Scaling Early Childhood Development – what to read this month | March 2025

Banner image courtesy: DFID on Flickr

This article is curated by Bet Caeyers (Lead Editor, Chr. Michelsen Institute), Meghan Taylor (Editor, Oxford Policy Management) and Daniel Munday (Editor, Oxford Policy Management) .

We kick off with new work coming from China, as Rao et al.’s paper reveals the interconnectedness of home environment quality, preschool quality, and academic achievement, in two socio-economically distinct regions: affluent Shanghai and economically challenged Guizhou. The authors assessed nearly 700 children across 29 pre-schools. They found that children in Shanghai had significantly better outcomes than those in Guizhou, with differences driven by factors such as classroom quality, parental education and the level of home learning activities. The study offers valuable insights from a scaling perspective, by highlighting the complex relationship between the quality of education received in school, and the surrounding parental and environmental influences on child development.

More findings related to early childhood care and education from the Thrive Ghana team. Anamuah-Mensah et al.’s brief examines kindergarten teachers´ perspectives on respect for their profession. While 68% of kindergarten teachers from 305 schools in northern Ghana felt respected by their local communities, only 39% reported feeling respected by national stakeholders. This result is even more striking when analysed by gender; only 35% of male teachers felt respected at the national or district level, compared to 47% of women teachers. Surprisingly, these feelings of respect are not influenced by levels of financial support or working conditions, indicating a deeper structural issue within the Ghanaian pre-school sector. Addressing this concern will be essential to overcoming existing challenges around motivation, retention and performance of teachers in Ghana.

How crucial are pre-school subsidies and cash transfers for longer-term child development, in the aftermath of crisis? Nasgowitz et al. explore this question in a recent VoxDev blog detailing the results of a randomised control trial conducted in Uganda. In the treatment communities, parents either received subsidised access to a local pre-school for their children, a cash transfer of equivalent value, or a combination of both. Shortly after the intervention completion period, the COVID-19 pandemic hit the country, leading to a strict lockdown. The team finds that all three interventions led to improvements in various anthropometric outcomes over four years, including weight-for-age and BMI. However, longer-term learning outcomes, such as maths and reading test scores, remained largely unaffected. The authors conclude that during crises, such as pandemics, subsidised pre-school and cash transfers can be instrumental in supporting anthropometric outcomes and fostering children’s physical development.

Wolf et al.’s mixed-method paper examines the Preschool Safe Space (PSS) programme, which provides free, play-based learning to marginalised girls in disadvantaged rural communities. The results? The programme significantly increased school readiness, improving socio-emotional, literacy, maths, and motor skills among girls. Many parents reported that their children became more confident, developed basic literacy and maths skills, and formed stronger emotional attachment to them. Notably for scaling: the study demonstrates that the benefits of the programme exceed those of comparable large-scale initiatives, including US early childhood care and education programmes from the 1960s and 1970s, as well as home visiting and parenting workshops in Jamaica. Further research is needed to determine whether the programme´s positive community effects on attitudes are widely spread and enduring.

Shifting focus to primary health and nutrition services, Maquengo et al.’s paper examines the primary health care system in Luanda, Angola. The city faces one of the lowest levels of primary healthcare access in sub-Saharan Africa, with only one primary healthcare centre available per 20,000 citizens. The study explores the relationship between the availability and quality of services, and the resulting adherence and trust citizens place in the system for diagnosis and treatment. By consulting 8,000 healthcare centre users, the study identified key metrics affecting user satisfaction and trust in primary healthcare provision: education levels, proximity to the centre, income level and treatment costs. Mistrust of healthcare professionals, inadequate quality of care and a lack of confidence in their ability to address their health issues, were the main reasons for infrequent visits to healthcare centres. The authors argue that improving healthcare provision and the attitudes of staff towards users are crucial for improving service uptake.

How can nutrition education programmes be effectively scaled to vulnerable rural populations? Mockshell et al. explore this question through a process evaluation focused on tribal groups in India. The programme aimed to facilitate early identification of anaemia and other conditions while providing parenting sessions on healthy living and nutrition. Initial implementation faced challenges, including difficulties finding training centres and a lack of adequate staff. However, the organisers’ flexibility and creativity allowed for a swift adaptation of the programme, shifting to existing informal community networks and utilising self-help group meetings for delivery. This experience highlights the importance of programme staff knowledge of local language and of informal networks, which are vital for implementation flexibility.

Let’s pivot to social protection programmes and their effects on health and nutrition in South Asia. Scott et al. assess the co-coverage of social protection benefits(food or cash) and key health and/or nutrition interventions, during pregnancy and childhood in Bangladesh, India and Nepal. The study uses nationally representative survey data from 2012 and 2019, on 253,703 women with children under 5 years old. In India, for instance, the results show that 52% of women and 51% of children received food transfers. However, only 3% of women and 8% of children benefited from both food transfers and recommended health and nutrition interventions (see Figure 1). The study underscores significant gaps in the simultaneous delivery of social protection programmes and health/nutrition interventions, highlighting missed opportunities to provide comprehensive support to mothers and children.

What do HIV prevention strategies in marginalised communities tell us about reach and impact? Emmanuel et al.’s study looks at access, barriers, stigma and service utilisation to better understand how the uptake of widely available preventative medicine can be improved in Nigeria. Results show that 57.7% of study participants expressed a willingness to engage with HIV preventative services, with 91% motivated by a desire to ‘know and confirm’ their status. However, the study also highlights significant challenges: 24.2% of participants identified the lack of free, accessible and comprehensive HIV services as the most significant barrier to service uptake. This was closely followed by stigmatisation and harassment (reported by 22.6%) and lack of awareness (noted by 19.5%). The authors suggest that creating anonymous, accessible and inclusive digital platforms may increase access to services, destigmatise HIV prevention and provide educational resources and support. Looking for more new content on this topic? Check out Essien and Mgbere’s review on the advances of preventative treatment of HIV/AIDS in sub-Saharan Africa.

On measurement, Tripathi and Abdullaevna review existing early childhood tracker applications in terms of their accessibility, pricing models, user ratings, data security and adaptability to diverse cultural and linguistic contexts. Applications subject to review include babyTRACKS, Child Growth Tracker, The Wonder Weeks, BabySparks, Kinedu, and Thrive by Five, among others. The lack of cultural adaptability and linguistic choice still seem to be the biggest gap in the market. Aside from recommending more cultural and language adaptations, the authors also advocate for flexible pricing models to ensure inclusivity and accessibility, the incorporation of educational content, and continuing efforts to strengthen data and privacy policies.

In another recent paper on measurement, Jeong et al. assess the effectiveness of the World Health Organization’s Global Scales for Early Development Long Form (GSED-LF)in evaluating early childhood development among children aged 0–24 months in Kenya. They examined the concurrent validity of the GSED-LF by comparing its scores to those of the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). The study observed moderate to strong correlations between the GSED-LF and BSID-III scores across various developmental domains, suggesting that the GSED-LF is a valid instrument for assessing early childhood development in this context. However, the authors remind us that the GSED-LF’s appropriateness as a tool for impact evaluation purposes remains unknown.