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

Newsletter | 31st May 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). 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), Erika Williams (Editor, Oxford Policy Management) and Meghan Taylor (Editor, Oxford Policy Management).

Can parenting apps be effective across cultures? We will soon find out. Earlier this year we highlighted the free mobile parenting app Thrive by Five. The app (Fig.1) links ECD information to childrearing activities in simple, user-friendly language. The team has now published its protocol for a planned mixed-method multi-site early valuation of this tool. While there has been a proliferation of parenting apps globally, the study will be one of the first to assess their usability, acceptability and effectiveness in diverse cultures. It is expected to provide valuable insights for scaling such technologies.

Figure 1. Screenshot Thrive by Five App.
Figure 1. Screenshot Thrive by Five App. Source: LaMonica et al. (2024)

What about the impact of home-visiting parenting programmes on the use of health services? Focusing on Brazil’s large-scale Primeira Infância Melhor programme, Viegas da Silva et al. show a positive effect on visits to health facilities during pregnancy but no impact after birth. This is despite home visitors and community health workers being co-located in the same facility. This study calls for improved integration of parenting programmes with primary healthcare to ensure a healthcare continuum during critical periods of child and maternal health.

Health systems are not the only platforms employed to deliver ECD services – social safety nets can too. New research led by Sheikh Hossain and Jena Hamadani reveals the positive outcomes of using a social safety net infrastructure to provide a parenting and nutrition education programme in urban Bangladesh. The programme is based on the Jamaican Reach Up model. Promising results underscore the potential for parenting programmes to be effectively integrated into a national safety net scheme. This is especially relevant in settings where the primary healthcare system is complex, patchy and not accessible to the people most in need of ECD support. Can (implementation) research really make a difference in programme delivery at scale? Yes, according to a new study by Frances Aboud and her team. Using the ExpandNet definition of scaling, the study discusses horizontal (within the country) and vertical (through government systems) scaling challenges and strategies across two different cultural contexts: Zambia and Bhutan. Examples of programmatic changes implemented thanks to findings from implementation research include modifying training materials, refining delivery methods, improving supervision, and strengthening advocacy and support at community and government levels.

Moving on to service delivery approaches for improved nutrition! A new paper by Winters et al. evaluates the long-run impacts of an innovative entertainment-education strategy on caregiver knowledge, infant and young child feeding (IYCF) practices in Bolivia. Delivered at home by community health workers, the Community Child Nutrition (CCN) programme used performing arts (puppet shows, theatre, songs, poems) to target caregivers with culturally relevant IYCF messages. About 18 months after project completion, the study found a sustained increase in caregiver IYCF knowledge, but effects on IYCF practice decreased over time.

Pivoting to the topic of inclusion, a narrative review by He et al. highlights implementation factors key to the successful scaling of group-based caregiver support interventions for children living with disabilities in LMICs. These include making sure content and delivery are culturally- and disability-relevant; using skilled facilitators; promoting active peer-to-peer learning (a support group feature that yields some of the greatest benefits); and building strong relationships with local service and community leaders. For more information, check out the new Routledge International Handbook of Disability and Global Health. Of note, Chapter 34 shows how research and practice can be approached in crisis settings.

Speaking of ECD in crisis settings, during the COVID-19 pandemic, the Ahlan Simsim Initiative brought ECD and playful learning to children affected by conflict in Jordan. The audio-only, phone-based adaptation of the Reach Up programme was the first phone-based parenting intervention programme delivered in a humanitarian context. Following a recent impact evaluation of this programme (which showed little impact), a newly published cost-effectiveness assessment report estimates the average cost per household of the intervention (2 phone calls per month on average over 6 months) to be $110. For a helpful overview of cost per child estimates of prior Reach Up randomised controlled trials, ranging from $10 to $963 in 2023 US dollars, see Table 1, pp. 4–5.

New longitudinal cohort studies are always thrilling, especially if they start early (in utero) and if they include marginalised population groups. So, good news: a new large longitudinal prenatal birth cohort study with Rohingya refugees and host communities in Cox’s Bazar, Bangladesh has just been launched – stay tuned!Finally, what is the role of NGOs in scaling ECD services? Some food for thought: sharing her personal experience in Guatemala, Gibbons claims that ‘the distribution of community-oriented projects by NGOs does not align with either the population distribution nor the needs of the people as indexed by poverty levels’ and ‘instead projects are located in areas with favourable climates that are frequented by tourists’. She argues that programmes based on Western parenting practices fail to take culturally and contextually adapted approaches, ultimately resulting in the implementation of ineffective or unethical interventions. The proposed solution, according to Gibbons, lies in rigorous impact evaluations.

Country

Bangladesh, Ghana, Kiribati, Sierra Leone, Tanzania

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