Nine innovations to improve early brain development in the developing world — helping kids thrive
Grand Challenges Canada, funded by the Government of Canada, and the “Saving Brains” partners today announced investments in nine creative ways to protect and nurture the cognitive development of children in developing countries.
The investments total up to CDN $4.2 million, shared between projects in Africa (Cameroon, Kenya, Mali, Rwanda, Uganda), Central and South America (Brazil, Guatemala, Peru) and Asia (Pakistan).
The largest share, $1 million to be matched by partners, will improve the lives of almost 3,000 low birth weight infants in West Africa by the end of 2016 by expanding the use of “Kangaroo Mother Care,” a proven technique to reduce mortality and successfully nurture low-weight, prematurely-born babies.
Despite being recommended by the World Health Organization as a cost-effective way to save and improve the lives of low birth weight and pre-term infants, use of Kangaroo Mother Care remains low globally.
Headed by the Colombia-based Kangaroo Foundation, the new initiative is using a culturally sensitive “train-the-trainer” model, supported by e-learning and a data tracking platform, to increase access to Kangaroo Mother Care in Mali and Cameroon. Two existing Kangaroo Mother Care units will become centres of excellence in the technique and will help establish and train 10 new hospital units. It is anticipated that each of these new units could reduce neonatal mortality by about 30%.
Grand Challenges Canada is simultaneously exploring whether a “pay-for success” financial tool, known as a Development Impact Bond, could be used to expand Kangaroo Mother Care to as many as 25 regional hospitals and 30 district hospitals in Cameroon.
Kangaroo Mother Care helps low birth weight infants not only to survive, but also to thrive into adulthood. Research conducted by the Kangaroo Foundation in 2012, with Grand Challenges Canada’s support, has compared young adults aged 18-20 who were randomized at birth to receive either Kangaroo Mother Care or traditional incubator care. The results, to be made public later this year, demonstrate the important long-term implications of Kangaroo Mother Care for human capital formation.
Meanwhile, eight new innovations at a seed stage (including two projects led by Canadian institutions: Save the Children Canada and the University of Toronto) will each receive CDN$265,000 to pursue a range of creative approaches to help children reach their full potential.
The innovations, detailed below, include:
- Using an online crowdfunding platform to raise money to treat severely stunted children in Guatemala
- A new pre-school curriculum for Pakistan, delivered by youths aged 18 to 24, to improve school readiness and reduce the nation’s high student drop-out rate in Grades 1 and 2
- A program offering quality cognitive stimulation activities, training, and support for caregivers in low-resource areas of Brazil
- Educational radio programming and community support groups for parents in Rwanda
- A program for nurses to conduct at-home visits for first-time pregnant youth in Sao Paulo, Brazil
The nine innovations, selected by Grand Challenges Canada, are part of a growing portfolio supported by Saving Brains, a partnership of Grand Challenges Canada, Aga Khan Foundation Canada, Bernard van Leer Foundation, Bill & Melinda Gates Foundation, ELMA Foundation, Grand Challenges Ethiopia, Maria Cecilia Souto Vidigal Foundation, Palix Foundation, UBS Optimus Foundation and World Vision Canada.
The Saving Brains program supports new approaches to ensure children thrive by protecting and nurturing early brain development, providing a long-term exit strategy from poverty. Saving Brains has invested a total of $41 million in 107 innovations, including 6 “Transition to Scale” investments, and the Saving Brains technical platform that helps to track and accelerate progress against the challenge. The Saving Brains program has launched its 5th Request for Proposals: bit.ly/1IRaEgk
To date, over 20,000 children have accessed Saving Brains innovations designed to improve early child development. Given the early stage of the innovations, the full impact will occur in the coming years as the most promising of these innovations transition to scale.
The announcement was made at the 2016 Women Deliver conference concurrent session “Implementing the Sustainable Development Goals: A Dive into the Global Strategy”, which provided an overview of the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health, launched in 2015.
“A third of the world’s children under 5 fail to reach their full potential,” said Dr. Peter A. Singer, Chief Executive Officer of Grand Challenges Canada. “Investing in innovation is an essential part of the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health to support the implementation of the Sustainable Development Goals. It also helps ensure that every newborn, mother and child not only survives, but thrives. Canada and the Saving Brains partnership are leading the way in creating a pipeline of innovations to help every child reach their full potential.”
Transition to Scale Project
“Kangaroo Mother Care” for low birth weight infants in Mali and Cameroon
Kangaroo Foundation Colombia (Implementation Countries: Mali & Cameroon) http://www.fundacioncanguro.co
“Kangaroo Mother Care” is a cost-effective intervention known to save and improve the lives of low birth weight and pre-term infants.
More than 20 million low birth weight infants are born each year, 96% of them in less-developed countries, according to the World Health Organization. Low birth weight is a major contributor to infant mortality, accounting for up to 80 percent of all neonatal deaths. It is associated with increased morbidity, as well as a higher risk of impaired cognitive development.
Low birth weight infants generally require extra care to avoid illness and death from secondary, preventable complications such as hypothermia and infection. This is a particular problem in developing countries, where incubators and similar technologies are often scarce, over-crowded or unreliable, as well as costly.
With Kangaroo Mother Care, a caregiver becomes a child’s incubator, as well as its main source of food and stimulation. The technique involves continuous skin-to-skin contact between caregivers and low birth weight and preterm infants, with the baby nested in a “kangaroo” position on the caregiver’s chest as soon as possible after birth. The technique is accompanied by exclusive breastfeeding.
Kangaroo Mother Care calls for and prepares the mother and child to go home as soon as possible from the hospital. Another component is the multidisciplinary and rigorous monitoring of the baby and mother in the weeks after leaving the hospital, until the infant reaches one year of corrected age. Family solidarity around the frail child is a key element in the success of Kangaroo Mother Care and helps the infants not only to survive, but to thrive.
A Cochrane review of 16 randomized control trials concluded that Kangaroo Mother Care significantly reduces mortality, infection and hypothermia rates, as well as the number of days in hospital when compared to conventional care. The technique has also been shown to improve bonding between parents and babies, infant growth and brain development.
Sadly, access to Kangaroo Mother Care remains low globally. The Every Newborn Action Plan, endorsed by World Health Organization Member States in 2014, set a target to reach at least 50% of the world’s low birth weight infants with Kangaroo Mother Care by 2020.
Scale-Up Will Create 2 ‘Centers of Excellence,’ 10 Treatment Centers
A grant of up to $1 million by federally-funded Grand Challenges Canada will be matched by partners, lifting the total financial injection up to $2 million.
Organizations involved include CrossKnowledge Foundation, Engineers Without Borders Colombia, Gabriel Toure Hospital in Mali, Kangaroo Foundation Cameroon, Kangaroo Foundation Mali, Laquintinie Hospital in Cameroon, and the Senate of France.
The new funds will enable the Kangaroo Foundation to build the capacity of two certified Kangaroo Mother Care hospital units in Bamako and Douala, turning them into “Centres of Excellence” for the training of teams at ten additional hospitals. The training will be supported by a state-of-the-art web-based learning platform being developed in partnership with CrossKnowledge Foundation.
The result: 12 certified hospital units delivering quality Kangaroo Mother Care in Mali and Cameroon, countries where infant mortality rates are among the world’s highest. The work will enable both countries to further disseminate quality Kangaroo Mother Care throughout their health facilities.
The Kangaroo Foundation is based in Colombia and is a global leader in the promotion of Kangaroo Mother Care. The organization has made significant contributions to the body of research supporting Kangaroo Mother Care and has trained over 60 teams from over 30 developing countries in its use.
Beyond the grant: A “Pay-for-Success” Development Impact Bond in Cameroon
Grand Challenges Canada is simultaneously exploring whether a “pay-for success” financial tool could be used to help expand Kangaroo Mother Care in Cameroon beyond the grant period.
The pay-for-success instrument, known as a Development Impact Bond, involves private investors agreeing to underwrite efforts to achieve specific results, such as improved health outcomes for low birth weight infants using Kangaroo Mother Care. Donors – and country governments where feasible – commit to making payments to the investors if the interventions succeed. Investors’ financial returns are therefore directly linked to independently verified outcomes.
A Development Impact Bond would provide strong incentives to test and refine the Kangaroo Mother Care scaling model through continuous data feedback loops and performance management systems. And rigorous outcome measurements (such as access to the technique, weight gain, reduced mortality rate) would authoritatively demonstrate a model for scaling Kangaroo Mother Care, with relevance to other low- and middle-income countries with high low birth weight infant mortality rates.
Earlier in May, the World Bank announced that a US$2 million contribution to the Development Impact Bond has been approved as part of the Global Financing Facility (GFF) in support of Every Woman Every Child.
The Development Impact Bond could fund the rollout of Kangaroo Mother Care to as many as 25 regional hospitals and 30 district hospitals in Cameroon, improving health outcomes for around 4,000 low birth weight infants each year.
Proof of Concept Projects
Crowdfunding to help severely stunted children in Guatemala
Wuqu’Kawoq – (Implementation Country: Guatemala)
Almost half (49.8%) of children under five in Guatemala are stunted, the highest prevalence of any country in Latin America. Stunting, or short height-for-age, refers to reduced physical growth as a result of malnutrition, and has a profound impact on a child’s developing brain. This project will use online crowdfunding to finance an intensive in-home intervention for severely stunted children. Representing the first use of crowdfunding for this purpose, donors and patients will convene via Watsi.org, which will harnesses the power of individual patient narratives and social networks to dramatically increase the resources available for nutrition programming. This overcomes the primary barrier for a personal approach to the financing of health programs: cost. This intervention includes micronutrient supplementation, food support for the most food-insecure families, growth monitoring, and extensive individualized counselling of caregivers. The intervention will be compared to the standard care approach to child stunting, which follows national policy guidelines and includes growth monitoring and micronutrient supplementation.
First Steps: Educational radio programming and community support groups in Rwanda
Save the Children Canada – (Implementation Country: Rwanda)
Parent-child interaction in a child’s earliest years can have a long-term impact on their physical health, social and emotional well-being, and cognitive capacities. While other parenting education programs exist, few countries have implemented nation-wide holistic parenting education approaches, and most are limited in communications effectiveness. The First Steps project is piloting a nationally-scalable and holistic approach to parenting education, initially reaching an estimated 2,430 parents from 1,620 families. The intervention is integrated with Rwandan government structures, combines radio programming with community-based peer learning groups, and collaborates with local publishers and entrepreneurs to increase parents’ access to books for young children.
Chamas for Change: Mother-Child Clubs in Kenya
University of Toronto – (Implementation Country: Kenya)
Chamas (‘groups’ in Kiswahili) have a longstanding presence in East Africa as effective networks through which individuals can meet outside the home and pool resources in emergencies. Building on this cultural tradition, innovators at the University of Toronto, working with Moi University through AMPATH (Academic Model Providing Access to Healthcare), developed mother-child groups, called Chama cha Mamatoto, tailored to the needs of mothers and children living in poor rural areas in western Kenya. Upon joining, women pledge to participate in bi-weekly meetings for one year and uphold the goals of the chama: support each other, save money and become entrepreneurs, and commit to self-selected health and child development goals. During meetings, women discuss social, health, and child development topics, learn accounting, safekeeping and parenting skills and receive mentorship from their peers to engage in income generating activities. Facilitated by government community health workers, chamas are a low-cost, self-sustaining and self-managed solution that integrates health, social and financial literacy education with a savings/loans program. These groups offer the opportunity to introduce a core set of adult capabilities through coaching and training to break the intergenerational cycle of poverty and provide children with the positive environments needed for their growth and development.
Youth Champions to help kids in Pakistan get ready for primary school
Aga Khan University – (Implementation Country: Pakistan)
Pakistan is coping with a large school dropout rate. A proven strategy to reduce this number is enrolment in high-quality preschool programs that bolster young children’s school readiness. With funding from Saving Brains, Aga Khan University is developing a preschool curriculum supported by a community and district government engagement strategy. This interactive school readiness curriculum, which is delivered by “Community Youth Leaders,” aged 18 to 24, will ease the transition to primary school and reduce dropout rates among Pakistani children aged 6 to 7. It is anticipated that roughly 300 children will participate in the pilot study.
Visiting first-time pregnant youth in Brazil to promote babies’ brain development
Institute of Psychiatry, University of São Paulo – (Implementation Country: Brazil)
A novel, intensive, nurse home visitation program for first time pregnant youth in poor areas of Sao Paulo will be tested with a randomized controlled trial – the first of its kind in Latin America. The aim is to mitigate the harmful effects of toxic stress over the developing brain when still in the mother’s womb and infancy and so improve outcomes for the developing child. The innovators took two well-known interventions (Nurse Family Partnership and Minding the Baby) and tailored them to the socio-cultural situation and health system of Brazil. The model could be adopted for use nationwide and in other developing countries with similar characteristics. About 30 first-time pregnant youth will receive the intervention and it is estimated that their babies’ exposure to toxic stress will be reduced by half.
Empowering caregivers to offer stimulation to boost children´s brains in Brazil’s Steps Brain Booster Program
Steps Baby Lounge Recreação – (Implementation Country: Brazil)
This intervention in low-resource areas of Brazil will focus on children 1 to 3 years old whose brain development is hindered by lack of adequate stimulation. The Steps Brain Booster Program enables caregivers to offer quality cognitive stimulation activities, through an integrated in-class coaching and recognition program, dynamic and easy-to-use lesson plans and state-of-the-art educational equipment. The multidisciplinary modules involve psychomotor activities, socio-emotional learning, language development, musical sensibility and artistic expression. The kit includes over 50 motor skill circuits, physical therapy equipment, varied educational toys, musical instruments and differentiated art material, all within a public school’s budget. Conducted weekly in an integrated manner, the program helps form “building blocks” in the brain for improved cognitive function. The program delivery model is an innovation in itself, emphasizing ease-of-use and affordability, and applying a successful private sector model to the public sector. The training modules are structured in a step-by-step lesson plan that empowers educators with minimal qualification to offer quality stimulation. 220 children and 24 caretakers will participate in the initial research phase.
Early identification, care and follow up of high risk babies in Uganda
Makerere University – (Implementation Country: Uganda), http://mak.ac.ug
In Uganda, poverty, lack of knowledge and long distances to health facilities hinder access to newborn care services. This project will overcome some of these barriers for the most vulnerable infants to ensure full childhood brain development. A foot length card for community health workers to identify preterm and low birth weight babies, along with a danger-sign screening card, will help identify sick newborns and improve their referral to health facilities for quality care. Delivery details of both children born at health facilities as well as information of high-risk newborns will be linked to Geographic Information System (GIS) to help health providers reach every high risk baby and provide ongoing care and monitor growth and proper brain development. It is anticipated that over 1,100 infants will be screened, identifying an estimated 200 children who will be linked to appropriate care and monitoring.
Better parenting skills, air, water & hygiene to improve early child development in rural Peru
Universidad Peruana Cayetano Heredia – (Implementation Country: Peru)
In rural Peru, health risks like poor indoor air quality and inadequate access to safe water and improved sanitation can threaten early childhood development. This innovation focuses on improving two critical foundations for healthy child development: parent-child relationships through promoting responsive and stable caregiving, and environmental risks like indoor air quality and access to running water. The project also emphasizes hand hygiene, thereby reducing environmental risks and creating safe, supportive physical environments where children can thrive, play and develop to their cognitive potential. It is expected that 160 children and 800 family members will receive the intervention.
About Saving Brains
Saving Brains is a partnership of Grand Challenges Canada, Aga Khan Foundation Canada, Bernard van Leer Foundation, Bill & Melinda Gates Foundation, ELMA Foundation, Grand Challenges Ethiopia, Maria Cecilia Souto Vidigal Foundation, Palix Foundation, UBS Optimus Foundation and World Vision Canada. It seeks and supports bold ideas for products, services and implementation models that protect and nurture early brain development relevant to poor, marginalized populations in low- or middle-income countries. http://www.savingbrainsinnovation.net
About Grand Challenges Canada
Grand Challenges Canada is dedicated to supporting Bold Ideas with Big Impact; in global health. We are funded by the Government of Canada and we fund innovators in low- and lower-middle-income countries and Canada. The bold ideas we support integrate science and technology, social and business innovation – we call this Integrated Innovation. We focus on bringing successful innovation to scale, catalyzing sustainability and impact. Grand Challenges Canada works closely with Canada’s International Development Research Centre (IDRC), the Canadian Institutes of Health Research (CIHR) and Global Affairs Canada to catalyze scale, sustainability and impact. We have a determined focus on results, and on saving and improving lives. http://www.grandchallenges.ca