A sustainable public-private partnership for delivering integrated child development care in Pakistan

Country of Implementation:



Lahore and Rawalpindi district in Punjab province



Target Beneficiary:

Mothers; 0-2 years

Delivery Intermediaries:

Caregiver; Medical Professional


To improve maternal mental health, and the child development knowledge and practices of the caregiver.

Innovation Description:

Integration of maternal care and child care in private clinics through a public private partnership.

Stage of Innovation:

Proof of Concept

A sustainable public-private partnership for delivering integrated child development care in Pakistan


Lahore and Rawalpindi district in Punjab province



Target Beneficiary

Mothers; 0-2 years

Delivery Intermediaries

Caregiver; Medical Professional


To improve maternal mental health, and the child development knowledge and practices of the caregiver.

Innovation Description

Integration of maternal care and child care in private clinics through a public private partnership.

Stage of Innovation

Proof of Concept

Innovation Summary

0585-asd-association-social-development-logoIn Pakistan, around 15% of young children have hindered development, underperforming in at least two domains. [1] As in most developing countries, early child development has been a grossly neglected area of public health in Pakistan. There is inadequate measurement of early child development, and little assessment of the determinants of brain development. Further, women in Pakistan have limited access to early child development care because public hospitals are overloaded, many private clinics simply do not offer the service, and/or families simply cannot afford the care.

The delivery of child development care (including maternal mental health) through private clinics has never been tested before in Pakistan. There is an existing countrywide network of private clinics and small hospitals which are currently unregulated. These clinics provide more than two-thirds of primary health care in urban regions. Through a public-private partnership, this innovation supports private clinics to promote optimal early development of poor urban children in their first year of life. This is done by providing clinics a package of guidelines and tools to integrate maternal care and child care. The care package will have three main components: nutrition, child development, and maternal mental health.


  • 44 doctors and paramedics, at 11 private clinics, will be trained and supported to practice the care protocols.
  • 1100 child-mother pairs will have access to the early child development and maternal mental health care package.
  • 44 and 88 young children will avoid delay in motor and language skills, respectively; 77 mothers with young children will not develop depression.


This project aims to develop and evaluate a set of child development and maternal care tools and materials that will allow private clinics to promote urban children’s brain development in the first year of their life.

This project has three main objectives:

  • Develop an integrated early child development care package with three key components: child development, nutrition counseling, and maternal mental health.
  • Arrange, implement and monitor the care package at 11 selected private clinics.
  • Evaluate the intervention’s effectiveness and feasibility through a randomized controlled trial and associated costing and qualitative studies.

At each selected clinic, the ECD care package will be integrated into the routine primary health care package. The child-mother pair enrolled for the intervention will visit the clinic on quarterly basis.

Each mother will be counseled, with the help of specially-designed pictorial tool, on the following: child brain development, child nutrition, and mother mental health. This counseling will be supplemented by providing mothers a take-home brochure as a reference, and in case of depression, drugs will be prescribed if/as needed.

The innovation will engage the respective local district health office mainly in: mapping and selection of private clinics; training of clinic staff; enabling community advocates; and monitoring ECD care delivery at the clinics. In these ways, it will enable the local district health office to support these clinics in their provision of child development care package to mothers and young children living in poor urban localities. An average of five community advocates will be enabled in the catchment population of each private clinic to generate awareness about the “need” and the “services” offered, and to “mobilize” mothers and families to access the services.



Key Partners


Community- and Context-Sensitivity

During the intervention development phase, the context (including health care providers and consumers) will be reviewed to ensure the implementation modalities and materials are sensitive to the ground realities.

Stakeholder Engagement

The engagement of provincial programs, institutions, districts, private clinics and communities will help to make the intervention effective and sustainable.


If the proposed intervention is found feasible and effective, it will be scaled to 40 districts in Pakistan (covering more than 35 million urban population), where district-steered public-private partnerships are already being implemented for TB and/or malaria control interventions.

Evaluation Methods

The effectiveness and feasibility of this intervention will be assessed.

The effectiveness of this intervention will be prospectively measured, through a cluster randomized controlled trial that will  assess changes in child development outcomes in the first 12 months of life. Outcomes will be compared between cohorts of mother-child pairs at eleven “intervention” and eleven “control” clinics. Child motor skills, language development and cognitive development and mother mental health (depression) will be assessed and recorded at the time of initial registration and when the child is 12 – 15 month old.

The feasibility of wide-scale implementation will be assessed through an incremental cost-effectiveness analysis using a set of tailor-made cost estimation tools. In addition, a qualitative study of health services and client will be conducted, to gain their perspectives on the intervention.

Impact of Innovation

Costing analysis is planned for the second project year (last quarter of 2015 and three quarters of 2016).


  1. Poon J et al. (2010). Developmental Delay: Timely Identification and Assessment. Indian Pediatrics, 47: 415-422.


Saving Brains is a partnership of

Saving Brains is a partnership of