Stepping Stones- Positive Parenting Program

Parents in rural India lack optimal education and awareness about domains and activities of early childhood development. The status of ECD is far lagging behind the urban children. 

To bridge this gap in ECD and school preparedness at 5 years of age, we will implement a community based positive parenting programme delivered by trained and certified community peer mentors which will be locally adapted and culturally acceptable. 

Given the results of our pilot, we expect this solution adaptable and implementable  to positively change the lives of millions if scaled globally.

Child Care and Parenting Practices in low and middle-income countries:

Only 39 percent of infants aged 0-6 months in LMICs are exclusively breast-fed, despite strong evidence on its benefits (Lancet, 2011).

As per UNICEF data, only 38% mothers engage in activities that promote learning with less that 40% of children under the age of six. 

250 million children (43%) younger than 5 years in LMICs are at risk of not reaching their developmental potential (Lancet 2017; 389: 77-90).

80.8 million children aged 3 and 4 years in LMICs experienced low cognitive and/or socio-emotional development in 2010, with a significant number from South Asia (27.7 million; 37.7%) and the East Asia and Pacific region (15.1 million; 25.9%). [PLoS Med. 2016 Jun; 13(6)]

We plan to implement this program in Maharashtra state of India. 

Human Development Index: India – 0.467 & Maharashtra state - 0.572 (2011)

Under-5 Mortality Rate: India  43 & Maharashtra state - 18 per 1000 live births (SRS 2015)

India ranks 112 in the Child Development Index (CDI) [Save the Children]. 

Child Development Index of Maharashtra was 0.769 (2014-15) [NHFS 3] 

Our target population will be villages from selected districts from state Maharashtra of India. These rural area in India have an average annual per-capita income below the state average. People are predominantly farmers or farm laborers or involved in cattle rearing. These areas are also known for farmer’s suicides due to reduced income from farming due to erratic monsoon and climatic change. Traditional practices are widely prevalent in these regions strongly influencing health seeking behaviour and child care practices.  Women face specific gendered risk and vulnerabilities in rural area. Women are overburdened with multiple responsibilities, such as income generation, household work, child care etc. This social and economic distress contributes to inadequate nutrition and parenting and may have an adverse consequence on pregnancy outcomes, child growth and development. 

 The reason for selecting the district is  DMIMS is based in Wardha . In addition, DMIMS Wardha research team has worked here over last 15 years. We have established successful links between public sector, community and other stakeholders. The linkages needed to carry out work at three sites are in place due to the previous engagements. 

We aim for a scalable and replicable integrated intervention that includes developing and promoting a positive parenting curriculum and early childhood development program for rural children under 5 years of age that is effectively delivered through the Community Peer Mentors with support from the public AWW /ASHA, a public-private partnership approach. Innovation that we intend to evaluate as a proof of concept includes  training materials, development of locally adapted parenting program around the six key parenting competencies for ECD ; identification, training and certification of Community Peer Mentors (BalSakhi) for effective delivery, continuous support and mentoring of women in rural area for nutrition and parenting program with support from public AWW/ASHA; promoting a social franchising among the local women groups and supporting them through the training and then subsequently strengthening them to have a sustainable business model. Overall our proof of concept aims at developing and promoting a ecosystem at village level promoting the early childhood development in rural and undeserved area in the districts.

Current health programmes in India focus more on care during pregnancy and infants care regarding immunization and feeding. Limited initiatives specifically aim at improving the ECD with creating stimulating environment at home for optimum growth and development of children under 2 years. Critical period in child’s life is between 1-5 years that receives limited attention due to other health priorities. Studies have identified that the parenting stimulation  will have a positive impact on child’s growth and development in future. Our innovation address these gaps in the current government program by developing and implementing culturally sensitive and locally managed integrated intervention - community based parenting program and will be supported by the local government and using locally available resources within community. Other innovative elements are developing a social business model around the concept of positive parenting, supplementary nutrition and  will be managed by LWGs. A Community  Demonstration Centre (CDC) will be developed to serve as an resource for enhancing the knowledge, awareness and skills with regards to ECD in rural community.

We will use tablet PC based assessment tools for child development and utilize Fast track learning cycle approach to identify the most in need, vulnerable children. The data of assessments on child development and parenting practices will be collected on tablet PCs and submitted to server for timely analysis . 

The implementation of intervention sessions will include Photo-elicitation/Photo-story approach which has been found to be very effective in our previous project. All intervention data will be captured electronically. Dashboard will be used for monitoring and evaluation.

For Children with neurodevelopmental delays and special cases, we will use Functional MRI technique to assess the brain development.

Theory of Change: It will include inputs like appropriately selected , trained and motivated staff; sufficient funding for programme delivery. The activities will include Formative research that involves development of Positive Parenting curriculum and programme. Other activities will include training of staff and Peer Mentors, identification and training of Local Women Groups on Social Business Model , identification and training of caregivers from selected intervention areas. 

The expected outputs includes trained caregivers, Field Staff, effective implementation of positive parenting programme, and established Social Business Model. 

Short term outcomes include improved knowledge, skills and practices of parenting by caregivers, and sustainable community business model. Intermediate outcomes include improved cognitive, motor, socio-emotional and language development of children under 5; improved home environment and mother-child interaction; improved nutritional status and mental health status of mothers and children. Also there will be increased accessibility for caregivers to Business model and sustainable resources will be ensured in the community.

Long term outcomes include optimal child development in this region and improved career progression is expected in future.

Currently our direct beneficiaries include 30 Peer Mentors, 20 Field Staff and around 850 families of children aged 0-5 years. Thus this intervention is currently catering to a population of 10000. We expect to reach about 1500 families of under 5 children in next year and about  5000 families from a population of 100000 is expected to be served in next five years.

We aim to reach 100 villages (Anganwadi Centre areas) from Wardha and Nagpur district in next one year. Thus we will train 100 AWWs and Peer Mentors in next 1 year and establish 10 Community Demonstration Centres  (DMC). We anticipate an improvement of 0.3 SD in child development indicators from baseline status in intervention areas. 

By the end of 5 years , we aim to reach about 300 remote villages from 4 districts namely Wardha, Yawatmal, Amaravati and Nagpur, thus reaching a population of about 100000 and 1500 children under 5. The anticipated improvement in ECD indicators is 0.5 SD in addition to improved caregiver skills and home environment. 

Currently, we are working in 50 intervention villages and barriers to expanding include limited financial resources, accessibility to targeted remote villages, limited  human and other resources in newer villages, educational level of caregivers in remote rural areas; differences in language dialects. The non-availability of active LWGs in smaller villages for collaboration to expend social business is another barrier. Also many villages have limited or no mobile networks and other telephonic communication facilities, limited infrastructure facilities to start CDCs.

We are looking for active LWGs from a group of closely situated villages which will be ready to reach and cater to all villages in that zone. We will help them in providing facilities of vehicles and accessibility to remote villages, apart from training and financial support. We are also seeking for the support of some NGOs involved in providing supplementary nutrition services, training and capacity building for raising water reuse and promoting kitchen gardens which will help to raise green seasonal vegetables locally. These NGOs also support Anganwadi centres in providing supplementary nutrition services. 

Also, we have a chain of peripheral health centres through which we are accessing these villages. The potential volunteers and facilities will be identified through these centres and outreach activities to targeted population will be planned. For mitigating Financial  constraints we are trying to raise revenues from currently established Urban Business Counters of our social business.

Stepping Stones is an ambitious project under the department of  Research and Development of Datta Meghe Institute of Medical Sciences, Wardha (DMIMS). DMIMS is a Deemed to be Medical University in Central India with it's constituent colleges including Medical, Dental, Nursing, Ayurvedic, Physiotherapy and other allied paramedical sciences. 

Our team is a multidisciplinary team that includes -

2 Consultant Child Psychologists 

a team of 08 Advisors from different specialities like Pediatrics, Nursing etc

2 people from Financial management

We have  a team of 20 full time research assistants

team of 5 IT and Computer Science experts from Data Management Unit including Data Manager, 

1 full time Project Manager and 

30 Peer Mentors.

2 Principal Investigators 

2 Office assistants

Apart from this , we have -

4 subcontractors for Project training and capacity building Activities and 

Centralized system for logistics and materials procurement. 

The Stepping Stones project is a collaboration of multiple Indian researchers which include an interdisciplinary team at the Datta Meghe Institute of Medical Sciences (DMIMS) lead by Dr Quazi Syed Zahiruddin and Dr Abhay Gaidhane. We have been working in collaboration ICDS program of Government of Maharashtra for last 4 years on this aspect, also State PublicHealth Dept., Dept. of Women and Child Development. The team includes Dr. Sylvia Fernandez-Rao, an expert in child development, an expert psychologist and senior scientist from the National Institute of Nutrition, Hyderabad. She is also member of IndianPsychological Association and Nutrition Society of India. Our Consultant, Dr. Deepak Saxena, is an expert in community health and epidemiology from the Indian Institute of PublicHealth, Gandhinagar;  experienced in large scale assessments of child cognition. Also we have Dr. Penelope Holding, eminent Child Psychologist from Nairobi, Kenya and currently platform committee member of Saving Brains Programme of Grand Challenges, Canada.

We have a team of well trained field staff and research assistants and experienced in implementing similar project over last 4 years. All links and channels are in place for the implementation of this programme in newer areas.

We have collaborations with Yeshwantrao Chavan College of Engineering and Datta Meghe Institute of Engineering , Wardha who will be assisting our team in technology related activities of the project. Also we have Innovince, an esteemed IT firm from Nagpur as our partner. Indian Institute of Public Health, Gandhinagar Gujarat is our technical partner. The Meghe Group of Schools is a chain of 22 high quality preschools in 8 districts of Vidarbha region which is our partner in implementing the Positive Parenting Programme in rural areas and  also in Business model for revenue generation through Urban areas.

Higher  Educational Institutes like GS Gawande College, Umarkhed, SRMMCON College of Nursing and have been partners with us for previous child development and Anganwadi centre related project implementation activities.

We also have linkages with National Environmental Engineering Research Institute , Nagpur and Vishweshwariya National Institute of Technology Nagpur.

This Social Business Model will cater to the families of around 1500 children under 5, caregivers, around 150 Peer Mentors, 100 Private Preschool Teachers and ECD staff of other NGOs. 

Value Proposition

Core values  delivered to the customer:

-        Customized Skills for enhancing Early Childhood development of their children and package of activities/kits for their children for better school readiness, physical, motor and cognitive development, Supplementary Nutrition products.

Customer needs  satisfied:

-        Knowledge about good parenting , early childhood development and skills to enhance ECD, supplementary nutrition .

Key Resources/Products

-        Intellectual (workshops , guidebooks); Physical (ECD Toy kits), Supplementary Nutrition products.

Distribution Channel

-        Awareness through established Private preschool partners; evaluation, Sale/delivery of developed ECD kits, Online marketing and sale  through website, Supplementary Nutrition products through Urban and Rural sale Counters.

Cost Structure

-        Complete annual  package of Parenting costing around Rs. 5000 - 20000/- 

-      Supplementary Nutrition @Rs. 500/- per month per customer.

Revenue Stream

-        Subscription fees and Product /service charges for Child development assessments/ profits from Nutritional products.  Workshops on Parenting - 40%; ECD Kits with Guidebooks – 40%, Nutrition Package -20%.

Through this 'Organization Support' business model, we anticipate to generate about 60% of funds through sale of products and services. In addition we are seeking for potential investors and donors from CSR of companies in this area. 

The business of Supplementary nutrition products will be self sustainable through revenues generated from sales. 

Also we are seeking for additional funds from funding agencies to expand this project in newer geographic locations.

We expect Solve to help us overcome the barrier of Funding through one of the prize from-

1. Al Innovations Prize

2. Innovation for Women Prize

3. Innospark ventures prize

4. Dubai Cares Early Childhood Development Prize

These funds will help us for implementation of Scale-up business plans of our Business Model.

This will be a social business model and will be implemented in remote rural areas of Central India. The revenues will be generated through Urban sale counters and and most of the resources will be mobilized from rural-urban channels. For Supplementary nutrition component, we plan to create a self-sustainable model involving rural women groups which will help in their capacity building and empowerment in addition to assuring local support for emerging business. So partnerships with such type of active Local Women Groups will be a good catalytic solution. 

We would like to partner with-

1.  Indian Institute of Public Health , Gandhinagar as technical partner

2. Meghe Group of schools as implementation partner

3. Innovince and YCCE - For Technical upgradation and digital Marketing

4. S. Radhikabai Meghe College of Nursing - for Training, Capacity building and monitoring of field implementation.

5. National Institute of Nutrition Hyderabad- For Supplementary Nutrition Products related activities and Mother-child Nutrition status assessments.

• We will utilize this prize to invent technology based solutions to -

• Enable parents and caregivers to support their children’s overall development and provide positive and safe surroundings.

• Promote exploration, early literacy skills, and language experimentation in preparation for primary school.

We will utilize the prize for the capacity building and women empowerment activities through our support to Local Women Groups by collaboration and training for our business activities. The supplementary nutritional products and the local materials/ toys prepared for ECD activities will be patented and urban/rural sale counters will be raised for promotion and marketing of these products with women leaders team. We anticipate this to boost our social business and generate appreciable amount of revenues. 

We will be collecting data using tablet PC based app and technology. We have well established Data Management Unit and will ensure the protection, maintenance and ethical use of data for project implementation. We will invest to leverage artificial intelligence to create a disruptive impact for society in terms of healthcare, education and life sciences.