The Role of Primary Care Nurses with Integration of Nurturing Care During the Era of Decentralization for Developing Child Health Systems from Birth to Age 3

Abstract

Early childhood is a critical period for laying the foundation of human development. However, many children still lack access to well-child clinics and suffer from malnutrition, neglect, or domestic abuse, while healthcare systems often struggle to adequately address these complex issues. The application of the Nurturing Care Framework (NCF) serves as a strategic approach for management and the enhancement of nursing roles. This article aims to conduct a system-level analysis and propose a framework for the role of primary care nurses in caring for children from birth to three years of age. The analysis covers: (1) the transfer of Subdistrict Health Promoting Hospitals to Provincial Administrative Organizations; (2) the Nurturing Care Framework (NCF); and (3) the role of primary care nurses in integrating this framework into practice.

The findings demonstrate that, prior to decentralization, nursing roles were primarily oriented toward health promotion, disease prevention, treatment, and rehabilitation at the individual and family levels. Following the transfer, these roles have tended to expand toward more system-oriented functions, including the use of health information, area-based coordination, and the integration of health, developmental, and caregiving dimensions. However, the implementation of these expanded roles remains constrained by limitations in regulatory mechanisms, health information systems, and the clarity of policy-related roles. This article proposes the Nurturing Care Framework (NCF) as a conceptual framework for explaining and defining nursing roles, thereby supporting the development of a more integrated, continuous, and context-responsive system of care for children from birth to three years within the context of decentralization.