A pilot programme, Care for Child Development (C4CD Plus) was found to be successful in improving children’s home environment and interaction with parents.

This was presented at an impact evaluation of the C4CD Plus, a programme that is designed for caregivers of children below three years, in Thimphu on December 14.

Save the Children International and health ministry pilot tested the C4CD Plus in Punakha and Paro, in September last year. 

A total of 322 parents and caregivers completed 12 group sessions that the health assistants provided in about 11 BHUs.

Data collectors surveyed 307 children and caregivers of which, 145 were control group (did not receive group sessions) and 162 (received group sessions) caregivers in the treatment group.

About 15 health assistants were trained to deliver sessions to parents and caregivers.

In each session, four games or activities were taught. Sessions were conducted once or twice a month for a year. 

Learning research specialist with Save the Children, Jonathan Seiden, said that caregivers and health assistants saw change in the way children behaved and communicated. “Caregivers recognised that these changes were important for children’s later pre-primary or primary schooling.”

He said that caregivers in the treatment group had significantly increased learning and play activities with children. “Caregivers in the treatment group reported having significantly more storybooks and homemade toys. Caregivers in the treatment group were less likely to report spanking their children.”

While the programme was reported to be successful in reducing spanking, there was still a room for improvement, he said. “It was also meant to instil positive discipline techniques. Although caregivers understood why children cried or misbehaved, it wasn’t easy to change their ways according to them.”

He said that the C4CD Plus programme emphasises the potential for parental programmes to improve children’s outcomes. “Community-based and caregiver-based programs can be a cost-effective alternative (or complement) to center-based programming.”

He said that caregivers and health assistants had changed attitudes regarding the use of reading materials. “Books were not given to children with the thought that they would spoil or damage it. However, now the attitude is changed. They feel that with books, children can develop reading habits.”

Caregivers recognised that children could love reading and how using books could introduce them to new concepts, he said.

Overburdened staff and lack of awareness on the importance of the programme according to some health assistants were some of the challenges.

Senior programme officer with the Department of Public Health, Tshedar, said that in the programme, the focus was on early stimulation, health and nutrition, and safety protection. “It covers the four domains of child development. It was built on the existing programme called C4CD for children between age 3 and 5.”

He said the pilot was conducted to improve holistic child development outcomes for children below three years old in the project area, and to increase caregiver knowledge, attitudes and skills to stimulate children’s development.

The programme was also conducted to understand whether developmental delays could be mitigated and whether a support system could be established.

Tshedar said that although it was a success, poor attendance was one of the challenges during the programme. “Sessions included activities to help stimulate children’s brains along with the lessons that concern child health, safety, wellbeing, and positive discipline techniques.”

Rinchen Zangmo