Promoting Nurturing Care for Early Childhood Development Through India’s Public Health System

T he Nurturing Care Framework (NCF) for early childhood development (ECD) provides a roadmap for all sectors, including the health sector, to support the healthy development of all children. Although ECD covers children aged 0–8 years, the NCF Framework focuses on the period starting from pregnancy to three years of age as this is a sensitive period for brain develop- ment, and children are most susceptible to environmental influences. This age group is usually not well addressed in programming for ECD. The health sector is unique in providing nurturing care through its extensive reach to women, children, and families and the possibility of intervening across the life course. However, healthcare workers need to collaborate with nutrition and social workers to engage with pregnant women, families with young children (0-3 years), and other stakeholders in the community [1]. While health and young child nutrition are essential services provided through the public health system, there are several missed opportunities for promoting the five nurturing care domains. In this paper, we discuss the potential to advance nurturing care for ECD through the public health system. We discuss the relative strengths, some of the persisting gaps and challenges in promoting ECD and propose a set of actions as the way forward for the public health services. LEVERAGING THE STRENGTHS OF THE PUBLIC HEALTH SYSTEM The reach of the public health system is extensive: Population coverage with a large cadre of Community Health Officers and Auxiliary Nurse Midwives (ANM) at every sub-center or Health and Wellness Centre (HWC), Accredited Social Health Activists (ASHAs) (one per 1000 population) is a unique strength for service delivery. Through various health programs, these health workers have the mandate to reach out to the adolescents, pregnant women, families, and mothers of 0-3 year olds and young children themselves. With HWCs becoming functional closer to the community, it enhances their capacity to mobilize the local population to avail primary care. They can directly reach out to the families with advice on various components of nurturing care after assessing risk factors in individual households through home-based services. Health and wellness centers (HWCs) bring services closer to the community: Under Ayushman Bharat, 150,000 HWCs are being created by transforming existing sub-centers and Primary Health Centers (PHCs). They will deliver comprehensive primary health care, focusing on wellness and delivery of an expanded range of services, including free essential drugs and diagnostic services, closer to the community. Provisions include universal coverage of the target population and establishing a continuum of care through a two-way referral system between various facility levels. This means streamlined referral of children at risk or those requiring indicated support (special care) to higher levels with electronic re