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Mother Mentors for Child Development [updated Jan 5]

Mother Mentors provides strength and support to mothers and families so that young children can thrive. Strength and support comes in the form of a long-term mentorship, which starts with the development of an individualized plan. The aim is to ensure that the pregnant woman and her family have all that they need to provide their child with cognitive stimulation, good nutrition, and to prevent recurrent infections, all critical to good health and development. The mother and families' strengths and challenges are continually assessed and addressed over the first three years of the child's life.

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Pregnant women would enroll in the Mother Mentors for Child Development program, and be paired with a trained Mentor. An initial assessment would consider the mother’s and family’s strengths and challenges, and an individualized plan would be devised. The plan would have components unique to each family, for example, constructing a latrine, and components that are constant for all families, such as nutrition education and support. The Mentor would visit the mother at regular intervals from pregnancy until age three of the child’s life, with more frequent visits during infancy. 

Visits would be structured based on the age and needs of the child, and would likely include health monitoring, advice and training, as well as provision of needed items, e.g. insecticide treated nets. Visits would be supplemented with mobile phone check-ins or reminders and play groups.

Known challenges to healthy development in our communities
We know some of the challenges in our communities for young children in the domains of cognitive stimulation, nutrition and recurrent infections based on our program monitoring. Examples include:

Cognitive Stimulation: 70% of households with children age 1-4 years have no child-friendly books and only 25% were read to in the prior 3 days.

Nutrition: 48% of children under age 5 years with moderate or severe stunting, and only 55% were exclusively breastfed for 6 months.

Recurrent Infections: 16% of children under age 5 years had diarrhea in the preceding two weeks; 58% slept under an insecticide treated net the prior night; 73% use improved drinking water, while only 67% of households have a latrine.

Pregnancy health (from our refinement interviews and prototyping): women often cite not feeling supported by their husbands; there are many nutritional myths that may be detrimental to the woman and fetus.

Expected outcomes
1.    Decreased prevalence of stunting and wasting
2.    Decreased prevalence of diarrhea and malaria
3.    Improved language and cognitive development
4.    Decreased stress on mothers and fathers

Possible program components (please see attached "reimagined program" document for additions and changes)

Cognitive stimulation of the child:
  • Provision of children’s books and training for parents and siblings on how to use them to engage their children regardless of literacy.
  • Training and modelling on other methods of stimulation like singing, talking and play.
  • Play spaces and supplies, and facilitated play groups housed in our community library.

Nutrition:
  • In pregnancy: nutrition education and support, dispelling myths
  • Breastfeeding support for exclusive breastfeeding until 6 months and continued breastfeeding until 24 months
  • Complementary food provision or subsidization/education starting at 6 months of age

Recurrent infections:
  • Provision and maintenance of insecticide treated nets from pregnancy onward
  • Assistance with obtaining a latrine, if not present
  • Creation of a station for handwashing with soap, if not present
  • Evaluation of drinking water safety
  • Ensuring child vaccinations and other preventative health visits happen on time

Other:
  • Strengthening of the relationship between clinic staff and mothers at child wellness clinics so that they are more effective
  • Engaging fathers throughout pregnancy, and early childhood


What this might look like to someone in our community (see file under documents to be able to read some of the small print)





Why we believe this idea will succeed (updated 12/28)
We are uniquely poised to tackle this idea, as we are a child-focused organization working in the sectors of health and education. We have the knowledge and experience that comes from many years of programming in our communities.  We have tried different approaches over the years to various community health and education concerns, and have learned a tremendous amount from both our failures and successes (see attached document on our lessons learned).  
 
We know the community, we ARE the community
Our staff, including the leadership, is almost entirely comprised of community members who were raised here.  We built the organization over the past eleven years. We have a unique investment because our families and friends are the beneficiaries.
 
Additionally, we have a strong partnership with the district government education and health departments, as well as local leaders. 

Most importantly, we know that the health and development of this age group is a priority for our communities, so we would have their buy-in, enthusiasm, and support.
 
We have demonstrated success
On an exam taken after middle school to obtain entry into high school, we’ve seen a ten-fold increase in the high pass rate for girls, while the district has had a two-fold increase between 2001 and 2013.  99% of children have passed this test for the past five years, whereas the country keeps passing rates at ~63% annually, and our community started with only 4% of girls passing in 2001.
Diarrhea prevalence in young children decreased from 31% to 17% and has been sustained over the past five years, without significant changes in other factors.  Our community uses insecticide treated bednets at a much higher rate than nationally (58% vs. 39%).

Intensive individual investment is right for our community and the pregnancy through age three age group
Individual relationships built through mentorship gives a depth that cannot be obtained through group lectures or meetings.  There are intangible mentorship opportunities that don’t fit into categories of nutrition or prevention of malaria.  One example that we learned during this refinement period is the stress that first time pregnant moms endure over preparations for the physical environment for the baby, which ultimately is linked to how women are perceived by community members. 

We recognize our upcoming challenges
We recognize that it is bold, and some might criticize as foolhardy to focus on pregnancy health, child nutrition, stimulation and infection prevention when creating an effective program for one of these components is challenging.  However, we believe that, to maximize the outcomes for the child, we need this comprehensive investment.  It is unusual to focus broadly when so much of development work is done in silos of nutrition, malaria prevention etc.

To overcome the potential barriers of a broad focus, we will do the following:
  • Start our program with pregnant women, not with women and children at different stages.  This gives us some flexibility to focus on the initial needs and assets assessment and pregnancy programming, while refining programming for complementary feeding and other areas, which will come later.
  • We will draw on resources and expertise within our network, primarily at UCLA, but also hopefully with some partnership of programs in this challenge (Hands to Hearts International, for example) in the areas where we aren’t as knowledgeable.

Why this idea is unique (added 12/28)
This idea is new to GHEI: we have education programming for children age 5-18, with most of it individualized and intense, and health programming that is community-based with small individual investments.  This would be the first time we could truly merge our two sectors and this would be the first time we invest significantly in very young children.

Globally, there are one to one programs elsewhere that aren’t as comprehensive (i.e. include nutrition and cognitive development, but not infection control and pregnancy health) or have somewhat different focus on some social outcomes domestically (i.e. Family-Nurse Partnership in NYC).  This program is unique because it supports the pregnant woman and child through a comprehensive approach tackling nutrition, infection prevention and cognitive stimulation simultaneously to maximize a child’s health and development.  Equally important, it is delivered through a close mentorship relationship, allowing for support that doesn’t neatly fall into the category of nutrition or cognitive stimulation etc.

We have extensive program design and monitoring and evaluation systems in place to continually prove our programs are working or modify and discontinue them when they aren’t.  We plan to apply the same rigorous program improvement and evaluation systems with this program, so that after we achieve our goals, the program can be replicated elsewhere.


Update 12/10/14- Initial mother interviews

We conducted brief individual interviews with five mothers with young children- themes and insights below

What is challenging about being a mother of a child under age 3? Financially difficult (2 of 5 women): “Had to purchase all the delivery supplies prior to birth and supplies for the baby, which are expensive, there is a lot to buy”; Nutrition concerns (2/5):  including poor growth, difficulty breastfeeding; Health concerns (4/5) including “falling sick” often; Worrying about development (1/5) unsure when the child should be talking and walking.
 
What would make your family’s life better during this time?  Being financially more secure (4/5); Health (2/5): “keep [the child] from falling sick”, “having a healthy family.”           
 
What would make your baby/child healthier?  Nutrition (5/5) including “give baby adequate nutrition” and “breastfeed well”; Sleep under a bednet (5/5).
 
What could GHEI do to support you and your family?  Provide items (3/5) including bednets, soap for handwashing, items needed for delivery.  Provide money (2/5).  Include children in GHEI programs (5/5)[note that GHEI does not currently offer programs for this age group).
 
  • Insights to take forward 
    • Women are concerned about financial costs, recurrent infections, and providing proper nutrition.  They appropriately see prevention of malaria and proper nutrition as ways to improve the child’s nutrition. 
      • What does proper nutrition mean to them? What approaches are they currently taking to provide good nutrition? What are the barriers? What changes would be feasible for them?
      • Stimulation is missing from all responses.  Need to explore current practices, beliefs and potential program design.
    • They would like to see GHEI provide items to improve health or money.  How can we make this expensive time period less so?  Or at least ensure that we are not asking women to do things that cost more than they already spend? 
    • They universally mention having their children enroll in GHEI programs (which are for older children).  This may be an endorsement of programming in general, and maybe they would respond positively to programming for this young age group as well.

 

Update 12/18/14- Stakeholder analysis

We completed a stakeholder analysis, which is posted under documents. Interviews are underway with these key groups.  

 

Update 12/18/14- Lessons learned

OpenIDEO asked what we have learned that will help us implement this idea.  We had a discussion with five Ghanaian and two foreign staff members and received email responses from five past coordinators (foreigners who served 1+years on-site with us).  It was a very fruitful discussion, and the results are posted on this site.


 

Update 12/19/14- User experience map completed (see above and posted under documents)

Update 12/24/14- interviews with local authorities, clinic nurses, additional mothers, one father

To gain additional insight from stakeholders, GHEI staff interviewed the queenmother (traditional authority member), a local leader from a church, five nurses from the clinic, six mothers and one father.


 
Interesting excerpts:
[traditional authority member] How can a health program for pregnant women using Mother Mentors help the community? Many women learn the right things to do after their first or second child, seeing the mistakes they made. A Mother Mentor would help women do the right things to help their child from the beginning.
 
[traditional authority member] What are some of the problems that pregnant women, especially first time mothers, face in the community? Many feel sick and weak during pregnancy, and in a farming community, this means they cannot work and creates problems in the family. Sometimes they are still forced to work and do not get much help or support from family members.
 
[traditional authority member] Do we have permission to start this program? Yes, and have the support of the Chief and Queen Mother to help promote the program, identify participants, and inform the community about the benefits of the program.
 
[clinic nurse] What can GHEI do to support women during pregnancy, and how can we support each other without duplicating efforts? GHEI can help by encouraging women to continue coming to the clinic after the baby is born, help the clinic obtain needed supplies and supplements, and help people enroll in health insurance.
 
[clinic nurse] Nurses also provide family planning counseling at these visits, but most women are not interested, think it is actually harmful to their health to not continue giving birth regularly.
 
[clinic nurse] What do you think about a program like this? Like the program idea and it could be very helpful for the community and for the nurses. Should involve husbands and encourage them to come with their wives to ANC visits so that they know what is going on and to accompany them when it’s time to deliver (many do not).
 
[mothers] Did you self-medicate, or use herbs, during your pregnancy and/or during breastfeeding? Used herbs during first trimester to help make it easier (1/6); used herbs at end of pregnancy to rid the womb of harmful things, protect baby, ensure safe delivery (3/6); only what was given by hospital/doctor (e.g. to prevent malaria) (3/6); during breastfeeding only (1/6); no, didn’t take anything (1/6).
 
[mothers] What are some of the challenges or problems you encountered during pregnancy? Paying for health insurance; affording doctor’s visits/ANC (4/6); still being expected to go to farm and do hard physical labor during pregnancy; sickness, weakness, loss of appetite (4/6); getting good nutrition.
 
[mothers] If we started a program focused on helping pregnant women and mothers of young children, what kinds of help/support would be most helpful? How would such a program have helped you? Help mothers provide good food/nutrition (4/6); help women afford ANC (3/6); help women with health insurance (2/6); enroll the children in GHEI education programs; provide books and learning materials; provide bednets for all members of family; provide clothes for mother and baby; have someone to advise mother; help/encourage mother to get to the hospital; help during nursing with taking care of the baby, so mother can rest and work; teach parents how to help child with literacy, especially if parents illiterate.
 
[father] Do you think this program will help fathers? They think pregnancy is the duty of the woman, so if we involve them and enlighten them about their duties, it may help.
 
Themes/insights to take forward
  • Nutrition always mentioned as something that’s important, but that people have a hard time affording, especially for the child.
  • Food myths during pregnancy widely held – all mothers we interviewed mentioned these and believed them.
  • Supporting child wellness clinics is a huge opportunity for our program – large disconnect here between mothers and nurses, both are dissatisfied with what the other is doing (nurses don’t think the women listen to what they tell them, just stop coming to the post-natal visits because they’re not receiving anything from the clinic; mothers feel the nurses don’t explain things to them or give them enough information about their health or their baby’s health, what they should be doing to ensure they’re healthy, etc).
  • Health insurance is something people need help with – either helping them to afford the annual fee, or make it easier for them to enroll (currently, people have to go all the way to Bibiani ~45 mins  away to enroll, and people don’t have the time or money to do this).
  • Because farming is their livelihood, pregnant women still expected to go to farm, even though they feel weak and husbands/family aren’t very understanding.
  • Husbands can do a lot more to support their wives, not just financially – help out around the house, allow wife to stay home from farm and rest, provide emotional support by accompanying her to ANC visits and delivery of the child. 
 

Update 12/28/14: Summary of feedback/learnings from prototype

Who: pregnant women, mothers of children 0-6 months, and 6 months-3 years (15 total)

What: skits demonstrating what the three main phases of the program might look like, to test different components of our idea and get feedback
Where: Humjibre community center



 
The good
  • These women really seemed to like the idea of having a Mother Mentor, someone working with them on a one-on-one basis, visiting them regularly to give advice and provide individualized support to the mother, to build a long-term relationship with, to be able to contact if any problems/questions/concerns.
  • They liked the idea of the Mother Mentor introducing good health behaviors to the mother and helping her to teach the child early on (i.e. washing hands with soap).
  • They liked the idea of the Mother Mentor helping to monitor the child’s development and showing the mother how to help her child progress through the development milestones.
  • They were excited about receiving more support and information during the first few years of their child’s life, as they don’t feel they are getting the support or counseling they need from the local child wellness clinics.
  • Many liked the idea of receiving bednets for their home, handwashing supplies, nutrition support for both the mother and the child, children’s books.
  • They were excited about the possibility of us providing latrines, as many said their family does not have one and they use the local trash dump.
  • They liked the idea of continuing to provide items commonly requested at the clinic for delivery, as it is difficult for many of them to afford to deliver at the clinic/hospital.
  • All said they would value a program like this and they would accept any/all of the things we proposed to offer them. 



The bad
  • No one had anything negative to say about the different components of the program, there was nothing they said we should take out or change.
  • They had ideas for things that we could add – for example, helping them to pay ultrasound fees (which are not covered by ANC), giving them a baby crib or play pen, helping to pay daycare fees, etc. So, we will need to further investigate to determine what components would be most helpful and what we can afford to do. 



The unexpected
It was interesting to hear how they feel about child wellness clinics, that they don’t feel they are given enough information about their child and what they should be feeding it or doing to help it grow/develop on schedule. For example, they are given a baby weighing card that has very good information on nutrition for the child, growth monitoring, etc, but many of these women cannot read and no one explains the information to them or how to use it.


Update 1/1/15: Lessons and applications from the refinement period; re-imagined program

After discussions of our findings and how they inform our program design, we created two documents attached.

Who will benefit from this idea and where are they located?

Primary beneficiaries are pregnant women and their families in five villages in rural Western Ghana, with a total population of approximately 9,000. We have ongoing programming (although not every program) in each of the five villages currently. [12/15/14] Most of the population farms cocoa as their primary occupation. One-third of the adult population has had no formal education, and most of those with no education are women.

How could you test this idea in a quick and low-cost way right now?

[12/28/14] Progress since ideas phase: 1. We have completed a user experience map (posted document), identified questions for prototyping, held prototyping meetings and are writing up the results. 2. Completed a stakeholder analysis (posted document) and posted stakeholder interviews results (see above). 3. We are in the midst of an extensive review of global health and development literature and best practices to guide program design and approaches. 4. Thanks to a helpful comment from the Ideo team, we held a discussion to review lessons learned and insights to be carried forward in this program (posted document).

What kind of help would you need to make your idea real?

Specific examples of input needed include: 1. One of our goals is to decrease stress on mothers and families during a very stressful time- does anyone have thoughts on indicators/measurement tools for this? 2. We are considering a tiered subsidization program for certain elements. For example, a family that could afford to pay a small amount would receive a subsidized cost for a latrine, but a family that could not afford it would not have to pay anything. The reason for this is that paying something seems to improve the value attributed and decreases our expenditures, however, ANY cost can make assistance out of reach for some families. Does anyone have any experience with tiered subsidization with community programs? How do you assess wealth? Any problems with perception/jealousy in the community? We know of programs that do this for health care in the US, for example, but not in communities where paystubs are not common (since almost everyone earns income from farming cocoa).

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.

37 comments

Join the conversation:

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Spam
Photo of Clement Donkor
Team

In practical terms the idea is happening already and indications are that first time mothers are supportive and appreciative.

Spam
Photo of Maria Van Doremalen
Team

Really liked your idea!

Spam
Photo of Irene Blas
Team

Very nice idea! no one could help you as much as someone you feel equal to you, in the same situation! Congratulations for your idea! Its great!

Spam
Photo of Meena Kadri
Team

Wow – great updates! We're especially loving your User Experience Maps including photos. Tip: replace Word files uploaded to your idea with PDFs as they are easier to access. (you can convert your files into PDFs from Word)

Spam
Photo of Ghana Health and Education Initiative
Team

Thanks for the tip- I just replaced the files and added our ongoing q&a file.

Spam
Photo of Meena Kadri
Team

Awesome. Great refinement, folks!

Spam
Photo of Ghana Health and Education Initiative
Team

Meena,
We've updated a lot of the content above and added some additional updates re: interviews. We'd love any additional comments, suggestions or critiques. We appreciate your help!

Spam
Photo of Meena Kadri
Team

Fantastic updates, reflections and ordering of your post! We're especially excited by the way you recorded your lesson learnt during Refinement – way to go.

Spam
Photo of Chioma Ume
Team

Hello GHEI! We've been having early childhood experts take a look at the ideas in Refinement and one asked whether you are familiar with the work of Philani http://www.philani.org.za/. If not, they suggest looking at their work for ideas and suggestions. Their potential as a scaling partner could be interesting going forward.

Spam
Photo of Charlotte Cashman
Team

Great idea! We are also prototyping our idea in Ghana and feel sure there may be some useful collaboration here! https://openideo.com/challenge/zero-to-five/refinement/phonics-by-phone-children-who-can-read-get-the-best-start-in-life

Spam
Photo of Charlotte Cashman
Team

Our idea might well contribute to this part of your content
Cognitive stimulation of the child:
Provision of children’s books and training for parents and siblings on how to use them to engage their children regardless of literacy.
Training and modelling on other methods of stimulation like singing, talking and play.
Play spaces and supplies, and facilitated play groups housed in our community library.

Spam
Photo of Charlotte Cashman
Team

Ot in the longer term help to address issues of illiteracy for these pregnant women
For example, they are given a baby weighing card that has very good information on nutrition for the child, growth monitoring, etc, but many of these women cannot read and no one explains the information to them or how to use it.

Spam
Photo of Ghana Health and Education Initiative
Team

Charlotte,
Thanks very much! What is the youngest age this would be appropriate for? Would up to age 3 be too young? We do have a program specifically targeting children in primary 1 who are falling very far behind. I wonder if this might be a point of collaboration? Our teachers might benefit from the program, as might the parents of our enrolled children.

Spam
Photo of Charlotte Cashman
Team

Hi, the reality is it is never too early to start interacting and communicating with your child. This early bonding is key to developing communication and if children are introduced to activities like learning to listen and differentiate between sounds from a young age it will help them to learn to read later on. We already have some of our team training teachers who are working in KG1 and KG2, so 3 year olds definitely fall in our target group. The more we can involve parents of these young children the better as they spend more hours of the day with their children than teachers in a school or KG. The process of effectively teaching reading by using phonics is tried and tested around the world. We will be adapting these methods for specific cultural contexts and explaining through our course how the phonic approach is a process of learning and matching sounds (phonemes) and letters (graphemes) which can then be blended together to give the basic tools for reading, writing and spelling. Once the basics have been mastered progress can be dramatic. We really want to share this life transforming Phonics by Phone course with any who are interested and would potentially be keen to collaborate.

Spam
Photo of Ghana Health and Education Initiative
Team

Charlotte,
Thanks. Our kids would age out when they turn 3. Would 2 year olds be an appropriate audience (and their parents) for your intervention?
Thanks very much.

Spam
Photo of Clement Donkor
Team

Mother Mentors for Child Development is very well thought! I like the way things are unfolding and it is definitely going to serve our communities well.

Spam
Photo of Bettina Fliegel
Team

Hi GHEI. Congratulations on moving on to the refinement phase of the challenge. Looks like GHEI is doing great work and this project seems like a natural extension of your current work in the community.
As I reread your proposal the mentor's role as you describe it appears to be heavily health based. How does this role differ from that of a community health worker? What do community health workers focus on currently when interacting with families with children age 0 -3? Will training for a mentor differ from that of the current health workers? Will this be a paid position?
Your website describes an affiliation with UCLA and it's Global Health Program bringing medical students to this community. (I am a pediatrician in NYC - and very interested/inspired!) Will medical students participate in this initiative? Will this project tap into local resources as well as global resources? Are there resources within the UCLA community who can provide educational materials and insights on early childhood development that you can tap into? The neonatal resuscitation evaluation and training program in Ghana outlined on your website is great! Do you have follow up on whether local health professionals trained in the program are now conducting trainings in the broader communities?
Your library looks awesome! Are there many children's books printed in Ghana? Is it a lending library? Will families be able to travel there to participate in play groups? Rather than give families books have you considered having mentors loan books so that books can vary overtime and you can share community resources?
As your idea is broad what aspect of the program do you plan to investigate and prototype first?
Interested to learn more about your approach and what the community identifies as priority needs. Good luck!

Spam
Photo of Ghana Health and Education Initiative
Team

Bettina,
Thank you so much for your very helpful and thoughtful questions. We are gathering information to best answer your questions, and will respond soon. If you have any other thoughts in the meantime, we would love to hear more from you!

Spam
Photo of Ghana Health and Education Initiative
Team

7. "Are there resources within the UCLA community who can provide educational materials and insights on early childhood development that you can tap into?"
Yes, for example, we have one pediatrician working with us who is an expert in early childhood education/cognitive stimulation, although her expertise is more domestic than international. If you have leads on ECD experts and curricula globally, that would be wonderful.

8. "The neonatal resuscitation evaluation and training program in Ghana outlined on your website is great! Do you have follow up on whether local health professionals trained in the program are now conducting trainings in the broader communities?"
We have not instituted a training of trainers model at this point, although it is something we are trouble shooting and working through for the future. One interesting finding from our recent program evaluation is that only 38% of facilities in our district have appropriate resuscitation equipment- we are in the process of addressing this.

Spam
Photo of Bettina Fliegel
Team

Awesome stuff! Thank you for this outline. It really highlights your plans.
I think the collaborative approach between med students, applying their skill set, combined with the local program directors and clinicians is really great! This is more what I was asking about, how the local teams interact with providers coming in from abroad - students, volunteers, staff etc. Your description above describes it well!
The curriculum development and training sounds great! There are several projects on this challenge that are tackling similar issues. Great to see the conversations here and sharing of information.

Regarding child development experts or curricula in the developing world - I do not have any specific knowledge. I wonder if there is a working group in the AAP that may have members doing work in the developing world. (if I find any will definitely share here!) I do know that the World Wide Orphan Foundation has a toy library program which includes tools for developmental assessment. It is really cool and interesting! Might be something to learn from. They have done play programming in Haiti, Ethiopia, Vietnam and Bulgaria.
From the Ideas Phase of the challenge - https://openideo.com/challenge/zero-to-five/ideas/element-of-play-supporting-vulnerable-children-to-develop-and-thrive-through-play
Post during the research phase of the challenge - https://openideo.com/challenge/zero-to-five/research/ensuring-that-orphans-worldwide-thrive-the-world-wide-orphan-foundation
There are some other projects posted on the challenge that may be good resources as well.

re: Nutrition - Alex Mokari and IYEN are located in Uganda. They are a group working on several projects. There are several nutritionists in the group and they may know of a guide to complementary feeding.
IYEN - https://openideo.com/challenge/zero-to-five/ideas/solve-two-legumes-one-cereal-meal-for-smart-children
Alex - https://openideo.com/challenge/zero-to-five/ideas/our-village-raising-our-children

Thanks again for all of the above! Excited to see this project develop!

Spam
Photo of Ghana Health and Education Initiative
Team

Bettina,
Thanks very much for your help and leads. We will reach out to them. We also have a nutritionist in our district who has worked with us in the past who we plan to enlist as we move farther along.

Answers to more of your questions after consulting with the education team:

9. “Are there many children's books printed in Ghana?”
There are children's books printed by an NGO that mainly works in Accra, Ghana. Our library maintains a large collection of books printed in Ghana and Africa. I would envision the same focus for this program.

10. “Is it a lending library?”
It is not a lending library. There is a fear amongst the local staff that many books would not be returned if they were allowed to leave the premise.

11. “Will families be able to travel there to participate in play groups?”
This is a great question. Mothers from our central village shouldn’t have distance as a barrier, but there are several other barriers that are important to varying degrees: overburdened mothers; conflicting responsibilities; history of poor community participation in group activities (hence our switch to an individual model); perceptions of time (class start time).

Possible benefits - mothers firsthand exposure to child learning experiences; empowering mothers to become "first teachers" of their children; mothers' exposure to new learning tools; improved understanding of development milestones and norms. It could provide the kind of firsthand insight that could help mothers create homes that are more kid friendly.

This may be the most challenging component of our model because of the group nature, but we believe it is worth investigating and prototyping to see if it would be perceived as valuable enough to overcome the barriers above.

12. “Rather than give families books have you considered having mentors loan books so that books can vary overtime and you can share community resources?”
The literacy outreach models that we are familiar with usually have home visitors come to the home equipped with a mini library. They would usually read in a group (possibly in a group made up of other children from the cohort or neighborhood), perform literacy games, then leave a few of the books until next time. We could alter as learn from our prototyping, interviews and focus groups. We could also have some books that circulate and others that are owned. Some would say that there is nothing like owning a book, and that it creates a different kind of connection to reading.

The fact that most of the mothers will probably be functionally illiterate will have to be addressed in our model. Picture books, trainings on how to make up stories while reading, education around the importance of reading to their kids, listening to them, using a range of vocabulary, encouraging their talking, asking kids to make decisions rather than making threats or demands, etc., will all be important to the education component of this program.

Spam
Photo of Bettina Fliegel
Team

Hi all. Thank you for answering the questions. The literacy program is exciting!

You mention that there is a history of poor community participation in group programming which lead to your switching to an individual model. This seems like a key insight. It is interesting as other project ideas in the challenge are focusing on group activities. It is exciting to hear how your approach is informed by past experiences in the community you are working within!

Keep up the great work! Good luck!

Spam
Photo of Ghana Health and Education Initiative
Team

Thanks very much! Yes, it is definitely an important learning point that group activities have not been well received in the past in our communities. I think it isn't so much that the education provided through these group activities isn't valuable, it is that it isn't valuable enough for the woman to choose to neglect responsibilities like farming, fetching water, making food etc.

Spam
Photo of Chioma Ume
Team

Great conversation! I've learned a lot reading it :) GHEI, you might find the Story Stones an interesting one to take a look at as an idea that addresses low literacy rates: https://openideo.com/challenge/zero-to-five/refinement/story-stones Also, in terms of curriculum, several ideas in the challenge have referenced Hands to Hearts, which you might be interested in taking a look at: https://openideo.com/challenge/zero-to-five/refinement/proven-parenting-program-leverages-massive-adult-education-network

You mention hiring mother mentors to take on this role in their communities. How many would you anticipate hiring? How would this and other elements of your proposed program be sustainable over time?

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Team

Chioma,
Thanks so much for your suggestions and questions. We've updated some of the content above on the post and would love any other suggestions, comments or critiques.
Great idea re: Hands to Hearts- I've posted on their site. I think their curriculum might be a great jumping off point for us. I like the idea of story stones, too. It is something that we might be able to modify and use with our population.

Re: the number of mother mentors, we will discuss and reply. Great question!

In terms of sustainability, because we will reach all or most first time mothers and the community is very tight-knit (exemplifies the idea of taking a village to raise a child), we believe that there will be spread of knowledge and, over time, the approach to child rearing will transform within our communities. We believe this has amazing potential to change not only the children in this generation, but their children's child raising practices later on.

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Team

Thanks for your responses – really appreciate that you are updating your idea too – so that newcomers to the site are able to see what's new. One thing I'm really looking forward to is seeing how you plan to translate some of the great insights that you received – particularly the ones from healthcare workers and mothers – into the program you are developing. Keep up the great work!

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Team

Thanks very much! We will work on directly answering that question- what we've learned and how we can apply it!

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Team

I think this great idea every new mother really need someone to mentor her throughout the pregnant until the child is 3 year. It is s very important to have the support and strength physical and emotion well being especially when the mother is her first child, the reason is when a woman is pregnancy they go through a lot upside down it could be health issue or emotional, same women don’t have family to guide them or partner to support. Even after birth child can develop illness and mother wouldn’t know how to support her child therefore mentor would be beneficial for her, either medical side or just general child development and well being.

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Team

Hello GHEI team,

This looks like a great idea! I love the idea of having mothers mentor each other. This is something we are hoping eventually develops out of our idea as well. I noticed down below you said you did not currently have criteria for the mothers who will be mentors, but have you considered working through your existing CHWs to identify potential mothers? Also, is there any compensation planned for the mothers, what benefits do they receive by participating as mentors? Final question, have you considered including a family planning aspect into the mentorship. If you equip your mentors with the information, they can then transfer that knowledge to the women after they give birth. That way, you are equipping them in the early stages post-pregnancy with the knowledge to plan their next, or not.

Good luck!

Anne

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Team

Anne,
Fantastic questions! Thank you so much for your input.
To answer your questions one by one:
"1. Have you considered working through your existing CHWs to identify potential mothers?"
Yes, I think this will be one of the sources of recommendation for mothers. There are community leaders like the queenmother who we will also go to for recommendations. From there, we'll need objective measures for selection. We've had difficulty with bias in the past (i.e. with our scholarship recipients) so we'll be very careful with this selection. If you've devised any selection rubrics, or have any advice, we'd love to have that insight.

"2. Is there any compensation planned for the mothers, what benefits do they receive by participating as mentors?"
Yes, they will be employees and receive a salary and health insurance. I think it will be important that they see this as an honor, and enjoy the process of mentoring.

"3. Have you considered including a family planning aspect into the mentorship?"
Interesting. It isn't something we've thought to include. It is a great idea as it obviously impacts the wellbeing of all the family's children, especially the newborn. It could be part of the newborn time period visits. We previously found (in 2003, so possibly still relevant) that the desired birth interval was five years, while the actual birth interval was 3 years. There was a clear unmet need for family planning. We'll be sure to include it in our assessment going forward. Many thanks for your help!

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Team

Congratulations on making it to the Zero to Five Challenge Refinement list, GHEI! We really appreciate your integrated approach to serving the mothers in your community, as well as the depth of your engagement in the area where you hope to implement this idea. You mention that you have learned a lot from success and failures in your work and we wonder – what have you learned that will assist you in designing and implementing this idea? Are the 9000 people you hope to reach ones that are currently involved in other GHEI programming? It’s great that you are seeking user feedback – during Refinement, we urge you to work on focusing and defining your idea with their help. We also suggest that you begin quick prototypes in your community, so that you can use the insights you gain to continue to improve your idea and leverage the skills of the OpenIDEO community. Speaking of, how can they begin to help you? Check out tips for Refinement http://ideo.pn/0to5-tips-refine for some tools to help you get started.

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Team

Awesome stuff – and it's great to see that you are already gathering fresh insights from interviews. Way to go on the human-centred approach!

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Team

This looks like a great idea! What a fantastic way to empower mothers to make sustainable change in their own families. Keep up the good work.

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Nice idea! I have questions about trained Mentors: What is the recruitment process of these Mentors? Are they all from local communities?
Wish your idea will be a success!

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Team

Andi,
Thanks very much. Great question! We currently employ community health workers who administer our malaria prevention and other programs. They work in a preventive capacity. We would likely transfer some of them into the role of Mentor, if there is interest and the person is a good fit. We are yet to develop a full rubric for the hiring process, however, one requirement is that each Mentor will be from the community she serves.

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Team

I was wondering if all pregnant women would be given a mentor or just those who want it or perhaps those who you have identified could benefit the most.

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Team

Great question Ellen! This depends on a couple of factors. Ideally, we would do this for all pregnant women. A rough estimate of pregnancies within our catchment area is 300-400/year. We would need to start with a subset for a pilot, which brings up the issue of fairness.

Certainly, we would only include women who are interested and who could commit to staying in the area (there are farmers who come for a few months and then return to their home, typically in the north). We also agree that a more vulnerable population is first-time mothers.

Another key question that our team has just begun to consider is working with pregnant girls under age 18. They may be the most vulnerable group, and yet some members of the community may view starting a program with them as incentivizing teenage pregnancy. In 2004, when we were about to start a youth-friendly condom distribution program in the community, there was a great deal of hesitation and even anger among some. They said that we would "spoil" the community's youth. After a lot of discussion led by our leadership who grew up and are respected in the community, it was allowed to proceed. Anecdotally, community members now praise the program.

We have a scholarship program for high school students, which has taught us a lot about fairness and transparency in selection if not all community members can be beneficiaries. For example, we have a selection committee that strategically leaves off our top leadership and is primarily composed of local leaders not affiliated with GHEI. We also have objective measures, and a score that ultimately determines the recipients.

Probably the main factor in determining how many people we could reach in this program would be funding.

Thanks for the great question!