Authors: Tanya Smith-Sreen and Carina Omoeva, FHI 360
As recognition of the importance of parenting programs and the implementation of these programs accelerates worldwide, so does the body of evidence. But gaps persist in important areas, including a lack of understanding
on what it takes to train and support the people delivering parenting programs.1 These gaps are particularly prominent for programs implemented in low- and middle-income countries (LMICs), especially as they move to scale. Evidence links a well-trained and supported workforce with positive developmental outcomes2. But how can this workforce better trained and supported? With the workforce sitting at the frontlines of parenting programs worldwide, they represent a critical ingredient in the process of improving the quality of parenting programs and allowing them to reach more parents. Whether these are community health workers, preschool staff, volunteers, or
beyond, we need a robust understanding of who the workforce is and their experience implementing programs to shape responsive programming.
Playful Parenting Implementation Research
As a research and learning partner to the LEGO Foundation on the Playful Parenting Initiative, we look at scalability of parenting programs in Bhutan, Rwanda, Serbia, and Zambia. One component of our research design involves examining questions around the workforce; from the diverse back-grounds they bring to the program, to the type of training they receive, to their level of knowledge and retention, as well as the quality of service delivery following training. Through the Playful Parenting community of practice and ongoing partnerships with the programs, we share insights to inform programmatic shifts and bolster program design.
To develop these insights on workforce, we employ on a mix of observations of trainings and service delivery; knowledge surveys; and in-depth interviews. We draw on existing instruments like Caregiver Knowledge of Child Development Inventory (CKCDI) for knowledge surveys and developed observation protocols, as well as a semi structured in depth interview guide for other components.
So what did we learn and how was it used?
A core tenet of the implementation research model involves embedding emerging findings into robust feedback loops with partners. Incorporating key insights into learning conversations in a sustained way sparks possibilities for adaptation and facilitates evidence utilization. Our partners Boston College and FXB Rwanda, implementing the Sugira Muryango program in Rwanda, and UNICEF, implementing Care for Child Development (CCD) in Zambia, all saw opportunities to do just this.
The high demands on the workforce is a recurring challenge for parenting programs, with health providers often facing additional burdens of the COVID-19 pandemic. This is particularly of note when the end goal is scale up and government uptake: if playful parenting is to be fully integrated into the system, health providers working with families must have the space in their routines to address the importance of play and responsive stimulation. Our workforce surveys for playful parenting frontline providers probe these questions in the four countries of the Initiative, including Rwanda, where Boston College and FXB/Rwanda implement Sugira Muryango, a parenting program delivered through volunteer interventionists (IZUs). IZUs conduct home visits with parents to promote ECD and prevent violence through active coaching and father engagement. Our initial surveys with the IZUs indicated that the majority of the providers surveyed across the three districts of implementation did not feel overworked at the time of the survey. However, the majority of the volunteer providers surveyed did not have other job responsibilities outside the family visits, indicating both the importance of a dedicated workforce to support families, and the challenges of sustaining the service beyond the life of the Sugira Muryango.
These data was used by Boston College and FXB Rwanda to inform scalability conversations with key
stakeholders, such as the Ministry of Health (MoH). While the MoH was concerned that the program
would overburden IZUs, the data does not confirm that.
Training represents another critical component in supporting workforce for effective program implementation. By taking a closer look at what was learned and how it was learned, we uncovered some important insights for workforce training. The pre- and post- test administered during trainings led by UNICEF for their CCD program revealed lower than expected levels of knowledge of developmental milestones among community-based volunteers (CBVs). These same CBVs are responsible for conducting group sessions and home visits with parents to promote nurturing care principles, such as responsive stimulation. Interviews with CBVs underscored complexity of concepts and language as core challenges with the training material. These findings prompted a plan by UNICEF Zambia to revise training materials to a) increase the focus on developmental milestones and b) simplify the content and messaging.
Armed with real-time data on workforce – from workload to training materials – partners infused programmatic decisions with evidence. These emerging insights from the implementation research are systematically incorporated into discussions with partners to inform and mobilize support for programs. As the research continues in Bhutan, Rwanda, Serbia, and Zambia over the next three years, we’ll be equipped with more evidence to not only inform ongoing programming, but also ground future programs in ‘what works’ for workforce delivering parenting programs at scale globally.
“Some of the [child development] concepts are difficult even for providers, especially when needed to be translated to local language.”(Community-Based Volunteer, Zambia)
1 SIEF Evidence File, 2021