Preschool, Poultry and Parenting (PPP) Intervention, Tanzania January 2021
Preschool, Poultry and Parenting (PPP) Intervention, Tanzania is an integrated parenting intervention which provides a community-based course of interactive parenting sessions, held weekly for twelve weeks, covering a holistic package of early childhood development parenting behaviours. The PPP intervention was developed by Mott MacDonald/Cambridge Education working closely with the Tanzanian Ministry of Health, Community Development, Gender, Elders and Children (MoHCDGEC) and the President’s Office - Regional Administration and Local Government (PO-RALG).
Good Health – incorporated content from UNICEF on treatment for common childhood illnesses and when to seek assistance.
Mott MacDonald invested its own funds to trial this intervention in three wards of Dodoma region: Ibihwa in Bahi ward, Chihanga in Dodoma Municipal and Mkombola in Hombolo Bwawani ward. The thriving community-based School Readiness Programme in these communities provided an entry point as parents of preschoolers were invited to attend.
Adequate nutrition – facilitators were trained by staff from Tanzania Food and Nutrition Centre to lead practical cooking demonstrations using local available foods. Tanzania Veterinary Laboratory Agency (TVLA) provided practical training on poultry rearing and vaccination of birds against Newcastle disease to help families provide a valuable protein as well as income source.
Rationale
The period of early childhood, starting from conception, has a fundamental and permanent impact on a child’s future cognitive and physical development. Adversity in this period – whether through chronic under nutrition, toxic stress or deprivation of responsive caregiving has been shown to have psycho-social and economic consequences which persist into adulthood. Parents the world over are highly motivated to optimise their children’s future success and wellbeing but may not know the significance of nutrient rich foods or optimal feeding frequency, or the significance of communication and play, or damaging effects of harsh discipline. By presenting the best available evidence and allowing parents time to discuss this and decide on practical behaviours they can trial, the intervention aims to empower parents to maximise their children’s future chances in life.
Responsive caregiving – parenting sessions included content from the Care for Childhood Development curricula including practical exercises for parents to practise with their babies and young children at the sessions. Security and safety – sessions incorporated messages from the MoHCDGEC’s strategy and plan of action on violence against women and children, as well as the importance of safe environments for play. Opportunities for early learning - The PPP adopted the play-based learning culture of the Tanzania School Readiness Programme, using songs, activities and games to promote a relaxed and fun environment and encouraging parents to play and interact with their children during the sessions.
Operationalising the nurturing care framework The PPP intervention is unique in that it attempts to operationalise the WHO/UNICEF Nurturing Care Framework by consolidating existing interventions and bringing these together into a holistic bundle at the local level. The simple 12-week parenting course included the following:
By integrating these previously stand-alone interventions and messages under a single banner of promoting your child’s future development potential, we captured the imaginations of parents – mothers and fathers – and created momentum for change.
1
Baseline
Baseline
Endline 39.80%
Endline 54% 57.50%
Asked a child to help with a task
35.60%
34%
Listened to a child sing
30% 23%
Sang a song with a child
17.80%
Played any game with a child
65%
12%
2.70% 1 group
Implementation features
A short baseline and endline survey was conducted in the three intervention centres with a total of 74 households from the three wards. Parents were asked to selfreport on behaviours and we could not independently verify actual practices. As there may be some courtesy bias in responses, results need to be interpreted with caution. However survey results show very substantial improvements in practices, especially around nutrition and play-based interaction.
Sessions were largely practical, reflecting the real environment in which parents live, rather than very content-based. Facilitators demonstrated, for example, how whole eggs could be incorporated into maize porridge for feeding babies without affecting its texture or flavour. Participants were interested to learn that a dish prepared by mixing polished maize, legumes, offal (utumbo) and vegetables, when well-cooked, was very suitable for young children.
2 groups
3% 3 groups
4 groups
At baseline, results showed that many parents did not feed their children with adequate frequency or diversity. 30% of families in our intervention sites fed their child only once in a 24-hour period. By endline, the proportion reporting that they had fed their child once fell to 1.4% of households, while 42% fed their child four or more times (up from 18%). (See Figure 1) Baseline
5 groups
Helped a child to wash hands
The survey also investigated the amount of sugar consumed, as expenditure on sugar uses up household resources on a nutritionally “empty� food which, consumed in excess, can have damaging health consequences particularly linked to obesity and diabetes in later life. There was also anecdotal evidence that eggs sold by families were used for market purchases such as sugar. Baseline findings indicated that the average (mean) was 2.2 kg of sugar purchased in each household in the previous one month, with an average amount spent of TZS 5,463. The endline showed a decrease in the quantity of sugar reported to be purchased with the average falling to 1.7 kg and expenditure of TZS 4,475.
Prepared food for a child
Endline
27.30% 23.30%
Encouraging fathers to attend has been more of a challenge, as they are busy with agricultural activities, but in one location male participation slowly grew. It has been suggested that having two facilitators, one of each sex, might encourage more men to participate. Men were very keen to participate in the poultry vaccination training.
4.1%
1.40% Once
15%
13.7%
13.7%
Twice
3 times
4 times
5 times
Figure 1: Infant & Young Child Feeding (IYCF) Frequency
Parents were asked to list the food they had given their children in the last 24 hours. Responses were later categorised by food group as part of the data analysis. At baseline, a third of households fed their children from just one food group, 30% from only two groups and only 3% had fed their children with food from all five groups in the last 24 hours. Endline findings indicate that there had been a very significant improvement, with the proportion of children eating from all five food groups increasing from 3% to 35%, and those eating from four groups rising from 10% to almost 40%. (See Figure 2)
Support from community leaders was visible with village leaders and MoH representatives attending some of the sessions. Participating parents have reportedly been happy to see government representation.
2
71% 74% 48.8%
68%
61%
71%
Parents were asked whether they had engaged in a variety of activities in the past 24 hours. Baseline results showed that a majority of parents had carried out more functional activities, while more leisure and play-based interactions were less common. For example, only 13.7% had looked at a book with their children, 20.5% had sung and 24.7% had played a game. The endline results were very different. Most parents reported playing with their child (67%) and 66% singing with their child, while 48% looked at a book (although this was reported to mostly cover looking at their older children’s exercise books to see what they have learnt at school).
33%
30.1%
48%
Figure 3: Interactive activities in last 24 hours
38.4%
Every week parents were given plenty of time to provide feedback and share their experiences in trialling new practices. Parents were encouraged to attend with their young children to enable play-based interactions. Nutritional snacks were provided which not only boosted the enjoyment factor but was also an opportunity to educate on the diversity of local healthy snacks on offer.
13.7%
Talked to a child
Figure 2: IYCF Dietary Diversity
Results
To train and equip the staff who would be running the parenting sessions, we organised, jointly with Government, a 3-day workshop for Community Development Officers (CDOs) and other officials from the three wards. Community sessions began in January 2020 and continued weekly until they were suspended because of COVID-19 in March 2020. Sessions resumed in July 2020 following risk assessment and mitigation measures in place.
Looked at a book with a child
67%
24.7%
10% 4.10%
66%
20%
3
Community Feedback on Change
Scalability and Sustainability
Parents have been highly motivated to know that they possess in their own surroundings every food group they need to prepare nutritious food for children and their family. Previously, people believed that providing nutritious food meant buying ready-made foods from shops.
This was a new intervention which was jointly created by Mott MacDonald Tanzanian and UK-based staff in consultation with MoHCDGE&C, PO-RALG and national bodies such as TFNC, TVLA etc. Although it was carried out on a small scale, it was designed with scale in mind, as it i) used existing local government community structures (CDOs) to carry out the intervention; ii) followed a simple format with educational content condensed to key points parents needed to know (less is more approach); and iii) used existing materials that could be easily reproduced.
Most households have created home gardens as a result of the intervention. Some have decided to extend the cultivation of vegetables and sell the surplus to commercial vendors at the local market. Parents from Chihanga and Ibihwa centres have decided to form poultry farming groups and are registering their groups and planning to expand their projects not only to yield more eggs and meat for their families but also as an income source. The leaders in Hombolo centre in collaboration with the PPP trained community vaccinator have decided to vaccinate all the village’s chickens through villagers’ cost contribution instead of waiting for the government vaccination programme.
We gathered data on actual expenditure to allow analysis of the costs of replicating and scaling up the intervention. In this first trial, there was a relatively heavier investment in monitoring and evaluation. If we exclude the design and external M&E, the cost was US $11,130. See Figure 4. The biggest portion of this cost was the 3-day CDO training in Dodoma. The number of parents who completed 12 sessions is estimated at 100 (1197 total parents divided by 12 weeks). Total beneficiaries if local leaders and child participants are also included is 210.
An unintended benefit was that local leaders are now using PPP parent participants as local advocates to help sensitise the community on other different issues concerning general development of the particular villages. Parents who participated in the PPP training have started sensitising their colleagues in the villages on nutrition issues, farming as well as personal and environmental hygiene. Some parents reported advising their fellow parents to stop using harsh and violent punishment and language with their children.
Total Costs (US $) Monitoring by Govt.
519 1,502
Poultry Vaccinator Training SRP teacher’ paticipation
156
CDO travel / subsisdence
933 1,248
Vaccine and chick start up Snacks for sessions
882
Toys for centres
350
Materials
646
CDO Training Dodoma
4,894
Figure 4: Intervention Costs (US $)
Unit costs are US $112 per parent or US $53 per individual beneficiary. While these are quite high, when repeating and scaling an intervention, increased economies of scale are possible. For example the CDO training could be run for larger groups or delivered by local trainers in situ who were trained by TFNC / TVLA. There is potential for impact across multiple domains – nutrition, early learning, social welfare, livelihoods – and also signs that benefits can pass from individual families to communities. Both these suggest that integrated, holistic interventions, not only are time efficient for busy families, but can also be extremely cost-effective as the returns on investment are multiplied compared with a single sector intervention. With the Government of Tanzania we are exploring a further, scaled up phase, with independent M&E, and an embedded implementation trial to test alternative formats. There is an opportunity to explore whether other national programmes, such as agricultural outreach extension, could be leveraged (stress-tested) as potential entry points for the Preschool, Poultry and Parenting programme. Through further research, we see real potential for Tanzania to forge the way in operationalising the Nurturing Care Framework at scale. 4