A Pioneering Program Helps Children Grow Healthier, Stronger, and Smarter

By Jennifer Naiboka

	Photo by Carmen Crow
	IMC’s new psychosocial program encourages mothers to support their children’s development by stimulating them with simple, homemade toys, such as this rattle, constructed from an empty water bottle and rocks.

Most children in the Acholiland region of northern Uganda are born into communities that have been devastated by the 20-year civil war between the Lord’s Resistance Army (LRA) rebels and the government of Uganda. The LRA’s campaign of terror has been marked by rape, mutilation and child abductions.

As a result of Uganda’s brutal armed conflict, nearly two million citizens have been forced from their homes and into camps for Internally Displaced Persons (IDPs) where the living conditions are primitive and the opportunities for improving one’s circumstances are virtually nonexistent. While families are provided with food rations, many of them sell off the little food they get in order to buy other necessities like soap and clothing. And the more underfed these IDPs are, the more susceptible they are to disease and malnutrition.

In 2003, IMC launched an emergency program to provide health care and nutrition therapy for conflict-affected communities in northern Uganda. The aim of the initiative was to improve the overall health and nutritional status of groups particularly vulnerable to malnutrition and disease, such as women and children under the age of five.

But in August of 2006, Dr. Lynne Jones, IMC’s Technical Advisor on Mental Health, visited IMC’s Uganda program sites and discovered something missing from the program. There is growing evidence that nutrition therapy is only one part of the equation for the development of a healthy child. Physical growth has to coexist with emotional stimulation and psychosocial development. If children’s psychosocial needs are neglected, their development threatens to be significantly hampered: studies show that the first three years of life are critical for brain growth and intellectual development. Deprived of stimulation, a child’s brain may be 20-30 percent smaller than normal for his or her age.

Photo by Carmen Crow

Inspired by IMC’s suggestion to use toys to engage with their children, this mother cut up a plastic bottle into rings and strung it from a wire. By the next day, three other mothers had copied her.

With this in mind, in January 2007, IMC launched a combined psychosocial and nutrition program in three pilot sites in the IDP camps of Uganda. The program teaches mothers to support their children’s development through love, play, and communication. Already, mothers in the camps were visiting the IMC food distribution centers in northern Uganda every week or two so that staff members could weigh the children, check their height and provide them with nutritious food to supplement their children’s diets. Now, IMC is bringing those same women together in mother-to-mother groups to enhance the relationship between mother and child and actively encourage their children’s development.

One of the activities they have initiated is toy-making. Most Ugandan children in IDP camps don’t have a single toy; instead, they make do with everyday items like sticks and old empty jerry cans. During the mother-to-mother group, IMC staffers teach mothers how to make simple toys. They take an empty water bottle, put a small rock in it, and, voila! a rattle. “A lot of these children were quiet and inactive when they came in here,” says Carmen Crow, psychosocial program manager. “But when you engage them with a simple little toy, the light comes on in their eyes.”

While the goal of the program is to improve children’s overall development, IMC also seeks to establish a support network for the mothers to help them deal with the harsh reality of day-to-day life in the camps.

Before launching the new program, Dr. Jones conducted an ethnographic study to better understand the problems that displaced Acholi mothers faced in rearing their children. Among her findings: many of the women being served by IMC’s nutrition program reported having husbands who drank heavily. Often, their drinking translated into neglect, and on some occasions, violence. Furthermore, they often had to shoulder all of the work of maintaining the family. Perhaps it was no surprise, then, that many were depressed and that they struggled while caring for their children.

IMC’s nutrition program also includes an outreach component, where nutrition support staff make home visits to follow up with caregivers and their children one-on-one and to reinforce health education messages. As part of the new program, outreach workers were trained to incorporate a psychosocial component into their visits. They were taught about the different stages of early childhood development in order to help mothers keep their children on track, addressing such questions as: “When does a baby start rolling over?” and “How can I encourage my baby to talk?” During their home visits, IMC staffers examine various factors that relate to the child’s well-being. They look at the roof to see whether it leaks. They make sure that the family is registered to receive food distributions. They check that the children’s play area is free of hazards. Where possible, they help link the mothers to the resources they need. They also observe the mother’s interactions with her child, and monitor the child’s development relative to the known stages of healthy development, encouraging and advising the mothers accordingly.

Photo by Carmen Crow

Mothers participating in the program discover how enthusiastically their children respond to  something new, like a home-made toy.

“When children react enthusiastically to one of the activities, their mothers become enthusiastic as well,” says Crow. “They see their children get excited and they say, ‘Wow, it’s like magic!’ They are beginning to understand the importance of nurturing their children’s development.”

Crow and her team are conducting an ongoing evaluation of the new psychosocial program, measuring factors such as mother-child interaction and maternal mood before and after group meetings. If the evaluation proves the program to be as successful as anticipated, the model can be extended to other countries where IMC works.

There are more macroscopic goals as well. Early childhood development (ECD) programs like this one are widely acknowledged to reduce poverty and spur economic growth. “Well-executed and well-targeted early-childhood development programs . . . stimulate improvements in education, health, social capital, and equality that have both immediate and long-term benefits for the children participating in [them],” according to economist Jacques van der Gaag. “Investments in ECD programs are in many ways investments in the future of a nation.” In nurturing the healthy development of these children, IMC is simultaneously nurturing the healthy development of the communities in which they are born.