Child Development, Social Protection Clinical Trial
Official title:
Effectiveness Trial of a Family Home Visiting Intervention to Promote Early Child Development Among Families Served by the Social Protection System in Rwanda
The proposed study will test the effectiveness of the Strong Families, Thriving Children "Sugira Muryango" program as delivered by community based workers and aligned with the Rwandan social protection system. Sugira Muryango is a preventive, family-based model that uses home visiting and coaching to encourage responsive parent-child interactions and discourage violence and harsh punishment targeting families living in extreme poverty. Integration of scalable, cost-effective interventions into poverty-reduction and other social welfare programs has great potential as an effective means to promote child development and reduce familial violence and in a range of culturally diverse, low-resource settings.
Globally, more than 200 million children may not reach their full developmental potential due
to poverty and adversity. This is most evident in World Bank-classified Low- and
Middle-Income Countries (LMICs) struggling with the confluence of war, community violence,
poverty and disease. Research across a range of cultures and settings finds that children
living in compounded adversity face increased risks of poor child development outcomes and
emotional and behavioral problems that can perpetuate a cycle of poverty and violence.
Integrated programs and family-based interventions for promoting child development, healthy
parent-child relationships and reducing household violence affecting children are
insufficiently tested in culturally diverse and low-resource settings despite compelling data
about such risks. The proposed study will investigate the effectiveness of the Sugira
Muryango program as an innovative approach to early childhood development promotion. Sugira
Muryango is a preventive, family-based model that uses home visiting and caregiver coaching;
it encourages responsive caregiver-child interactions and discourages violence and harsh
punishment among families living in extreme poverty. By providing home-based coaching that
helps parents manage stress, reduce harsh punishment and engage in responsive parenting with
early childhood stimulation, it is possible to effect improvements in parent-child
relationships and child development outcomes. Sugira Muryango will be implemented alongside
Rwanda's flagship poverty reduction initiative, Vision 2020 Umurenge Program (VUP). Classic
VUP components mainly focus on cash-for-work on labor intensive public works projects. With
government and development partner support, VUP is piloting a more enhanced public works
model that has child and gender sensitive components, with flexible public works options that
are closer to beneficiary households. Along such the expanded public works program currently
under pilot by VUP, a minimum graduation package is also available, which is providing
additional variables of financial literacy, asset transfers, skills training, and
sensitizations surrounding a range of topics (e.g., education, health, nutrition).
A four-arm cluster randomized trial (CRT) will enroll 1,040 VUP-eligible families with
children aged 6-36 months to compare outcomes among children and parents in families
receiving: (1) Control/Classic VUP, (2) Expanded VUP, (3) Combined Classic VUP plus Sugira
Muryango and (4) Combined Expanded VUP plus Sugira Muryango. A cost analysis will provide
practical information on the feasibility and cost of integrating Sugira Muryango into VUP
programming and a process evaluation will produce useful implementation tools for
dissemination and scale-up.
Study Aims are to (1) assess effectiveness of Sugira Muryango in promoting responsive
parenting, reducing violence and harsh punishment and promoting early child development in
families living in poverty; (2) to assess the interaction between Sugira Muryano and
classic/expanded VUP programming and (3) to assess costs, barriers and facilitators of
integrating the Sugira Muryango package into VUP or other government programming, such as the
Ministry of Gender and Family Promotion (MIGEPROF), which holds the early childhood
development mandate. This initiative seeks to promote cross sectoral and ministerial
collaboration, a key pillar of the Government of Rwanda.
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