Improving early childhood development in rural Ghana through scalable low-cost community run play schemes

The intervention focuses on unlocking the potential of caregivers, both mothers and teachers, training and empowering them with the knowledge, skills and confidence to run educational Play Schemes in kindergarten classes and provide better care and stimulation at home, using local materials. The intervention will be carried out by Lively Minds, an award winning organisation that has been running the programme in rural Ghana (as well as Uganda) for 8 years. The structure of the program is as follows:
1. Kindergarten teachers trained at centralised workshops
a. There are ten practical and participatory sessions, which cover the importance of education and play, classroom management, how to use and make games, and how to train Mothers.
2. Teachers train 30 Mothers in their community.
a. Training includes two community meetings and nine participatory workshops. It is designed for women who are illiterate and have never been to school. Content includes how to make and play games, child-friendly teaching, and health practices. The syllabus uses behaviour-change and play-based approaches to transform mindsets, gain buy-in and volunteerism. Teachers are supervised and supported by high performing Kindergarten Teachers from schools with existing Schemes.
3. Play Schemes run
a. A different group of 7 Mothers come into kindergarten each day of the week for an hour. 6 Mothers teach 30 kindergarten children indoors (1:5 parent child ratio). The remaining children and Mothers participate in outdoor play. The teachers supervise. Children learn by playing with a variety of games that strengthen six different skill sets (counting/numeracy; matching/sorting; imagination and creativity; reading/books; sensory awareness; and physical education). These crosscutting skills develop executive functions, providing the foundation for learning. Teaching uses discovery and play based methods, rather than rote method which is the norm in school.
4. Health and hygiene activities are incorporated
a. Children have to handwash with soap before using the Scheme, sensitising them to this vital practice. Mothers are also taught how to erect simple handwashing devices (tippy-taps) at home. Once the Schemes are running, Mothers and teachers are given regular training on health and parenting topics to improve their childcare.
5. Teachers and Schemes are supported
a. Play Schemes are given regular supervisory visits by Lively Minds staff and Ghana Education Service officials to quality control. Regular “top-up'' training sessions are held for teachers where they discuss problems, share successes and also are trained to provide the Mothers with monthly skills workshops.
6. Mothers are supported
a. Mothers are given monthly workshops on parenting and health topics and life skills by Teachers (topics include nutrition, hygiene, child rights, play, communication, malaria prevention, financial awareness, self-esteem, inclusive education). This increases awareness on a variety of childcare and public health issues, reinforces new behaviours, and is a powerful incentive to keep the Mothers committed to volunteering.
7. Sustainability and scalability
a. District Education officials are involved in the mobilisation and training of schools. They monitor the Schemes and supervise the teachers and schools as part of their normal supervisory duties. High performing teachers and officials are trained to participate in the training and support of new cadres of teachers. Play Scheme Committees are established in each community.

2017-10-11

2018-07-26

1. Target children’s cognitive and socio-emotional developmental outcomes

1. We will measure developmental outcomes of the child, through the use of the International Development and Early Learning Assessment (IDELA) tool, developed by Save the Children. This provides measures of development along 5 core domains; emergent numeracy, emergent literacy, socio-emotional skills, motor skills, and executive function.

2. Target children’s health outcomes
3. Developmental outcomes of siblings
4. Child pre-school attendance and participation in the Play Schemes
5. Maternal knowledge of child stimulation and care practices
6. Psychological well-being of primary caregivers
7. Enhanced quantity of resources allocated to child within the households
8. Target children’s hygiene knowledge
9. Pre-school engagement of primary caregivers
10. Teacher wellbeing, teaching practices and knowledge

2. We will collect data on the incidence of diarrhea, fever and respiratory infections using the definitions of the WHO as measures of morbidity. We will also measure arm circumference.
3. We will measure the development of younger siblings through the Caregiver-Reported Early Development Index (CREDI) short form, and of older siblings through Ravens progressive matrices and tests of basic literacy and numeracy.
4. The household survey will collect details on target child’s pre-school attendance.
5. We will collect information on the mother’s knowledge of stimulation and care practice, and her beliefs regarding the importance of these for children’s development. To test knowledge, we will rely on a selection of items from the Knowledge of Infant Development (KIDI).
6. We will measure psychological wellbeing outcomes of primary caregivers through the use of two scales: the SRQ-20 measure of depression and the Rosenberg measure of Self-esteem.
7. The presence of toys and learning materials in the house will be assessed together with parental involvement with the child, the child’s routines and organisation of the child’s time inside and outside the family house. This will be assessed using the Family Care Indicators, developed by UNICEF.
8. We will construct a hygiene knowledge score based on child’s responses to questions such as what are good times to wash your hands, what material is needed to wash hands and what are reasons for why washing hands is important.
9. We collect data on the frequency of primary caregivers’ school visits and the extent to which they know the teacher’s name
10. We will measure outcomes of teachers using an instrument developed in a previous study in Ghana. This includes a variety of measures including teacher presence, practices, burnout and job satisfaction. The SRQ-20 will also be administered to teachers to assess their mental wellbeing. Given the small sample size of teachers in our study, however, we may not have sufficient power to detect significant impacts on this outcome.

The evaluation design will be based on a cluster randomized trial in which a target sample of 80 schools will be allocated randomly to either the treatment group or the control group. The treated communities will receive the play scheme programme from Lively Minds. The control communities will not receive play schemes during the evaluation period. In total, there will be 40 schools in each of these two groups.

For each school we will take a random sample of target children (defined as being (i) aged between 3 and 5 years as of the start of the school term on the 11th September 2017, (ii) report to either be currently attending, or intending to attend in the academic year the study school). There will be on average, 30 children for each school, resulting in a total sample size of 2400.

For each target child we will also collect information about his/her primary caregiver, household head, and older and younger sibling (where available).

We will also survey all primary school teachers of our study schools.

Randomization will be done in office by a computer using the statistical software stata, version 14, and will be stratified by circuit (a geographical cluster of on average 6 schools falling under one supervisor from the Ghana Education Service) and school size.

The unit of randomization will be the school

Yes

80 schools (clusters), 40 each for treatment and control

The total sample size will be 2400 target children aged 3-5 years (and corresponding primary caregiver, household head, and siblings), distributed among 40 treatment schools and 40 control schools. The sample will also include all KG teachers in each of the 80 sampled schools.

40 schools treatment, 40 schools control

Power calculations were made based on the assumptions of 30 individuals per community, 80 communities (40 treatment and 40 control), power to reject a wrong hypothesis with 80% probability, the use of two-tail tests of size 5% and controlling for lagged outcome variable as covariates. This provides a minimum detectable effect size of between 19% and 30% of a standard deviation (for intra cluster correlations assumptions of between 0.1 and 0.3), for the primary outcome.