**2.2 Description of intervention**

In 2015, the Catholic Relief Services (CRS) Lesotho, a partner with Ministry of Education and Training, the Early Childhood Care and Development (ECCD) Unit, started a project, *Whose Child is This?* The project was an intervention to address the deplorable condition of children in the daycare facilities at the Thetsane Area. In 2014, a child who had been seriously ill-treated by a caregiver in one of the day-care centres in the area prompted action of the community and ECCD stakeholders. The story had gone viral in local radio stations and newspapers. Due to that, the ECCD Unit visited the concerned facility and discovered there were many other daycare facilities that had mushroomed and were not known or "registered" with Ministry. The response to this situation resulted in more visits to the facility from ECCD stakeholders, partners and non-governmental organizations. The visits revealed the following concerns: "unsafe physical environments where children were cared for, unsanitary practices among facilitators/caregivers, overcrowding, inadequate and poor nutrition, and lack of activities to stimulate the development of children" [7]. The major challenge faced by caregivers in the daycare centres was lack of training and experience in the care of children aged below 3. Catholic Relief Services therefore designed the *WCiT* project to address the situation. Three strategic objectives of the project were:


One of the interventions made was the design of "one stop service delivery centres" that offered critical services needed by children and families and the services were provided by specialist agencies such as nutrition sector, immunization and health checks to detect any malfunctions and disabilities among the children, protection and education services. Activities days named *well-being days* (WBD) were designed by CRS and held once every quarter on a Sunday in the community affected. The WBDs were meant to sensitize parents and communities about the importance of child development. On such days, CRS in collaboration with the departments of health, social protection, nutrition and other critical partners, offered their specialized services of immunisations, deworming and others to ensure all children whose parents attended the activity, benefited from the services given. Additionally, there is training of caregivers in child care and stimulation that is provided, resulting in implementation of all the three strategic objectives of WCiT? project indicated above.

### **2.3 Achievements**

Achievements were realized due to the intervention. First, the training of caregivers including their willingness to participate in the project was realized. In the particular daycare centre, the caregiver went further to enroll for a 2-year training programme in early childhood education with the Lesotho College of Education. She reported that she completed her studies and now holds a certificate in early childhood education (CECE). She further explained that she took the decision to enroll because she felt it was important for the children to receive proper care provided by a knowledgeable person. She alluded that she was aware that children had the right to *good and loving care* provided by knowledgeable and trained adults.

Secondly, the project was successful in introducing well-being days (WBDs) since the services that were offered attracted a lot of parents who under normal circumstances rarely had time to take their children to access some of the services, particularly in the health centres. In her words, the caregiver said, "*Now I understand the importance of good nutrition in the early years of a child's life, therefore I cook for them so that I can introduce different foods and menus. That has made me happy."*

Lastly, the project has helped to improve child development outcomes through parents' better understanding of child nutrition, health, protection and stimulation by parents and families. In this regard, parents provide children with adequate and proper nutrition.

## **3. Lessons learned**

In discussing the lessons learned by the caregiver, the Nurturing Care Framework (NCF) is used to form the basis of the discussion. The Framework [8] promotes a holistic approach in early childhood development. It asserts that for a child to grow up well it must be healthy, have good nutrition, responsive care, stimulation, safety and security. There are five components of the NFC. However, in this paper, specific focus is on components 1, 2 and 3. Components 4 and 5 were not specifically highlighted in the study because issues of safety and security including early learning surfaced in the care practices discussed in the three components researched on. The components are presented as individual themes that guide the discussion and are accompanied by questions that were posed to the caregiver and the observations that were made. In that regard, it is hoped that the study would inform how the caregiver's care practices linked with the Framework.

#### **3.1 Component 1: good health**

The nurture and care surrounding this component relates to monitoring of children's physical and emotional condition; giving affectionate and appropriate responses to child's daily needs, protecting child from household and environmental hazards, practicing hygiene which minimizes infections, use promotive and preventive health services and seeking appropriate treatment for children's illnesses.

In **Table 1** below, the caregiver commented on good health and related health matters of babies in her centre.


*Child Care for the under 3 Year Old Children: Experiences from Lesotho DOI: http://dx.doi.org/10.5772/intechopen.93918*


#### **Table 1.** *Good health and health matters of babies.*

### **3.2 Component 2: adequate nutrition**

The component relates to a baby's nutrition right from when a mother is pregnant and eats well in order to supply micronutrients and supplements that help baby to develop. Brain development is critical in the first three years of a child's birth hence breastfeeding, particularly exclusive breastfeeding, is critical from immediately after baby's birth. Complementary feeding must be introduced from 6 months hence food safety and family food security are essential for adequate nutrition.

Below in **Table 2**, the caregiver commented on the issue of nutrition of the babies in her centre.


**Table 2.** *Nutrition of babies.*

#### **3.3 Component 3: responsive caregiving**

Responsive caregiving entails observing and responding to babies' and children's needs and their movements. This caregiving practice is the basis for protection of baby against injury; recognition of baby's illness or discomfort, learning and building of social relationships and trust.

The caregiver was surveyed on how she provided responsive caregiving to babies and toddlers in her centre (**Table 3**).


*Child Care for the under 3 Year Old Children: Experiences from Lesotho DOI: http://dx.doi.org/10.5772/intechopen.93918*

#### **Table 3.**

*Responsive caregiving to children's needs.*

#### **4. Discussion**

The Nurturing Care Framework provides the importance of why care and nurture must be accorded the children in order that they can "survive and thrive". The critical attention we need to pay to the earliest moments of a child's life cannot be understated. A child's foundation to survive and thrive is nested in the nurturing environment in order for a child to develop socially, physically, cognitively, emotionally and spiritually [9]. The role of nutrition, good health, early stimulation, protection and safety of both the mother and child can ensure that children have a chance to develop holistically.

In the case study centre, the caregiver seems to be familiar with some of the critical actions and requirements for child development and wellbeing. She further applies some of the knowledge she had when she was bringing up her own children and she applies that appropriately. However, being unsure of the immunization schedule and proper injections children require at a specific time might compromise the health of the child and put children at risk. Nonetheless, she seems to rely on the services she gets from scheduled visits of clinic nurses in the area to undertake

health checks of the children. One critical finding from the daycare centre was that the caregiver had no knowledge of the pregnancy history of the mother. That lack of knowledge would possibly deny the baby proper attention it required in the event the mother herself had had a difficult pregnancy period that might have affected the baby's healthy development. It would seem the caregiver needs to conduct one-to-one interviews with the mothers of the babies in her care in order to learn more about the history of the baby from conception. Such additional information would then be documented in the baby's health book and when necessary it would be shared with the health facility when need arose.

On the other hand, some serious challenge the caregiver had was that of parents who did not provide balanced and nutritious food for the children's meals. The fact that some children had only starch-based foods compromised their nutrition. Nevertheless, the caregiver with consent from the parents introduced feeding at the centre and parents had to pay increased fees and that practice allowed children to be provided with good nutrition. Through the CRS training that the caregiver had attended, she was able to design an appropriate menu for the children. Adequate nutrition throughout the early years from pre-natal to eight years cannot be over-emphasized. Inadequate nutrition before birth and in the first years of life can seriously interfere with brain development and lead to such neurological and behavioral disorders as learning disabilities and mental disorders [10]. Therefore, when children do not feed well, they become vulnerable to diseases that could otherwise have been curbed through good nutrition.

At the beginning, Retšepile Jesu Day Care centre was neither registered nor formally known to the Ministry of Education and Training. Resultantly, the daycare centre was not receiving any support in terms of training of the caregiver and advice or guidance on baby care. After the Day Care centre and others in the area were known to the Ministry and other partners in ECCD, the caregivers in the area were exposed to basic training on child development and care. The caregiver's enthusiasm and desire to provide improved and quality child care service, prompted her later to enroll for a Certificate in Early Childhood Education (CECE) course at the Lesotho College of Education. She qualified in 2018 and currently she strives to improve her practice at the centre. In a study conducted in Kenya in 2000, mothers of children below 3 years of age reported that they ensured their babies were happy by singing lullabies to them or feeding them (p. 132, [11]). On the other hand, Dodge and Phinney [12] highlight the importance of play in early childhood. They inform that "play provides the foundation for academic or "school learning". It is the preparation children need before they learn…play is the work of young children", (p. 3). The issue of care and nurture is one of the critical ingredients to a healthy start for young children and where parents engage in such care practices, as stimulation and play, the children are likely to benefit.

### **5. Conclusions and recommendations**

As mentioned earlier, this study was undertaken to establish how far the care practices offered by the caregiver were aligned to some of the components of the Nurturing Care Framework. The Framework is relatively a new innovation and as such, had never been introduced to the caregiver, let alone to a number of ECCD stakeholders in the country. The extent of the quality of care and nurture that the caregiver has been sensitized about may be sufficient to ensure children benefit extensively from how she interacts and handles them. If the caregiver had been knowledgeable about the Framework, it would be expected that her care and nurture practices would be adequate. It is therefore concluded that

some aspects of components 1, 2 and 3 of the NCF are practiced by the caregiver although the quality of care and nurture may still remain inadequate given that the caregiver is still learning how to implement some of the practices in the Framework.
