Innovation summary

In Pakistan, like most developing countries, early child development is a grossly neglected area of public health. There is inadequate measurement of early child development, and little assessment of the determinants of brain development. Around 15% of young children living in Pakistan have hindered development.1

In a context where women have limited access to early child development care because public hospitals are overloaded, many private clinics simply do not offer the service, or families simply cannot afford the care, this innovation offers an integrated package to overcome these context hurdles. The integrated package will consist of a set of guidelines and tools for private clinics to promote optimal early development of low-income urban children in the first year of life, through a public-private partnership. 

Impact summary

  • 1,100 child-mother pairs will have access to early child development and maternal mental health care package 

This innovation is funded by Grand Challenges Canada.

Innovation details

The innovation aims to develop and evaluate a set of child development and maternal care tools and materials for the private clinics to promote urban children’s brain development in the first year of their life. The delivery of child development care (including maternal mental health) through private clinics has never been tested before in Pakistan. Though there is an existing countrywide network of private clinics and small hospitals, they are unregulated. These clinics provide more than two-thirds of primary health care in urban regions.

The  three main objectives are:

  • To develop an integrated early child development care package with three key components: child development, nutrition counseling, and maternal mental health
  • To arrange, implement, and monitor the care package at 11 selected private clinics
  • To evaluate the intervention’s effectiveness and feasibility through a randomized controlled trial and associated costing and qualitative studies

Content of the Project

The innovation will enable the local district health office to support selected private clinics/ hospitals to offer the child development care package to mothers and young children living in poor urban localities. The respective district health offices will be engaged primarily in:

  • Mapping and selecting the private clinics on predefined mapping guidelines(in progress)
  • Training clinical staff
  • Enabling community advocates
  • Monitoring ECD care delivery at selected private clinics

An average of five community advocates will be enabled in the catchment population of each private clinic to generate awareness about the services of this program to mobilize mothers and their families.

At each selected clinic, the ECD care will be integrated into the routine primary health care package. The child-mother pair enrolled for the intervention will visit the clinic on quarterly basis. Since the clinics have already a set pricing and payment modality, the intervention will not intervene on the pricing and/or payment arrangements between the clinic and the respective client.

Upon the visit, each registered mother will be counseled, with the help of especially designed pictorial tools incorporating child brain development, child nutrition, and mother mental health. This counseling will be supplemented by providing mothers a brochure to take home as a reference. In case of depression, medicine will also be prescribed, if needed, as per agreed guidelines. 

Key drivers

Stakeholder Engagement

Continuous engagement of provincial programs, institutions, districts, private clinics and communities will help to make the intervention effective and sustainable.  


Patient Retention and Follow up

There is an anticipated challenge in patient retention/follow-up as maternal mental health and wellbeing is a preventive process which is not widely accepted by the community or by general practitioners as a ‘condition’ for which care should be sought. 


If the proposed intervention is found feasible and effective, it will be scaled to 40 districts in Pakistan (covering an urban population of more than 35 million), where district-steered public-private partnerships are already being implemented for TB and/or malaria control interventions. 



Evaluation methods

The intervention will be evaluated for effectiveness through a cluster randomized controlled trial and assessed by a reduction in the percent of child development delays at completion of first 12 months of life.

In addition, a qualitative study of tailor-made interview schedules will be conducted, to understand the perspectives of the clients and health service providers.  

Domains to be Assessed

The mother’s mental health and child’s motor skills, language development and cognitive development will be assessed and recorded at the time of initial registration and when the child reaches 12 – 15 months. 

Cost of implementation

An incremental cost-effectiveness analysis is planned for the second project year (last quarter of 2015 and three quarters of 2016). The analysis will use a set of tailor made cost estimation tools. 

Impact details

During the lifecycle of the grant, 1,100 mother-child dyads will be able to access the early child development and maternal mental health care package. In addition 44 doctors and paramedics in 11 private clinics will be trained and supported to practice the early child development care protocols.

The development delay in motor skills and language is anticipated to be prevented in 44 and 88 young children respectively; mental depression is anticipated to be prevented in 77 mothers with young children.


1. Poon J et al. (2010). Developmental Delay: Timely Identification and Assessment. Indian Pediatrics, 47: 415-422.

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