The Government of West Nusa Tenggara (GoWNT) Province, Indonesia has proposed a Golden Generation Program (GGP) to support optimal child development. The GGP is supported by Provincial Decree No 7 to Improve and Protect the Health and Welfare of Women, Infants and Children. We propose a GGP that builds upon the existing collaborative efforts of the government, university and non-governmental organizations (NGO), to create an integrated intervention to increase the thrivability of young children by: [1] Strengthening existing Early Child Development Centers (ECDC) in each village with family centered approaches to increase caregiver capacities for health and early childhood development; [2] Training and deploying developmental community health workers (dCHW) to coach and certify baby-friendly couples (BFC) for early childhood development; [3] Deploy a mobile real-time data platform linking BFC, dCHW, ECDC and community health centers (CHC) to track infant growth and development and intervene if needed. The sustainability plan for GGP will include a dCHW Cooperative as a social business with revenue from insurance, goods and information provided to clients. Ongoing support will be from a Center for Early Childhood Development (CECD) established at the Faculty of Education at the local University of Mataram (UM). GGP impact will be assessed through a cluster randomized controlled trial involving 80 ECDC/CHC service areas covering approximately 520,000 persons, or about 104,000 households or 30,000 couples and their infants, with half of these exposed to the intervention over a 2-year period.

Our previous work underscores the vulnerability of growth and development of children less than 2-years of age. The household environment is a major determinant of cognitive development and maternal agency (i.e. maternal empowerment for decision-making) is strongly associated with reduced child illness. In Indonesia health program coverage and economic status can account for only 50% of mortality reduction in children below 2-years, the same period wherein 80% of growth faltering and stunting occur. These data indicate the household environment and caretaking as crucial factors affecting thrivability of children. Our work in WNT involving over 2 million persons has shown that community health workers (CHW) can be effective agents of change, but only in the context of full-time salaried work under management practices of rigorous recruitment, training and supportive supervision.

The GGP has three objectives: Objective 1: Enhance the existing ECDC to focus on family-centered programs to increase caregiver capacities for health and well-being of their children by improving skills and knowledge, enhancing the home environment, and fostering capacity for sustaining positive relationships with their child. Objective 2: Deploy dCHW via a sustainable social business model to conduct community-based training, certification and support of the BFC and to assure proper referral and coordination with the ECDC and CHC. Objective 3: Develop an electronic information system that integrates the work of the dCHW, ECDC and CHC such that child growth, health and development will be tracked and used to target intervention, and create the CECD at UM for long term technical support of the GGP.

Implementation will include establishment of dCHW cooperatives as a social business with a revenue stream from a package of low cost goods for child stimulation (e.g. toys) and services (e.g. education and advice), and a revenue stream from health insurance coverage. In addition, the National Population and Family Welfare Board (NPFWB) has agreed to provide a base salary for the dCHW as a pathway for ongoing development of the dCHW as a community-based agent for family welfare. The facility-based systems will be sustained through the existing budgetary allocations from the Departments of Health and of Education, while the dCHW mobile data platform and services will be maintained by a separate social business entity that will be self-sustaining through the revenue streams described above. The technical sustainability for enhanced programming will be assured by creation of the CECD as part of the University of Mataram.

The proposed solution integrates and enhances existing health and education agendas at the community level. It utilizes dCHWs guided by real time information on child growth and development to provide customized guidance to couples, and creates a sustainable social business through dCHW cooperatives marketing information and goods, and through a local CECD as a center of excellence for early childhood development. Impact assessments will focus on multiple domains including growth, cognition, expressive language and emotional regulation as well as parental knowledge and stress. We anticipate 50% of newborns in the intervention areas will be born to BFC increasing mean developmental scores by 0.3 SD at 2-years.