Given our evolving interest in place-based approaches to improving early childhood development, the Conrad N. Hilton Foundation commissioned this report to identify how these approaches can better support young children’s cognitive, socio-emotional and physical development. Since the Hilton Foundation began a strategic focus to supporting young children affected by HIV and AIDS in 2012, we have supported programs targeting five high HIV burden countries in East and Southern Africa (Kenya, Malawi, Mozambique, Tanzania and Zambia), understanding the multiple challenges to caregiving that HIV poses. We have further focused our grantmaking on relatively high HIV prevalence communities within these five countries.

Despite this geographic targeting, until recently, we have operated fairly traditionally by primarily funding individual non-governmental organizations (NGOs) to operate separate programs that often had very loose connections to local government and to one another. Although we recognized the importance of local government engagement and the complementary nature of these programs, formal mechanisms were not in place to facilitate collaboration for collective impact.

As part of the Siaya County Government’s commitment to a countywide approach, a social behavior change communication campaign has been launched to reach caregivers throughout the county and promote nurturing care of young children. Photo courtesy of campaign supporter

Professor Linda Richter and the Human Sciences Research Council led the monitoring, evaluation and learning (MEL) work for the first phase of our strategy (2012-2016). One of the formal recommendations in the final MEL report in 2016 was that we move away from funding individual programs to experiment with place-based approaches that could achieve population-based scale at a sub-national level (within a district or a county). This required a shift from a project-based frame to the more ambitious intent to reach an entire population of young children and their caregivers in a sub-national administrative region. We took this recommendation into the second phase of our strategy with a commitment to experiment with scaling at the sub-national level in two countries. We then began to explore opportunities within Kenya, given that the national government had placed responsibility within the counties and that we had already been supporting work led by NGOs in several counties in Western Kenya.

While the work is still evolving, we have learned so much through our partnership with the Siaya County government over the last several years. Smart Start Siaya was born when the Governor and First Lady, Cornell and Rosella Rasanga, committed to making nurturing care a focus for their efforts. We have seen firsthand the impact their committed leadership has had within communities throughout the county and to bring multiple county government sectors together. We thought it time to help document the Smart Start Siaya County model and to put this work into a broader context in order to distill broader lessons and success factors that would be useful for efforts to extend this approach to other counties in Kenya (which is already happening now) and beyond. At the same time, a separate effort in Monapo District, Mozambique, was beginning with the engagement of PATH, UNICEF and other partners, and we were keen to understand that model and how to strengthen it. This report includes case studies from both Siaya County and Monapo District.

This report from Spring Impact makes the point that these place-based approaches take the Nurturing Care Framework and demonstrate what it looks like in practice – given the Framework’s emphasis on a “whole of government” multi-sectoral approach and support for an enabling environment to ensure young children grow and thrive. It surfaces the fact that we need to emphasize the strengthening of existing systems while placing more emphasis on supporting local leadership – in government and at the grassroots community-level. Together with our partners, the Foundation has observed that political will is created once people understand the importance of the early years – and we’ve learned that our sensitization efforts need to include these highly influential local actors. We’ve seen that a movement can be created that draws many influential local leaders in. The progress that Siaya County has made has been inspiring, including the strong interest expressed by other Kenyan counties and by other countries.

We’re already seeing indications of sustainability and what government can do to create champions within the county assembly, as well as at the community-level, that results in changes that benefit young children. This work has required that everyone work differently, including government, civil society and donors, with more frequent communication and shared decision-making and power-sharing – which isn’t always easy. It means that the work is owned and driven by local governmental and civil society leadership, with international NGOs and donors in a support role.

This report is one means of sharing experience to date with the hope that it inspires others to adopt a place-based approach to prioritizing the early years. It makes the important point that, “Fragmented services are unable to address complex challenges.” It shares a range of inspiring examples from around the globe while encouraging us to think outside the box in adopting place-based strategies that enable young children to thrive, positioning them for success throughout their lives.