The role of community-based volunteers in integrating interactive playful parenting interventions for early childhood development in rural community systems for health in Zambia: a qualitative study

Early childhood development (ECD) programmes play a crucial role in child development through the promotion of health, nutrition, early education, and playful parenting interventions. Community-based volunteers (CBVs) also play an essential role in facilitating the integration of ECD into rural community systems for health to promote interactive playful parenting for early childhood development. However, little is known about the role of CBVs integrating interactive playful parenting interventions for early childhood development and health in Zambia’s community systems for health. This study explores the role of community-based volunteers in integrating interactive playful parenting interventions for early childhood development in rural community systems for health in Zambia. This was a qualitative study conducted in Katete and Petauke districts in Eastern Province, Zambia. We conducted 38 qualitative interviews including 12 focus group discussions (FGDs) with parents/caregivers and CBVs, 18 key informant interviews (KIIs) with district government and NGO stakeholders involved in the implementation, and 8 in-depth interviews (IDIs) with representatives from the Neighbourhood Health Committee (NHC). Data was analysed using thematic analysis guided by five domains of Atun’s conceptual framework on the integration of innovations into health systems: nature of the problem, attributes of the intervention, adoption system, broad system characteristics, and broad context. For the nature of the problem, the stakeholders recognized ECD as a cross-cutting issue and highlighted the need for the delivery of ECD interventions that foster playful parenting while emphasizing the need for trained manpower to deliver these interventions. The attributes of the ECD interventions included the design of an ECD training package, provision of capacity-building training and the distribution of training materials and resources to support implementation. The degree of adoption of ECD interventions into community systems for health depended on actors’ perspectives, including community leadership, parents, and teachers on ECD activities. The broader system characteristics shaping ECD integration included district-based multisectoral collaboration in delivery of ECD, community-based collaboration, education and linkages on ECDs. Additionally, the availability of community structures played a significant role in shaping the delivery of ECD activities, while school administration was instrumental in coordinating ECD programmes. Healthcare workers played a key role in providing supportive supervision for delivery of ECD interventions. The broader context influencing the integration of ECD interventions was shaped by the policy and legal environment, political commitment to deliver ECD interventions, challenges related to inadequate allocation of human, financial, and material resources. Furthermore, the lack of infrastructure development posed a barrier to collaborative efforts in delivering ECD services effectively. The integration of playful and interactive parenting highlights both barriers and facilitators, particularly regarding resources, personnel, and infrastructure. Addressing these challenges requires collaborative and coordinated efforts among the health, education, and social sectors to enhance the integration of ECD interventions. Strengthening ECD service delivery further necessitates increased resource allocation, expanded capacity building initiatives, and infrastructure development to support holistic child development and health.