Because the start of life sets the stage for later human development, TSA’s Early Childhood Development program focuses on a child’s earliest moments, with particular attention given to the first thousand days, which play a critical role. A solid first foundation is built on three core pillars1 – including a safe and stable home, free from chronic stress; healthy brain development, which is linked to nutrition and experience; and active stimulation and interaction with caretakers. Lack of early stimulation, poor nutrition, toxic stress, and other poverty-related risks may lead to falling behind in school and later reduced employment and earnings. Thankfully, this process can be reversed, with early prevention programs proven to provide high impact and long-term effects. Recognition of the importance of early childhood development programs has grown in recent years, with Bulgaria’s public sector showing an increased commitment toward early prevention programs, including a new pathway for universal access to nurse home visits for pregnant women, contained within the National Program for Improvement of Maternal and Infant Health 2014-2020. Despite this progress, gaps in vulnerable communities persist, and while Bulgaria has reduced its infant mortality rate, it is still 80% higher than the EU average (6.6 versus 3.6 per thousand births.) In some concentrated Roma settlements, this rate can reach levels 200% higher than the national average.2 The risk of infant mortality is compounded by malnourishment, with 42% of Bulgaria’s Roma malnourished, compared to 6% for the generation population.3 61.2% of Roma children also demonstrate high levels of iron-deficiency at 6-11 months and 30.2% of Roma 0-3 year-olds experience a delay in growth linked to poor nutrition.4 Both stunting and anemia can result from poor nutrition and put toddlers at risk for poorer cognitive, motor, socialemotional, and neurophysiologic development.5 This is why TSA is putting an emphasis on maternal health and well-being and is investing in the adaptation and expansion of proven interventions that target vulnerable communities and ensure healthy pregnancies, positive birth outcomes, and later cognitive and socio-emotional development– all with the aim to provide a solid foundation for a child’s future. This includes the adaptation and implementation of the Nurse Family Partnership program, which pairs nurses and midwives with first-time mothers, as well as other local initiatives that promote better linkages between health care professionals and pregnant women and mothers.