Why primary health care has the potential to make a massive difference in child development
Primary and community health care systems have made life-saving progress in improving health and nutrition outcomes for children globally. Since 1990, the global under-5 mortality rate has dropped by nearly 60 percent, stunting prevalence has declined from 33 to 22 percent between 2000 and 2022, and exclusive breastfeeding rates have risen by 10 percentage points, reaching 48% globally in the last decade.
However, there are still 250 million children under the age of 5 in low- and middle-income countries (LMICs) who are at risk of not reaching their full developmental potential due to poverty and stunting. While 86.2% of children aged 2-5 in LMICs have a healthy weight, less than one in three of these children receives adequate developmental stimulation or is protected from physical punishment. These developmental disparities can have lasting impacts on one’s cognitive, physical and socio-emotional development, thereby affecting health, education and economic outcomes in adulthood.
Growing evidence shows a more comprehensive approach can address these developmental disparities and enable children to better reach their developmental potential. This approach is “nurturing care,” which includes not only good health and nutrition but responsive care, early learning and protection (Figure 1).
And primary health care systems, which are already delivering key health and nutrition interventions to children ages 0-3, hold massive potential to deliver this more comprehensive nurturing care. For example, health workers could provide guidance to caregivers on responsive care during postnatal care visits, showing them how to be attentive to an infant’s cues and needs; health facilities could also set up demonstrations of playful learning in waiting areas with age-appropriate toys and books.
Through these interventions, PHC systems can contribute to addressing developmental challenges, continue to promote strong health and well-being across the life course, and support achievement of SDG 3 to ensure health and well-being for all, including universal health coverage (UHC).
What is primary health care?
Primary health care (PHC) is an essential component of all effective health systems worldwide, offering needed health services that are practical, scientifically sound, and socially acceptable. Covering vital interventions such as health promotion, maternal and child health services, routine immunizations, and treatment for common illnesses across the life course, PHC provides a cost-effective and affordable approach to achieving good health within communities. It supports first-contact, accessible, comprehensive, coordinated and continued patient-focused care across the life course and is delivered primarily through health clinics and community-based initiatives.
Figure 1. Nurturing Care Framework
Source: Nurturing Care for Early Childhood Development & Thrive Coalition
Why promote young children’s development through primary health care systems?
Primary health care systems provide a valuable and strategic foundation to promote services for young children’s development, given their:
- Demonstrated success in implementing health and nutrition services to young children
- Sustained success in implementing growth and nutrition monitoring programs and immunization initiatives
- Existing routine points of contacts with children and families, particularly during the prenatal period and first 1,000 days
- High levels of community trust, particularly among community health workers,
- Established resources and infrastructure that can be leveraged to promote young children’s holistic development
There is also emerging evidence from various countries, interventions and programs, and settings that show that providing families with support and guidance related to their children’s holistic growth and development results in:
- Improved well-child visit attendance
- Increased utilization and improved perception of health services by caregivers
- Increased health seeking behaviors and early identification of developmental delays
Therefore, to support PHC decision-makers to use entry points (i.e., antenatal care, birth and postnatal care, well-child visits, and sick child visits) to promote young children’s holistic development, R4D is developing a global resource that showcases existing evidence and country experiences to:
- Identify key factors that enable delivery of developmental monitoring and counseling, and interventions that promote responsive care, early learning, and protection into primary health care systems.
- Outline strategic actions that government health teams can take to strengthen these same interventions. This is in collaboration with a Global Advisory Group, including members from UNICEF, WHO, and other partner organizations, with support from the Conrad N. Hilton Foundation.
As part of this initiative, R4D is also working with local change agents, including the Ministry of Health in Mozambique (MISAU), Ministry of Health and the President’s Office – Regional Administration and Local Government (PO-RALG) in Tanzania, Ministry of Health in Kenya, and the Department of Health in Nyamira County, to reflect on relevant recommendations from the global resource, build on the valuable in-country work incorporating nurturing care into PHC services, and develop national and subnational action plans to promote holistic child development through routine PHC services. R4D will incorporate lessons learned from these experiences to further improve the global resource.
In a future blog post, we’ll explore key insights and takeaways from the development of the Global Resource on Strengthening Primary Health Care to Promote Optimal Child Development.
