Scaling Early Childhood Development: What to read this month | January 2025

Welcome to the first What to Read newsletter of 2025! We begin this edition with a new paper by Yousafzai et al. on the Early Childhood Assuring Children and Prepare for School (LEAPS) programme in Pakistan, which addresses limited access to early childhood care and education (ECCE) in rural areas. The initiative trains women aged 18–24 to provide ECCE in their communities while supporting the early childhood workforce and creating youth career opportunities. While LEAPS has shown efficacy previously, this new study evaluates its implementation in different districts and assesses short-term effects and scalability. Over two years, LEAPS improved school readiness scores by 0.30 standardised deviation for $106 per child annually – significantly less expensive than similar ECCE programmes. While the authors recommend a longer-term assessment, initial results are promising for sustainability. Interested readers can also find a podcast discussing the study findings with The Lancet.

Continuing with the topic of ECCE, Munday and Dzameni’s briefing note focuses on Ghana Education Service’s Kindergarten In-Service Training (KG-INSET) national scale-up plan. Utilising existing government structures and a cascade training approach, the kindergarten programme aims to use in-service training to promote play-based learning in line with Ghana’s early childhood education policy. Technology-based monitoring systems were developed to assess teacher performance and enhance data collection. Initial piloting results suggest that the new technology improves teacher monitoring. However, there are further challenges associated with building the kindergarten workforce in Ghana, alongside a need for more systematic training for effective tech integration. In implementing and scaling ECCE programmes more widely, the authors argue that clearer roles and increased human resources are crucial to upholding high kindergarten teaching standards.

What else can we learn from programmes already being implemented at scale? Buccini et al. conducted a qualitative case study on Brazil’s Criança Feliz Program – one of the world’s largest home-visit parenting interventions, now reaching 54% of municipalities and exceeding 57 million annual home visits. The study aimed to identify key quality control points and strategies for enhancing fidelity, quality and effectiveness during the programme’s second scaling phase. The authors found seven critical pathways impacting implementation quality: hiring municipal staff, on-the-job training, supervision, high-quality home visits, effective coordination of multisectoral actions, technical assistance, and funding to hire and retain municipal teams. These factors align with recent findings on scaling nurturing care programmes in LMICs.

Is it feasible to integrate interventions for psychosocial stimulation and child feeding? Isanovic et al. examined this in rural Liberia by providing fortnightly group-based parenting sessions, cooking demonstrations, and weekly supplies of 14 eggs and 20 pieces of dried fish to 30 caregivers and their children (aged 6–36 months). This initiative was integrated into existing government-led healthcare activities delivered by community healthcare workers. Piggy-backing new services onto existing delivery structures is an important route into ECD impact and innovation. Results over a short, four-week implementation period showed high caregiver adoption and satisfaction with the sessions and food provisions. The integration with local service delivery structures and trusted community workers contributed to its success. The study also highlights some scope for programme improvement, such as involving fathers, enhancing group sessions with home visits, and expanding eligibility criteria for facilitators.

Some important qualitative research on early childhood development workforce occupational mental wellbeing this month. Community health workers often face tough working conditions, including inadequate supplies, training, supervision and community support, alongside long hours and low pay. Sullivan et al. study community health workers in rural Mexico, exploring their mental wellbeing and strategies for improvement. While many community health workers derive fulfilment from offering health education, excessive workloads lead to negative mental health outcomes, particularly for women. Targeted interventions, like psychological screenings, referrals, peer support, ongoing training and improved resource access, significantly improved wellbeing for many. However, access to these resources is uneven, necessitating further improvements. The study advocates for viewing community health workers as both care providers and beneficiaries, fostering mutual benefits for them and their communities.

Taking a different mental health perspective, Ether et al. present a valuable systematic review of interventions aimed at supporting the mental wellbeing of refugee women during the pre-and post-partum periods in fragile and conflict-affected countries. Check out pages 5–7 for a helpful overview of all studies and their findings, and don’t miss pages 7–9 for fun infographics that bring the different interventions to life (see Figure 1 for a sneak peek)! The paper emphasises that various interventions – including home visits, group counselling sessions, the creation of social support groups, and voluntary health services – have demonstrated a significant positive impact on the mental wellbeing of pre- and post-partum refugee women. The authors call for further evaluation and research for some promising interventions including home visit programmes and the development of social support programmes for refugee populations.

How has the coverage of India’s national nutrition programmes progressed? A new study by Avula et al. reveals significant coverage improvements across all nutrition interventions during the first 1,000 days, between 2016 and 2021. Coverage increased by 1–22 percentage points during pregnancy, 7–20 points at delivery and postpartum, and 5–17 points in early childhood. Notably, rural and poorer areas showed greater improvements, with wealth gaps narrowing. The highest gains in coverage were in regions with added incentives and performance monitoring under India’s National Nutrition Mission (NNM). While intervention quality matters, the study suggests large-scale nutrition interventions are achievable. However, further research is needed to address ongoing coverage gaps related to wealth, education and location, especially during pregnancy, and it will be interesting to see whether there are possible fade-out effects in coverage over time.

On measurement, the Global Scales for Early Development (GSED) team continues to tackle the challenge of reliably tracking and interpreting ECD outcomes over time and across contexts. Many measurement tools exist (see for example the World Bank toolkit), but they vary widely in score definition, age appropriateness and contexts, complicating comparisons. This new study aims to enhance the existing Development Score (D-score) to create a universal, reliable and unidimensional scale, both for assessing ECD programme impacts and for monitoring development in children aged 0–3. This enhanced D-score uses data from caregiver reports as well as direct assessments. Additionally, a newly introduced conversion key allows existing measurements to be translated into a D-score. The authors believe this improved tool can be expanded and tailored for research needs and can be used to more effectively communicate findings to policymakers.

Kitamura et al. have validated the Early Childhood Development Index (ECDI) 2030 in Nepal – a caregiver report-based indicator of ECD for children aged 24–59 months. Due to the COVID-19 pandemic, data collection shifted from traditional in-person interviews to phone-based methods. Results indicate that phone survey data broadly aligns with data from face-to-face interviews, though the authors do acknowledge that there may be exclusion errors with households that do not have phone access. Further challenges arose throughout the study in building rapport and clarifying confusing questions, which can lead to inaccurate responses. This study offers valuable insights and recommendations for policymakers and practitioners collecting essential data on children in a timely and safe manner, especially in situations where traditional face-to-face methods may be challenging or unfeasible.

Some important findings on financing from Harris et al., who present a comparative overview of public expenditure on childcare and early childhood development across four African countries (Kenya, Rwanda, Senegal, and Côte d’Ivoire). The study reveals that public spending on pre-primary education in these countries is less than 0.2% of GDP, which is much lower than the recommended 1% internationally. Additionally, foreign education aid typically does not support ECD and pre-primary education. The authors suggest several policy changes. They highlight the need for greater transparency in how education funds are spent, stronger commitments from donors to prioritise ECD and pre-primary education, and increased awareness among governments of the significant economic benefits of investing in these areas, such as job creation and GDP growth.

Finally, how can scorecard systems enhance early childhood development? The Thrive team in Tanzania has outlined important lessons and recommendations for developing an ECD scorecard system within the Tanzanian National Multisectoral Early Childhood Development Programme (NM-ECDP). The briefing highlights several advantages of using scorecards, such as measuring key performance indicators and guiding policymakers in system improvements. Recommendations for better implementation of scorecards in ECD settings include ensuring strong political support for accurate reporting, establishing effective processes for data analysis, and making scorecard findings publicly accessible to promote accountability and awareness of ECD service effectiveness.