Maternal and Newborn Health, and Early Childhood Development in Rural Ethiopia

Country of Implementation:



Arsi Negele District, Oromia Regional State of Ethiopia



Target Beneficiary:

Mothers; 0-2 years

Delivery Intermediaries:



To increase knowledge and skills of parents in low-income, low-literacy, rural settings, enabling protection and nurturing of early brain development of children.

Innovation Description:

Implementation of Learning Through Play complemented by a cost-effective and interactive audio-visual communication technology.

Stage of Innovation:

Proof of Concept

Maternal and Newborn Health, and Early Childhood Development in Rural Ethiopia


Arsi Negele District, Oromia Regional State of Ethiopia



Target Beneficiary

Mothers; 0-2 years

Delivery Intermediaries



To increase knowledge and skills of parents in low-income, low-literacy, rural settings, enabling protection and nurturing of early brain development of children.

Innovation Description

Implementation of Learning Through Play complemented by a cost-effective and interactive audio-visual communication technology.

Stage of Innovation

Proof of Concept

Innovation Summary

0589 logo ccfcIn Ethiopia there are about 11 million children 0-3 years of age [1] of which the majority  are deprived of proper care. The psycho-social component of early child development, which is critical for proper cognitive, linguistic and social-emotional development and for adapting to new environmental situations, is largely ignored. About 44% of children in Ethiopia are stunted and 29% are underweight. [2] However, this is not due solely to the lack of available nutrition. The knowledge and skills of parents on child feeding practices and prenatal nutrition is generally very low.

The goal of the project is to improve holistic early childhood development (the health; physical, cognitive, linguistic and socio-emotional development) of 3,000 children 0-3 years of age in 2,500 households.

The project will use two complementary knowledge delivery approaches: Learning Through Play (LTP) and audio-visual early brain development education programs.  Pictorially illustrated LTP Calendars will be used by parents for stimulating the sense of self, motor, language, cognitive development of children 0 to 3 years of age. Audio-visual education (video messages) focusing on child nutrition,  immunization, sanitation, hygiene and prevention of harmful traditional practices and infections; and maternal health  will be locally produced and disseminated to rural low literacy families  in an interactive way using portable devices which are user-friendly. It will be delivered through the health extension packages of the Ministry of Health Extension Workers (HEWs), who are responsible for well-coordinated basic early childhood care services.


  • 60 social workers, health extension workers and Health Development Army members (health promoters) in 7 sub-district of Arsi Negele district will be trained
  • 2500 parents (caregivers) will be trained in Learning through Play (LTP), early brain development, the developmental needs of their children in sense of self, physical, cognition, communicative development and relationships, maternal and child health, and will gain access to LTP materials
  • 3000 children 0-3 years of age will receive the intervention (early and exclusive breastfeeding, proper child nutrition, immunization, relationship/secured attachment, hygiene, infection prevention, and other early stimulation) by their parents

“Investments in children and youth often come too late in their development, resulting in significant social and economic problems later in life. Too often, we end up addressing the symptoms of the main problems and not the underlying causes. We know that investing in early brain development leads to a reduction in the main problems facing children and youth as they grow up. We are a team of researchers, practitioners and social entrepreneurs that want to find a solution to the barriers to early child development (malnutrition, lack of proper care and early stimulation) and create a sustainable and scalable model that will do this. “
[Philip Tanner (PhD), the Project Lead]


The project aims to affect a cost-efficient knowledge delivery system, with content innovation, through low-level technology-based and consistent messaging. A proven LTP program will be delivered in rural, low literacy areas and low access to media areas, where health infrastructure is underdeveloped. It will support parents and caregivers by changing behaviors in child-rearing to better protect and nurture early brain development. The project will use two complementary approaches:

Learning Through Play Program

The Learning Through Play (LTP) program and materials were developed by the Hincks-Dellcrest Centre and Toronto Public Health. The LTP pictorial calendars, depicting the successive stages of child development, with brief descriptions of simple play activities that show parents what they can do to promote healthy child development, will be translated to the local language and illustrations will be adapted to local context. The project will mainstream the LTP program in the national health extension program to contribute to improvement of health and lives of young children and mothers.

Audio-Visual Early Brain Development Education Program

A community-led, participatory approach will be applied in production and dissemination of an audio-visual education program that can facilitate discussions and learning among parents in order to enhance adoption of best practices for early brain development. Trained social workers will produce locally contextualized scripts and videos involving model mothers and fathers who are already using best practices in early childhood care. The video messages focusing on exclusive breastfeeding, immunization, promoting early stimulation and maternal health will be disseminated by trained social/health extension workers using a portable, rechargeable battery-operated device.

Parents will be organized in groups to watch these videos and to be engaged in discussion and sharing experiences after the video is played.

Key Stakeholders Involved in Delivering the Program

Social workers will be responsible for identifying, mobilizing and organizing parents (caregivers) to attend trainings and education, providing training on LTP and assisting Health Extension Workers (HEWs) in delivering audio-visual education program, and  following up on the use of LTP calendar by parents (caregivers).

Health extension workers (HEW), who are employed by Ministry of Health to implement health extension program, will play the role of delivering the audio-visual education program with special emphasis on maternal, newborn and child health (MNCH) to parents. In addition, they will provide technical support to parents on the practices of what they would learn through home visits. HEWs will meet parents on monthly basis to share information and experiences, discuss successes, challenges, and lesson learnt.

The health development army (HDA) are community members (including model mothers) who will play an active role in facilitating community discussions, transferring information and knowledge, and encouraging mothers to seek MNCH care services and to practice better child rearing. The HDA closely work with HEWs in promoting MNCH and early childhood development in the communities at the grassroots level.



Key Partners



Collaborators to Support Scale-Up and Sustainability

Health Office (Ethiopia) (collaborating organization for supporting the scaling up and sustainability of the project)


Existing Health Sector Infrastructure

The existing government’s health sector development plan and early childhood care and education policy framework, along with willingness of the local government to jointly work with CCFC, will facilitate the implementation, scale up, and sustainability of the program.


Anticipated barriers to improving early childhood development through the program include:

Food Taboos

Existing food taboos that restrict pregnant women and children not to eat some food such as fruits with rich vitamins

Limited Father Involvement

Limited father involvement in caring for young children due to cultural norms

Lack of Parent Willingness

Lack of willingness of some parents to bring their young children to undertake anthropometric and psychometric measurement

Planned solutions for the challenges include:

Influential Community Members

The project will use influential community members such as leaders, elders and religious figures, to create awareness about existing harmful traditional practices and to convince parents of the importance of the program’s messages. These community members are well-respected and often sought for advice.


Trainings for fathers and mothers will be conducted to eliminate harmful traditional practices and gender disparity in child rearing practices


The innovation features a participatory approach which involves experienced researchers, child development program practitioners, health extension workers, local government, influential community members and parents in its implementation processes to achieve the expected results and scale up of the project. It is attractive to poor rural parents and caregivers, and adaptable to low-literacy communities which means it can easily be expanded to other rural areas.

CCFC and the Hincks-Dellcrest Centre have experience in implementing Learning Through Play (LTP) in Ethiopia, Burkina Faso, and Ghana and other countries, demonstrating that it can be scaled up to reach larger populations.

The involvement of all concerned project stakeholders will be high in project implementation, monitoring and evaluation and sharing knowledge and experience to determine the best strategy to scale up the project based on the findings of the evaluation of the project. The local CCFC’s partner NGO and district Health Office will take over and scale up the innovative approaches in other areas.

Evaluation Methods

The project will use a randomized control design by implementing the innovation and control arms in seven sub-districts of the Arsi Negele District each. The project will be evaluated for 1) improvement in  parents’/caregivers’ knowledge, and skills and behaviour in child-rearing, and for 2) change in physical, cognitive, language and socio-emotional development of children 0-3 years of age.

Quantitative and qualitative data collection methods (surveys, recording vital events, questionnaires, interviews, focus group discussions, children’s anthropometric and psychometric measurements) will be utilized at the baseline, post-intervention and 4-month follow-up both in the intervention and control areas.

The project will compare baseline and post-intervention child development assessments (Ages and Stages Questionnaires or Kilifi Developmental Inventory and MacArthur Child Communicative Development Inventory) to measure child growth and development.

Quantitative data: At the time of enrollment in the study, a background questionnaire will be administered to obtain demographic data such as parental age, marital status, parent education and number of children in the home. Household survey will be undertaken to collect data on child growth and development, child nutritional status, immunization and child illness, and maternal health.

Qualitative data: Focus Group Discussions will be held involving mothers and fathers with children 0-3 years to inquire about the use of LTP, change in parents’ knowledge, skills and practices in early brain development. In-depth interviews will be conducted with health extension workers, social workers, health development army, nurses and midwives at health facilities. The interviews will focus on the coverage and quality of maternal, newborn and child health services.

Data analysis: data entry, analysis and interpretation will be undertaken ensuring the quality and reliability of data with due diligence. SPSS and NVivo software or other better software will be used for quantitative and qualitative data analysis, respectively.

Impact of Innovation

The innovation will have the potential to change the lives of children by improving their physical, mental and emotional health, and also to change the lives of their parents by creating strong attachments to their young children while improving child-rearing knowledge, skills and behaviour. This will subsequently have a positive and measurable change on development outcomes (physical, cognitive, language and socio-emotional) of children 0-3 years of age. It will reach 3,000 children 0-3 years of age in 2,500 households, enabling children to achieve normal development milestones.

Cost of Implementation

The innovation is based on the knowledge delivery model which is more effective, per dollar spent, and interactive in enabling parents to acquire knowledge and skills than the conventional, lecture-based, theoretical approach. The model uses local personnel by building their technical capacity (at a lower cost) through training on how to produce and disseminate audio-visual education instead of hiring external videographers (at a higher cost).


  1. Central Statistical Agency (CSA). [Ethiopia]. The 2007 Population and Housing Census of Ethiopia. Statistical Summary Report at National Level. Addis Ababa, Ethiopia: Central Statistical, 2008 1:p.8-9.
  2. Ethiopia Central Statistical Agency and ICF International. 2012. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia, and Calverton, Maryland, USA, 2012. p. 18-19, 110-186.
  3. Squires, J., & Bricker, D. (2009) Ages and stages questionnaires 3rd Edition: A parent-completed child monitoring system. Baltimore, MD: Paul Brookes Publishing.
  4. Hao M, et al. Early vocabulary inventory for Mandarin Chinese. Behav Res Methods. 2008 Aug;40 (3):728-33.
  5. Squires, J. et al. (2002) The ASQ: SE User’s Guide for the Ages & Stages Questionnaires®: Social-Emotional: A parent-completed, child-monitoring system for social-emotional behaviors. Baltimore, MD: Paul H. Brookes Publishing Co., Inc..
  6. Cohen NJ, et al. (2012) Learning Through Play International Program: Early Childhood Development Resources and Training- Program Outcomes. Edmonton, AB.


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