ri Lanka is in a better footing compared to most countries in South Asia in the context of child healthcare; especially in terms of health indicators such as infant mortality rate, maternal mortality rate and life expectancy in the country. Nevertheless, one of the biggest challenges we have been facing is the stagnating indicators of child nutrition and the nutrition of children particularly under the age of five. In a candid interview with the Daily Mirror, National Health Advisor for Plan International Sri Lanka and Lecturer in Health Promotion at the Rajarata University Dr. Manoj Fernando highlighted the significance of applying a novel technique like ‘Health Promotion’ to address this problem in Sri Lanka.
Signifying that Sri Lanka has pockets located all around the country affected with poor nutritional status, Dr. Fernando noted that poverty and poor socio- economic status of people are some major determinants inducing a negative impact on child nutrition. Underweight, stunting and wasting are important health indicators of nutrition status where Sri Lanka needs to work more to ensure that child nutrition is in a stable position. These health indicators have been stagnating for almost ten years in several districts due to the lack of competent, health staff in some rural areas and due to various other determinants such as socio-cultural contexts.
Among the others affecting child nutrition, alcoholism and use of tobacco by fathers’ gain prominence as it drains a major portion of money from families and associated with violence against women which leads to poor family functioning. Moreover, scarcity of food, lack of quality food and food security have become issues that come into direct conflict with ensuring child nutrition. Dr. Fernando explained that despite the current progress in several districts by applying the ‘Health Promotion’ model as a powerful tool, there was still a need to build the capacity of the government and non-governmental community health staff on applying ‘Health Promotion’ to achieve intended results in the area of nutrition.
Child Nutrition and Community Empowerment
To address nutrition effectively, the health promotion model used by Plan International is based on principles mainly focusing on empowering communities. Accordingly, a set of principles facilitating ‘Health Promotion’ has been introduced under the model. Dr. Fernando said Health Promotion was a very recent model developed by the WHO, which had a history not more than thirty years.
“Firstly, the principles of the model focus on engaging communities actively and making them capable of taking control over the factors that affect the well-being of their community. For instance, we have encouraged people to identify and address the determinants that negatively affect health promotion by empowering mothers and developing mothers’ groups. The next principle aims at focusing on the most powerful determinants influencing nutrition. On the other hand, health facilitators are trained on how to help mothers’ groups to thrive and develop. Mothers are regularly sensitized with the support of health facilitators. We have focused on strengthening health care workers including public health midwives in the areas that we have begun work. We tried strengthening them on health promotion scales and knowledge,” Dr. Fernando said.
"The graduates from the Rajarata University recruited by Plan International have played a proactive role in promoting health principles among the community. The public health midwives are also trained on this health promotion scheme"
Currently, Plan International is closely working with the Rajarata University and Foundation for Health Promotion in carrying out the projects related to health promotion. The health promotion activities conducted so far have focused on changing several determinants of health that need to be addressed forthwith. For example, violence against women, family functioning, alcohol and tobacco use, diet practices and food insecurity were seen as some major determinants that needed immediate attention. During the health promotion programmes that were carried out, people organized themselves as feeding groups where they get-together once or twice a week to address the problem of food insecurity and healthy diet practices. For instance, mothers accompanied by their children meet at a place convenient to everyone within the group, to facilitate a wholesome and healthy meal for their children at least twice or thrice a week. Dr. Fernando explained that based on affordability, people bring different food item to the selected gathering. Thus, the children are given the opportunity to have a healthy meal for at least twice or thrice a week.
“There are two aims of this particular activity. The first is involved with empowering mothers to work together as a group, making them more resilient to many issues including gender based violence. The second is focused on introducing healthy food items within a group in order to ensure that children are getting a healthy meal at least twice or thrice a week. However, we mainly focus on making the mothers aware of the constituents of a proper meal and how to prepare a healthy meal without spending in excess. This awareness is well created through feeding group practices. Feeding group practices also helps in creating awareness about diseases, how to approach a hospital if there is an outbreak of disease while shedding light on the importance of measuring child weight on a regular basis.
"ECCD is the most cost-effective and powerful intervention we should invest on because the first three years or the first thousand days of life is key to determine the future of a child"
Today, these feeding groups have been effective in also addressing the issue of alcoholism in areas such as Kekirawa, Wellawaya and Aandiyagala. In the case of Wellawaya, these interventions have increased to a level where the community has taken initiation to address the issue of selling tobacco in the area. As a result, shops in Wellawaya have decided to stop selling cigarettes due to the pressure created by the community against tobacco. It was stimulated through the feeding groups headed by women in the locality. However, these activities have to be facilitated by someone capable of initiating health promotion principles. Thus, the graduates from the Rajarata University recruited by Plan International have played a proactive role in promoting health principles among the community. The public health midwives are also trained on this health promotion scheme,” he added.
Holistic approach to Early Child Care Development (ECCD)
Speaking to Daily Mirror, ECCD Specialist Dayananda Tillekeratne said a holistic approach to the subject of early child care development was crucial to understand and create the ideal setting and healthy environment required for a child’s development. He said children were often exposed to a very organized setting within preschools, as there was a teacher and there were many activities that the child could get involved with. However, he stressed the need to break the notion that the preschool should be similar to a school environment.
“Firstly, we need to prepare the child for the school. Often, year-one teachers expect some response from students. For example, the teacher expects the child to be capable of understanding and interacting within his or her school environment. These are elements known as inter-competencies and it is the duty of the preschool teacher to prepare the child with such competencies for primary school. Understanding this crucial role, Plan International decided to prepare a preschool manual for teachers. The first book deals with the theories of ECCD while the others focus on the activities that need to be done during preschool hours. Along with the activities suggested in the book, the teacher will be able to improve the capacity of children in terms of competencies, physical skills and emotional development and their aesthetic sense.
"We produced a manual, trained teachers and introduced a set of activities that cater to the needs of these children. Therefore, these children will not have to be stigmatized from society and they can attend preschool just like any other ordinary kid"
Under the 13th Amendment to the Constitution, ECCD is a devolved subject where Provincial Councils should establish any institution or separate entity to handle ECCD-related matters. Therefore, we compiled study material to stabilize and monitor the preschool settings and today we are very happy to note that we have started the first institution in the North Western Province called the Early Childhood Development Authority. Nowadays, similar institutions are operating under different names such as Preschool Teacher Education Bureau or Preschool Education Committee, to promote preschool education. In addition, we have also compiled a book to educate parents on how to be productive in their crucial role,” Mr. Tillekeratne added.
He also noted that in the Sri Lankan context, many disabilities and development delays in children were unidentified at an early stage due to their hidden nature.
“This is so important. We did a research with the Medical Faculty of Ragama which led us to identify that fourteen per cent of children were going through development delays and disabilities. The research was carried out in the Monaragala, Batticaloa and Anuradhapura divisions. We produced a manual, trained teachers and introduced a set of activities that cater to the needs of these children. Therefore, these children will not have to be stigmatized from society and they can attend preschool just like any other ordinary kid,” he said.
Further, Dr. Fernando pointed out that health promotion should be viewed as a holistic approach to address issues evident in ECCD.
"This is so important. We did a research with the Medical Faculty of Ragama which led us to identify that fourteen per cent of children were going through development delays and disabilities. The research was carried out in the Monaragala, Batticaloa and Anuradhapura divisions"
“Here, the future including the physical, emotional and social development of the child is taken into serious account. ‘Play House’ is one of the tools that were developed accordingly to promote the efforts of health promotion in terms of ECCD where depending on the capability; families built a play house for their child. This created an ideal opportunity for neighbouring children to play with each other and get along well. The ‘Happiness Calendar’ is another similar tool that was developed to measure individual happiness of family members. This is used to address the determinants of family well-being and is used even by health workers across the country.
ECCD is the most cost-effective and powerful intervention we should invest on because the first three years or the first thousand days of life is key to determine the future of a child. The three phases of early childhood development include the first thousand days of life where all five senses should be stimulated to gain the maximum since eighty per cent of the brain development takes place during this period,” Dr. Fernando added.
Thus, the inclusive early childhood care and development programme led by Plan International is a cost-effective and holistic model that helps address various health indicators including ECCD-related issues through active community engagement and empowerment, thereby ensuring the well-being of the nation.
Pics by Kithsiri De Mel