“The First Thing Is to Love the Child”

The sky is blue and a gentle breeze rolls through the maize fields in Igambilo Village in Tabora, Tanzania. Janet Kapona, a village elder and EGPAF-supported community health worker, is visiting Zamzam, a mother of three who’s youngest, Leila, is just over one year old. Janet is here to check on Leila as she grows, to help Zamzam cultivate a strong connection with her daughter, and to link her to any resources she may need as a mother. Janet and Zamzam talk under the shade of a tree as Leila flings herself, giggling, into her mother’s lap.

Janet has been trained in early stimulation and responsive caregiving using a UNICEF-tested training package on childhood development, Care for Child Development (CCD), through the Malezi Project, funded by the Conrad N. Hilton Foundation. Malezi, which means “Caring” in Kiswahili, is being implemented in 86 health facilities in the Tabora region of Tanzania. The project addresses early stimulation for infants from birth to age 3 by integrating early stimulation within health services and by building capacity of health care workers at the facility and community health workers.

Janet has been visiting Zamzam’s home ever since Zamzam became pregnant with Leila. During her visits, Janet advises Zamzam on how to ensure that her child is engaged, healthy, and on track to reaching developmental milestones. She checks on the child’s nutrition and activity level. If the child or the parents are unwell, she can provide advice on seeking medical treatment and referrals to local clinics. She even takes the time to show them how to make developmentally appropriate toys, like dolls and music makers, and plays with the family.

Janet has been visiting Zamzam’s home ever since Zamzam became pregnant with Leila. During her visits, Janet advises Zamzam on how to ensure that her child is engaged, healthy, and on track.

“The counseling has taught me to play with her in a way that stimulates her mind,” Zamzam explains. “[Leila] likes to play with the ball the most” Zamzam says, as Leila, with a beloved stuffed animal in one hand, fishes for the ball in a basket full of toys.

Counseling on developmental stages of play, nutrition, and activity level all serve to reinforce a positive relationship between the parents and the child. “The first thing,” Janet says, “is to love the child.”

“The counseling that I have received from Janet has helped me become even closer to my child and strengthened our love,” Zamzam says. “I used to sit and play with my belly, and touch it while saying, ‘I love you baby’ when she was still in the womb,” Zamzam recalls. “I’ve gained more understanding on how to raise her with love since she was in the womb so that as she grows up that love is still there.”

While Janet was raising her four children, she had access to counseling services at the health clinic that supported her in motherhood. “I feel proud of how I have been able to take care of my children. That education, that experience, it fuels the love I have to help someone else.” she says.

“That education, that experience, it fuels the love I have to help someone else.” Zamzam, Malezi participant and mother

“With early childhood development we want to see all children not only survive in terms of receiving only health services, but we want to see them thrive and transform”, says Josephine Ferla, senior program manager for Early Childhood Development at EGPAF-Tanzania. “We [are] reducing the number of deaths in children, but we also want to see them as successful human beings later in life”.

“When we give counseling, we help children cultivate self-awareness and self-confidence,” Janet explains. “We want them to have a good life intellectually and physically so that our community and the nation have good children who are doing really well.”

That is exactly what Zamzam sees for her daughter. “She’s going to be a good child,” Zamzam says proudly. “[She will be] a child who listens and has a deep understanding of others and the world around her.”

Most of the time Janet will visit Zamzam here, at her home. Home visits enable Janet to meet with families more consistently, and with those who are unable to travel to the clinic. Janet and her fellow community health workers provide counseling and education to every family in the village that has a pregnancy or an infant up until three years of age. This decongests the clinic and links people to care who may not otherwise hear about available resources. For Zamzam, this has meant a link to family planning services, which she says has also been very helpful.

Community health workers like Janet are often neighbors of their clients and have longstanding relationships with one another.

“This education about early childhood development and nurturing, for me how I see it, it helps me and the community to work together,” Janet says. “It helps me to have confidence in what I am doing and also for [members of the community] to believe in me. The education can help the children and also the caregivers in the community.”

This structure of healthcare has proved to be a tremendous asset in the time of COVID-19. Health workers like Janet can continue counseling families from a safe distance on play and nutrition in the open air just outside their homes, and can even incorporate COVID-19 messaging into their visits. Some adjustments have to be made, but with the support of the Conrad N. Hilton Foundation, clinic staff and community workers have succeeded in adapting their practice to provide continued care in this new health landscape.