The Enormous Challenge of Implementing Good Ideas

Mexico is working to develop a methodology to serve children with developmental delays in the first five years of life.

The framework of the strategy consists of a periodic assessment of children age 5 and under, performed by doctors and nurses during routine check-ups within the health system. This screening, which has been carefully validated in Mexico, identifies children with delays in gross and fine motor development, as well as language and social development. According to the degree of delay identified in this first assessment, children who could have more serious conditions are referred to a pediatrician or a psychologist for more in-depth analysis and follow-up.

Children with less severe delays, along with their families, are invited to participate in weekly workshops that seek to strengthen parents’ ability to stimulate their children. The workshops are taught by community-based staff from health centers, and the children’s progress is tracked on a quarterly basis.

Now I would like to focus the discussion on aspects related to the implementation of this strategy. I admit that I have only described it in brief, but I want to zero in on the complexity of implementing such a proposal. Here are some of the critical challenges:

• I think the emphasis should go beyond stimulation. We want to achieve a change in behavior in order to improve the quality of the home environment and the interactions between parents and children.
• We know that a workshop program depends on the quality of the staff that runs it. The challenges are many: minimizing staff turnover to ensure continuity, building skills, and providing incentives that reward effort, to name a few.
• I think it is possible to implement a program of this nature with community staff, provided that there is a great deal of investment in training and supervision.
• A communication strategy is essential in order for the program to encourage parents to pave the way for their children to develop their potential, without creating a stigma.
• Although it may seem obvious, if the workshops are not interesting, clear, and relevant in different cultural settings, they will be useless.
• Attending a workshop represents a cost (in time and money) for the family. We must think about operational designs adjusted to the realities of urban and rural environments in order to minimize the dropout rate.
• I think we must involve both mother and father, and other adults responsible for the children’s upbringing in this initiative.
• Lastly,  addressing child development in a comprehensive manner involves, at the very least, understanding (if not responding to) the shortcomings in different areas that create stress in the home, which directly and indirectly affect parents and children. With this program, the opportunity presents itself to better coordinate the offering among various programs, sectors, and levels of government.

These ideas and others were discussed last week at a workshop organized by the Ministry of Health (Secretaría de Salud), the Popular Health Insurance (Seguro Popular), and the ¨Federico Gómez¨ Children´s Hospital (Hospital Infantil Federico Gómez) in Mexico City. I returned from the workshop very impressed with the quality of the technical work behind this proposal. I hope these days of group reflection contribute to an operational design for this program that yields better results. If we can unite these ideas with the political will to fund this initiative without sacrificing quality, this will be a wonderful opportunity to help bridge the developmental gaps between children at different income levels, beginning in their first years of life.