May 25, 2023 – A lot has changed since the onset of COVID-19, when the world transformed, along with the roles of parents and caregivers. The Playful Parenting Community, a consortium of partners implementing and researching playful parenting programs internationally convened by the LEGO Foundation, has also changed. With a mission to bring programs to scale, the distinct pathways for each program have evolved alongside the shifting operational realities and national priorities. We last reflected on what it meant to implement playful parenting programs for scale during a pandemic. Now, three years into implementation, we reflect on innovations towards scale employed by each program.
ExpandNet’s Definition of Scale Up
Deliberate efforts to increase the impact of innovations successfully tested in pilot or experimental projects so as to benefit more people and to foster policy and program development on a lasting basis
But, what do we mean by scale? We use the ExpandNet framework to shape our approach to scale up, along with our research design for the implementation research conducted on each program by FHI 360. While literature points to the importance of parenting interventions during the first 3 years of life for improving child development and parenting outcomes, evidence gaps persist in how to effectively bring those programs to scale with quality. We work to understand the ingredients for scale up, from the enabling environment at different levels of the system to the resources and capacities of those delivering services, across diverse country contexts. By deepening this understanding through research and intentional knowledge exchange across partners, we aim to develop a road map for scalability shaped by programmatic experiences.
Innovations to Scale
Engaging Men in Group Sessions
The Prescription to Play (P2P) program in Bhutan is scaling up Save the Children’s Building Brains Common Approach for children from birth to three years nationally, based on the results from a successful pilot. The project baseline found that most caregivers do not tell stories and read to their young children and caregivers engaged in one harsh discipline activity per week, most commonly spanking, criticizing and shaking babies as young as 17 months.
Through the P2P project, Health Assistants (HA) at public health service centers throughout the country deliver monthly group sessions with hands-on demonstration of four developmentally appropriate games for caregivers and babies. Sessions also cover responsive care, positive discipline, health, safety and screen children for developmental delays. Building Brains is being incorporated in the pre-service training of all HAs through the Khesar Gyalpo University of Medical Sciences and is monitored through the District Health Information Software 2 (DHIS2).
Engaging male caregivers at scale has been a challenge. The project created a session called “Daddy and Me” to promote men as caregivers, and while male caregivers did participate, most of the session participants were women . To shift gender norms and promote men as caregivers, the project is preparing a month-long national media campaign called “Active Apas” to promote increased male caregiver engagement.
The PLAY Collaborative
Sugira Muryango (SM), an active coaching-based home visiting program implemented by FXB/Rwanda and the in Collaboration with the Rwanda National Child Development Agency (NCDA) and University of Rwanda Center for Mental Health, with support from Boston College Research Program on Children and Adversity, works with both male and female caregivers in Rwanda to promote ECD and prevent violence. The program comprises of 12 modules focused on topics from playful parenting to conflict resolution, facilitated by child protection community workers, known as IZUs, linked to the Rwandan government child protection system under NCDA. Two booster/follow up sessions are organized after 3 and 6 months following the completion of session delivery.
Expanding their smaller-scale evidence-based program to 10,000 families, the SM team also created committees known as the Promoting Lasting Anthropometric Change and Young Children’s Development (PLAY) Collaborative. Operating as a multisectoral group to engage key stakeholders from cell to district level, the PLAY Collaborative meets regularly to discuss implementation issues encountered by individual families and raised by the frontline workers. The PLAY Collaborative features several active ingredients for scalability drawn from implementation science research, including integration into an innovative delivery system, a core seed team of Rwandan experts serving as trainers and supervisors, and cross site learning using plan-do-study-act (PDSA) cycles.
Data on the use of this approach in California point to its potential as a strategy for scalable and sustainable delivery. In Rwanda, members of the PLAY Collaborative shared positive perspectives of the group in interviews, as well as a desire to see it continue. Mayors of the three districts of implementation have expressed strong interest in adding SM to their annual performance contracts, which determine district budgeting, and the Ministry of Gender & Family Promotion (MIGEPROF) supports advocacy for additional funding. Further empirical data and analysis is needed to better understand the role of the PLAY Collaborative in scaling SM. So far, minutes from over 2500 meetings have been recorded, with plans for FXB/Rwanda and the team at Boston College to study the PLAY Collaborative with a finer-grained analysis.
National & Municipal Government Support
The ongoing Playful Parenting Programme (PLP) in Serbia includes 10 home visits to families starting from pregnancy up to 4 years by home visiting nurses, who talk to parents about responsive care and early stimulation along with hygiene and nutrition, among other services. Support at the national and municipal levels manifests in national policy formulation prioritizing ECD and local demand for horizontal expansion of the program. For the former, the cross-sectoral National Steering Committee on Playful Parenting composed of five line Ministries (Family Welfare, Health Care, Social Protection, Public Administration, and Education), chaired by the Special Advisor of the Prime Minister on SDGs, has taken on the task of developing a standardized quality assurance system. On the latter, the program recently began scaling from the original 6 pilot municipalities to 27 additional municipalities, receiving applications from over 46 municipalities, underscoring the growing demand. Furthermore, strategic partnerships between UNICEF/Serbia and over 50 relevant national actors and 85 local policymakers enables targeted budget allocation for ECD at a local level.
While government partnerships represent a key ingredient for scale up for the program, Serbia has already undergone two changes in the national government since the start of implementation, triggering turnover in these same partnerships. These transitions require sensitivity and continuous alignment (and realignment) with government priorities. The program is now focused on persistent advocacy with policymakers to position playful parenting as a cross-sectoral priority by leveraging relevant national initiatives, like inclusive preschool education supported by the World Bank.
Playful Parenting Embedded into Policy Framework
In Zambia, UNICEF is working to scale up quality services for younger children and families, including strengthening counseling/support for parents using the Care for Child Development (CCD) approach. The program aims to support the operationalization of the Nurturing Care Framework, as well as playful parenting at both the national and local levels. This is done by embedding play into the national policy framework across multiple sectors, including health, education, and social welfare, as well as in training modules for frontline workers. Multisectoral committees operate at national, district, and community levels to increase overall prioritization of play in parenting practices. Advocacy with key stakeholders has been a major focus of the program with mass media campaigns to promote playful parenting ranging from broadcast interviews with Ministry officials to a flash mob in a public market. Such campaigning resulted in UNICEF/Zambia receiving the Best Social Marketing Organisation Award at the 2023 Zambia Institute of Marketing Awards Gala. While advocacy efforts and policy alignment illustrate the national priority for ECD and responsive stimulation, adequate structures for quality supervision of workforce persists as a challenge. The program is implemented by community-based volunteers (CBVs), who possess intimate knowledge about their communities and cultural practices but lack supervisory support systems needed to strengthen quality provision of parenting interventions. The use of health facility staff for supervision without additional monetary compensation poses challenges to the additional responsibilities that accompany that supervision. Moving forward, the program team plans on implementing adaptations to strengthen supervisory systems, including changes to support co-mentoring, to support quality implementation.
From engaging male caregivers in Bhutan to employing implementation science-grounded collaboration models in Rwanda to national and local advocacy in Serbia and Zambia, each playful parenting program pursues pathways to scale distinct to their operational context. These approaches feed into potential for both vertical and horizontal scale and offer a window into strategies for maneuvering some of the challenges programs face when scaling up. Stay tuned for more updates from the Playful Parenting Community on what comes next on our journey to identify pathways to scale for playful parenting
By the Playful Parenting Community. Contributed to by Tanya Smith-Sreen, FHI 360; Frances Aboud, McGill University; Sara Dang, Save the Children; Karma Dyenka, Save the Children; Jean Marie Havugimana, FXB/Rwanda; Gabi Phend, Boston College; Theresa Betancourt, Boston College; Rachel Stram, Boston College; Mila Vukovic Jovanovic, UNICEF/Serbia; Zewelanji Natashya Serpell, UNICEF/Zambia