Table 4.

Perceived changes as a result of the pilot

Theme	Quote	Respondent
Perceived changes to the health system
Integrated and streamlined operations	Before I used to tend to the pediatric unit, and I used to wait for the [child health] cards. However after the training, we have created a “one stop shop” where all the technicians from CCD [sick-child provider], CCS [well-child provider], CCR [child-at-risk provider] meet together. We identify all the cards and after weighting the mothers and then send to respective sections. At the “one stop shop” area, everything is done including giving the children vitamin A, so if the child is here with a case of, for example, malnutrition, we undertake monitoring. This has changed and our work has been made a little bit easier. Everything is done at the “one stop shop,” and later they come to our [consultation] doors for specific cases.	Sick child consultation provider #1, health facility #2
Increased referrals	First after the introduction of all these topics, we are now able to get a lot of referrals of mothers to the health facility. They say, “My child is not eating like he/she should eat.” We are having an influx of mothers consulting and this for us is good, because it shows that we are working. We are having a lot of referrals in this area, and this means they are also paying attention that if this child is not ok, he/she has to rush to the health facility before the condition worsens. Another success is on the side of the health worker that we are now paying attention from an integrated perspective instead of focusing one by one like nutrition or [developmental] delays.	Health facility director, health facility #1
Reduced waiting time	They [caregivers] are very satisfied due to the reduction of waiting time and attendance. The time they take at the health facility has really reduced. They are happy because they no longer spend a whole day in the health facility during their consultations. They are now attended in one room regarding all the issues they bring with them to the health facility. There is no need to move around from one place to another. Once they are attended, they go back home early to continue with their other activities.	Maternal and child health nurse #1, health facility #1
Perceived changes to providers
Increased knowledge about nurturing care	[Before the pilot] I did not have the knowledge of child simulation, their diet, how they should eat… Now with PATH, we learned about handwashing, tippy-taps, child feeding, how to stimulate the children, playing with their fathers. I did not have all these, that is the reason I am saying we have learned a lot of things through PATH.	ADEMO provider, community catchment area #2
Capacity to carry out developmental monitoring as part of routine care	[Before the pilot] I was only dealing with the nutritional part, the pathology and the follow up. But I did not have that alerting signal, for example why is this child not sitting on its own and he/she is more than 6 months old. We used to take it lightly as we used to think that each child grows on its own speed and rate. For some children, it was alarming to see that even after 12 months they still could not walk. It was worrying but we did not know how to act. I had limitations and could only send the caregiver away because I did not have the proper diagnosis. I had no information on how to deal with such a situation… Now everything is integrated. It is very beautiful… Now I take a toy and give it to the child and assess if the child is able to sit on its own or he/she can reach the toy without difficulties and hesitation. I also carry the child on my lap and examine the neck whether the child can balance its own head without falling according to the age.	Well child consultation provider #1, health facility #3
Perceived changes to caregivers/children
Increased parental engagement in providing homemade toys for children	[After the pilot] we managed to see in some of the houses some toys. In the community, parents often think that a toy is only the modern one that you can buy from the shop. But we had this opportunity [through the pilot] to demonstrate that even from the local materials, it is possible to make toys. [For example] a bottle of water could be used to make a toy car and the child could play with it. We realized that some of parents in the community are now starting to implement what they are learning from the talks at the hospitals and communities.	Head doctor, MoH representative
Father involvement in nurturing care	I now know that I need to make toys for my son, not to only be at the market undertaking business. I bought a mosquito net in order to protect him from malaria. I take him to the hospital always when he is not feeling ok. I made a ball for him and I normally see him running with the ball from one place to another. I help my wife to bath him and when I am at home. I make toys like a ball from plastic papers, parrot, toy car from reed, and I also make some dolls.	Father #1, community catchment area #3
Improved child development and nutrition	Yes, there are changes. We have children who could not walk and today they are walking. There are children who could not sit and now they can. The malnourished children are now gaining the desired weight and growing well.	ADEMO provider, community catchment area #3