Table 1.

Summary of main findings by program evaluation dimension (rows) and primary respondent groups (columns)

	District stakeholders (MoH, APE, ADEMO, AMASI, and UNICEF)	Providers (well-child and sick-child consultation providers, nurses, APE, ADEMO, and AMASI)	Caregivers
Program engagement Listed in order of frequency mentioned	Roles and responsibilities: - Training their colleagues to increase awareness and counseling for ECD - Strengthening systems to promote ECD (e.g., supervision, referrals, M&E) - Participation in the district and provincial technical working groups for ECD	Messages promoted: - Nutrition, breastfeeding, and dietary diversity for young children - Maternal and child health - Developmental monitoring - Stimulation practices - COVID-19 prevention measures - Father involvement in nurturing care	Messages received: - Nutrition, breastfeeding, and dietary diversity for young children - Maternal and child health - COVID-19 prevention measures - Developmental monitoring - Stimulation practices - Father involvement in nurturing care Most common sources of information: (1) health facility providers, (2) media, and (3) community-based providers
Acceptability	- Improved coordination and collaborations among various district stakeholders/partners - Raising awareness about ECD messages - Increased demand for ECD services in other districts	- Satisfaction with the training and supervision received - Acceptability and usefulness of program content (i.e., nutrition and ECD) and other materials received	- Nutrition and parenting messages were all described as useful - Satisfaction with interpersonal counseling received from health facility providers - Those who observed videos enjoyed them - Some dissatisfaction with long waiting times at health facilities
Perceived changes to the health system	- Stronger partnerships among district stakeholders and partners - Improved referral processes - Increased capacities for monitoring and evaluation of children at-risk - More efficient health system operations and streamlining of child-centered services	- More efficient health system operations and streamlining of child-centered services - Some reductions in waiting time (at well-child consultations in particular) - Improved referral processes - Increased awareness of the health system’s role in promoting ECD - Collection and monitoring of ECD indicators in health information system	- N/A
Perceived changes to providers	- Increased knowledge of ECD - Increased appreciation for the links between ECD and nutrition - Enhanced training and supervision received by providers	- Improved knowledge of ECD - Sensitization to the importance of nurturing care for ECD - Enhanced counseling skills - Increased number of responsibilities	- N/A
Perceived changes to caregivers	- Improvements in some caregivers nurturing care behaviors (feeding practices and provision of homemade toys)	- Sensitization around various community health issues (e.g., decreasing stigmatization of HIV, addressing gender norms/male engagement) - Increased participation in child health services - Increased engagement of male caregivers in childcare - Improved child health outcomes - Increased identification of children at-risk (developmental or nutritional)	- Improved care for child health and nutrition - Increased participation in child health services - Increased engagement of both male and female caregivers in play activities with and provision of toys for their children - Improved child nutrition and health outcomes (e.g., lower rates of malnutrition and illness)
Barriers/challenges	- Resistance to change among some providers and at health facility operations-level - Generally, long patient waiting lines at health facilities - Limited staff at health facilities - High staff turnover - Far distance between households and health facilities - Poverty (e.g., low financial resources, low providers salaries)	- Inadequate resources to carry out responsibilities (e.g., infrastructure, personnel) - Increased responsibilities associated with the intervention and low motivation among some providers - Language barriers (i.e., no fluency in the local language) - Weak linkages between health facilities and community providers	- Lack of money (e.g., cannot afford to buy medicine or nutritious food for children) - Some households are far from health facilities - Some messages cannot be understood by some caregivers (i.e., Portuguese language barrier or illiteracy) - Lack of male caregiver engagement in children’s health services - Limited presence of community providers (APEs, AMASI, ADEMO) in some communities
Facilitators	- Strong leadership and support from the district government	- Training to providers - Supervision to providers - Provision of materials and job aids (e.g., posters, pamphlets, diagnostic tools, and equipment)	- Reinforcement of messages at both health facility and community levels - Messages that do not require financial input from caregivers - Community groups to discuss nurturing care with peers - Availability/use of local resources (e.g., surplus harvest from caregivers’ farms)