Anne Muthoni Gitimu
Director, Family & Reproductive Health, AMREF
Katherine M. King
Director of Education and ECD, RTI International’s Center for International Development
Ms. Gitimu is Program Director for Family and Reproductive Health at Amref Health Africa. Ms. King is Director of Education and Early Childhood Development at RTI International’s Center for International Development.
As early childhood development (ECD) practitioners with decades of experience in varied contexts, we have often observed a wide gap between policy and practice when it comes to services for young children and their families. Throughout the world, it is common that national and sub-national governments may have beautiful plans to support children’s healthy development on paper… and not much happening in practice.
This gap is especially pronounced in places where communities are hard to reach, affected by conflict and environmental hazards, or facing extreme hardship.
Kenya has exemplary policies that call for integration of ECD into primary health care and early education. Its national Community Health Policy and Community Health Strategy embed Nurturing Care principles that ensure children are healthy, growing, and nourished within routine health services. On the education side, Kenya has set standards for school access, inclusion, safety, and readiness for young children. And these policies reinforce each other, connecting primary health care to early learning environments.
How are these policies being implemented in practice – especially in Kenya’s most challenging contexts?
The nomadic pastoralist and refugee populations in northwestern Kenya’s Turkana County face significant challenges in accessing essential services due to vast distances and mobile lifestyles. The remoteness of these communities and their infrequent contact with government systems make it difficult to operationalize Kenya’s exemplary ECD policies. And yet, Turkana County government is demonstrating strong leadership in integrating ECD into health systems. Through a working group dedicated to maternal and newborn health, the county regularly reviews data from health actors to see how well children and mothers are cared for and identify opportunities to improve performance. These reviews also help pinpoint areas where implementing partners can align efforts and avoid duplication of activities. The county is also collaborating with Amref Health Africa, a Kenyan-based non-governmental organization focused on providing community and environmental healthcare to countries in Africa, to integrate ECD messages and practices into care sessions for pregnant women and mobile outreach clinics to promote early learning and responsive caregiving.
In Turkana, we are observing that inclusive, community-led sessions are strengthening parent-child bonds and enhancing caregiver knowledge on ECD, nutrition, and maternal health.
Meanwhile, in Nairobi’s informal settlements, ECD policy implementation faces a different set of challenges. In the informal settlements, fragmented governance, extremely high population density, and social marginalization make coordinated service delivery difficult to achieve. Fortunately, Nairobi County government is leading with purpose. Through an established technical working group of diverse partners and county departments, the county is strengthening multi-sectoral coordination related to Nurturing Care and ECD across key sectors—including health, wellness and nutrition, talent and skills development, finance, urban planning, child development and vocational training. This coordination structure ensures that Nurturing Care is embedded within county systems, promoting holistic development for young children across Nairobi.
With support from the Hilton Foundation, Amref has collaborated with the Nairobi County government to train pre-primary teachers and childcare providers on responsive caregiving and child safety. In this densely populated urban setting, the initiative connects pre-primary centres to nearby health facilities, enabling joint follow-up for immunization and developmental screening. Parents’ groups facilitated by community health workers offer safe spaces for caregivers to share experiences and learn together.
These examples demonstrate that even in complex environments, practical, locally developed interventions embedded in existing health and education platforms can succeed.
Despite this important progress, several bottlenecks are constraining the implementation of Kenya’s policy vision at national scale:
Not all caregivers and health care providers are using Kenya’s standardized Mother and Child Health Handbook, resulting in inconsistent counselling on responsive caregiving.
Community health promoters juggle multiple competing priorities with limited support.
High recurrent costs in county budgets leave little flexible funding for community outreach and caregiver-group sessions.
Refugees, pastoralists, and informal-settlement communities face significant barriers to accessing early childhood services.
Pre-primary teachers and other early childhood care providers seldom receive professional development opportunities akin to those provided to health workers.
Routine monitoring systems rarely examine the quality of ECD counselling, developmental screening, or caregiver mental health support.
Kenya’s vision for every child to reach full potential is within grasp. The progress emerging from Turkana, Nairobi, and other counties illustrates that through collaboration, resourcefulness, and local ownership, the promise of healthy child development can become a reality. With deliberate coordination and modest investment, Kenya can move from policy to practice with positive results for all children.