Leadership and Governance for Child Development

Leadership and governance are foundational to creating policies, accountability mechanisms, and coordination to support nurturing care within PHC systems. Strong leadership can help mobilize investment, strengthen oversight, elevate community voices, and promote transparency in implementation. It also creates the enabling environment needed for the other health system building blocks — health workforce, information systems, financing, and service delivery — to function effectively.

Enabling factors for strong leadership and governance to improve child development outcomes

Four enabling factors are essential to strengthening leadership and governance for improved child development outcomes.

1. Policies and plans clarify the role of PHC in nurturing care.

Clarifying how nurturing care fits within the PHC system can catalyze action. This may require building awareness among PHC and health sector decision-makers about what nurturing care means and how PHC can support it (see Advocacy Strategies for PHC Decision-Makers below).

With shared understanding, nurturing care can be mainstreamed within existing PHC guidelines and help ensure key interventions are included in the basic benefit packages for universal health coverage. In addition, PHC leaders can dedicate resources for activities such as training and supervision, and promote accountability for high-quality service delivery.

Advocacy Strategies for PHC Decision-Makers

Raising awareness and support for nurturing care —particularly among PHC decision-makers and caregivers — is critical. Advocacy is needed for policies to better reflect nurturing care and for resource allocation to support delivery. Advocacy strategies include:

Strategic messaging around developmental science and the benefits nurturing care for health, education, and economic outcomes.
Cultivating champions within the government who can advocate for interventions, build investment cases, and establish dedicated teams within ministries.
Raising community awareness to encourage demand for government programs that support young children and families.

2. Roles are clear across all levels of government.

Successful implementation of both multisectoral and health-specific policies requires clear roles for all actors involved. Coordination from national to community levels is essential to ensure technical guidance is relevant and implemented effectively at the local level — particularly at the facility level.
Coordination structures within the health sector can ensure collaboration across departments and levels of health facilities, promote accountability, and support implementation of interventions that promote nurturing care across domains. This enables leaders to make informed decisions, take appropriate actions, and allocate the necessary resources to drive progress within the PHC system to promote optimal child development.

3. Mechanisms are in place to monitor implementation of policies and plans.

Government commitment to nurturing care should be reflected not only in relevant health sector policies and plans, but also in effective implementation and service delivery. Tracking progress toward these goals (see Topic 6: Health Information Systems) can help strengthen accountability and transparency and assess whether plans are being implemented effectively.
Collecting feedback from caregivers can also help identify gaps in service delivery and implementation and promote accountability and transparency.

4. A multisectoral policy framework facilitates coordination across sectors.

Interventions that promote nurturing care are provided across multiple sectors – such as health, education, social protection, and agriculture – and through government, civil society, and private-sector organizations. Currently, many countries rely on a patchwork of different frameworks and strategic plans to cover all aspects of nurturing care.

Multisectoral policies can help establish a more coordinated and supportive environment for nurturing care. Nearly 100 countries and territories have adopted multisectoral policy frameworks to promote early childhood development. These policies, particularly when costed, are crucial to harmonizing various elements of sectoral policies and services and facilitate greater coordination and collaboration among sectors.

Examples of specific actions that PHC decision makers can take to realize these conditions include:

Hosting learning and sensitization sessions for health leadership on PHC’s role in promoting optimal child development.
Incorporating interventions that promote child development in existing national health plans, policies, and guidelines.
Including indicators around nurturing care and child development outcomes in health sector reviews.

Case Study: Promoting nurturing care in Ethiopia’s primary health care system

Read the case study

Ethiopia has made significant progress in reducing infant and child mortality and advancing nurturing care through the health sector. In 2019, the Government of Ethiopia revised its national Early Childhood Care and Education framework and developed a National Health Sector Strategic Plan for Early Childhood Development to better promote nurturing care in PHC services. The plan was informed by a situational analysis that identified gaps in responsive caregiving, early learning, cross-sectoral coordination, and provider awareness. In response, Ethiopia strengthened nurturing care in maternal and child health services, expanded provider training, clarified roles and responsibilities across the health system, and strengthened coordination across sectors and levels of government. Champions within government also played a critical role in advancing the agenda, supporting policy development and national sensitization efforts, and implementation.

Since the plan’s launch, Ethiopia has taken concrete steps toward national scale-up, including developing implementation guidelines, revising training materials, and training and deploying 5,000 parental coaches in Addis Ababa. Work to expand and sustain these efforts across the health system continues.

To learn more about Ethiopia’s experience, key lessons, and implementation approach, read the entire case study in the full toolkit PDF.

The following additional resources can be found via the link below, or by downloading the full toolkit PDF :

Resource 6 includes a table with the full list of enabling factors and corresponding actions for Leadership and Governance.
Resource 7 includes reflection questions to support discussion and planning related to Leadership and Governance.
Resource 8 features a list of resources for health sector leadership with guidance on what nurturing care is and how it can be operationalized.