New global study highlights the importance of supporting caregivers for family well-being
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Research published in The Lancet Global Health shows promising results for a frontline worker-delivered interventions.
Research published in The Lancet Global Health shows promising results for a frontline worker-delivered intervention designed to support parents of young children.
A new multi-country study has found that a UNICEF-developed counselling intervention, Caring for the Caregiver (CFC), is associated with significant improvements in caregiver mental health, social support and parenting stress. The findings are grounded in the understanding that supporting caregiver wellbeing is a critical pathway to improving outcomes for children.
The evaluated the intervention with more than 600 caregivers of young children across six low- and middle-income countries: Bhutan, Brazil, Rwanda, Serbia, Sierra Leone and Zambia. The intervention provides caregivers with structured behaviour change counselling support delivered by trained frontline workers during routine home visiting services.
CFC is delivered through UNICEF-supported country and regional programmes where resources and government partnerships are in place.
By strengthening caregivers’ emotional resources and reducing isolation, CFC fosters conditions widely associated with healthier parenting practices and more positive social and emotional development in children.
Although South Africa was not among the countries included, the findings have strong relevance given the country’s high levels of poverty, unemployment and violence, all of which can add to the strains faced by caregivers.
Strong improvements in caregiver well-being
Within three to six months of receiving the intervention, caregivers showed lower levels of depression, anxiety and parenting stress, alongside increased confidence and social support.
Although the intervention is not a mental health treatment, its preventive approach is designed to help caregivers cope with stress before it escalates. Caregivers who reported receiving a higher dose of the programme showed the greatest improvements.
“Considering that Caring for the Caregiver is not a treatment for mental health problems, we were encouraged by the size of the changes we saw, particularly for depression, anxiety, parenting stress and social support,” says Stephanie Redinger, the lead author and a Postdoctoral Researcher at the DSI/NRF Centre of Excellence in Human Development (CoE-HUMAN).
Understanding longer-term impact
The long-term purpose of the CFC programme extends beyond short-term improvements in well-being and requires systems-level integration within existing social programmes.
According to Redinger, “The ultimate purpose of the Caring for the Caregiver package is to strengthen the capacities of frontline workers, caregivers and communities to mitigate the effects of multiple adversities on caregiver and family well-being, social isolation and barriers to providing care to children.”
While the study focused on caregiver outcomes and did not directly measure child development, the researchers emphasise that the broader evidence base is clear.
“We know from existing research that improving a caregiver’s mental health and increasing social support around the child has a positive impact on children’s development over time,” says Redinger.
Looking ahead, the research team has highlighted the importance of examining longer-term impacts and system-wide effects.
Meaningful changes in daily life for caregivers
Caregivers who participated in the study described changes that felt tangible and deeply meaningful in their everyday lives. Many spoke about improved coping and emotional regulation during moments of stress.
One caregiver in Rwanda reflected, “It helped me be patient in stressful situations so I can see a way to cope with my problems.” This ability to pause and respond more calmly was echoed across countries and contexts.
Improvements in relationships were another strong theme. Caregivers reported being better equipped to navigate conflict within their families. A participant in Sierra Leone explained that they “learnt to identify the source of stress, and possible solutions to conflicts with [their] partner”.
These shifts extended to parenting relationships. Over 79% of participants in each country felt that the programme helped them build better relationships with their children. One caregiver in Brazil said it equipped them to provide more responsive emotional support: “I can deal better with situations, especially with children’s emotions.”
Lessons on scale and sustainability
Caring for the Caregiver has been designed with scale and affordability in mind.
Its flexibility has allowed the programme to be adapted to different literacy levels, cultural contexts and types of adversity. To date, government, NGO, and community-based organisation teams have successfully integrated the full CFC package into existing frontline worker home-visiting programmes.
While the package should be delivered in full, Redinger notes that the core of CFC lies in its Essential Skills and that the toolkit allows the frontline worker to use only what is needed, which makes it more efficient and targeted. These enable frontline workers to collaborate with caregivers to plan responses to stress and identify the emotional and practical support they may need. She also stresses the importance of robust monitoring and evaluation systems to guide decision-making and resource allocation.
Relevance for South Africa
Although CFC has not yet been implemented in South Africa, the researchers believe the approach is highly relevant to the local context and would require minimal adaptation.
The intervention is designed to be low-cost, flexible and easily integrated into existing home visiting services. At its core are essential counselling skills that enable frontline workers to collaborate with caregivers, identify stressors and mobilise emotional and practical support.
South Africa’s existing community health worker platforms, early childhood development initiatives and ward-based outreach teams could provide a strong foundation for such an approach.
“We see the intervention as an important opportunity to improve the capacity of all frontline workers to deliver caregiver sensitive counselling, even if their role is not to deliver parenting or early child development programming, of which there are many excellent examples in South Africa,” says Redinger. She adds that the gap CFC tries to fill is that all home visitors are trained to see and support caregivers because there are so many missed opportunities for this outside of parenting and ECD programmes where caregivers encounter frontline workers as part of the decentralised health and social care system.