Process evaluation of integrated early child development care at private clinics in poor urban Pakistan: a mixed methods study

Article Figures & Data

Box 1. Early child development care in private GP clinics (adapted from the published protocol). ¹⁰

Intervention clinics

Mother–child care^a

Standard counselling session using pictorial flipbook:
- childhood nutrition
- development
- maternal mental health
Assessment and treatment (including referral to specialist) of childhood nutrition, development, or maternal depression.
Follow-up of mother–child pairs in clinic at 3, 6 and 9 months (including SMS or telephone reminder, if required)

Training of private doctors and clinic assistants

Clinic assistants training:
- Conducting a standardised counselling session using the flipbook
- Measurement and recording child length and weight

Private GPs training:
- Clinical management of children with malnutrition and developmental delays in the private clinic setting.
- How to assess the mother–child pair for a specialist referral, when required, to the appropriate public tertiary care facility.

Box 2. Logic model summary (adapted from the published protocol). ¹⁰

	Inputs	Processes and actions	Intended
	Inputs	Processes and actions	Changes	Outputs	Outcomes
Intervention	Contextualised counselling tool Training of private GPs and clinic assistants – technical and practical training	Quarterly counselling for mothers (child development, child nutrition, maternal mental health) Assessment and treatment of child developmental delays (may include referral)	Clinic staff knowledge, skills, and resources	ECD care delivered, as per protocol, at the clinics ECD care uptake by mothers	Reduced child developmental delays at 12 months of age
Both intervention and control arms	District endorsement Community advocates Child Growth Cards Infant weighing scale and infantometer	Recruitment of mother–child pairs referred by community advocates		Adequate participant recruitment and recording data

Box 3. ECD task categories, indicators and data collection methods.

Task categories	Process indicators and data collection methods
Task categories	Quantitative	Qualitative
Organisational
Provider engagement and public–private partnership	Number of clinics reviewed and short-listed for selection Number of clinic doctors and clinic assistants trained	Types of clinics suitable for ECD care Objectivity and transparency of clinic selection
Community engagement through community advocates	Number of community advocates recruited for ECD care promotion Number/proportion of mother–child pairs referred by community advocates	Types of advocates engaged Enabling of advocates
Other	Attrition of clinics form ECD care intervention Number of monitoring visits	Any subsidy (by private clinics) on ECD care visits
Case management
Care delivery by private clinic assistant (structured counselling)	Number of mothers counseled	Integrating ECD counselling in routine care Use of pictorial tool for mother counselling
Care delivery by private clinic doctor	Number of children identified with development delays	Child development assessment and recording
Continuity of care
Follow-up by private clinic	Number of mother–child pair attending quarterly follow-ups Relationship between adherence and child development	Mothers adherence to follow-up visits Clinic staff action for better follow-up adherence
Referral by private clinic	Children referred for specialist care	Referral arrangements: access and cost Referral experiences of clinic staff and mothers