Scaling Early Childhood Development- what to read this month (October 2024)

We start with a paper highlighting knowledge gaps in implementing multisectoral ECD programmes, summarising the results from a 2021 World Health Organization (WHO) expert consultation. The study – focusing on interventions mitigating low birth weight – discusses programmatic considerations such as coordination, context-specific risk factors, choice and number of delivery platforms, system capacity, costs and ease of access across India, Ethiopia and Brazil (see Table 1 on page 2). Implementation research such as this is crucial as more countries prepare to plan and implement multisectoral ECD programmes at scale. Check out Box 1 on page 5, in which the paper helpfully lists specific implementation research areas on which knowledge is lacking.

Sticking with the theme of health and thinking about an emergent ECD workforce, this paper by Rutledge et al. builds on the experience and a large body of evidence (see Table 1 on pages 3–4) to explore how informal traditional birth attendants can be better engaged and integrated into existing formal healthcare systems in Haiti, a context with limited infrastructure, a less developed healthcare system and a shortage of quality health facilities. Traditional birth attendants’ cultural knowledge, trust and accessibility to many women make them a critical component of the care system. Recommendations include, among others, integrating traditional birth attendants throughout prenatal, perinatal and postpartum care (just as doulas are utilised in high-income countries), building the capacity of traditional birth attendants, and developing appropriate channels to transition pregnant people from traditional birth attendant care to facility-based care.

More on the ECD workforce – this time on using faith leaders and challenges related to coordination across multiple types of service providers. In Western Kenya, Jeong et al. undertook a process evaluation of the initial stages of implementation of Moments that Matter – an integrated community-led parenting programme delivered by trained volunteers and faith leaders. The study finds that the volunteers implemented the programme with fidelity and competence during the initial implementation period. However, the roles and responsibilities of the faith leaders acting as coordinators were considered clear, and faith leaders felt inadequately supported by the programme. This finding aligns with prior evaluations conducted in other settings, similarly highlighting the challenges of coordinating across multiple types of parenting programme service providers. This study demonstrates how process evaluation conducted early on during programme implementation can contribute to programme adaptations and quality improvement.

Can non-specialists provide high-quality care in mental health and psychosocial support interventions, and what is the role of supervision and training? Looking at the implementation outcomes of Sugira Muryango – an ECD and family-strengthening intervention with mental health outcomes delivered by community-based volunteers in Rwanda, – Bond et al. look at the relationship between supervision, training and the quality of delivery. The result? The majority of community-based volunteers self-reported that the training and supervision provided not only gave them the confidence to deliver the intervention competently but also that their learning had influenced their home environment and even positively influenced their standing in the community. Investment in high-quality training and supervision for community-based volunteers could be a cost-effective and clinically effective way to scale. For more research on the use of non-specialists in mental healthcare provision, look at this new paper by Jayasinghe et al. on Sri Lanka.

Figure 1: Example of results of return-on-investment analysis for one specific scenario, as presented in the cost-benefit calculator tool (Source: Bauer et al. 2024)

How to facilitate cost-benefit analysis to inform country-specific strategic planning and priority setting? In this exploratory article, Bauer et al. introduce a user-friendly cost-benefit calculator to compare the return on investment for different options for scaling screening and psychosocial treatment for perinatal mental health problems in Malawi – for example, looking at screening provided by professionals versus trained volunteers, in group versus individual sessions and treatment in the clinic versus in the community. The objective is for the tool to be used by local policymakers to inform investments in maternal mental health. See Figure 1 for an illustration of the tool for one selected scenario. Initial findings suggest that net economic benefit starts relatively small but increases over time as more women go on to receive cost-effective treatment. The authors note that this research could be advanced further by using machine learning tools.

Can large-scale cash transfers break the cycle of intergenerational poverty through human capital development? Du, Shi and Qin explore the effect of China’s Targeted Poverty Alleviation (TPA) policy to find out. Findings suggest that TPA improved parent-child relationships, reduced depression in mothers, improved local infrastructure and child investment (e.g. use of education and medical services) and increased children’s cognitive ability to surpass an extra 19% of all children. A back-of-the-envelope calculation suggests that exposure to the TPA policy during childhood led to more than 6-month increase in schooling and a 13.1% increase in wages for adults in their twenties.

Can family-centred interventions improve responsive care practices for women living with HIV and their HIV-exposed and uninfected children? This qualitative study by Matenga et al. in Lusaka, Zambia, assesses the acceptability of engaging and training family members (male partner, other adult family member) of women living with HIV as home promotors of exclusive breastfeeding practice, responsive caregiving and adherence to antiretroviral therapy. Participants were interviewed as they tried recommended behaviours using a participatory research method called ‘trials of improved practices’. Results suggest that increasing family engagement and tailored counselling can improve caregiving practice. The findings highlight the importance of using a family systems lens when designing interventions to support vulnerable groups to ensure the most appropriate people are engaged.

In keeping with the theme of supporting vulnerable groups, how do we assist caregivers of children living with disability in a humanitarian context? This realist-informed evaluation by Evans et al. of the Mighty Children programme in Kabul, Afghanistan, explores how the programme improves caregiver quality of life. Key elements of the participatory educational support group programme were to teach caregivers how to look after children with a disability (e.g.feeding, bathing), to provide psychological resilience skills and to offer peer support. This exploratory mixed-method study sheds light on the importance of providing emotional support to caregivers, which improves their ability to manage care in humanitarian and crisis environments. These findings underscore the need for localised and adaptable strategies to ensure that humanitarian action is disability inclusive. The authors call for further studies to explore pathways to scale, sustainability and potential application to other settings.

Let’s end with a monthly round-up of narrative reviews! First up – a review of the extent of the usage of theories of change and causal pathways in impact evaluations of routine immunisation programmes. Vadrevu et al. conclude that we need to strengthen theory-based evaluation approaches. This means developing clear theories of change, integrating these into results frameworks on large-scale programmes, and combining both impact and process evaluations to understand how the intervention has affected outputs and outcomes. Our next review looks at financing for women’s, children’s and adolescents’ health in LMICs, highlighting that financial interventions are insufficient unless coupled with other non-financial interventions that address knowledge and geographical barriers. Do and McCoy’s systematic review explores the relations between caregiver education, household stimulation and ECD in Brazil, Guatemala, India, Jordan, Lebanon, Pakistan, the Philippines and Zambia. Key findings highlight the importance of expanding education opportunities to caregivers to support intergenerational wellbeing and home learning environments. However, differences in outcomes based on the child’s sex suggest more needs to be done to promote gender equity. Looking for more? Check out this comprehensive paper reviewing 540 publications from randomised control trials in child and adolescent health in LMICs from 2023–2024 for a deep dive into the evidence.