Health

1. Funding was allocated from equitable share. After the initial introduction of the project, activities were integrated into normal comprehensive services. Expenditure for 2020 has been absorbed into routine operations and services.

Table 1: Budget Allocation First 1000 days project funds

2. The First 1000 days initiative was, and is, implemented across the entire province in the Western Cape province and integrated into routine maternal and child health services at all levels of care.
3. The table below is a summary of coverage over the first 1000-day period for mothers pre and post-natal visits, children immunised and caregiver support through household visits.

Over the past 3 years the focus on First 1000 days at household level have significantly improved as well as working together with stakeholders at community level to strengthen social support, involvement of fathers and enhancing nurturing care.

4. (a) The First 1000 Days (FTD) is implemented applying the Whole of Society Approach. It includes health sector staff working closely with other government departments, partnering and collaborating with nongovernmental organisations, civil society in local geographies.

(b) The Unique identifiers in the form of GROW, LOVE and PLAY icons were developed to depict the key building blocks and were prominent in all communication to date. The concepts were adapted over the past 4 years to the Western Cape context and as new national and international policy, strategy and evidence developed e.g. National Integrated ECD policy (2015), Global Strategy for Women's, Children's and Adolescent's Health 2016-2030 (Survive thrive and transform framework), WHO Nurturing care framework (2018), new Road to Health Booklet (RTHB) and the national side by side campaign (2018).  The more recent nurturing care framework provides a good basis for intersectoral alignment, planning and implementation as it reflects the following 5 key components:

• Good Health
• Adequate Nutrition
• Responsive caregiving
• Opportunities for Early learning
• Safety and Security

The Department identified FTD as a priority in the life course, started internal strategic alignment and integration of the key building blocks in services. FTD was included in the WCG: Health’s - Annual Performance Plan and a transversal project plan from 2016/2017 – 2019/2020. In the new provincial strategic plan 2019 -2024, FTD is currently included as an Apex priority with specific touch points with the Vision Inspired Priorities (VIP), specifically VIP 1(Safe and cohesive communities) and VIP 3 (Empowering people).

First 1000 days service offering

FTD interventions are now integrated into services of WCG: Health at all levels of care and includes facility based and community-based services.  Service components include Maternal and New-born health, Child and Adolescent health, Sexual and Reproductive health, Nutrition and Healthy adults and ageing. FTD activities included the development of a parent caregiver support package that is in process of being implemented in services comprising of the following interrelated components: 

• Communication (Awareness, Education and Community activations)
• Risk Assessment, referral, support and response of vulnerable clients
• Implementation of Side by Side under 5-year campaign and new Road to Health Booklet
• Parent support at health facility touch points antenatally, postnatally and early childhood
• Home and community touch points for family relational support
• Training, support and mentoring of staff
• Capturing and sharing learnings

Interventions/ key activities that will be developed/ strengthened further over the next 4 years

• Conduct a baseline and follow up stunting survey including predictors of stunting
• Risk assessment - Mental Health Screening in antenatal and post-natal care
• Growth Monitoring and Promotion as to detect growth failure and prevent stunting, specifically training, supervision and mentoring of staff. Exploring community-based growth monitoring models for scale.
• Home and community-based support – structured relational support visits in homes
• Development of a maternal and child health dashboard to monitor progress
• Interface meetings with services and sectors

Integration of book-sharing into the parent caregiver package and expansion in library services as a further intervention/ service offering.