How Caregivers are Changing The Path of Children in Zanzibar

When we think of frontline health workers, community health workers may be the first thing that comes to mind. But there’s another crucial frontline actor in every child’s life: their caregiver.

Parents and caregivers are often the first to notice a fever, introduce the first solid foods and play the games that spark learning and connection. Yet historically, parents have been under-supported actors in the health system in many low- and middle-income countries.

At D-tree, we believe that caregivers are critical drivers of child health and development and that with the right support, they will have a huge impact on the future health and well-being of their children.

In Zanzibar, that change is already underway.

Through Jamii ni Afya, Zanzibar’s national community health program, caregivers are gaining the tools and guidance they need to support their children’s early development, from nutrition and play to recognizing danger signs and seeking timely care, and we have the evidence that the approach works. D-tree recently completed a large-scale evaluation of the program’s impact on early childhood development (pre-print available here). Using rigorous scientific methods, we surveyed a representative sample of households both before the program launched in 2019 and again in 2023, allowing us to measure real changes following implementation. The results are compelling:

• • Caregivers are now twice as likely to recognize key child health danger signs
  • They’re 2.5 times more likely to understand healthy nutrition
  • Families are nearly 4x more likely to have books at home
  • Fathers are engaging in play at unprecedented rates and are 11x more likely to play one activity

These changes point to better parenting as well as a stronger foundation for children’s lifelong learning and well-being.

The change has been made possible through our approach to creating better coordinated and connected care journeys for all. At D-tree, we recognize that children’s development is a journey and does not happen at isolated times throughout their childhood. Yet in many health systems, the care children receive is fragmented.

A child might be seen by different providers for immunizations, growth monitoring and illness, and with no shared record or follow-up, critical opportunities are lost.

Through Jamii ni Afya, we ensure continuity of care. From early stimulation to nutrition counseling and referrals for specialized support, every interaction with a health provider will build on the last, giving each child the chance to reach their full potential.

Our approach also recognizes that stronger parental agency is a core part of primary health care and community health workers are enabling parents to become active participants in their child’s development.

Community health workers are trained to coach parents on effective parenting, alongside providing health screening services. The community health workers will observe and listen to the challenges parents are facing and find solutions together.

The evaluation is one of the few scientific studies to show the real-world impact of digital community health programming on early childhood development and it shows that when we co-create digital solutions with governments, health workers and communities, real change will happen. By embedding evidence generation into our programs, we create a model for governments, partners and funders to scale what works with confidence.

Stay tuned for the peer-reviewed publication and more insights to come.