Scaling Early Childhood Development – what to read this month | March 2026

Scaling Early Childhood Development – what to read this month is curated by Bet Caeyers (Lead Editor, Chr. Michelsen Institute), Tanvi (Editor, Oxford Policy Management) and Daniel Munday (Editor, Oxford Policy Management).

A new The Lancet Regional Health – Africa commentary by Richter et al. makes a clear case: Africa’s youngest children will shape the continent’s economic future, yet too many still grow up without the conditions needed to thrive. Drawing on the Countdown to 2030 regional and country early childhood development profiles for Africa, the authors highlight stark disparities – stunting ranges from 12% in North Africa to 40% in Central Africa, while early learning participation drops from around a third to just 6%. Despite progress in reducing risks linked to poverty and stunting, major data gaps remain, particularly on whether children are developmentally ‘on track’. Crucially, the paper emphasises that data must move beyond monitoring to decision making. For scaling, this positions country-owned, standardised data systems linked to planning, budgeting and accountability as a core ingredient for building effective, system-wide ECD delivery.

Stengelin, Kanngiesser and Milward challenge a core assumption in child development research: that early social development is best understood through one-on-one interactions. Much of what we know about child development comes from dyadic research. They argue this ‘dyadic default’ reflects theoretical bias and methodological convenience, leading to an over-reliance on simplified interaction models that do not reflect how children experience learning in many contexts globally. Because children often develop within larger social groups, especially in LMICs, this bias may distort both measurement and intervention design. The authors call for a shift towards studying polyadic interactions to better capture real-world dynamics (see Figure 1).

A randomised clinical trial by Chang et al. provides rare evidence on the effectiveness of a parenting programme completely owned by a government and implemented through a health system. Implemented via primary health care in Jamaica, a blended Reach Up model, alternating home visits with phone calls, improved child development (SD = 0.17) and parenting behaviours, including stimulation and responsivity. The study responds to a key evidence gap on remote delivery, showing that hybrid models can maintain impact while reducing delivery intensity. Crucially, the intervention was delivered by community health workers within routine services, demonstrating feasibility within existing systems. With an estimated benefit-cost ratio of 12:3 and most costs borne by the Ministry of Health & Wellness, the study strengthens the case for integrating hybrid parenting support into routine primary care as a scalable route to improving ECD in resource-constrained settings.

Using longitudinal Young Lives data from India, Santiago and Gupta examine whether preschool participation affects long-term schooling outcomes. They find that attending preschool for at least 6 months between the ages of 3 and 6 reduces dropout before upper secondary completion by 7 percentage points – a 17% reduction relative to the mean – even after accounting for observable differences. Importantly, these gains persist despite fade-out in early test scores, suggesting that preschool effects may operate through longer-term behavioural or non-cognitive pathways such as confidence and aspirations. The study strengthens the case for preschool as a system-level investment: beyond improving school readiness, it can increase retention and efficiency across the education system, particularly in LMICs, where dropout remains high.

Sun et al. analyse early achievement gaps in Hong Kong and the role of preschool quality and parental engagement. They find that socioeconomic status disparities in development emerge early and are significant across domains. High-quality preschools are associated with better outcomes and appear to disproportionately benefit children from lower socioeconomic backgrounds, indicating a compensatory effect. In contrast, parental engagement, while beneficial overall, does not significantly reduce these gaps. The findings reinforce that improving access to quality preschool – rather than relying primarily on family-level behaviour change – is critical to reducing inequality and delivering equitable ECD outcomes at scale.

The 2025 Lancet Countdown report by Amouzou et al. highlights a slowdown in progress on maternal, child and adolescent health across LMICs. While coverage of health services increased, and mortality and nutrition indicators continued to improve, the rate of change since 2015 is insufficient to meet Sustainable Development Goal targets. The report attributes this slowdown to structural pressures – including rising debt burdens, conflict, climate change and food insecurity – which are increasingly constraining health systems. Programme effectiveness is tightly linked to broader system conditions – particularly financing, workforce capacity and system resilience – highlighting the limits of intervention-focused approaches without parallel system strengthening.

Okoye et al. synthesise evidence on why maternal and child nutrition programmes often underperform in LMICs despite strong policy frameworks. Across studies, implementation is constrained by weak multisectoral coordination, limited local capacity, inconsistent funding, and weak monitoring and accountability systems. These gaps create a persistent disconnect between policy design and delivery, leading to suboptimal impacts on key outcomes such as stunting and dietary diversity. The review underscores that improving nutrition outcomes requires strengthening governance and implementation systems, not just designing better programmes.

Miyares, Stansert Katzen et al. review the cost-effectiveness and affordability of reproductive, maternal, newborn and child health community health worker programmes across LMICs. Most interventions are found to be cost-effective compared to alternative services or delivery modalities (e.g. health-facility-based delivery), particularly for maternal and child health outcomes. However, the evidence base is highly heterogeneous, and few studies assess affordability or fiscal sustainability. This highlights a critical gap for scaling: while community health worker-led reproductive, maternal, newborn and child health programmes are often effective, decisions to expand depend on whether governments can finance them at scale and integrate them into health systems. The review positions community health workers as a key delivery platform but emphasises the need to align cost-effectiveness evidence with real-world budget and system constraints.

Ng’oma et al. review evidence on the identification and treatment of perinatal depression in LMICs – a condition with significant implications for both maternal wellbeing and child development. While brief psychological interventions, such as cognitive behavioural therapy delivered by non-specialists, have demonstrated effectiveness, access remains extremely limited. Barriers include low detection rates, stigma, workforce shortages and weak referral systems. Approaches identified by the review as promising include task-sharing by peers rather than health workers and the use of digital technologies. However, evidence on the large-scale implementation of these remains limited. The review highlights maternal mental health as a critical but under-integrated component, requiring stronger integration into routine services and investment in delivery systems.