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To reduce under-five mortality, we need to deliver group pediatric care

Across the globe, under-five mortality in low-income countries has dropped from 90 deaths per 1000 live births to 50 today. Even with this decrease, we still have hit stubborn "implementation gaps" in impoverished communities that threaten our ability to reach the global target of 20 deaths per 1000 live births by 2030. Our mental model of healthcare remains doctor/hospital-centric. One strategy to reduce the implementation gap is shift the clinician-parent interaction to one more community and group-oriented.

Photo of Duncan Maru
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I'm a pediatrician and implementation researcher who works in Nepal with Possible (hyperlink), a nonprofit healthcare company. I've been compelled by the work of midwives and doctors who've shown impressive results when providing antenatal care in group settings. But how do we extend this into early childhood care?
While the traditional approach to pediatric, preventive care has succeeded in tracking children's weights, delivering vaccinations, and educating families, it has fallen short in developing stronger parenting skills. In particular, the single doctor-parent encounter has fundamental limitations in addressing the broader community and social context that real-world parents face. In impoverished rural communities in particular, social ties form a critical component to better parenting and advocacy for improved services. 

I am proposing that we shift routine preventive pediatric care from an individual to a group setting. We could group parents (more commonly, mothers) and deliver group pediatric care, which will:
1) Provide expert and facilitated peer counseling around parenting
2) Incorporate participatory learning and a shared, community action
3) Integrate into community health worker networks who provide follow-up care and parental guidance.

The group setting is designed to create a supportive social network among parents with shared challenges, the opportunity to promote detailed parenting strategies, and the ability for peers to elicit and share context-specific advice. Additionally, a participatory learning and action process allows parents to identify and solve problems around healthcare access and service for their children. This intervention draws on the strength within communities of parents to transform how they collectively raise their children. 

Initial process outcomes for this work could include community malnutrition rates, rates of follow-up for preventive and acute follow-up visits, and measures of parents' experience and self-efficacy. Then, one could test the intervention at scale by assessing under-five mortality and the attainment of developmental milestones. 
What other ways have you experienced group-design as a method for delivering better healthcare access and services?


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Photo of Loris Bottello

Interesting thoughts, thanks for sharing. I can imagine that the creation of groups of parents with children on the same age could be very useful in contexts where there are few doctors looking after big communities. Parents would start to know the clinical history of other children and maybe ask their peers advice if the same conditions happen to theirs.

Photo of Duncan Maru

Thanks! Yes, part of the key is to figure out a way to engage parents that can lead to meaningful activation of community + healthcare system resources. That was part of the lessons around the "participatory action learning" for group antenatal care in Nepal-- identifying an approach that can translate ideas into collective action. This is especially important in places where the healthcare systems and its providers are less responsive , or capable of response, than needs to be for adequate prevention and care of young children.

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