As I’m arriving to the conference “Every Child’s Potential: Integrating Nutrition, Health, and Psychosocial Interventions to Promote Early Childhood Development” in the amazing city of New York, I remember the last time this group met to talk about how to integrate nutrition and child development interventions in an effective and practical way.
This conference, as wells as the one that took place last August, were largely the brainchild of Pat Engle. They were successfully carried out by her large group of friends and collaborators at the Global Child Development Group (Maureen Black, Lia Fernald, Sally G. McGregor, Ted Wachs, Susan Walker, Aisha Yousafzai, and Mandana Arabi).
One of the most important issues discussed in last year´s workshop was that while program integration, when well-designed, can work to the benefit of children, we must be careful to clearly define what is meant by the word “integration.” Is it the content of the intervention that is being integrated (as in the case of the India or Bangladesh interventions presented during the sessions) or is it the service delivery platform that functions as an integrator?
Early stimulation interventions may be complementary to nutritional interventions if the presence of one increases the impact of the other. This is something quite different from the issue of targeting stimulation programs at malnourished children, which would achieve increased economic returns relative to a less focused intervention. Yet another form of program synergy can occur if the impact of the stimulation is independent of the effects of a nutritional intervention but the total cost of delivery of both services is less because the two are administered jointly in terms of infrastructure, use of staff, etc. In conclusion, it’s important to analyze all of these factors since, even though an integrated intervention may have a lower cost, for example, because the services of both interventions are provided in the same place (a health center or even a private home), the content might not be appropriate. Thus, the intervention would be inexpensive but also ineffective.
One of the most relevant panels in August showed us that there’s little in the way of existing evidence on integrated nutrition and child development interventions. We learned something very interesting from Sally Grantham McGregor, who told us about home visits coupled with the delivery of micronutrients in Colombia. Frances Aboud explained about responsive feeding and micronutrients in Bangladesh. Sally argued that the benefits of delivering micronutrients in the context of a program of home visits to provide stimulation to young children in Colombia are insignificant and that the effects on child development are only seen in children over 18 months old. Frances shared with us that one of the major determinants of good responsive feeding (beyond the provision of micronutrients to the home) is the mother’s problem-solving abilities. Pat told us about the positive effects of a play and responsive feeding initiative in India on several indicators of child development, while no effects were seen in the nutrition program without responsive feeding. Dr. Butta, Lia Fernald, Jena Hamadani and Peggy Bentley also related similar experiences in Bangladesh, Pakistan and Mexico.
I found it interesting that Colombia’s experience, along with that of CONAFE in Mexico, were the only Latin American programs with an integrated approach that were presented in this workshop.
This last reflection immediately leads me to think about several recent studies that look at the long-term results of nutritional interventions on several indicators (see the Food and Nutrition and Early Childhood Development sessions at the Northeast Universities Development Consortium Conference – NEUDC in Hanover, NH last November) and, more specifically, about a study of a conditional cash transfer program (Red de Protección Social) in Nicaragua and its results after 10 years. The presentation by Tania Barham, Karen Macours and John Maluccio during session 2 of that same conference shows encouraging results of how conditional cash transfer programs with two conditionalities, one based on nutrition and health and the other on education, have significant effects on child development.
It makes me proud that two countries in the region are demonstrating positive effects and are being presented so successfully in the academic world. Now all that’s left to do is roll up our sleeves and learn how to effectively implement these programs…which just so happens to be the topic of this new workshop.