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Global child health: Design and implementation for early child development programmes P1
Paper 1
Contextual design choices and partnerships for scaling early child development programmes
  1. Kate M Milner1,2,
  2. Raquel Bernal Salazar3,4,
  3. Sunil Bhopal5,6,
  4. Alexandra Brentani7,
  5. Pia Rebello Britto8,
  6. Tarun Dua9,
  7. Melissa Gladstone10,
  8. Esther Goh11,
  9. Jena Hamadani12,
  10. Rob Hughes5,13,
  11. Betty Kirkwood1,
  12. Maya Kohli-Lynch1,14,
  13. Karim Manji15,
  14. Victoria Ponce Hardy1,
  15. James Radner16,17,
  16. Muneera Abdul Rasheed18,
  17. Sonia Sharma19,
  18. Karlee L Silver20,
  19. Cally Tann1,21,
  20. Joy E Lawn1
  1. 1 Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  3. 3 Economics Department, Universidad de los Andes, Bogota, Colombia
  4. 4 Centro de Estudios de Desarrollo Economico (CEDE), Universidad de los Andes, Bogota, Colombia
  5. 5 Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
  6. 6 Northern School of Paediatrics, Newcastle-upon-Tyne, UK
  7. 7 Departamento de Pediatria, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  8. 8 Early Child Development, UNICEF, New York City, New York, USA
  9. 9 Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
  10. 10 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  11. 11 Bernard van Leer Foundation, The Hague, The Netherlands
  12. 12 Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
  13. 13 Children’s Investment Fund Foundation, London, UK
  14. 14 School of Social and Community Medicine, University of Bristol, Bristol, UK
  15. 15 Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  16. 16 Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
  17. 17 Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
  18. 18 Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
  19. 19 Mobile Crèches, Sector IV, New Delhi, India
  20. 20 Grand Challenges Canada, Toronto, Ontario, Canada
  21. 21 Neonatal Medicine, University College London Hospitals NHS Trust, London, UK
  1. Correspondence to Dr Kate M Milner, MARCH Centre, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E7HT, UK; kate.milner{at}lshtm.ac.uk

Abstract

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.

  • early child development
  • child health
  • health policy
  • health systems
  • scale-up

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2018-315433

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    Footnotes

    • Contributors Technical oversight of the series was led by JEL and KMM. The first draft of the paper was undertaken by KM. Other specific contributions were made by RBS, AB, PRB, TD, MG, EG, JH, RH, BK, MKL, HK, KM, VPH, JR, MAR, KLS, CT, JEL. The Early Child Development Expert Advisory Group (PRB, TD, EG, Sally Grantham-McGregor, MG, JH, RH, KM, JR, MAR, KLS, Arjun Upadhyay) contributed to the conceptual process throughout. All authors reviewed and agreed on the final manuscript.

    • Funding This supplement has been made possible by funding support from the Bernard van Leer Foundation. Saving Brains impact and process evaluation was funded by Grand Challenges Canada.

    • Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institution with which they are affiliated.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Data sharing statement All data within this research article are covered by a data sharing agreement as part of the Saving Brains, Grand Challenges Canada, grant with Saving Brains and other individual project teams. We are happy to provide further details on request.