Journal Article

Enablers and Barriers to Implementing Early Childhood Development Assessment and Nutrition Interventions in Community Settings: Qualitative Case Study From Sidama Regional State, Ethiopia

Stoecker, Barbara J., Wondimagegne, Zelalem Tafese, Hailemariam, Hailu

2026

Overview

Despite improvements in children's nutritional status and a commitment to early childhood development (ECD) policy developments in Ethiopia, the risk of poor ECD outcomes remains alarming. This study aimed to identify enablers and barriers to the implementation of ECD assessment and provision of nutrition‐focused interventions in community settings. A qualitative case study was employed in Hawassa city and Dore Bafano district of Sidama region from November 2023 to February 2024. Fifteen key informant interviews (KIIs) and five focus group discussions (FGDs) were conducted with purposively selected key informants from the healthcare system and mothers of children under two years old, respectively. Pre‐tested interview and discussion guides were used for data collection and a narrative thematic analysis was applied at different levels of the socio‐ecological model (SEM). The existing ECD policy and strategy landscape, healthcare system, communication and trust built between the health Extension workers (HEWs) and the community, existence of different mothers groups and the HEWs positive attitudes were identified as enablers; however, gaps in ECD practical knowledge and community awareness, low commitment of HEWs and political leaders at multiple levels, as well as absence of training, facilities and standardized indicators of ECD were identified as barriers for the implementation of ECD assessment and provision of nutrition‐interventions in the community settings. ECD assessments and nutrition‐focused interventions can be integrated into the existing health extension program, with HEWs playing key roles. This requires raising awareness of ECD policies across all healthcare levels and providing targeted training for HEWs on ECD assessment and its targeted interventions. Building the capacity of all persons associated with health posts, and incorporating ECD indicators into HEWs' services and their supervision checklists will enhance the effectiveness and sustainability of ECD integration in the community, leading to improved child health and development outcomes. Additional research is required to develop a tailored, user‐friendly and time‐saving ECD assessment tool for use in the community by the HEWs to assess, classify and identify children at risk of developmental delay. Summary Early childhood development (ECD) assessment and targeted nutrition interventions potentially can be integrated effectively in the community setting through the existing healthcare system. ECD policy and strategy landscape, the existing healthcare system, communication and trust built among Health Extension Workers (HEWs) and the community, existence of mothers' groups, and HEWs' positive attitudes towards ECD were enablers, while gaps in ECD practical knowledge, poor HEWs and leaders commitment, low community awareness, limited ECD training, facilities, and absence of standardized ECD indicators were barriers to ECD assessment and provision of targeted nutrition interventions in community settings. Understanding key enablers and barriers can support the design of evidence‐based, multi‐level strategies to mitigate implementation gaps and strengthen the integration, delivery, and sustainability of ECD assessments and provision of targeted nutrition interventions within the existing healthcare system. Capacitating health institutions and frontline health workers with ECD practical skills and facilities would benefit the integration of ECD interventions in community settings.

• Publisher: John Wiley & Sons, Inc,Wiley
• Subject: Adult / At risk populations / Attitudes / Barriers / Capacity building approach / Case studies / Child Development / Child, Preschool / Childhood / Children / Childrens health / Commitment / Community / community setting / Data collection / Development policy / Developmentally delayed children / Discourse strategies / Early childhood education / ECD assessment and nutrition‐focused intervention / Ecological models / Ecological studies / Ethiopia / Evaluation / Extension education / Female / Focus Groups / Health care / Health Knowledge, Attitudes, Practice / Health services / Health status / Humans / Infant / Intervention / Interviews / Leadership / Male / Mothers / Nutrition / Nutritional Status / Original / qualitative case study / Qualitative Research / Regions / Respondents / Risk assessment / socio‐ecological Model (SEM) / Training / Working mothers