Nurturing care, encompassing early learning, responsive caregiving, safety, security, good health, and adequate nutrition, is vital for optimal early child development. The World Health Organization (WHO) has developed the Nurturing Care Framework, which health workers are advised to translate into practice. However, their role in the aspects of early learning, responsive caregiving, and safety and security have not been adequately mapped. This review synthesizes evidence on delivery mechanisms, strategies to strengthen health worker support, and barriers and enablers influencing implementation. Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we searched peer-reviewed and grey literature published before 23 April 2025. Inclusion criteria involved literature pertaining to various domains of nurturing care delivered by health workers. Data extraction focused on delivery mechanisms, promotion strategies, and enabling or hindering factors. Analysis was guided by the Nurturing Care Framework and socio-ecological model, using combined inductive and deductive thematic strategies. From 29,997 records, 99 peer-reviewed articles and 14 grey literature reports from 48 countries were included. Common delivery mechanisms were community-based platforms (e.g., home visits, group sessions), facility-based counselling, and blended community-facility based supports or technology-enabled methods. Interventions were primarily delivered by community and primary health workers through task-sharing approaches. Key strategies to enhance support included training and supervision, integration of nurturing care into routine maternal, newborn, child health and nutrition services, and caregiver coaching. Less frequent but influential drivers of scale-up were supportive policies, multi-sectoral collaboration, and digital technologies. Barriers included time constraints, workloads, inadequate training, limited supervision, and restrictive cultural and gender norms affecting caregiver engagement. Health workers are central to advancing early learning and responsive caregiving within health systems, yet safety and security remains the least institutionalized component of nurturing care. Effective integration requires strengthening frontline worker capacity while embedding interventions into routine services supported by policies, financing, and intersectoral platforms. Without systemic commitments, efforts risk remaining fragmented and unsustainable, limiting their long-term impact on child development.
Bhandari et al. (2026) studied this question.