Scaling Early Childhood Development – what to read this month (June 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 Lin k s.  

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).

Kicking off this month’s newsletter is a detailed narrative of an emerging scaling success. The Early Journey of Life (EJOL) programme in Vietnam supports parents through community centre-based group sessions during the first 1,000 days of children’s lives. After an initial pilot in 2013 and a randomised controlled trial in 2020, the programme transitioned to scale in all of Ha Nam provinces’ 109 communes, now reaching 29,866 women. Key ingredients: systematically using real-life digital monitoring data and data from rigorous impact evaluations; transparency; shared ownership of the programme; and frontline capacity. Check out pages 226–227 to see how EJOL compares to the Reach Up programme, referred to in our May newsletter.

Another positive scaling example! A year ago, Ubongo – a pan-African social enterprise that produces TV and radio programmes (many readers will know Ubongo Kids and Akili and Me) – turned 10. Mark Wahome takes us through Ubongo’s decade of innovation and impact through edutainment. Children who engage in Ubongo programmes demonstrate a 13% improvement in early cognitive skills, a 7% improvement in social-emotional learning and a 19% improvement in health. Ubongo’s ability to tap into vast distribution networks and tailor content to numerous languages has contributed to this success, so much so that it plans to reach 60 million children by 2025.

More discouraging is the recent evidence on the impact of phone-based parenting interventions. A new paper from Arteaga et al. evaluates an intervention in India where parenting advice is delivered through automated phone calls to caregivers with children aged 6 to 30 months. The content of the calls is derived from global evidence, including the successful Reach Up curriculum. Just as the phone-based Reach Up intervention in Jordan described in our May newsletter, the impact of this one is disappointing. Caregivers’ knowledge of child development deteriorated, anxiety increased and there was no effect on child development.

In line with this result is the conclusion of a new systematic review of mobile health (mHealth) interventions on maternal, newborn and child health during children’s first 1,000 days in LMICs. Almost 90% of the available mHealth studies concern client education and behaviour change communication, typically sending reminders to caregivers via mobile phone. With some exceptions (improvements in antenatal care attendance and the timeliness of child immunisation), findings across most indicators are inconclusive. Conclusion: lightly nudging caregivers with information and reminders may not necessarily improve behaviour rooted in sociocultural beliefs and constrained by limited economic and physical access to quality services.

What then are key success factors for effective behaviour change communication? According to a new paper by Kihagi et al. on nutrition and health counselling in Kenya, it comes down to ensuring services are delivered by well-trained community healthcare workers (see pages 8–9 for a list of 7 key implementation features). Fivian et al. assess the feasibility, user acceptability and equity of an mHealth intervention in India and find that mothers think that mobile phone interventions do not adequately replace the benefits of face-to-face group sessions. A recent scoping review from Litvin et al. advocates for the focus of behaviour change communication interventions to move beyond the individual towards more norms-focused and gender-transformative approaches.

Another new paper explores what we can learn from two-generation approaches – interventions designed to simultaneously improve ECD and the livelihood of the caregiver. Sommer, Franchett, Yoshikawa and Lombardi identify three emerging categories of such programmes: (1) high-quality childcare, (2) ECD and parental non-formal education and (3) cash transfers and parenting. Success hinges on the integration of additional services, such as those targeting nutrition and physical health; on quality and intensity of services for both generations; and on ensuring that the intervention is tailored to the specific context. For more on the importance of community systems in ECD, check out Lombardi’s blog post from earlier this year, which emphasises the value of place, community and strong social connections in working towards the common goal of positive ECD outcomes.

What intervention components are most successful in simultaneously preventing or responding to intimate partner violence and violence against children? According to a new systematic review by Bacchus et al., such factors include improved communication, conflict resolution, reflection on harmful gender norms, and awareness of the adverse consequences on children. Interestingly, all but 1 of the 19 prevention interventions identified were in LMICs, whereas all but 2 of the 11 response interventions were based in high-income countries. See here for another recent systematic review of interventions aiming to reduce child maltreatment (by Malmberg-Heimonen et al.).

More on vulnerable groups – displaced populations. Dickson et al. systematically review processes, perspectives and experiences related to the delivery and receipt of mental health and psychosocial support programmes for displaced groups in LMICs. In addition to language barriers, poor literacy and location/reach, stigma is a recurring factor in influencing the acceptability of mental health programmes. There are also notable gender differences in the type of programme activities caregivers are willing to engage in. Whereas women requested more advice on quality time activities with children, programme content on ECD was perceived as ‘irrelevant’ by men who believed they ‘had essentially no role to play in the raising of children below the age of 5’.

Research doesn’t just strengthen the workforce – the workforce strengthens research too! In a cross-country study, Zosh et al. explore and compare how teachers engage with an interactive formative assessment tool designed to support the implementation of playful learning approaches. The study uses observations of teachers’ use of the tool as a valuable data source to gain insights into context-specific perspectives. The study calls for a more bidirectional relationship between the researcher and the teacher; lessons from how teachers experience and use tools can and should be used to inform the future study of the science of learning.

Innovative finance approaches have a lot of potential to close education funding gaps but have so far fallen short. In a new paper, Patrinos and Tanaka explore what it will take to make blended finance—strategically using development funds to attract private investment— more popular in education. How to get more private investors on board? Make a case – again – for spending on education as an investment in the future; improve market conditions to create favourable investable opportunities; and put more emphasis on measurement to allow investment decisions and payments to be based on the achievement of results.

Finally, let’s not forget the importance of advocacy work for scaling ECD. Efforts like the Scaling Up Nutrition (SUN) Movement have contributed to the recognition of the first 1,000 days. Yet not all advocacy work is equally effective, and it is important to understand why. In an insightful paper, Resnick et al. assess and compare several aspects of the enabling environment for nutrition advocacy in Nigeria and India – two federal democracies with high malnutrition despite vibrant nutrition advocacy communities. The paper features (among other contributions) nice nutrition advocacy landscape graphics (see Figure 1 and Figure 2 below). These visuals highlight that advocacy networks in India are denser than in Nigeria, that certain advocacy actors are central in both contexts (e.g. UNICEF) and that unlike in India, there is a lack of domestic ownership for the nutrition agenda in Nigeria, with efforts driven mostly by external and international actors.