Resources and Tools for Promoting Nurturing Care in PHC

A presentation template that:

• Helps deepen PHC decision-makers’ understanding of how to promote nurturing care for optimal child development in PHC services.
• Makes the case for strengthening PHC for optimal child development, reviews ongoing global and country-engagement efforts, and examines how health leaders can adopt a systems approach to strengthening and promoting nurturing care within PHC.

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A guidance document for conducting a “stocktaking exercise” to understand the strengths and challenges of ongoing efforts to promote nurturing care in PHC and to identify further opportunities. It includes illustrative data collection methods, guiding research questions, and key stakeholders to consult as part of a stocktaking process.

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A sample agenda for a multi-stakeholder participatory workshop to develop an action plan for promoting optimal child development in PHC. It includes session guidance, workshop materials, and a theory of change to help participants develop the action plan.

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A costing tool to support PHC decision-makers in costing health systems priorities for promoting nurturing are, using a structured, activity-based approach. It aims to clarify the policy and financing decisions the tool is meant to inform, set clear expectations on scope, level of detail, and time horizon, and reduce misuse, duplication of effort, and unnecessary analytical complexity.

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An illustrative list of interventions that promote nurturing care for optimal child development in PHC.

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The full list of enabling factors and corresponding actions for each health systems building block.

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A list of reflection questions to support discussion and planning related to each health systems building block.

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A list of tools to support the strengthening of PHC to promote nurturing care for optimal child development across each building block.

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• Reach Up and Learn: Reach Up and Learn is a home visiting program that provides caregivers in LMICs with skills to promote responsive care and early learning to their children. The program, which has been adapted to a group session format, has a comprehensive training package for trainers, supervisors, and home visitors. It is based on the Jamaica Home Visit intervention and has been used in several countries.
• The Responsive Caregiving and Early Learning (RCEL) Addendum: The RCEL consists of a set of counseling cards and accompanying training and implementation materials for incorporating counseling on responsive caregiving and opportunities for early learning into existing child health and nutrition platforms. RCEL has been tested in Ghana and the Kyrgyz Republic.
• The Essential Package (EP): Early Stimulation and Responsive Parenting: The EP is a set of tools and guides for policy makers, program managers, and service providers to use to address unique needs and competencies of young children, particularly those affected by HIV/AIDS. The tools include an implementation guide, M&E framework, data collection checklist, policy brief, and counseling cards and a visual reference guide for home visitors.
• Care for Child Development (CCD): CCD is an intervention by WHO and UNICEF that promotes early learning and responsive caregiving by guiding caregivers on play and communication activities that promote motor, cognitive-language, and social-emotional skills and coaching caregivers to observe, interpret and respond to their child’s signals. It includes a participant manual, counselling cards, facilitator notes, guidance for clinical practice, M&E framework, and a poster with recommendations for play activities.
• Caring for the Caregiver (CFC): CFC is a training module being developed by UNICEF to equip front-line workers with counseling skills to support the emotional well-being of caregivers in resource-constrained low- and middle-income countries, recognizing the importance of caregiver mental health for optimal child development.
• Integrated Management of Childhood Illness (IMCI): IMCI is an approach by the WHO that promotes child health and wellbeing by improving case management, quality of care, and community health practices for health, growth and development. In facility settings, IMCI helps promote identification and treatment of childhood illness, enhance caretaker counselling, and referrals for severely ill children. In home settings, IMCI promotes care seeking behavior, improved nutrition and support for ECD, illness prevention, and treatment adherence. The package includes IMCI training manuals and videos, resources for implementation, and an online course.
• Building Brains: Building Brains is an approach by Save the Children that provides a guide for implementing responsive caregiving and stimulation programs using different sector platforms. Key activities include conducting situational analysis, influencing systems and policies, monitoring and evaluation, delivering content on communication, play and responsive care through selected contact points, and building workforce capacity.
• Thinking Healthy: Thinking Healthy is an evidence-based approach that guides community health workers (or other non-specialists) through low-intensity, cognitive behavioral techniques to address maternal depression as part of their routine work. The Thinking Healthy program consists of 5 modules and 16 sessions and targets mothers experiencing depression during the period from pregnancy to one year postpartum. A digital version is also available (see here).

• Early Childhood Development: A Critical Investment: This video course was developed to support policymakers in understanding the scientific and economic rationale for investing in optimal child development, the concept of nurturing care and developing policies for young children and families.
• Operationalizing nurturing care for early childhood development: The health sector alongside other sectors and actors (2019): This guidance note specifically targets the health sector and aims to catalyze country-level dialogue and action focusing on health service delivery and systems strengthening while also outlining complementary actions by other sectors.
• Scaling What Works for Early Childhood Development: Compendium of Good Practices in ECD Policies and Programs in Eastern and Southern Africa and beyond (2025): This compendium documents good practices in scaling ECD policies and programs across Kenya, Uganda, Tanzania, Mozambique, Rwanda, Zambia, Zimbabwe, and beyond, organized around the five Nurturing Care Framework components and covering multisectoral service delivery, governance, financing, community mobilization, and M&E — including examples of integrated cash-plus models embedded in primary health care and health-system integration of ECD.
• Nurturing Care Handbook: Lead and Invest (2023): This guide corresponds to the first strategic action in the Nurturing Care Framework and explores how to do governance, planning, and financing
• WHO Guideline: Improving Early Childhood Development (2020): This guideline provides direction for strengthening policies and programs to better address early childhood development, with recommendations for caregivers, health professionals, and policy-makers.

• ECDI2030 Technical Manual: This resource explains the ECDI2030 tool to monitor progress against SDG indicator 4.2.1 and the rationale for developing it. It points users to the suite of resources available to use the ECDI2030, including guidance and implementation tools (interviewer guidelines, training materials, syntaxes, tabulation plans, reporting templates).
• Global Scales for Early Development (GSED): WHO is developing the GSED package to provide population and programmatic measures for ECD for 0-3 years. It collects information across all domains of ECD and calculates a D-score and development-for-age score (DAZ) for comparison.
• ECDAN Countdown to 2030: ECD Country Profiles: UNICEF and Countdown to 2030 Women’s, Children’s, and Adolescent’s Health developed these country profiles with the launch of the Nurturing Care Framework. The profiles are available for 197 countries and were last updated in 2023. The profiles show 40 ECD-relevant indicators and are available in 5 languages (English, Arabic, French, Russian, and Spanish).
• WHO Nurturing Care Handbook – Section 4: Monitoring Progress: This section of the Nurturing Care Handbook provides information and guidance on how to monitor implementation of the Nurturing Care Framework. It outlines the NCF logic model, provides example indicators via the Countdown to 2030 country profiles, and suggests actions to overcome common barriers to monitoring. The Annex includes the NCF 24 core indicators across the 5 domains of nurturing care and internationally validate milestones for monitoring.
• WHO Nurturing Care Framework – The Logic Model: The Logic Model section of the Nurturing Care Framework provides an overview of inputs, outputs, and outcomes that can support health programs in gathering data on interventions and reporting that promote more comprehensively on ECD outcomes.
• Toolkit for Measuring Early Childhood Development in Low- and Middle-income Countries: This World Bank toolkit “provides a practical, ‘how-to’ guide for selection and adaptation of child development measures for use in low- and middle-income countries. Users can follow the proposed step-by-step process to select, adapt, implement, and analyze early childhood development data for diverse purposes and projects. Researchers, evaluators, and program personnel from various disciplines interested in assessing early childhood development in LMICs will find the book useful for planning and evaluating interventions, monitoring development over time, or conducting a situation analysis.”
• ECD Measurement Inventory: Accompanies the Toolkit above and “contains 147 measurement tools for children under 8 years. For each test it reports the domains assessed, age range for which the tool is appropriate, method of administration, purpose of the assessment, origin and locations of use, logistics, and cost.”
• Washington Group / UNICEF Child Functioning Module (CFM): The CFM is a questionnaire administered to parents or caregivers to identify children aged 2-4 with disability. It assesses difficulties in: vision, hearing, mobility, communication and comprehension, behavior and learning, and dexterity and playing.
• Responsive Interactions for Learning (RIFL) Observation Tool: These assessment tools from the University of Toronto support primary care workers to measure interaction quality between a parent or caregiver and his or her child. It assesses responsivity in interactions across family members by measuring three categories of responsive behavior – communicative clarity, mind-reading, and mutuality building.
• UNICEF’s Program Guidance for Early Childhood Development: UNICEF’s program guidance for early childhood development is available in English, French, and Spanish. It provides a framework to articulate a vision, goals, and indicators linked to commitments for ECD within the SDGs and identify intervention packages, delivery platforms, and implementation strategies.

• Brookings Childhood Cost Calculator: The Brookings Institution Childhood Cost Calculator is an online tool that calculates total and unit costs and identifies cost drivers of past, current, or future programs. This tool can be used to cost health sector and PHC implementation plans that incorporate services that promote nurturing care and make an investment case.
• Cost of Inaction Tool: The Cost of Inaction (COI) Tool is a simple and accessible program for ex-ante economic evaluations of nurturing care interventions. It calculates the COI, which is the net economic benefits foregone in a country for not investing in specific nurturing care services. These estimates can be used to persuade policymakers and other funding stakeholders of the importance of investing in services that promote nurturing care.
• UNICEF ECD Budget Analysis Guide: UNICEF’s Estimating Government Spending on Early Childhood Development: A Methodological Guide is a technical resource that outlines a stepwise process for analyzing government budgets to determine the scale and composition of public investments in services that promote nurturing care. Its primary aim is to provide policymakers, civil society organizations, and development partners with a clear methodology to measure and report on ECD spending. The guide primarily focuses on evaluating investments by national and local governments, placing less emphasis on off-budget expenditures by private sector providers.
• JPAL Cost Effectiveness Analysis Tool: The JPAL Cost-Effectiveness Analysis Tool is a resource intended for researchers who are interested in collecting cost data and conducting comparative cost-effectiveness analysis (CEA) for education programs. The resource provides tools and guidelines to help users generate the data needed for CEA (i.e., an estimate of the cost of the program and the program’s impact).