TY - JOUR
T1 - Contextual design choices and partnerships for scaling early child development programmes
AU - Milner, Kate M.
AU - Bernal Salazar, Raquel
AU - Bhopal, Sunil
AU - Brentani, Alexandra
AU - Britto, Pia Rebello
AU - Dua, Tarun
AU - Gladstone, Melissa
AU - Goh, Esther
AU - Hamadani, Jena
AU - Hughes, Rob
AU - Kirkwood, Betty
AU - Kohli-Lynch, Maya
AU - Manji, Karim
AU - Ponce Hardy, Victoria
AU - Radner, James
AU - Rasheed, Muneera Abdul
AU - Sharma, Sonia
AU - Silver, Karlee L.
AU - Tann, Cally
AU - Lawn, Joy E.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 'Transition to Scale' and 34 'Seed') were evaluated. 63% were delivered through health and 84% focused on Responsive Caregiving and Early Learning (RCEL). Multilevel partnerships, leadership and targeted situational analysis were crucial to design and adaptation. A theory of change approach to consider pathways to impact was useful for design, but practical situational analysis tools and local data to guide these processes were lacking. Several RCEL programmes, implemented within government services, had positive impacts on ECD outcomes and created more enabling caregiving environments. Engagement of informal and private sectors provided an alternative approach for reaching children where government services were sparse. Cost-effectiveness was infrequently measured. At small-scale RCEL interventions can be successfully adapted and implemented across diverse settings through processes which are responsive to situational analysis within a partnership model. Accelerating progress will require longitudinal evaluation of ECD interventions at much larger scale, including programmes targeting children with disabilities and humanitarian settings with further exploration of cost-effectiveness, critical content and human resources.
AB - Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 'Transition to Scale' and 34 'Seed') were evaluated. 63% were delivered through health and 84% focused on Responsive Caregiving and Early Learning (RCEL). Multilevel partnerships, leadership and targeted situational analysis were crucial to design and adaptation. A theory of change approach to consider pathways to impact was useful for design, but practical situational analysis tools and local data to guide these processes were lacking. Several RCEL programmes, implemented within government services, had positive impacts on ECD outcomes and created more enabling caregiving environments. Engagement of informal and private sectors provided an alternative approach for reaching children where government services were sparse. Cost-effectiveness was infrequently measured. At small-scale RCEL interventions can be successfully adapted and implemented across diverse settings through processes which are responsive to situational analysis within a partnership model. Accelerating progress will require longitudinal evaluation of ECD interventions at much larger scale, including programmes targeting children with disabilities and humanitarian settings with further exploration of cost-effectiveness, critical content and human resources.
KW - child health
KW - early child development
KW - health policy
KW - health systems
KW - scale-up
UR - http://www.scopus.com/inward/record.url?scp=85063142759&partnerID=8YFLogxK
U2 - 10.1136/archdischild-2018-315433
DO - 10.1136/archdischild-2018-315433
M3 - Article (Academic Journal)
C2 - 30885961
AN - SCOPUS:85063142759
VL - 104
SP - S22-S33
JO - Archives of Disease in Childhood
JF - Archives of Disease in Childhood
SN - 0003-9888
IS - Suppl 1
ER -