PLH Toddlers (Book-sharing) for Community Health Workers in South Africa

About this project

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  South Africa
  2023 - 2024
Principal Investigators Kaathima Ebrahim (Mikhulu Trust)
Co-Investigators Prof Cathy Ward (University of Cape Town)
Partners Mikhulu Trust


The purpose of this project is to evaluate the impact of the training of Community Health Workers in the PLH Toddlers programme (called Dialogic book-sharing). The project will assess Community Health Workers’ knowledge, attitudes and behaviours with regards to the role that early stimulation, responsive caregiving and book-sharing can play in helping families and their young children thrive. The project will also assess the feasibility of the programme as well as the training needs of Community Health Workers in this area. In addition, the impact of the programme on parents will be assessed.


In South Africa, the Early Childhood Development (ECD) sector’s main approach to creating opportunities for early learning is through ECD centres and playgroups. While this is an important avenue for creating early stimulation opportunities, it currently only reaches  about 20% of all children under age-6. Mikhulu Trust is developing a parallel approach to capacitate and support parents to enable their children’s early stimulation.

The PLH Toddlers programme has been evaluated in several studies, and has been shown to have positively enhanced children’s language development, wider cognitive development, focal attention and their socio-emotional development. In addition to child outcomes, it has also been shown to enhance parents’ sensitivity and reciprocity, thereby improving the relationship between the parent and child.

South Africa’s Department of Health works with a cadre of Community Health Workers (CHWs) to provide “last-mile” health support through home visits. All pregnant women who visit a public health facility in South Africa will receive a number of visits from CHWs for the duration of their First Thousand Days (FTD) – from pregnancy to the baby’s second birthday. The PLH Toddlers programme has been adapted for delivery by the CHWs with mothers and babies, during the home visits conducted throughout the FTD.

Traditionally, CHWs’ main background and expertise is on health- and nutrition-related topics. Little has been done to systematically expand their knowledge and expertise to include the elements of early stimulation and responsive caregiving into their work with families in the FTD. Mikhulu Trust is providing training, mentorship and support to CHWs on the book-sharing programme. This research study will focus on evaluating this adapted programme.


The objectives of this study are to evaluate the impact of providing training to CHWs’ in the book-sharing programme, and the impact on parents. For both groups, we will assess the knowledge, attitudes and behaviours related to:

  • The First Thousand Days, child development and the role of early stimulation and responsive caregiving

  • The implementation of the programme


Project Setting

The project is being implemented in the Western Cape province of South Africa, with CHWs within the Western Cape Department of Health. Three districts have been trained in the programme; Beaufort West, Eden Karoo and Saldanha and three new districts will be trained in the coming year, which will form the sites for the research.

Significance and Wider Impact

The wider significance of this work, and study, is in developing a parallel avenue for South Africa to reach all children with effective early stimulation support, by training their parents in an evidence-based programme that supports early stimulation and responsive caregiving. This has the potential to impact South Africa’s long-term education trajectory, and overall future well-being of the children benefiting from this work.