Enablers and barriers to scaling an ECD parenting program into primary health care services in rural Bangladesh

In rural Bangladesh, scaling an early childhood parenting program for caregivers of 6–36-month children with mild-to-moderate malnutrition is enabled by strong government ownership and high CHW compliance.

• Why it matters: Scaling evidence-based early childhood development interventions in low- and middle-income settings is difficult, and implementation weaknesses can undermine fidelity and sustainability in primary health care.
• What they did: A mixed-methods evaluation integrated the parenting program into community clinics across four districts, using clinic logbooks, session-quality observations (n=60), mother interviews (n=185) and phone interviews (n=164), plus CHW (n=20), inspector (n=16), manager (n=4) interviews and focus groups (n=30 mothers; n=28 grandmothers).
• The result: Enablers included adequate session quality, satisfactory attendance, and positive stakeholder attitudes, while barriers were low supervision, limited community advocacy messaging, weak cross-level communication, and difficulties supplying play materials at scale.

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