Nurturing Care for Early Child Development
Using the common elements approach to develop an integrated and scalable intervention for at-risk mothers and children in Pakistan. The project integrated evidence-based components addressing early stimulation, responsive feeding, and perinatal depression, and developed an online training platform for non-specialists to enable scalable delivery.
Partners
- World Health Organization (WHO), Geneva
- University of Liverpool, UK
- Human Development Research Foundation (HDRF), Pakistan
Why it mattered
Early child development and infant nutrition are global priorities. Scalable interventions that integrate key theoretical constructs influencing ECD and overcome implementation barriers are limited. The common elements approach offers a pathway to create integrated, scalable interventions to improve health, well-being, and future potential of populations in low-resource settings.
The challenge in South Asia
In South Asia, 35–45% of children are undernourished and over 40 million lag behind in their cognitive and socioemotional development. Millions of children in low-resource settings are at high risk of poor development due to undernutrition, inadequate stimulation, and maternal depression. Although evidence-based interventions exist, they are often delivered as separate, overlapping packages through disjointed systems—creating barriers for scale-up.
1) Integrated intervention (Common Elements)
A single integrated package was developed using a common elements approach—combining evidence-based elements from packages addressing early stimulation, responsive feeding, and perinatal depression.
2) Online training platform
An online training platform was developed to train non-specialists—including community health workers and caregivers—to deliver the intervention at scale.
What the integrated package covered
Maternal Psychological Well-being
- Family support during pregnancy, childbirth, and breastfeeding
- Behavioral activation and problem solving
- Praise and positive reinforcement of desired behaviors
- Engaging family and improving social support
Child Development
- Improving maternal sensitivity and responsiveness towards infants
- Knowledge and resources for pleasurable, responsive play activity
Nutrition
- Psychoeducation and behavior change on infant nutrition and feeding
- Responsive feeding
- Early initiation of breastfeeding
- Exclusive breastfeeding for six months
Scalability focus
- Common elements approach to integrate overlapping packages
- Training non-specialists through an online platform
- Designed for low-resource delivery pathways
Where it was implemented
The Nurturing Care Intervention was implemented in a rural sub-district of Rawalpindi, in close collaboration with government programmes.
- Government collaboration for feasibility and integration
- Non-specialist delivery supported through training
- Designed for scale-up through practical implementation pathways
Evaluation design & outcomes
Evaluated through an individual randomized controlled trial involving over 250 mother–infant dyads followed up over 12 months. Outcomes included caregiver–child interaction, infant development, quality of the home environment, maternal distress, social support, and quality of life.
- Caregiver–child interaction
- Infant development
- Home environment quality
- Maternal distress & social support
- Quality of life
Health Applications of Technology (HAT) supports scalable health and mental health programmes by translating evidence-informed interventions into practical digital systems—enabling training at scale, strengthening delivery workflows, and improving implementation feasibility in low-resource settings.