1. From Uganda to Lebanon:
Experiences with Integrating Early
Childhood Development, Health and
Nutrition Programs
Presenters:
Inka Weissbecker, International Medical Corps (IMC)
Jennifer Burns, International Medical Corps (IMC)
Mary Helen Carruth, Medical Teams International (MTI)
Laura Peterson, Hands to Hearts International (HHI)

2. Early Childhood Development
• Early years of childhood form the basis of intelligence,
personality, social behavior, and capacity to learn and
nurture oneself as an adult.
• Health services/workers and providers play an important
role in promoting development of young children.
• Focusing exclusively on targeted interventions such as
health and nutrition without considering the holistic nature
of ECD risks the hindrance of children’s complete growth
and development

3. Adverse Childhood Experiences (ACEs)
ACEs include:
•multiple types of abuse
•neglect
•violence between parents or caregivers
•other kinds of serious household dysfunction
•alcohol and substance abuse
•and peer, community and collective violence

4. Early Childhood – roots of health
Toxic stress (Adverse Childhood Experiences) in childhood
creates life-long consequences for a person's health and
well-being. It can disrupt early brain development and
compromise functioning of the nervous and immune
systems.
In addition because of the behaviors adopted by some
people who have faced ACEs, such stress can lead to
serious problems such as alcoholism, depression, eating
disorders, unsafe sex, violence, HIV/AIDS, heart disease,
cancer, and other chronic diseases.

5. Times of exceptional stress?
The settings we all work in –
•Emergency & post-emergency
•Conflict & post-conflict
•Developing communities/economies
These are all times of great risk for increased family stress,
abuse, violence, neglect, hunger, illness, mental health
issues, etc…

6. Lira Child
Survival Project

7. Post Conflict Environment
 In the Northern Uganda, post-conflict context, service
provision is continually improving as the Ministry of
Health and NGOs re-construct health facilities and
provide health services at the community level.
 Characterized by food insecurity, unreliable
infrastructure, and a fragile family unit.
 It is an important time to rebuild community resilience
by strengthening the parent-child bond, developing and
reinforcing positive caregiving practices to improve long
term child health and well-being.

8. Early Childhood Development in Uganda
 Early Childhood Development (ECD) policy was
established in 2007.
 Investment in ECD is low.
 ECD services are primarily sector based. Health,
education and social services are provided in different
settings.
 The Early Childhood Learning Framework developed for
ages 3-6 years. As of yet, there is no framework for the
ages of 0-3 years.

9. Project Location

10. Approaches to Promoting Positive ECD
Practices
1) Group sessions by health staff and Peer Educators for
patients waiting for services in health facilities and
during immunization outreach
2) Before midterm Peer Educators worked in female/male
pairs led group trainings in their communities to reach
both men and women caregivers (8 - 3 hour weekly
sessions)
3) After midterm Peer Educators delivered ECD lessons
directly to caregivers in their homes (8 visits to cover
each module)

11. Indicators to track ECD Impact
Linguistic Learning: % of mothers who told a story, sang or
named objects for their child at least 2 times per week
Responsive Feeding: % of mothers who report talking or
singing to their child while feeding them
Physical Development: % of mothers who report helping
their child walk, playing a lap game, massaging or rubbing
them gently, or by giving them objects with which to play
Cognitive Stimulation: % of mothers who provide cognitive
stimulation in the form of games such as “where are your
eyes”, etc.

12. Findings from Focus Group Discussions
• Health Clinic staff reported giving ECD messages to 60-85% of
their patients
• baby massage, breastfeeding, nutrition, baby cues, language
and cognitive development and the importance of love and
affection.
• They credited the ECD trainings with improved relations
between staff and parents, increased use of HC services, and
a decrease in using traditional healers.
• They also attributed outcomes such as: improved child and
hygiene; greater affection between parent and child, with
parents being more communicative and gentle with their
child.

13. Findings from Focus Group Discussions
•Village Health Workers & Peer Educators reported giving
ECD lessons to an additional 88 people each (avg.) –
beyond their formal trainings that were documented

14. Findings from Focus Group Discussions
ECD trained parents:
•“because of the good relationship I
have established between me and
my child she now understands me
and listens to me and above all
loves me more than before”
•“children do not fear us anymore”
•“whenever my child hears the
sound of my bicycle while arriving
home, she runs out to greet me.”

15. Findings from Focus Group Discussio
•One father indicated that the ECD trainings showed him
that he had true value as a caregiver, something he had
not seen before. This realization led him to come home at
nights and not stay out drinking. At home he enjoyed the
affection his child had for him.

16. Findings from Final Evaluation

17. Findings from Final Evaluation
Arenas of Positive Change
1. Relationship with the child
2. Relationship between
parents
3. Health behaviors

18. Findings from Final Evaluation
•“Decreased family violence is an unexpected finding; attributed
it to the ECD interventions. ECD peer educators (PE) did teach
parents alternatives to violence when relating to their children
and parents found them effective.”
•“It is not possible to determine the causal factors for this
behavior change but we can say that in the non-ECD
intervention community, men did not talk about their wives
loving them more and they did talk about caning their
children.”
~ USAID Evaluator, Sue Leonard

19. How ECD is related to protection
Research has shown that six protective factors are linked
to a lower incidence of child abuse and neglect:
• Nurturing and attachment
• Knowledge of parenting and of child development
• Parental resilience
• Social connections
• Concrete supports for parents
• Social and emotional competence of children

20. WHO “Prevention Violence” report
Child maltreatment is in families that:
• Have difficulties developing stable, warm
and positive relationships
• Have a poor understanding of child
development, and therefore have unrealistic
expectations about the child’s behavior.
• Do not show the child much care or affection
• Have a harsh or inconsistent parenting style,
and believe that corporal punishment is an
acceptable form of discipline

21. WHO “Prevention Violence” report
1. Opportunities for parents to
practice new skills
2. Teaches parenting principles
rather than specific techniques
3. Teaches positive parenting
strategies, including age-
appropriate discipline
4. Considers difficulties in the
relationships between adults
in the family

22. Summary
ECD offers the perfect in-road to address a wide variety of issues,
and in particular, can promote safe, stable, and nurturing
relationships between children and caregivers which are protective
against neglect and abuse.
Benefits are lifelong foundation for > health, wellness and success.