The document summarizes a situational analysis conducted in Siaya County, Kenya on integrating early childhood development services. Key findings include: - Services for children ages 0-5 are limited and fragmented, with little awareness of national ECD policies. Preschools have poor quality and many children do not attend. - Health services are limited and barriers include poverty, beliefs, and lack of provider capacity. Nutrition is inadequate for vulnerable children. - Economic support is needed for caregivers. Data collection by community groups needs strengthening. - Recommendations include improving community ECD knowledge, preschool quality, and integrating services through partnerships. The analysis will inform project design.

1. Page 1Newsletter 3 April 2013
We would like to showcase each of the five countries in which the Hilton
Foundation and implementing partners are working—Kenya, Malawi,
Mozambique, Tanzania and Zambia. In this newsletter, PATH shares a
brief description of a situational analysis focusing on the integration of
early childhood development services in the Nyanza province of Kenya.
INTRODUCTION: The Government of Kenya has operationalized the National Plan of Action on Orphans and Vulnerable Children (OVC),
which seeks to strengthen the capacity of families and communities to support OVC. Policy and service standard guidelines outline the
development of a comprehensive and coordinated implementation strategy to meet the needs of children 0–8 years. As a result, Kenya
has witnessed dramatic improvements in areas such as the use of insecticide-treated nets, immunisation coverage, and reduction in infant
and under-five mortality. The prevalence of HIV has also declined. However, there
has been little improvement in certain areas: of children’s health and wellbeing
e.g., the prevalence of stunting has remained almost constant.
AIM: In order to understand the state of ECD, health, nutrition, and poverty
alleviation support and services being offered in institutions and community-
based settings and the capacity of service providers, PATH’S I-ECD Project
conducted a situational analysis in the three districts of western Kenya’s Siaya
County: Siaya, Bondo, and Rarieda.
METHODOLOGY & SAMPLING: Altogether 83 key informants were interviewed.,
including community health volunteers/workers (CHVs/CHW), social workers,
village elders, community-based organizations (CBOs), preschool teachers, and
Ministry officials at the provincial and district level.
KEY FINDINGS: Enabling environment for ECD and care of vulnerable children
Most key informants were not aware of the existence of the national policy on ECD and the National Plan of Action on OVC.
General services provided by CBOs for children 0-5 years and their caregivers
CBOs offer services related to health (preventive and referral), economic support (income-generating activities [IGAs]), nutrition (infant
and young child feeding and providing food supplies and micronutrient supplements), and education (buying of school uniforms and
paying school fees).
ECD services provided to children 0-3 years
There is little sensitization of parents and caregivers on the importance of learning through play in a child’s early years. Moreover, parents
consider ECD to be synonymous with preschool.
“Most of the parents do not know the importance of taking their children to ECD centres before joining
primary.” (Preschool teacher, Bondo)
Situational
Analysis
Kenya
Situational analysis on integrating early
childhood development services in Siaya
County, Nyanza Province, Kenya
In this issue of the newsletter we feature a situational analysis
from PATH focusing on the integration of ECD services in Nyanza
Province, Kenya; we introduce more team members working on
Hilton Foundation-funded projects; we go up close with the Fire-
light Foundation and the work they are doing; we begin a series
on the ‘Nutrition and Nurturance of Young Children’ with a com-
panion piece on breastfeeding; and we discuss what we can and
can’t learn from before and after measures in evaluations.
Newsletter 3 April 2013

2. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS
Page 2Newsletter 3 April 2013
Educational services provided to children 3-5 years
Preschools are often dilapidated and do not provide a child-
friendly environment. Each preschool had 75-165 children and 1-3
teachers with the corresponding teacher:child ratio ranging from
1:25 to 1:60. Children
walk between ten
meters to three
kilometres to get to
preschool. Some children
aged 3-5 years do not
attend preschool
because their caregivers
cannot afford fees and
school uniforms. Other
caregivers keep children at
home to take care of younger siblings or do household chores.
“As early as 5 years, children are assigned household
duties.” (CBO leader, Siaya)
Health care services provided to children 0-5 years and their
caregivers
The most common early childhood diseases are malnutrition,
diarrhoea, malaria, pneumonia, measles, and skin conditions.
Nutrition services provided to children 0-5 years
Vulnerable children are sometimes left in the care of aged
grandparents who cannot meet their nutritional needs. Quite
often, a small quantity of food needs to be distributed among a
large number of dependents.
Child protection services
Child protection is the sole responsibility of parents and
guardians. They are assisted by the provincial administration
through the chiefs, assistant chiefs, and village elders to ensure
that each child is given proper care and that action is taken
against child abuse.
“The environment is not safe; where there is poverty; safety of
children is not a priority. In one case, a child was left to play near
a pond and ended up drowning.” (CBO leaders and social
workers, Siaya)
Vulnerable children and children affected by HIV/AIDS
Key informants defined vulnerable children as those who come
from poor families, or children with ailing parents and guardians -
including those affected by HIV/AIDS. Some vulnerable
households receive KES. 2,000 (~US$24) bi-monthly via a
Government of Kenya cash transfer program. Some CBOs support
vulnerable children as well, although service provision to these
children is scanty and fragmented. Vulnerable children often feel
humiliated because of their poor economic situation at home.
“Children with disability suffer a lot; some are hidden in the
homes.” (Social workers, Siaya)
“Grandparents are everyday taking up parental roles; this has
affected the care and support the children receive since most of
the caregivers are elderly.” (Ministry official, Bondo)
Economic support for caregivers and guardians of vulnerable
children
Caregivers engage in income-generation activities (IGAs) such as
kitchen gardening, bee-keeping, and rearing livestock. However,
not all families and vulnerable children are reached through IGAs.
Data collection and management
Some CBOs have good systems for collecting and tracking data,
although the capacity for rigorous monitoring and evaluation
(M&E) is lacking.
CHALLENGES:
 Community attitudes toward ECD, the poor quality of
preschools, and lack of sensitization on the rights of children
are barriers toward age-appropriate care and stimulation of
children.
 Poverty, community beliefs, and lack of capacity of service
providers are major barriers toward accessing health care
services.
 CBOs often have limited capacity to deliver services, as well
as organizational challenges and limited capacity in proposal
writing and fundraising to solicit funds from donors.
RECOMMENDATIONS
 Support organizational capacity building of CBOs; improve
the capacity of CBOs to deliver health, nutrition, ECD, and
poverty alleviation interventions.
 Give special attention to vulnerable children and children
with special needs.
 Reach children 0–3 years at home through home visits,
parenting workshops, etc.
 In addition to home visits, use preschools as an entry point
for reaching children 3–5 years with ECD, health, and
nutrition services at the community level.
IMPLICATIONS FOR PROJECT DESIGN
 Work with caregivers to improve their knowledge, skills, and
practices in major aspects of child development—including
learning through play, safe spaces for play, and child rights.
 Work with relevant partners to strengthen preschools—
including materials development and sensitization of
caregivers on the importance of preschool.
 Through partnership with relevant ministries, support
caregivers to carry out IGAs to improve their economic
wellbeing and instill a saving culture through
entrepreneurship.
 Integrate ECD agenda in relevant forums to share
experiences, success, and challenges.
Teresa Mwoma
RESEARCH
Fernald, L. et al (2012). Socioeconomic gradients in child development in very young children: Evidence from
India, Indonesia, Peru and Senegal (2012). Proceedings of the National Academies of Science of the USA.
Children’s development shows gradients by socioeconomic status as early as 3 months of age. Children from
better-off homes have higher development scores. Statistical analyses show that these gradients are due the
fact that poor children don’t grow as well because of poor nutrition and they receive less home stimulation.

3. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS
Page 3Newsletter 3 April 2013
INTRODUCTIONS
Damaris K. Wambua is the Early Childhood
Development (ECD) Specialist based in Child-
Fund Kenya’s National Office. She is responsi-
ble for coordinating ECD and for giving tech-
nical support to 51 community organizations
affiliated to ChildFund Kenya and 7 grant-
funded implementation projects. Damaris is
providing technical support to the Hilton
Foundation project from the national office.
She has over 8 years of experience in community development
work. Damaris holds a Bachelor of Education degree in Early Child-
hood Development from Kenyatta University and is currently work-
ing towards a Masters degree in Education Planning at the Univer-
sity of Nairobi.
Elizabeth Kamau is Kenya’s Program Director
with responsibility for all ChildFund pro-
grams, implemented by 51 local partners and
under 8 grants in 24 counties, reaching 1.2
million children. She coordinates, manages
and gives support to the work of 61 staff.
Elizabeth will provide managerial support to
the Hilton Foundation project. Her experi-
ence of 20 years is in community develop-
ment work. Elizabeth is a founding member of one of the largest
networks in Kenya, the Girl Child Network (GCN). She has a Mas-
ters in Criminology from the University of Wales, College of Car-
diff, UK.
Rachel Maris-Wolf is the Project & Grant Man-
agement Specialist supporting the Hilton Founda-
tion project from ChildFund International’s head-
quarters. Her background is in community devel-
opment; community health; intercultural service,
leadership, and management; and international
education with over 5 years overseas experi-
ence. Rachel has been with ChildFund for 7 years.
She holds a B.A. in French from Mount Holyoke
College and an M.A. in International Education
from the SIT Graduate Institute.
Francis Lwanda is the Monitoring and Evalua-
tion Coordinator for Africa at ChildFund Inter-
national and is based in Addis Ababa. He has
13 years of NGO experience between CARE
and ChildFund, working on youth empower-
ment. With experience in Asia and Africa,
Francis has applied M&E and social accounta-
bility methodologies and approaches in vari-
ous sectors including education, social pro-
tection, health services quality improvement, SRH, and nutri-
tion.
Victoria Dunning is t he Vice President for Pro-
grams of The Global Fund for Children (GFC), with
oversight of an annual $4.5 million global grants
portfolio supporting community-based organiza-
tions. She has been instrumental in defining and
developing GFC’s GrantsPlus capacity-building
grantmaking model, its accompanying metrics
framework, and the streamlined Grantee Path-
ways to Success - “GPS” – grants management
systems and analytics. Victoria has a MPH from
Columbia University and a BA from Mount Holyoke College. Apart
from English, she speaks French, Spanish, Wolof and Swahili.
Emmanuel Otoo is a program officer at the
Global Fund for Children (GFC), responsible
for the Africa and Middle East regional pro-
gram, supporting 81 grassroots organizations
in 19 countries. Emmanuel has managed a
number of integrated corporate social devel-
opment programs for organizations such as
Plan International, African Development
Fund/Government of Ghana, UNDP, and ILO/
IPEC. His work with Free the Slaves was featured on CNN’s Free-
dom Project. Emmanuel holds an MSW, an executive MBA in pro-
ject management, and a Bachelor’s degree in Sociology.
Susan McCallister has 15 years of experience
editing material at Hesperian, as senior editor/
project coordinator of the current edition of
A Book for Midwives, and production manager
for Helping Children Who Are Deaf. She is cur-
rently leading the development of the book and
supplemental materials for the Helping Children
Live with HIV project. Prior to joining Hesperian,
Susan designed and helped run a library-based adult
literacy program in one of the Bay Area's poorest com-
munities.
Sarah Shannon has led Hesperian since 1996,
providing editorial oversight on, amongst oth-
ers, Where Women Have No Doctor, A Health
Handbook for Women with Disabilities, Help-
ing Children Who Are Blind, and Helping Chil-
dren Who Are Deaf. Prior to joining Hesperian,
Sarah trained health workers in refugee com-
munities in Honduras, and co-founded an NGO in El
Salvador to train residents in financial and small busi-
ness skills. Sarah served on the Global Steering Council
of the People’s Health Movement from 2004–2012.

4. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS
Their goal was to understand how capacity level affects the implementation of the EP and if smaller CBOs could easily adapt the EP to their
programming. In August 2011, Firelight provided feedback to both Save the Children and Care on year one of the validation process. The re-
vised EP was tested with the same four partners. In the second validation phase (May–August 2012), each organization continued to imple-
ment their programs using the revised EP and also completed baseline and endline data collection using the Comprehensive Checklist (CC). A
minimum of 15 households served by each organization was included in the data collection process. The objective was to gauge any changes
at the household and child levels and to ascertain if CBOs found the CC useful. While all four partners found the CC cumbersome to use, they
all intend to continue using the EP in their ECD programming.
Firelight’s approach to ECD work
Firelight believes CBOs are well positioned to help co-ordinate between and among government and other key stakeholders and to integrate
interventions within services so as to increase the effectiveness of parents and government services, and fill the gaps in social safety nets as
needed. Firelight’s grant from the Hilton Foundation focuses on enhancing CBO organizational management and strengthening program de-
livery in order to improve developmental outcomes of children 0-3 years of age and the school readiness of children 4-5 years of age. Fire-
light will pursue these goals by (1) resourcing and building the capacity of each of the 16 CBOs selected in three countries for participation in
the project; (2) supporting CBO delivery of support and services to young children and families; and (3) generating knowledge on the attrib-
utes and competencies of CBOs to deliver quality programs of support.
Page 4Newsletter 3 April 2013
UP CLOSE WITH
THE FIRELIGHT
FOUNDATION
Firelight’s approach and philosophy
The mission of the Firelight Foundation is to improve the well-being
of children made vulnerable by HIV, AIDS and poverty in sub-
Saharan Africa through supporting grassroots organizations.
Firelight's approach to grantmaking is child-centered, family-
focused and community-based.
Firelight’s involvement in testing the Essential Package
Firelight participated in the validation of the Essential Package (EP)
from 2010 to 2012. They selected one high-capacity community-
based organization (CBO) and one smaller lower-capacity CBO in
both Zambia and Malawi to assist with testing.
Key learnings are expected to emerge from several sources:
1. Country-level learning circles facilitated by Lead Partners;
2. Peer-learning exchanges between Firelight funded
grantee-partners; and
3. Data collection by Firelight Foundation on individual child
development levels using ZamCat.
Firelight plans to generate knowledge about CBOs and their
successful work by:
 Articulating a set of learning questions to be answered
during the three-year initiative;
 Documenting effective program models;
 Analyzing and synthesizing the information gathered
into useful knowledge products;
 Gathering and publishing information on CBO action for
improving the lives of young children and;
 Participating in at least two major conferences.
The country and organizational implementers are:
Malawi: The Lead Partner is Namwera AIDS Coordinating Com-
mittee (NACC) and all the CBOs are located in the southern re-
gion, close to NACC’s current areas of operation in Mangochi.
Tanzania: The Lead partner is Tanzania Home Economics Associ-
ation (TAHEA), located in the Mwanza area, which is near Lake
Victoria.
Zambia: The Lead partner is Mulumbo Early Childhood Care and
Development Foundation (MECCDF), which is located near Lusa-
ka, and one partner is located in the Copperbelt region.
Some Firelight Team Members:
Peter Laugharn became the Executive Director in July
2008. Previously he was the Executive Director of the
Bernard van Leer Foundation. Before that, Peter worked
in a variety of roles for Save the Children USA, with a
great deal of experience on Africa. As Save the Children's
Deputy Director in Mali, Peter helped develop the "Village
Schools" model. A graduate of Stanford and Georgetown Universities,
Peter holds a Ph.D. in education from the University of London. Currently
a member of the Council on Foundations International Committee, Peter
is also co-chair of the Inter-Agency Task Team on Children and HIV and
AIDS, and past chair of the Coalition for Children Affected by AIDS.
As a Program Officer at Firelight, Kristen Molyneaux
works with grantee-partners in Zambia and Tanzania.
Kristen joined Firelight in April of 2012 after completing
her Ph.D. in Educational Policy Studies - Comparative
International Education at the University of Wisconsin-
Madison. Kristen was a Peace Corps Volunteer in both
Uganda and Cape Verde and has been an education consultant in Burundi
and Mozambique.
Mia Schmid joined Firelight in 2011 as a Grantmaking
volunteer and a year later was promoted to Program As-
sistant. She works closely with a Program Officer to main-
tain the Lesotho, Malawi, South Africa, and Zimbabwe
portfolios. During her undergraduate years, Mia studied
abroad with the School for International Training in Ugan-
da. She graduated in 2010 with a BA in International Studies from the
University of Denver.

5. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS
Page 5Newsletter 3 April 2013
Nutrition and Nurturance of Young Children: Breastfeeding
Nutrition (feeding) for young children during foetal and infant development is one cornerstone of human development. The other is
nurturance, the loving responsive interaction and care provided by one or more devoted and engaged parents who fall literally “in love”
with their baby . Although breastfeeding and eating other foods when weaned come naturally to mothers and babies, neither can be
left entirely to chance. Breastfeeding requires that babies are put to the breast immediately after birth so they can express their innate
capacity to latch onto the breast and suck vigorously to stimulate the mother’s milk flow. Mothers must be rested, comfortable and
patient to enable her “let down” (oxytocin) reflex to release milk, and her baby to get and remain attached to the breast through
sucking. The World Health Organization (WHO) and UNICEF have produced guidelines for Baby Friendly Hospital Practices1
to ensure
sucking immediately after birth and a good start to breastfeeding as well as Breastfeeding Counselling2
materials to assist health and
community workers and mothers to overcome common problems that can upset optimum nutrition and the happy exchanges of eye
contact, communication and love that occur during feeding.
Exclusive breastfeeding is best for babies for the first 4-6 months of their life. Exclusive means that babies should not be given any other
liquids or foods, including water. Breastfeeding is best “on demand” (recall Traditional Practices that Promote Early Child Development
from the last Newsletter) and babies also enjoy using the breast as a pacifier. Babies engage in “non-nutritive sucking”, or pacification,
when they are stressed and when trying to cope with their newly developing physiological and psychological regulatory capacities (for
example, when they are tired). This sucking has been shown to help the baby ‘regulate’ and thus promotes development.
Mothers establish and stabilize their milk supply better if they rest after birth. This can be done by “bedding in” – mothers and babies
lying and sleeping together and letting the baby feed whenever he or she wants. Many traditional cultures have customs during which
the mother and baby are secluded together for two or more weeks, and the mother is relieved of her usual work by relatives so her and
the baby can be together and establish their relationship, including breastfeeding. This is one of the reasons why social support for
women from partners and family is important for infant feeding and mother and child health and wellbeing
Women often introduce formula milk in a bottle and other foods earlier than f4 months because they think the baby is not getting
enough breast milk. This conclusion is based on the fact that infants cry more between 6-12 weeks. But infants cry more also because
their crying vocalization matures and they are better able to express discomfort, not only because they are hungry. Unfortunately, the
introduction of formula, pap and other foods creates a vicious cycle – the baby sucks less vigorously on the breast and the mother
produces less milk, making the baby more dependent on non-breastmilk feeds. In future Companion Pieces, we will discuss infant crying
and active and responsive feeding of weaning food to young children.
1
http://www.who.int/nutrition/topics/bfhi/en/ 2
http://www.who.int/maternal_child_adolescent/documents/who_cdr_93_3/en/
ADVANTAGES OF BREASTFEEDING
Breastfeeding
 Helps bonding
and development
 Helps delay
a new pregnancy
 Protects mothers’
health
Breastmilk
 Costs less than
artificial feeding
DANGERS OF ARTIFICIAL FEEDING
 More allergy and
milk intolerance
 Increased risk of some
chronic diseases
 Overweight
 Lower scores on
intelligence tests
 May become
pregnant sooner
 More diarrhoea and
respiratory infections
 Persistent diarrhoea
 Malnutrition
Vitamin A deficiency
 More likely to die
 Increased risk of anaemia,
ovarian and breast cancer
Mother
 Interferes with bonding
WHO Breast feeding Counselling Participant Manual
 Perfect nutrients
 Easily digested
Efficiently used
 Protects against
infection

6. Monitoring, Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS
The opinions and views in the newsletters are those of the HSRC team involved in the Monitoring,
Evaluation and Learning Initiative for Young Children Affected by HIV and AIDS and do not neces-
sarily reflect the views or opinions of the Conrad N. Hilton Foundation as a whole or any of the
twelve implementing partners.
Page 6
30440 Agoura Road
Agoura Hills,
California, 91301
USA
818.851.3700
leah@hiltonfoundation.org
750 Francois Road
Intuthuko Junction
Cato Manor, Durban, 4001
South Africa
+27 31 242 5400
snaicker@hsrc.ac.za
Newsletter 3 April 2013
What can and can’t we learn from before and after measures?
Following on from the last issue, most partners have set up their M&E plans such that
measurement is made before the intervention starts and after it ends, with the intention of
concluding that the difference between the baseline and endpoint measures is due to the effect of
the intervention. These measures might be of individual children, families, households, villages or
organizations.
The difficulty with before and after assessments is that changes can occur independently of the
intervention. For example, even if the intervention was not implemented, the per cent of children
achieving an appropriate developmental milestone will increase simply as a consequence of the
children getting older. Families may find sources of support other than the intervention, etc. The
challenge is to design an evaluation which isolates change specifically associated with the
intervention. Randomized Control Trials (RCTs) are designed to do this. The children, households or
organizations are randomised to receive the intervention or not and this has the effect of evening out extraneous influences. But RCTs are
expensive and require specialized personnel to design and run them. Because procedures need to be standardised across children,
households or organizations, they may hinder the usual operations of agencies working to help children and families.
How then to isolate the impact of an intervention without conducting a RCT? It is not possible to fully isolate the effects of interventions on
many outcomes, but certain approaches to before and after assessments are better than others. The key is to select appropriate measures.
Two types of measures help isolate the impact of the intervention:
1. Measures which are unlikely to change in the absence of intervention, and
2. Measures which change in predictable ways in the absence of intervention
An example of the first type is participants’ knowledge of the progression of children’s developmental milestones. Although knowledge
levels may well change over time, it is unlikely that they will change rapidly in the absence of intervention. Therefore, if knowledge is higher
after the intervention than it was at baseline, it is reasonable to assume that the improvement is a result of the intervention.
An example of the second type is children’s growth. Predicting the growth of an individual child may be difficult, but for groups of children,
growth curves are available that have been established from measures taken from many children. If, relative to the growth curve, the
average growth of children in the intervention group improved over the period of intervention, it is not unreasonable to argue that this may
be a result of the intervention.
With both types of measures, evaluators must be careful to question if there are other influences which are occurring simultaneously with
the interventions, and which may also contributed to differences between before and after measures. If other changes are occurring
simultaneously, isolating impact will be difficult without a control group.
Take home points:
 RCTs disentangle intervention related and non-intervention related change
 If an RCT is not possible or desirable, select measures which are, either a) unlikely to change in the absence of
intervention, or b) change in predictable ways in the absence of intervention
 Always look out for influences which may be affecting the selected pre- and post-measures
The World Health Organization commits itself to promoting early child development
Using a total institutional approach involving many departments, the World Health Organization (WHO) in January 2013 convened
a meeting, with external stakeholders, entitled Nurturing Human Capital along the Life Course: Investing in Early Childhood De-
velopment to consider state-of-the-art evidence, effective interventions, tools and indicators, and successful strategies for getting
programs to scale. Key messages from the meeting include that there are two important periods for interventions to overcome early ad-
versity and encourage human capital formation. These are (1) Prenatal-3 years of life by ensuring the health and nutrition of parents-
(especially mothers) to-be, and the promotion of nurturing early care environments for young children, and (2) Adolescence and precon-
ception by ensuring supportive transitions into adulthood and preparing the next generation of parents.