Socios En Salud Sucursal Peru seeks to transition to scale a culturally-specific, evidence-based early intervention (CASITA) delivered by community health workers (CHWs) in Lima, Peru. With support from Grand Challenges Canada (GCC), the CASITA intervention pilot successfully demonstrated that this low-cost, community-based strategy improves neurodevelopment among children ages 6-24 months. Proof of concept was also demonstrated by the enthusiastic endorsement from all stakeholders (trainers, CHWs, families, and healthcare providers) and their belief that this program can be realistically scaled up in Peru. Identified through the pilot, the core effective components of CASITA are: 1) high-quality training and supervision of CHWs, 2) structured community-based sessions to deliver evidence-based coaching on parenting behavior and child stimulation, and 3) validation of caregivers’ parenting efforts.

The three year transition-to-scale funding for CASITA will allow the team to provide a community-based early intervention and social support package to approximately 3000 caregivers with children that have neurodevelopmental delays across the Municipality of Carabayllo. CASITA intervention sessions will be provided at existing Casa Amiga community centers which offer specialized services for women afflicted by domestic violence (including mental health, legal support, and shelter), 10 “Casas de la Salud” and 9 Health Centers of Carabayllo.

Funders:

• Municipality of Carabayllo
• Ministry of Health (MINSA). We will work with RED de Salud Túpac Amaru and Microred Carabayllo.
• Partners In Health
• Korean International Cooperation Agency (KOICA)
• Saving Brains Partners

Key Partners:

• Socios En Salud Sucursal Peru

Expected Drivers:

Multi-sector Partnership

Socios En Salud Sucursal Perú engages with the Peruvian Ministry of Health as well as civil, social, and community-based organizations to ensure projects are sustainable at the community and municipal level.

Mutual Health Priority Amongst Invested Partners

Recent trends in Latin America toward decentralization of health services have shifted resources and leadership from Ministry of Health programs to local municipalities. Municipalities, such as Carabayllo, have resources and infrastructure to implement health programs, yet lack necessary expertise to execute programs effectively. Responding to this mandate, Rafael Alvarez Espinoza, Mayor of Carabayllo, identified the impact of child labor and social inequality on NDDs.

As a result, he requested that Socios en Salud Sucursal Peru  lend their expertise in community-based interventions to improve early neurodevelopment through a scalable, relatively low-cost program. Thus, this program represents a mutual health priority among invested partners [6].

Expected Challenges:

• Demonstrating the role of caregiver in the family and community, a model of change for future families living around them.
• Showing the role of the community worker in early child development at the community level.

This project uses integrated innovation to grow and sustain impact for the foreseeable future through social, technological, and business strategies.

 The team plans to scale CASITA through a smart business model that attracts long-term investment from public funds through an early child Center of Excellence (“Center”). The Center will be designed similarly to the SPARK Center at Boston Medical Center and will have access to best practice interventions, metrics and research infrastructure [1], and the expert local and international early neurodevelopment CASITA team.

The team’s  vision for the Center is to create a point of reference for state-of-the art, community-based, early intervention in Peru. The Center will provide neurodevelopmental and nutritional support to children under 2 years old at developmental or social risk at no cost to users through the CASITA program and consulting, education, and training services through paid public contracts.

Outcomes to be measured and evaluated:

• Changes in child development.
• Changes in parenting behavior.
• Child, caregiver, and household characteristics that predict who benefits most from the intervention.

The innovation will evaluate the impact of CASITA on HOME scores as well as developmental status as measured by Bayley’s. Approximately 35% of the Study A cohort will be aged 12 to 18 months at the time of Study A enrollment (thus 15 to 23 months at the time of Bayley administration).  Based on estimates available in  existing literature, the team anticipates that a sample size of 128 will be adequate to demonstrate the effect of CASITA using Bayley measurements.

1. https://www.bmc.org/programs/spark-center
2. Fernald, L., Karigera, P, Hidrobob, M., y Gertlera, P. gradientes socioeconómicos en el desarrollo infantil en niños muy pequeños: Evidencia de la India, Indonesia, Perú y Senegal. PNAS, 2012. 109 (2): p. 17.273 a 17.280.
3. Schreiner, M., Progreso de Índice de Pobreza: Un Puntuación Pobreza simple para Perú. 2008, Fundación Grameen: St Louis, MO
4. Caldwell, B. y R. Bradley, eds. Home Observation For Measurement of the Environment Administration Manual.tempe, AZ : Family y Human Dynamics Research Institute, Arizona State University.
5. Totsika, V. y K. Sylva, La observación principal para la medición de Medio Ambiente Revisited. Child Adolesc Salud Ment, 2004. 9 (1): p. 25-35.
6. Análisis situacional de salud de la Microred Carabayllo. 2015