Improving Early Childhood Development for children with disabilities in Osun State, Nigeria

As part of the Global Health Workforce Programme (GHWP), the Health Partnership between Obafemi Awolowo University Teaching Hospital (OAUTHC) and the Royal College of Paediatrics and Child Health (RCPCH) is working to address this defecit in care. The GHWP is funded by the UK Department of Health and Social Care and managed by Global Health Partnerships (GHP – formerly THET), with Ducit Blue Solutions acting as local grant managers for Nigeria. 

In line with the Federal Ministry of Health’s commitment to: “ensure the survival, optimal growth, and development of all children in Nigeria”[2] this project aims to bridge the gap in the lack of identification and adequate early interventions for children with developmental delays and disabilities in Osun State, Nigeria by:  

• strengthening the capacity of frontline workers to identify and address ECD delays through the introduction of the Malawi Development Assessment Tool (MDAT), a developmental assessment tool, adapted for primary, secondary and tertiary levels of health service delivery implementing an effective referral pathway from primary clinics to secondary and tertiary level care 
• developing a centre of excellence with skilled multidisciplinary staff to provide specialist assessment and interventions  
• piloting an ECD strategy for the identification and management of children with developmental delays and disabilities, and 
• running caregiver support groups known as ‘Baby Ubuntu’ where caregivers can share knowledge and experiences, contributing towards inclusion and better care for children with disabilities. 

Early intervention is key to improving care for children with disabilities. Neural circuits, which form the foundation for learning, behaviour, and health, are most flexible during the first three years of life. The lack of ECD services in Osun State creates a significant gap between hospital care around the time of birth, and school health screening, which typically starts around age five. This gap can lead to developmental challenges becoming “locked in” as life-long disabilities, exacerbating individual and household exclusion and undermining social and economic development potential. For children with early developmental delays and disabilities, early identification, diagnostic understanding, and appropriate referral are crucial for ensuring that any emerging delays or disabilities are addressed as early as possible. 

The National Health Policy aims to provide UHC to all Nigerians, with the main policy goal being to strengthen Nigeria’s health system, with a focus on primary health care (PHC) to deliver effective efficient, equitable and accessible health services.[3] The project delivered by this Health Partnership contributes towards national policy by looking to train and improve the skills of Health Workers in early identification, referral and treatment of Early Child Development across all levels of the health system, with particular focus on Primary Healthcare delivery. 

So far the Health Partnership has set up five Baby Ubuntu groups which host 10 families each, reaching 50 caregivers within the first year of the project. They aim to reach an additional 60 caregivers if the programme is extended. The support groups are proving invaluable to caregivers, creating a space for learning how to care for the special needs of their children and for sharing their challenges and gaining emotional support from peers.   

As of September 2024, the Health Partnership has delivered training to 278 frontline health workers in Osun State in early identification and referral, as well as implementing a functional referral system from Primary Health Centres to OAUTHC.  

Following the training delivered as part of the Global Health Workforce Programme, paediatric clinicians in OAUTHC reported feeling more comfortable and empowered in managing and referring cases of childhood developmental delay:  

It is clear from Dr Samuel Ojo’s testimonial that the training delivered by this Health Partnership has improved the confidence of Paediatric Clinicians to provide appropriate care and referrals for children presenting with developmental delays and disabilities. 

“It’s going to improve the care outcomes because early identification will enable early management. Before, I would just know that this child’s development is delayed, but with the MDAT tool, we’re able to categorise the children with disabilities into care pathways.

So for me, it has improved the care, it has improved the level of confidence for me and my co-workers, it has improved the level at which we relate to this patient and offer care and attendance. So, with the development tool being systematic and very objective, it helps us to identify points of challenge, and other factors that may be contributing to the challenge. Now, we have more referrals, and it’s because there’s more awareness and a perceived solution to the challenge”.