Group Discussion What is new that has been

Group Discussion What is new that has been learned? What is already being done in the services we are providing (to pregnant women & babies & others)? What are we already doing but needs to be enhanced and how can that be done? What are we not doing that needs to be incorporated in the services? How can the new knowledge be incorporated into service provision to clients? What barriers to implementation are anticipated? 1 st 1000 days to City of Cape Town Health 1

FIRST 1000 DAYS SERVICE IMPLICATIONS 1 st 1000 Days Initiative Roadshow E Malek, J Giddy, , V De Azevedo, M Hendricks 15 April 2016

What are we already doing?

Provincial Strategic Plan 2014 -2019: 5 Provincial Strategic Goals STRATEGIC GOAL 1: Create opportunities for growth and jobs STRATEGIC GOAL 2: Improve education outcomes and opportunities for youth development STRATEGIC GOAL 3: Increase wellness, safety and tackle social ills STRATEGIC GOAL 4: Enable a resilient, sustainable, quality and inclusive living environment STRATEGIC GOAL 5: Embed good governance and integrated service delivery through partnerships and spatial alignment 2015/09/16 4 1 st 1000 days to City of Cape Town Health

Provincial Strategic Goal (PSG) 3 Inclusive, Safe and Healthy Communities Resilient and Healthy Families Engaged and Healthy youth Safe and Healthy Children

LIFE COURS E 1 ST 1000 DAYS INITIATIVE: PROJECT DESIGN ADOLESCEN T HEALTH & DEVELOPME NT PRECONCEPTION, PREGNANCY, CHILDBIRTH (1 st 1000 DAYS) POSTNATAL & NEWBORN DEVELOPMENT (1 st 1000 DAYS) INFANT & TODDLER HEALTH & DEVELOPMEN T (1 ST 1000 DAYS) PROGRAMME INTERVENTIONS Nurturing Care and Responsive Parenting Nutrition & Health Nurture, Care & Support YOUNG CHILD HEALTH AND DEVELOPMEN T (<60 MONTHS) Healthy growth and develop ment Health Interventions Intersectorial interventions Communication strategy Safety, Protection & Stimulation Adapted , Slide presentation, . Pia Britto, UNICEF , DOHa. D conference November 2015 6

PSG 3 Plan of Action for 2016/17 Deliverable Area/ Main focus Transversal Communication strategy Targeting commuters and caregivers (LSM 2 -4) Health Interventions Adolescent and antenatal health services Activities Target • • Branding of taxis Interior messages in taxis • Community radio sponsored interviews and talks on 9 radio stations in Metro and Rural areas • • First 1000 day social media campaign • Test the success of campaign with focus groups (caregivers & recipients of messages) • • 10 taxis 47 taxis 30 sessions Ante natal policy reviews • BANC checklists (risk screening tool) • Comprehensive health education package • 2 • • Quarterly reviews • • 10000 clients 10200 clients • 600000 condoms M & E, First 1000 days dashboard indicators against performance targets Adolescent programme • STI screening campaigns(4) • HCT & HCT couple campaign(2) • Adolescent family planning campaign(including condom distribution(4) Go to Insert > Header & Footer > Enter presentation name into footer field 7

PSG 3 Plan of Action for 2016/17 Deliverable Area/ Main focus Intersectoral Interventions including Drakenstein Activities First 1000 days Roadshows (Workshops and Dialogues) Including PHC, CBS, NPO and other departments • Metro • Rural • • 4 5 Adolescent programmes • Empowerment and Care programme • Empowerment, Care and Cash programme • • 6000 clients 2400 clients Seminar, Promotion, protection and support of Breastfeeding, • 1 Situation analysis – parenting programmes • 1 First 1000 day summit • 1 • Drakenstein Target Pilot Social Impact Bond Intersectoral linkages (DOE, DSD, DOCS) • PSG 2 links with ECD • Alcohol Harm Reduction prevention during pregnancy • Intimate Partner Violence, play environments (CSIP) • Stimulation and Play - Valcare Trust Intersectoral resource mapping for referral and support services of at risk clients Go to Insert > Header & Footer > Enter presentation name into footer field 8

Transversal Communication Campaign Unique Identifier 9

What Every Family and Community Have a Right to Know: Start Caring for Your Baby Before Birth Important First 1000 Day Facts! 1000 days + 270 Pregnancy 365 + 1 st year 365 2 nd year 3 Key Time Periods 3 Key Elements The brain grows to 80% of its full size by the age of 2 years! The brain needs 3 essential elements to grow & develop well, just like a plant The brain needs loving interaction with a caring adult to grow well Brain structure is affected by toxic stress during pregnancy & childhood! Harm to the brain is buffered by the consistent presence of a caring adult Positive parenting builds confident children to do better at school & get jobs! 1 2 Nutrition & Health Nurture, Care & Support 3 Safety, Protection & Stimulation To grow the best brain by 2 years… Start Caring for Your Baby Before Birth …Start early in Pregnancy

Implications and Opportunities

What to aim towards? A vision for re-engineering Maternal and child health services. . 1 st 1000 days to City of Cape Town Health 12

First 1000 Days Circles of Support While the pregnant woman is the environment of the developing fetus, the community is the environment of the mother. First 1000 days W Cape Transversal Communications Workshop 14 May 2015 13

First 1000 days care contexts First 1000 days W Cape Transversal Communications Workshop 14 May 2015 14

First 1000 days: Existing Health Service Opportunities Primary Health Care, MCH, Nutrition, Mental Health & Emerg services: • Antenatal (BANC): Every pregnant woman & teen and partner/family – IYCF • Intrapartum (MOU’s): Every pregnant woman & teen and partner/family - MBFI • Postnatal (clinics): Every child and parent/caregiver/family – Postnatal care • Infant (0 -2 years): Every child and parent/caregiver/family: - RTHB (well child), IMCI, “Surge season” process, etc Other: Adolescent & FP services: Every teen and partner/family Emergency services: Every pregnant woman and partner/family 1 st 1000 days to City of Cape Town Health 15

• • • • • Nutrition and Health Protection from unwanted pregnancy Adequate Family planning and pregnancy spacing (>2 years) Empathetic service providers Comprehensive Antenatal, Postnatal & Well-baby Care (incl RTHB) Comprehensive Risk screening in pregnancy Nutrition support for pregnant and breastfeeding women Maternal Mental Health Care & counselling services Referral and support services for substance, smoking & alcohol abuse Birthing (intrapartum) care (incl HBB) Breastfeeding Support (clinic, family, community & workplaces) Postnatal Care (incl KMC, high risk services) Infant wellbeing risk screening & Parent -Infant assessment Caregiver counselling (Infant Feeding, Attachment, Parenting, RTHB, ECD) Nutritious complementary feeding Emergency care (IMCI: DD, ARI, SAM, MSSN)) Community IMCI: danger signs, SSS, etc Partner, Family & Community support in pregnancy & for parents/caregivers Social service support/referral (incl birth registration, family and parenting) Nurture, Care and Support • • • Self care and wellness Mentoring / Peer support / group Recognising important role of men and fathers Family/partner support before, during and after pregnancy Social support services (eg CSG, SASSA, ECD, CPS) Community support during and after pregnancy Consistent, attentive caregiver arrangements Workplace support (mat. leave, breastfeeding, child care. . ) Empathetic counseling Substance, smoking & alcohol intervention services Emergency care arrangements / preparedness Safety, Protection and Stimulation • • • • Sensitive parenting/caregiving (responsive to baby’s cues) Infant Wellbeing (Sense of Safety & Wellbeing) Play, singing, story-telling, dancing, book-sharing Care-giving and Parenting support Social and community support services incl ECD, toy libraries Clean air to breathe (away from smoke) Clean water to drink Hygienic practices (handwashing, sanitation) Child safety in the home Road & pedestrian safety Safe spaces to play Safe neighbourhoods Environmental support services Community and Family engagement and support 16

PROGRAMME INTERVENTIONS Nutrition & Health Nurture, Care & Support Safety, Protection & Stimulati on ADOLESCENT HEALTH & DEVELOPMENT PRECONCEPTION, PREGNANCY, CHILDBIRTH POSTNATAL & NEWBORN DEVELOPMENT INFANT & TODDLER HEALTH & DEVELOPMENT (1 ST 1000 DAYS) YOUNG CHILD HEALTH AND DEVELOPMENT (<60 MONTHS) Nurturing Care and Responsive Parenting School Health Contraception Sexual Reproductive Wellness (STD’s, HIV) Mental Health Psychosocial support Social Services Prevent IPV Places of Safety Family/Community support Education curriculum to include parenting information Environmental Health Community Safety Road safety FP & TOP BANC Peer counselling IYCF & Breastfeeding Maternal Mental Health & Nutrition Risk screening CBS PNC incl risk screening MSSN Breastfeeding support KMC CBS Psychosocial support Social Services Prevent IPV Places of Safety Family/Community support Parenting information & Preparedness (conversations, skills) Environmental Health Community Safety Road Safety Parenting Support & Skills Environmental Health Community Safety Road Safety GMP (RTHB) EPI (RTHB) IYCF (RTHB) IMCI & SAM Danger signs CBS Psychosocial support Social Services Places of Safety Family/Community support Play & Development (RTHB) ECD Environmental Health Community Safety Road Safety GMP (RTHB) EPI (RTHB) IYCF (RTHB) IMCI & SAM Danger signs CBS Healthy growth and development LIFE COURSE 1 ST 1000 DAYS INITIATIVE FRAMEWORK Psychosocial support Social Services Places of Safety Family/Community support Play & Development (RTHB) ECD Environmental Health Community Safety Road Safety Adapted from UNICEF (Pia Britto) 17

Implications for Services Antenatal Birth to 6 months 7 months to 2 years General Health & wellness Booking < 20 weeks; 4 ANC visits; PMTCT Educate, screen / refer problems of alcohol, tobacco, drugs; Psychosocial risk screen & mental health screen Postnatal care Safe Family Planning PMTCT Immunisations Management of disease (pneumonia /diarrhoea) Developmental screening Hand washing & hygiene Immunisations Management of disease (pneumonia / diarrhoea) Developmental screening Hand washing & hygiene De-worming Adequate nutrition Balanced diet Micronutrients Optimal weight Support Exclusive breastfeeding Growth monitoring Prevent malnutrition Breastfeeding Complementary feeding Micronutrients Growth monitoring Prevent malnutrition Supplementary feeding Parenting information Promotion caregiving Early learning (home) Birth registration, Child Support Grant (CSG) Promotion caregiving Early learning (home) Parenting information CSG Breastfeeding counselling Stimulation & Support Psychosocial support Parenting information Promotion of caregiving practices

Implications for CBS level Basic First 1000 Days messages to be communicated / shared with CBS partners Training in MCH care & counselling (including parenting) for CCW’s Referrals of mother’s & children with risk factors CCW support (home visits) for example: o Adolescents who are pregnant / mothers o Newly diagnosed HIV infected women o Adherence problems on ART o Lack of support by family / partner o Violence / trauma and requesting support o Breastfeeding problems o Bereaved and struggling to cope o Depression / anxiety o Parenting problems shared o Drug and alcohol use and wanting to quit 1 st 1000 days to City of Cape Town Health 19

Implications for Maternal Health Services Optimising opportunities for Maternal Health during antenatal care. . Provide Comprehensive Antenatal Care: o Early booking encouraged o Empathic and compassionate attitude o Competent BANC services: including health education re nutrition (pregnant woman and BF education) o Maternal Psycho-Social risk factor screening Appropriate referral for both medical and psychosocial care & counselling NB Mental health services, substance abuse services, support for pregnant teens o Improve links with CBS – need more home visits Parenting-Infant attachment support o Establish Parent support groups starting in antenatal care (Use Club Rooms) o Promote the role of fathers and men; optimise antenatal waiting periods & areas o Discuss RTHB & Parenting during Antenatal care, Expand infant feeding counselling 1 st 1000 days to City of Cape Town Health 20

First 1000 days W Cape Transversal Communications Workshop 14 May 2015 21

Implications for Emergency Health Services First 1000 days W Cape Transversal Communications Workshop 14 May 2015 22

Implications: Infant and Child Services Infant and Child Health: o Implement new Postnatal care policy (& continue IMCI, SAM, MSSN) o Comprehensive integrated wellness care for children o Promoting, protecting and supporting breastfeeding o Optimising the use of the RTHB, which tracks wellness care : ü growth monitoring ü Immunization ü Vit A ü Deworming ü Key messages on nutrition, play, home treatement, danger signs Care of Mothers, caregivers and fathers: o Screening for psychosocial risk, basic counselling and referral o Provide integrated care where possible (e. g women on ART) o Parenting information & support (active) – links with NGO’s if needed Appropriate referral for psychosocial care 1 st 1000 days to City of Cape Town Health 23

Partnering with NGO’s & ECD Services Supporting a child starts with supporting a Mother The First 1000 days Relationship Support Tool “Ibhayi Lengane” (Ilifa Labantwana)was developed as an add-on to existing home visiting programmes with the purpose of enhancing the mother-child relationship during the first 1000 days. First 1000 days W Cape Transversal Communications Workshop 14 May 2015 25

Implications: Adolescent and FP Services 1 st 1000 days to City of Cape Town Health 26

Implications for all services Facilitate family and community dialogue and links to support – build relationships - not just provide information; o Empathetic staff o Strengthen “Communicator / Facilitator” roles o Family-centred approach – focus on child-family interactions, not child alone. (Children develop in context of relationships) o Know services in your area (local resource directory/map) o Be trained on parenting Actively encourage Positive parenting (sensitive, non-intrusive, consistent, assertive). Parents are an untapped resource. Build on child and family strengths and abilities (rather than focus on only problems) Trans-disciplinary teaming and staff support, include parents and family, shared decision-making, links to other support services, mapping of community resources 1 st 1000 days to City of Cape Town Health 27

Way Forward Op ? r tu co lla for niti es bo ra tio n po Health Interventions Intersectorial interventions Communication 1 st 1000 days to City of Cape Town Health 28

From Interventions to Packages and Platforms Interventions need to be packaged taking into Delivery Platforms need to be consideration the Identified for services unique set of risks and adversities that define complex environments & nurturing care Interventions are Implemented by single sectors , Slide presentation, . Pia Britto, UNICEF , DOHa. D conference November 2015

Promoting Integrated Service Models for 1 st 1000 days (1) ) 30 Source: “The Essential Package”, Ilifa Labanthana

Promoting Integrated Service Models for 1 st 1000 days (2) Ref: UNICEF ECD Update Workshop, 2014 31

Working with what we have Help create awareness: share what we have and what we know: “ 5 loaves & 2 fishes” principle The First 1000 days: a unique and powerful opportunity to facilitate changed life trajectories for children and society as a whole Optimise the Starting Points, “ 1 st 1000 day Champions” (badges), Roll -out training, use Resources (flashdrive), Recognise and strengthen the networks, Improve service point linkages Partner & Engage (use/expand existing platforms eg ECD’s, Subdistrict MCH working groups, ISDMT’s, community dialogues, NGO’s) Map resources and referral pathways 1 st 1000 days to City of Cape Town Health 32

Using existing mechanisms Provincial Clinical Governance structures : • Paediatrics, Obstetrics, Mental Health, Emergency Care • Metro Family Medicine Specilalists Forum, Nurses Forums District service coordination mechanisms • District Maternal /Child /Mental Health Forums Regional Training Centre and sub-district trainers Liaison structures Partnering with local Municipalities 1 st 1000 days to City of Cape Town Health 33

Some Action Points Know your service environment Map of Social services & supportive counselling for referrals from clinics Available Parenting Information and Support Programs Local district/sub-district intersectoral liaison committees/structures M&E: Know the relevant Indicators (MNCH&N Dashboard) Health Promotion: Health & Wellness in Pregnancy (1 st 1000 Days IEC tick list) Food security during pregnancy Community components: Prevention Intimate Partner Violence, Safe play environments Pregnancy prevention & parental readiness/planning (Do. E) Child supervision (Road/Pedestrian Safety) Community dialogues re data on pregnant women and infants at risk First 1000 days W Cape Transversal Communications Workshop 14 May 2015 34

Resources & Support First 1000 Days Initiative Roadshow Resources Roadshow presentations and videos (Flashdrive) 1 st 1000 Day Trailer (16 slides) for staff orientation (Flashdrive) 1 st 1000 Day Flyers (hand-out today) 1 st 1000 Day Champion Badges (hand-out today) 1 st 1000 Day related existing Health Promotion Materials (listed on Flashdrive) & masterfile Provincial support: First 1000 Days = W Cape DOH OPEXCO Key Priority First 1000 Day Initiative point persons: EXCO Chair: Hilary Goeiman; Parent Infant Child Health & Wellness (1 st 1000 Days PSG 3 Intersectorial WG) Chair: Elmarie Malek RTC Training on Empathetic skills, etc Metro support: Metro GSA planning a session on 1 st 1000 Days Initiative Metro 1 st 1000 Day Point Persons: Co. CT: Dr De Azevedo; MDHS: Family Medicine Clinicians and District Paediatricians (Dr J days Giddy, Dr. Town M Health Hendricks, Dr T Wessels), other 35 1 st 1000 to City of Cape

Flyers & Badges & more. . Button Badges for Facility Champions Flyers (in 3 languages): English, Afrikaans, Xhosa Communication Campaign Key messages combined pamphlet (to follow) W Cape Province Website (First 1000 Days launch radio-interview) 1 st 1000 days to City of Cape Town Health 36

Many things we need can wait. The child cannot. Now is the time his bones are formed, his mind developed. To him we cannot say tomorrow, his name is today. Gabriela Mistral 1 st 1000 days to City of Cape Town Health 37