Next steps Scaling up nurturing care in Siaya The Siaya County government, with leadership from the Governor’s oce, County, Kenya will continue to strengthen the enabling environment for nurturing care. The A county-wide eort to reach children through the health sector passing of the health bill is a top priority to ensure that nurturing care, and health and beyond service delivery generally, are enshrined in a context-specific, legal framework that ensures the sustainability of the necessary structures and services. The government plans to develop a memo that articulates ECD-related issues to include in the health bill and highlights the resources that must be set aside to meet the developmental needs of young children. In western Kenya, the government of Siaya County is demonstrating the vital role of In Siaya County, we have prioritized subnational leaders in promoting nurturing The government aims to roll out integrated early childhood development (ECD) care for early childhood development nurturing care services for children aged as a high-impact intervention that (ECD). The Governor is leading the scale- will enable children in Siaya to 0-5 across the county, which will require a Photo credit: Conrad N. Hilton Foundation/Joop Rubens up of policies, programmes and services in concerted, multisectoral eort and support achieve optimal development. The support of nurturing care and ensuring that from many development- and private-sector approach we are using to scale up caregivers have the tools and information partners. For example, the MoH is working ECD is multi-sectoral and led by needed to promote health, nutrition, safety with PATH, Medic Mobile and the African Achieving Vision 2030, which is government. and security, responsive caregiving and Early Childhood Development Network aimed at transforming the country early learning. Dr. Samuel Omondi Owino, County Director to adapt a mobile health platform to into an industrializing middle-income of Health, Siaya County improve the management and performance country, makes investing in early childhood development a priority. of community health volunteers. Context for nurturing care in mNurturingCare will give volunteers access Dr Stewart Kabaka, Director, Newborn, Siaya to child development information during Child and Adolescent Health Unit, MoH shifted to counties, including the delivery home visits and enable the uploading of health and ECD services. Though policy of data into the county district health Siaya County is home to approximately development continues to originate from information system (DHIS2). 200,000 children under the age of the central government, counties are With leadership and coordination from the five, many of whom are at risk of poor charged with domesticating policies to fit In addition, the government and partners government, and strong technical capacity, developmental outcomes due to factors their unique contexts and are responsible are planning a campaign to increase Siaya County is well positioned to fulfil such as poverty, poor nutrition and lack of for designing, planning, and budgeting for demand for services and promote improved its devolved mandate to care for young responsive caregiving. For example, nearly services. Devolution of government roles nurturing care practices in the home. children holistically and to promote their 25% of children in Siaya are stunted because should ensure that health services are development and well-being. of chronic malnutrition in early life.1 In 2011, more responsive to population needs, but just 22% of children aged 36 to 59 months many counties lack guiding frameworks, as in Siaya were developmentally on track, well as the capacity to deliver services. To underscoring the need for more attention to address this, Siaya County is in the process nurturing care in the early years.2 of enacting a health bill, which will anchor nurturing care in health service delivery Like all 47 counties in Kenya, Siaya is as a high-impact intervention. The county adapting to a new governance context. is also building the capacity of service Since a constitutional change in 2010, many providers to promote responsive caregiving government functions and responsibilities and monitor children’s development as part previously held at national level have of routine health service delivery. This profile was developed in support of Nurturing Care for Early Childhood Development. A framework for helping children to survive and thrive to transform health and human potential. 1 Kenya National Bureau of Statistics. Kenya Demographic and Health Survey 2014. Nairobi: Kenya National Bureau of Statistics; 2015. Writer: Katelin Gray, PATH USA. Contributors to development and review: Matthew Frey, Bettina Schwethelm. Design: PATH. 2 Kenya National Bureau of Statistics. Nyanza Province Multiple Indicator Cluster Survey 2011, Final Report. Nairobi: Kenya National Bureau of Statistics; 2013. Reflecting government commitment to Lessons learned a systems-based approach for quality improvement, eorts are underway to The experience of Siaya County highlights institutionalize supportive supervision the importance of cultivating champions at all for nurturing care. Four sta have been levels of government to move the nurturing hired by the Ministry of Health (MoH) to care agenda forward. Champions can ensure coordinate ECD services and provide the prioritization of nurturing care in policy mentorship for service providers as they development and resource allocation. master new counselling skills. They identify training needs, collect data and monitor the level of integration and the quality of service provision. They also directly observe the counselling skills of trained As Governor, I see Siaya leading service providers and oer coaching on the way and providing an example areas of weakness. to other counties. I want to use my platform nationally on the Council of Governors to ensure that all Placing nurturing care on the political children in Kenya develop to their full agenda potential. Photo credit: Conrad N. Hilton Foundation/Joop Rubens To close gaps in the legal framework left H.E. Cornel Rasanga Amoth, Governor by devolution, MoH champions sought of Siaya Actions to scale up nurturing care to elevate nurturing care on the county’s “At the Ministry of Health, we know political agenda and renewed commitments Integrating nurturing care into health that platforms for the delivery to enacting supportive policies and service delivery of nurturing care already exist guidelines. For example, the Government Political commitments to nurturing within health facilities. This is why and development partners convened to care have resulted in government-led The government of Siaya began to we believe that health system revive the county health bill, which had coordination and mobilization, both integrate nurturing care into the county’s integration is so critical. Not only stalled, after being drafted in 2015, because between sectors and among the more health system in 2014 in order to improve does integration help us reach young of elections and turnover of government than 100 civil society partners active in development outcomes for children. In children as early as possible, it is ocials. To support these eorts, newly the health sector. For example, at the health facilities, priority services included cost eective, it enhances quality, it elected County Assembly members of the subcounty level, nurturing care focal points clinical monitoring of developmental reduces missed opportunities, and it Health and Public Governance Committees are responsible for coordinating service milestones, referral of children with will enable us to scale up nurturing were made aware of the importance of delivery, training and mentoring. A key suspected developmental delays, care services faster.” nurturing care and the crucial role of the lesson is that government must lead eorts counselling on responsive caregiving and health sector in delivering ECD services. to scale up nurturing care and play a strong Dr. Elizabeth Omondi, RMNCAH Coordinator early learning and structured play sessions. & ECD focal person, Siaya County role in coordinating the various sectors and The government also sought to use Governor of Siaya County, Cornel Rasanga partners involved in its implementation. community health volunteer networks to Amoth, endorsed the need for new provide nurturing care-related counselling nurturing care policies, and undertook to Capacity-building is an essential and to oer additional support through nongovernmental health partners—including lead the work from his oce. He created component of eorts to scale up nurturing home visits. nutrition, maternal and child health, an interministerial coordination committee care work. In Siaya County, government community health, HIV, and reproductive focused on increasing coverage and quality sta now have the skills and knowledge Siaya’s County Health Management Team health— to include nurturing care content in of nurturing care services. The committee to train health workers, provide supportive partnered with PATH to adapt the World their training and capacity-building activities. convenes all sectors and stakeholders supervision and mentorship, and integrate Health Organization and UNICEF’s Care This “top-up” approach is cost eective and involved in child development – including nurturing care into the health system. for Child Development (CCD) package reinforces the inclusion of nurturing care health, finance, social protection,