World Vision’s Time and Targeted Counselling: the world’s most widespread family inclusive maternal health project (28 countries)

World Vision in Ghana

The most widely implemented family inclusive approach that we have found to date is World Vision’s Time and Targeted Counselling (ttC) for health and nutrition. The approach is now being implemented in 28 countries, and 7 of these countries have now adopted ttC as a national government-led approach.

In ttC “Home Visitors”, typically community health workers or mothers’ support group volunteers, regularly attend homes during pregnancy and during the first two years of the baby’s life. They provide health information and support to women and to all influential family members. The “targeted” in the name refers to the fact that the support is delivered to those in the family who can make a difference and that almost always includes men, who are highly influential over family decisions and finances.

The Home Visitors are trained and supported to promote health and nutrition through a distinctive problem-solving, storytelling approach. Men as partners and fathers are given special emphasis: positive and negative male roles in family health are explored through stories designed to stimulate discussion.

Negative stories capture issues around family finances, HIV and domestic violence, and challenge men to consider their impact. Meanwhile, positive stories illustrate steps that men can take to support family health. ttC includes promotion of play and communication between baby and father, as a key way of strengthening the father-child bond from birth, so enhancing early development of the child.

World Vision
“The ttC-HV told David and Mary that it is very important for Mary to go to the health facility and receive prenatal care. Prenatal care means special care for Mary while she is pregnant, for the benefit of both her and her unborn baby.” Example of a positive story, showing the husband involved in supporting a visit to a clinic.

Furthermore, ttC goes a step further than almost all other programmes we have presented on – the final step in a family inclusive approach. ttC makes family inclusion one of four key performance indicators and this is measured against a target of 75% of home visits including male partners. This means it happens consistently and embeds the family inclusive approach in the foundation of the service, not susceptible to individual discretion. It also simplifies the performance management of home visitors, enabling male involvement not to be ‘lost’ in large amounts of other data.

The other three performance criteria are % of cases referred being seen at a clinic, % of referrals followed up at home, % of pregnancy visits registered in the first trimester.

The family keeps a Household Handbook where they record practices and discussions. Once the family have identified gaps in their current health practices the home visitor helps mother and father work together to find solutions. The father can then be held accountable for the changes that they’ve agreed to make, during the subsequent visits, which increases their sense of ‘ownership’ over ensuring positive health changes happen in their families.

The method is currently being implemented in diverse country settings.

World Vision coverage

The method has been officially adopted by seven ministries of health: West Bank/Gaza, Mauritania, Sierra Leone, Ghana, Kenya, Swaziland and Uganda.

ttC has been evaluated in several countries. For example, in India the method increased exclusive breastfeeding from 23% to 48%, in Palestine from 26% to 45% and in Ethiopia from 81% to 83%.

In 2016, World Vision has been adapting ttC for use in Islamic settings including Sudan, Somalia and Mauritania, and despite initial reservations from field staff, the male involvement element has been much appreciated by Ministries of Health and the stories are being adapted for these cultural contexts.

Polly Walker of World Vision, who coordinates the roll out this programme globally, says that the reception in developing countries of this approach has been overwhelmingly positive – the idea is considered the “obvious” approach to take. She explains that in her work with fathers she has found that if they feel responsible for managing things well for the mother and baby they are much more likely to engage. The key is to empower them in the process not just to ask them to “help”. Capturing and harnessing positive male involvement is more than just asking men to sit passively by whilst their wives and children receive health information. The method finds ways to inspire fathers to feel involved and be valued as part of the solution.


Images: World Vision.