Research and Program Outcomes
Healthy Start Program:
Investing in the Filipino Children’s Future*
By Felicitas C. Rixhon
Executive Director, Consuelo Foundation Inc.**
We all have met or read about individuals who have grown up in undesirable family circumstances and yet, somehow, have been able to overcome barriers put before them. We hear their stories and wonder at the miracle of their transformation. It is sad to say that they are the exception. For every person who broke away from his disadvantaged situation, there are hundreds of thousands of Filipino children who did not beat the odds; born into a resource-poor household and living a life more deprived than their parents. Our vision for the children of Healthy Start is that Filipino children from poor, high-risk families will no longer fall behind their more advantaged peers because their parents, caregivers and communities provided a nurturing environment where they can grow, thrive, and learn.
Healthy Start is a comprehensive, community-based, early prevention and intervention program that has, for the past seven years, been successfully addressing the challenges of raising infants and young children in conditions of severe poverty. It is designed to improve family coping skills and functioning, promote positive nurturing parenting skills and parent child relationships, promote optimal child development, and as a result, prevent child abuse and neglect among impoverished families with 0-3 year old children. It supports the child’s development by supporting his family and his community.
Healthy Start is a voluntary program offered to parents prenatally or shortly after the birth of a child. For 3 years, parents are visited in their homes and grouped with their neighbors who have children within a 3-month age difference. During regular group meetings, parents learn new information about early brain development, nurturing childcare practices and simple learning activities to enjoy with their children. They have the opportunity to share their own knowledge and opinions on childcare as well as on family values, goal setting, communication and conflict resolution. Parallel to the family strengthening efforts, program staff undertakes referral, advocacy and networking activities focused on communities, local government agencies and other non-government organizations, not only to increase the families’ access to basic services, but also to sustain the continuity of the program.
Healthy Start aims to eliminate the root causes of poverty, child abandonment, violence and destructive parenting practices by:
- Continually focusing on strengthening the parent-child relationship during home visits and group sessions, providing motivation for parents to support their child’s health, development and education.
- Supporting parents’ active utilization of pre and post-natal services, well-baby check-ups, weight monitoring and feeding services, immunization, developmental screening, and other preventive health services.
- Anchoring learning through activities for both parents and children including the use of toys made from recycled and indigenous materials.
- Using a process called Individual Family Support Planning whereby parents are able to think critically and reach responsible decisions regarding parenting based on their dreams for their children.
- Encouraging joint decision and action by parents on family size and child spacing.
- Reducing the parental isolation and depression associated with living in urban squatter or poor rural communities.
- Developing community leaders by cultivating the self-confidence and communication skills of family support workers.
Program Replication and Adaptation
The Healthy Start Philippine Program traces its roots to a home visitation program initiated in Leeward, Oahu, Hawaii in 1985. The success of this US program prompted Consuelo Foundation to introduce it to the Philippines seven years ago in partnership with Great Kids, Inc., a US-based, nonprofit training and consultation firm, whose directors at that time were involved in piloting the Healthy Start Hawaii program.
Consuelo Alger Foundation funded two pilot sites in the Philippines in 1996. The first two sites are located in Paco, Manila, and in Bacolod City, Negros Occidental. Since then, three more sites have been opened: in San Carlos City in 1999, Negros Occidental; in Dumaguete City, Negros Oriental in 2001; and Malapatan, in Sarangani Province in 2002. Christian Children’s Fund is funding a similar program called Growing Great Families in several sites in Quezon Province and Nueva Ecija since year 2000. To date, over 1,700 families have already benefited from Healthy Start.
While the Philippine sites are still carrying the name Healthy Start, the program has undergone significant adaptations to contextualize it to local conditions. Among these model adaptations are:
- Use of paraprofessionals as Family Support Workers or FSWs on a half-time basis to bring down the implementation cost. FSWs, the primary contact of families to the project, were recruited from the target communities. The US model uses full-time staff.
- Interactive group discussions were incorporated into a purely home visitation model, to reach more families and break the social isolation of parents.
- A father-involvement component was added to entice fathers to join the Healthy Start activities. Sessions involving fathers focus on skills training, value orientation, and reproductive health.
- The nutritional and medical assistance became part of the services directly provided to families by Healthy Start staff. These are not offered in the Hawaii program.
- Referral, advocacy and networking activities were focused on the Local Government Units, not only for provision of social and health services to the enrolled families, but also as a means to sustain the continuity of the program.
An important milestone in the adaptation process was the development of a parenting and child development curriculum called Growing Great Kids or GGK. Development work started in 1998 in answer to the expressed need of the Philippine sites for a curriculum that will assist family support workers in choosing the content and focus of home visits and group sessions. The curriculum was pilot tested in the Manila and Bacolod sites in 1999 and was finalized in 2000.
Beginning prenatally, the GGK curriculum supports the development of nurturing parent-child relations for 0 to 3 years old. It does so by focusing on:
- Basic care, health and nutrition
- Growing parental empathy and nurturing relationships
- Practical suggestions on physical protection, safety and regulation for every stage of development of young children
- Providing experiences and stimulation to suit different temperaments of children
- Interesting, fun and developmentally appropriates activities that parents can do with their children
- Practical options for parents to take in providing child guidance and discipline
- Brain development during the first three years and how parents can enhance this window of learning opportunity
- Reading baby’s cues and communication and the importance of language development for school success.
An accompanying set of modules called Growing Great Families focuses on enhancing family functioning. It emphasizes the benefits of connecting families to each other and to the community, and the critical need to develop empathy in children. It contains activities on values clarification, writing and working on goals, family planning and problem solving.
Workers and supervisors attest that it provides the structure for each home visit and group. It also provides a framework for supervision specific to age appropriate development of the target child and parenting issues. The curriculum that has been developed for the Philippine sites is now also being used in the US and in Canada.
Program Impact
Our work in the last seven years has demonstrated the effectiveness of the Healthy Start approach as contextualized for local conditions. Four studies on Healthy Start and the Growing Great Families, have shown that the model is effective in changing parenting practices and child health indicators of even those families living in the most severe poverty.
The first study was a mid-term process evaluation conducted in 1999 in the HS-Bacolod and HS-Manila pilot sites. An impact evaluation was later conducted in 2002 to compare the conditions of enrolled families in the HS Bacolod site with families in another barangay that did not receive Healthy Start services. A third study in 2000, commissioned by an independent non-government organization, looked into the needs of very young children in two low-income communities in Metro Manila--the Healthy Start- Manila site and one providing a comparison group. The last study is the project assessment of the Christian Children’s Fund’s first three Growing Great Families project sites. The GGF was assessed in 2002 after the first year of implementation.
Let us look at what the statistics are saying about the Healthy Start model.
The reports say that the program has improved the child’s general health and welfare.
- The 1999 study of the Bacolod and Manila sites documented that target children improved in their nutritional status: 3rd degree malnutrition was eliminated for newborn babies in the Bacolod site. The same report mentioned that children's general health, weight and immunizations were well monitored.
- The 2002 impact evaluation of HS Bacolod showed that 85% of children
were fully immunized by age 2. The control group
only has 69% immunization rate.
- Malnutrition among target children declined from 36% during the first year to 26% during the final year of implementation.
- Mortality rate among the HS children below 5 is 7%. The control group has a child mortality rate of 11%.
- The incidence of child abuse and neglect among HS families is 7%. In the control group, the incidence of child abuse and neglect is 34%.
- In the assessment conducted of CCF’s Growing Great Families sites, the report showed that 84% of target children became healthier. Their parents reported a reduction in cases of simple illnesses like colds, cough and fever. 90% of enrolled children received recommended immunization, while 76% gained normal weight.
The reports attest that parents and caregivers showed improvements in childcare practices and family life.
Among parents and caregivers, the evaluators were able to document the following behavioral repertoire that showed Healthy Start’s impact on caregiving and family functioning:
- In the Bacolod site, 84% breastfed their children while in the control group it is 48%. 75% of families in the HS site practice or subscribe to family planning while in the control group; it is just 50% of the families.
- The 1999 study that compared the HS Manila site with a control
group showed that there are significant differences
between the sites even if the families have similar socio-economic conditions.
- 42% of mothers from the HS site said that their goals and aspirations for their children changed in the course of the program. Goals focused on meeting financial needs of children, gaining healthy status, giving full attention to baby, completing education, instilling proper values, having a good life free from vices, and marrying outside of the community. Only 10% of non-HS site respondents mentioned changes in goals for their children.
- More babies in the HS site, or 94%, follow a regular daily routine compared to only 48% of the non-HS mothers.
- 63% of mothers in the HS site indicated that they stopped unhelpful traditional beliefs in caring for their young children versus 36% in the non-HS site. HS mothers said they and learned from HS staff, doctors, and priests and observed themselves the ineffectiveness of such practices.
- Among the parent participants of the CCF-run program, the majority said that before their participation in Growing Great Families, they did not pay attention to the emotional needs of their babies as they thought that providing the basic needs for food, clothing and shelter is enough.
- 81% said they appreciate and enjoy spending time with their own children;
- 74% said that they treated children with respect.
- 75% are able to recognize and respond in a nurturing and sympathetic way to baby’s cues;
- 74% said they understand what to do to stimulate healthy brain development of own children;
- 48% disciplined their children using non-violent methods.
Community-based workers gained competencies in effectively delivering services.
At the level of the project implementers, the CCF assessment report indicated the following changes among the workers as a result of their participation in the GGF:
- 85% of the parent-facilitators, the equivalent of the family support workers, said that they developed confidence with other people
- 85% said they gained knowledge on child care and family strengthening
- 71% gained skills in facilitating, communication and documentation
- 85% have better relation with husband and children and other family members
- 85% are more actively involved in community and barangay activities.
All of the workers surveyed claimed that the GGK curriculum helped them in their work “because the modules specified the steps that families should undergo for effective childcare.”
Collaborative Partnership with Other Organizations
These assessment and evaluation of Healthy Start sites in the Philippines have propelled Consuelo Foundation’s plans to bring the program to scale. After seven years of testing, adapting and fine-tuning the model, we are now ready to expand Healthy Start’s coverage to more children, more families, more communities, and to more LGUs. We are inviting organizations in the ECD sector —both governmental and non-government— to look closer at how this approach works for the prevention of child abuse and neglect.
We are looking for partners who operate in sites where the need for ECD intervention is great as indicated by current child development indices. Concentration of high-risk families in a geographic area will also be considered in the choice of sites not only because it is in these areas where family dysfunction will be more prevalent but also the operational costs will be lower.
We are likewise looking into the readiness of local government units or partner organizations to assume partial costs of the project. We believe that the strong support of the LGU or partner organization for Healthy Start, manifested by its willingness to invest its own resources, already provides a higher chance for the project to be sustainable after our funding stops.
The presence of community resources which can be tapped to provide other services needed by the target families is an important factor in site selection. Since the success of Healthy Start relies on a strong referral system, community resources like the availability of health services in the area, livelihood projects or pre-school or day care centers will greatly improve child development indicators.
For our partners, we provide orientation and technical assistance in setting up the project management structure, staff selection, staff training, caseload assignment and quality management. Our support also consists of training family support workers on the use of the GGK curriculum as well as guiding supervisors in setting up a competency-based supervision to sustain transfer of learning from training to actual field practice. Consuelo continues its support after the initial training phase by assisting partners in setting up a documentation system that keeps track of project milestones. For three years, our partners receive quarterly monitoring, field visits, assessment, and strength-based feedback to project staff to ensure effective delivery of service.
With the joint investment of Consuelo and its program partners, we believe we can greatly increase the impact of Healthy Start. Let me end my presentation by quoting a few lines from the poem, Children Learn What They Live.
If children live with criticism, they learn to condemn
If children live with hostility, they learn to fight
If children life with fear, they learn to be apprehensive
If children live with tolerance, they learn to be patient
If children live with encouragement, they learn confidence
If children live with approval, they learn to like themselves
If children live with acceptance, they learn to find love in
the world.
Let us work together in providing the very young Filipino child, a healthier, safer, more compassionate world.
*Paper presented during the Philippine Pre-Conference to the 2nd International Conference” Children and Residential care/New Strategies for a New Millenium held on March 12-14, 2003 at the Bayview Hotel, Manila.
**The author acknowledges the assistance of Abigail Belza of Great Kids Inc. in preparing this presentation.
Overview : A Global Approach : Orphanage Training Programs : Adopt An Orphanage : Research & Program Outcomes