Scaling Early Childhood Development – what to read this month | June 2025

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

Kicking off this month’s newsletter, we have an engaging interview with Costas Meghir, Professor of Economics at Yale, and Amer Hasan, Senior Economist at the World Bank, conducted on the side lines of the recent Designing Quality Care conference in New Haven. In this conversation, two leading early childhood development (ECD) researchers discuss the latest updates from their work and the impact of key interventions, and delve into the cost-effectiveness of ECD programmes – plus tips on building stronger connections between different initiatives.

Lilford et al. make a compelling case for transforming primary care in low and middle-income countries (LMICs) at scale. They previously argued that urban primary care often varies in quality, not availability — patients can find clinics but poor diagnosis and treatment force them to travel further and pay more. In this latest study, they emphasise the need for big policy shifts to reshape the primary care market, pushing out low-quality providers. Suggested solutions include better staff training, forming clinical teams for quicker assessments, and boosting health literacy so patients can advocate for themselves. With urbanisation accelerating in LMICs, the authors stress that investing in primary care is more urgent than ever and call for more research to guide these efforts.

Two articles shine a light on pre-conception nutrition in South Asia, highlighting key gaps in policies and programmes. Miller et al. review current research and identify challenges, including limited data on effective interventions, weak stakeholder engagement, and a lack of diverse programmes for underserved groups. They stress that developing culturally sensitive, evidence-based approaches and stronger collaboration could help scale successful initiatives. Meanwhile, Hazra et al. examine public policies, finding that many countries lack basic services like nutrition screening, nutrient provision, and support on healthy eating for at-risk women. They urge governments to boost investment, improve workforce training, and ensure equitable access to strengthen existing programmes and overcome service bottlenecks.

On water, sanitation and hygiene (WASH), in a new VoxDev blog, Quattrochi et al. discuss the results of a trial of the Healthy Villages and Schools programme in the Democratic Republic of the Congo. The initiative combined community-driven behaviour change campaigns with subsidies for water and sanitation infrastructure. While a great step forward — 96% of villages created action plans and 86% implemented them — behavioural changes among community members did not improve compared to controls, and child health stayed the same. Waterborne illness rates and diarrhoeal infections did not change, likely because water quality was unaddressed — contamination was high across all villages. The team calls for bolder WASH efforts that target not only community actions but also the root water quality issues. They point to a Mexican programme using point-of-collection chlorination as a promising example.

Turning to childcare centres, a new report by Children in Crossfire dives into the rapidly expanding Tanzanian urban childcare market that is driven by private providers of predominantly informal daycare. In Dar es Salaam’s rapidly growing, crowded, low-income areas, these daycare centres are vital—giving parents, especially mothers, the opportunity and peace of mind to work while their kids are safe and cared for. While the report observed decent quality relative to context across many of the minimum regulatory standards, evidently gaps remain. More training is needed around including children with disabilities and nurturing social-emotional skills. Given most centres are private, informal enterprises —charging very low tuition fees and daily food payments — financial resources remain extremely tight for reinvesting in quality improvements. The consensus: governments and partners must step up to support an enabling ecosystem around these centres, helping them become more sustainable, stimulating, and safe spaces for the hundreds of thousands of children and their households that rely on this childcare lifeline.

Using unconditional cash transfers (UCTs) as a benchmark? In a new VoxDev blog, Crosta et al. review 115 studies reporting on randomised evaluations of 72 UCT programmes from 34 LMICs, to advocate for a cash-first approach. UTCs bring a diverse range of benefits in low-resource settings—boosting labour supply via entrepreneurship, increasing income, consumption and savings, and improving welfare (e.g. school enrolment, food security and mental health). Based on these findings, the authors conclude that, if alternative programmes outperform cash, they should replace it; but that due to their simplicity, scalability, and sustainable impact, cash transfers should remain a key policy option. This study encourages us to seek more rigorous evidence on the cost-effectiveness of labour-intensive ECD interventions (such as parenting programmes) relative to that of programmes simply giving cash without any strings attached. For more on cost-effective cash+ programming, take a look at Hoddinott et al.’s recent paper on social assistance consumption in Bangladesh.

Talking about parenting, Tipu et al. give us a heads up for planned research on a scaled psychosocial stimulation programme that will be delivered fortnightly for one year to small groups at community clinics by health workers in Bangladesh. The intervention uses a modified curriculum from the Reach Up programme, focusing on play-based learning to aid cognitive development and language skills, while also delivering nutritional knowledge sessions for mothers. The team plans to train 1,500 healthcare staff to deliver sessions across rural community clinics, in the process developing the first ECD service for children under 3 delivered by the health service in Bangladesh. The study will eventually incorporate over 500 community clinics, with 10,000 children enrolled in the programme.

In another newly published protocol, Howells et al. outline their planned work to validate the measurement of child development in Kiribati using the Global Scale for Early Development Short Form (GSED SF) – something that has not been done before for in the Oceania-Pacific region. The GSED validation is designed to use a convenience sample of 500 children in the villages of South Tarawa. The study is being conducted in close collaboration with the Government of Kiribati to build local capacity and will add to the literature investigating the performance of the GSED SF in a new context and culture as well as provide Kiribati with a tool for monitoring and evaluating ECD in children aged 0–3 at the national and programmatic level.  

Bliznashka et al. did a systematic review of the psychometric properties of tools used to measure ECD in LMICs – 60% of which were found to have been developed in high-income countries. They looked at 160 studies covering 117 tools from 55 countries, focusing on children aged 0–6. Most tools were tested on narrow age ranges – sometimes just one month. The studies mainly applied to urban settings, with little information as to how well the tools worked across different cultures or in rural areas. Plus, the authors noted a lack of reporting and transparency about training assessors and handling data, which hampers the critical appraisal of these measures. Despite there being an abundance of tools, many have not been thoroughly tested for cultural fit or across all areas of development, especially social and emotional skills. For reliable child development monitoring and comparisons, more research is needed to establish the applicability of existing tools in diverse populations.

Let’s now turn to financing. Holla and Pan’s new paper uses an ingredients-based approach to assess the costs of Brazil’s state-run home visiting programme (PADIN). When implemented for 10 months annually, the estimated cost is BRL 1,597 (USD 438 in 2018) per child. The main cost drivers are home visitor compensation, state-level personnel, and municipal supervisors, accounting for 64% of total costs. Municipalities´ decisions to supplement or not supplement state-level funding led to significant differences in per-child spending. This costing exercise offers much-needed clarity on early childhood home visit costs, supporting realistic budgeting and scaling. It also highlights equity and data accountability challenges essential for ensuring programmes deliver impact efficiently and inclusively.

In Tanzania, the Thrive research programme has published a new paper assessing the institutional landscape for planning and budgeting for ECD within the public financial management (PFM) system. It estimates that around TZS 2.4 trillion (USD 890 million) was allocated to ECD services in FY 2023/24, with details in Table 13 (p. 42). The study highlights challenges such as limited transparency, poor coordination at local levels and heavy donor dependence — 98% of the PSSN is donor-funded. Despite these issues, Tanzania continues to invest substantially in ECD, with opportunities for further engagement. The research also introduces a practical framework for estimating ECD budgets and addressing resource allocation priorities.

To conclude, Coria et al.’s paper, ‘USAID’s Role in Saving Children’s Lives’, reviews six decades of funding dedicated to combating communicable diseases, malnutrition and strengthening health systems. They highlight USAID’s significant impact in saving children’s lives and improving global socio-political stability and health security. However, they caution that recent funding cuts threaten the progress made over the past half-century in reducing childhood illness and mortality. The authors call on the global community to prioritise the continuous delivery of essential healthcare services, ensure widespread access to USAID-supported tools and models (such as DHS surveys and evaluation mechanisms), and critically assess the sustainability and equity of current foreign aid structures.