| The Pakistan Early Child Development Scale-up Study (PEDS), implemented from 2009 to 2012, is an example of an intersectoral ECD program using existing child health infrastructure to deliver a responsive caregiving intervention. The CCD curriculum was successfully integrated into a nutrition intervention delivered by the well-established national Lady Health Worker Program. With a workforce of 100,000 female community health workers, the Lady Health Workers provided needed health outreach, including community and home visits, to supplement areas with weaker and rural clinical infrastructure. Local and international researchers partnered with the Lady Health Worker Program to provide additional training for the PEDS intervention. Lady Health Supervisors also received additional training to adequately supervise these new activities. The program delivered responsive caregiving coaching to parents in combination with nutrition education and micronutrient powder distribution. The existing Lady Health Worker workforce, which was coordinated by health authorities, served as an effective platform to deliver additional responsive caregiving and nutrition outreach activities to vulnerable rural families. Importantly, Lady Health Workers only had time to complete these additional activities because most health workers were not adequately meeting their pre-existing work requirements. When integrating responsive caregiving programs within existing health outreach programs, it is critical to monitor intervention delivery quality and not overburden the implementation agents. |
