Understanding the unique role of community-based para-professionals delivering early childhood development in low-resource contexts: a Delphi study

Abstract

Background: Community-based para-professionals are trained or untrained professionals who assist in the delivery of health-related care in communities where they live. The role of community-based para-professionals in supporting early childhood development (ECD) supports has attracted increased attention recently, particularly in the context of severe constraints in the global health workforce. However, these practitioners face challenges associated with low status and poor working conditions. In response, the study reported here aimed to gather expert views on essential knowledge, skills and competencies for this workforce, to contribute to strengthened recognition of their unique role in supporting ECD.

Objectives: The objective of the study reported here was to contribute to evidence that provides insight into essential training needs of professionals and para-professionals providing ECD services to families and children in low-income contexts. This paper focuses specifically on findings related to training needs of community-based para-professionals.

Method: A Delphi study was conducted to reach consensus among 14 global experts around essential training needs of ECD workers delivering nurturing care in low-resource contexts. Three rounds of open-ended and rating scale data were collected.

Results: Strong consensus was found among experts around a unique set of Skills; Knowledge and Dispositions that should be supported through training for community-based para-professionals. A key feature threaded across these three training components was strong emphasis on effective communication and relationship-building with families and communities, to ensure that early childhood development programmes are culturally-responsive and authentic. This supports previous work that has highlighted the important 'bridging' role of community-based workers, particularly in communities at risk of marginalization.

Conclusion: The findings provide a basis for supporting and strengthening this important workforce, through advocacy around (i) their unique contributions in supporting contextually-sensitive, responsive ECD, (ii) training approaches and strategies that support and build on these contributions, and (iii) mechanisms to support stronger recognition through career pathways and training needs that are shared with other ECD cadre groups (including health and education professionals).

Keywords: Community-based workers; Early childhood development; LMIC; Low-resource contexts; Para-professionals; Public health; Training.