Scaling Early Childhood Development – what to read this month (July 2024)

In this monthly blog – also available as a newsletter – we highlight recent advances in research, materials, tools and practices related to how to design, implement, monitor and evaluate scalable early childhood development (ECD) programmes in low- and middle-income countries (LMICs) worldwide. The inspiration for this new series came from Ugo Gentilini’s excellent Weekly Social Protection Links.   

Scaling early childhood development – what to read this month is curated by Bet Caeyers (Lead Editor, Chr. Michelsen Institute), Gemma Knights (Editor, Oxford Policy Management) and Meghan Taylor (Editor, Oxford Policy Management). 

Let’s start with a success story on preschool construction programmes, for which recent evidence has been somewhat mixed. Bassi et al. use a Randomised Controlled Trial (RCT) to evaluate the effectiveness of an at-scale preschool construction programme for ages 3 to 5 in rural Mozambique. The public-private partnership involved constructing traditional and sustainable preschool centres at walking distance from local primary schools, hiring and training local instructors selected by the community, and holding parenting education sessions. 

The programme has been explicitly designed with scalability, replication and sustainability in mind. The authors attribute high impacts on participation and ECD outcomes relative to other preschool construction programs, to the interaction between the programme and the local primary school system by design.

Do government subsidies for early learning service providers in South Africa improve access and quality? Not necessarily if the costs of meeting “eligibility standards” are passed on to families in higher user fees.  A new paper by Kika-Mistry and Wills uses the 2021 ECD Census and 2021 Thrive by Five survey to explore this trade-off for Early Learning Programmes (ELP) in South Africa.  Whilst both the registration and receipt of subsidies are associated with higher programme quality, they are also associated with higher monthly costs per child, and these higher programme costs per child are associated with higher user fees (Figure 1). Importantly, however, the increase in user fees for each marginal increase in programme cost is significantly lower for subsidised programmes than unsubsidised programmes (note that the graph is flatter for the former than the latter). To the extent that user fees deter access, these findings suggest subsidies improve the twin goal of enhanced quality and access in this context.  

Figure 1: Average user fee per child per month over total cost per child per month, by subsidy receipt status. Source: Figure 9 (page 19) in Kika-Mistry and Wills (2024). Notes: (i) Sample (N=413 ELPs, 308 subsidised and 105 unsubsidised ELPs), (ii) ELPs charging more than R700 per child per month excluded, (iii) in addition to cost and subsidy receipt, the regression controls for the nearest school quintile and province, (iv) includes 95% confidence bands, (v) 2021 Rands.

Next are two new systematic reviews on parenting programmes, each published by one 2024 fellow from the Early Childhood Development Action Network’s (EDCAN) Knowledge Fellows programme. Amon-Kotey reviews adolescent parenting support programmes and interventions in Africa whilst Pethe’s review focuses on scaled and transitioning to-scale ECD parenting programmes, identifying enablers such as government cooperation and support, funding, and a well-compensated healthcare workforce. Check out ECDAN’s Knowledge Fellows programme if you are an early-career ECD professional and wish to gain professional development, mentorship, and networking opportunities by collaborating with experienced ECD professionals.

How do community health workers (CHWs) in large geographic areas decide whom to visit? Owoputi et al. provide a rare glimpse of CHW coverage and targeting factors in the context of the Addressing Stunting Early (ASTUTE) health and nutrition programme for children under 2 in Tanzania. Only 13.4% of eligible households report having received a visit from a CHW in the past 6 months, with poor and food-insecure families frequently missed. The main reported barriers to home visits include distance and poor weather conditions. Interestingly, CHWs also report being less inclined to visit families where they expect visits to take longer (e.g., because of cultural barriers or low education) or where they expect caregivers to ask for food or money (e.g., disadvantaged families). Study recommendations? Changes to CHW remuneration, better role specification, limiting the target population and use of digital services to carry out some programming.

Moving to measurement: How valid, reliable, accessible and applicable are developmental screening and assessment tools across different demographics? A new review by Kurbatfinski et al. compares tools across contexts and makes some useful observations. The Ages and Stages Questionnaire (ASQ) and the Battelle Developmental Inventory (BDI) were rated most favourably as screening and assessment tools, respectively. The article also includes practical recommendations about how to improve the validity and accessibility of tools across cultures, such as simplifying the administration processes and ensuring that tools are available in multiple languages. 

On gender, IFPRI’s new systematic review by Hidrobo et al. (soon to be included as a chapter in the forthcoming MIT Press Handbook of Social Protection: Evidence to Inform Policy in LMICs) provides a helpful overview of the policy discourse and research on social protection and gender. The focus is on women’s health, economic, empowerment and violence exposure. Key takeaway? Accessible, affordable and quality childcare systems are critical to promoting gender equality and women’s labour market participation. See Section 3.4 on pages 17-21 for a summary of findings and recommendations on design and operational programme features that facilitate positive impacts for women.

On equity and inclusion,  in a recent Comment in the Lancet, Smythe et al. argue for a paradigm shift to recognise the importance of the psychological well-being of caregivers in ECD policy and practice, particularly those caring for children with disabilities. Through some examples, the commentary illustrates how programmes co-developed and led by caregivers and people with disabilities are most effective, fostering inclusivity and empowerment. Involving all stakeholders in the development process ensures services are grounded in local evidence and practical recommendations are systematically assessed, improving scalability, integration, and sustainability.

Speaking of the importance of stakeholder dialogue and engagement, in a new case study, van der Heyde summarises the lessons learnt in South Africa through the Violence Prevention Forum (VPF). The VPF is an innovative platform to catalyse and foster dialogue and relationships between researchers, policymakers and practitioners working on violence prevention. This case study confirms that building such dialogues can allow the research to be better informed by the needs of the end users. The next step is to ensure the insights gained through these dialogues translate into action.

For more on the power of research and stakeholder collaboration, check out this paper by Rao et al. in a series of interesting papers in a special issue on ECCE in LMICs in the journal Children. The paper concludes that through appropriate and purposeful collaboration, researchers, policymakers and practitioners can innovate, bolster evidence-based policy-making and most importantly, improve access and participation in high-quality care and education for all children.