Jamii ni Ayfa: improving early child development through a digital CHV program in Zanzibar: evidence from a quasi-experimental study

Early life experiences impact a child’s health, development, and economic productivity throughout their lifetime, making early childhood development a critical investment area globally. Inclusion of early child development in community health programs has shown promising results, positively impacting responsive caregiving, early learning, and child safety. In Zanzibar, implementation of a national, digitally supported community health program, Jamii ni Afya, promoted improvements in caregiving practices, the home environment, child health and development, and nutrition for children from birth to age 5. This study presents findings from a quasi-experimental evaluation of Jamii ni Afya’s impact, comparing panels of children aged 18–29 months from a baseline (2019) and endline survey (2023) conducted after program implementation. After adjusting for key confounders, small but significant improvements were found in children’s overall development scores as measured by the Caregiver Reported Early Childhood Developmental Index (Mean score difference 0.591, p < 0.001) and in all specific (motor, cognitive, linguistic, and socio-emotional) developmental domains. Caregivers in the endline survey provided a more stimulating home environment, with increased availability of books (Adjusted OR 3.733 p < 0.001), homemade toys (Adjusted OR 1.643 p < 0.001), greater paternal engagement in play activities (Adjusted OR 11.148 p < 0.001)) and lower levels of harsh physical or verbal discipline (Adjusted OR 2.912 p < 0.001). Caregiver knowledge related to child health and nutrition improved. Changes in care-seeking behaviors, immunization rates, and nutritional status did not reach statistical significance, likely due to high baseline levels or limited sensitivity of these indicators. Implementation of a national digitally supported community health program in Zanzibar was associated with improvements in caregiver knowledge, practices, and child developmental outcomes. National early childhood development strategies should consider integrating digital solutions to support standards-based comprehensive care at scale, while integrating digital components with national health services to promote sustainability. Further studies should explore optimizing digital child development interventions in community health, including the impact of digital tools on health worker-caregiver-child interactions and opportunities for targeting services to higher risk clients.