Measurement for Change dialogue, which motivated the launch of the series.

“…Aligned to the M4C aspirations, an MEL system that applies the principles of shared listening and learning using participatory methods was key to achieving this objective. Experience was created in partners of information collection and utilisation methods that are consistent, rigorous, systemic, feasible, and supply useful information in context ( 4 ).…”

Section: Monitoring and Evaluation Using M4cmentioning

confidence: 99%

“…In this paper, we discuss the pathways and the A bacha , through which the rights and needs of children are met locally. Like the Silk Road, these pathways are networked, multi-faceted and change over time ( 4 ).…”

Section: Introduction: Starting Point Of the Journeymentioning

confidence: 99%

Realising distributed leadership through measurement for change

Watkins¹,

Muhamedjonova²,

Holding

2023

Self Cite

Through a systematic reflection on the journey that transformed traditional state-run baby homes in Tajikistan from closed institutions into community-oriented Family and Child Support Centres (FCSC) we reveal key moments of change. This review describes how community consultation with local participants in a development project shifted responsibility and accountability from international to local ownership and how distributed leadership contributes to the decolonisation of social services. Based on these interviews we ask, ‘How do the innovations of a social development project become a fixed part of normal local social, cultural and political life; and, how do we know when a new normal is self-sustaining at a local level?’ This analysis builds on a network-mapping tool previously described in this journal. Our interviews show that each participant has taken a non-linear journey, building on the networks previously described, under the influence of activities and discussions that emerged throughout the project. We consider how a monitoring, evaluation, and learning process should be responsive over time to these influences, rather than be set at the start of the project. Using the themes that emerge from participants’ journeys, we apply a ‘measurement for change’ (M4C) approach that integrates Monitoring, Evaluation and Learning (MEL) into decision-making. The journey framework applied represents a systematic application of the M4C approach that gives us insight into where local ownership is responsible for the sustainable management of the intervention, and where continued partnership will further strengthen impact and accountability. The exercise has provided evidence of progress towards decolonisation and of the centring of local priorities in MEL and implementation processes.