About Psycho-social Early Childhood Development (ECD) and public health: a health systems approach

Nakazinga (Zina) Ndugwa


Nakazinga (Zina) Ndugwa - PhD Confirmation Review milestone presentation


Professor Maxine Whittaker (Principal Supervisor) and Dr Hebe Gouda (Associate Supervisor)


It has been estimated that 200 million children aged 0-5 years in Sub-Saharan Africa and South East Asia were not reaching their development potential; this was predicted to create a 20 per cent loss of adult productivity during the later stages of life[1]. What  was concerning is that 25 per cent of children in Low and Middle Income Countries (LMICs) were exposed to psycho-social risk factors such as poor stimulation, lack of learning opportunities, parent unresponsiveness, and parental inability to understand infant behaviour[2]. Each of these risk factors have been linked to caregiving practices, and can be prevented using simple public health initiatives like responsive parenting programs. Public health care systems have the potential to reach thousands of children between the ages of 0-5 years through the provision of essential child health services. Therefore these systems have been identified as a key opportunity for ensuring caregivers access information on, and skills in, how to positively support their child’s development. So, given the above, how can we maximise this to improve psycho–social Early Childhood Development (ECD) in LMICs?

The aim of this PhD is to explore how Uganda’s public health systems (an LMIC system) can consolidate psycho-social ECD, through the support and scale-up of stimulative and responsive caregiving practices at its Maternal and Child Health (MCH) services. Using the WHO/UNICEF Care for Child Development Package and the Health System Strengthening Building Blocks, the thesis will explore the governance and service delivery elements of MCH services and articulate how governance, finance, service delivery, health workforce, health technology and health information capacities can be strengthened in efforts to improve psycho-social ECD.

Brief Bio

Zina has a professional background in project management and an educational background in health sciences. Her career in project management saw her work on development aid health projects that served to strengthen health systems in the Asia Pacific region. She also worked at the Support Service for Australian Nurse Family Partnership Program (ANFPP), a nurse-led home visiting program that supports women pregnant with an Aboriginal and/or Torres Strait Islander child to improve their own health and the health of their baby. Her experience in this program led her to explore how LMICs can further strengthen psycho-social ECD using public health systems.


[1] Grantham-McGergor S, Cheung YB, Cueto, S., , Glewwe P, Richter L, Strupp B. Development Potential in the first 5 years for children in developing countries. The International Child Development Steering Group. The Lancet. 2007;369(9555):60-70.

[2]   Walker SP, Wachs TD, Meeks Gardner J, Lozoff B, Wasserman GA, Pollitt E, et al. Child development: risk factors for adverse outcomes in developing countries. The Lancet. 2007;369(9556):145-57.



Room 234, Level 2 Public Health Building, Herston