Accountability for funds for Nurturing Care: what can we measure?

Abstract

BackgroundUnderstanding donor, government and out-of-pocket funding for early child development (ECD) is important for tracking progress. We aimed to estimate a baseline for the WHO, UNICEF and World Bank Nurturing Care Framework (NCF) with a special focus on childhood disability.MethodsTo estimate development assistance spending, the Organisation for Economic Cooperation and Development’s Creditor Reporting System (OECD-CRS) database was searched for 2007–2016, using key words derived from domains of the NCF (good health, nutrition and growth, responsive caregiving, security and safety, and early learning), plus disability. Associated funds were analysed by domain, donor, recipient and region. Trends of ECD/NCF were compared with reproductive, maternal, newborn and child health (RMNCH) disbursements. To assess domestic or out-of-pocket expenditure for ECD, we searched electronic databases of indexed and grey literature.ResultsUS$79.1 billion of development assistance were disbursed, mostly for health and nutrition (US$61.9 billion, 78% of total) and least for disability (US$0.7 billion, 2% of total). US$2.3 per child per year were disbursed for non-health ECD activities. Total development assistance for ECD increased by 121% between 2007 and 2016, an average increase of 8.3% annually. Per child disbursements increased more in Africa and Asia, while minimally in Latin America and the Caribbean and Oceania. We could not find comparable sources for domestic funding and out-of-pocket expenditure.ConclusionsEstimated international donor disbursements for ECD remain small compared with RMNCH. Limitations include inconsistent donor terminology in OECD data. Increased investment will be required in the poorest countries and for childhood disability to ensure that progress is equitable.

Scaling early child development: what are the barriers and enablers?

“…To further elaborate, we summarised our resulting recommendations in table 3 and structure the following discussion under a range of ‘Cs’ that cut across this series of papers. 11–14…”

“…An additional way to support financial sustainability with scaling, repeatedly mentioned during interviews, was involvement of the private sector to capitalise on private sector capacities and resources 25 26. At the same time, as Arregoces et al have highlighted, improved tracking is needed to hold donor agencies and financing bodies accountable to commitments of long-term support of programmes, in line with SDG targets 14. A closer look is needed to understand underlying reasons why this does not happen consistently, so that compelling arguments could be better directed to persuading donors.…”

“…This paper is the fifth paper of the series and focuses on the overall process to scale-up; previous papers have reviewed partnerships and overall design,11 monitoring and evaluation (M&E),12 13 and financing 14…”

Counting outcomes, coverage and quality for early child development programmes

“…The purpose of this series is to inform design and implementation of ECD interventions at national and subnational level in diverse low-income and middle-income countries (LMIC). The series is structured around a programme cycle, outlined in figure 1 and built on a mixed-method evaluation of the Saving Brains, Grand Challenges, ECD portfolio as well as several additional analyses 12–15. The first paper in this series detailed methods for Saving Brains portfolio evaluation and findings related to programme design and implementation decisions in diverse LMIC 12.…”

“…The first paper in this series detailed methods for Saving Brains portfolio evaluation and findings related to programme design and implementation decisions in diverse LMIC 12. Subsequent papers explore measurement of ECD in routine health services,13 global funding for ECD14 and multistakeholder perspectives on scaling 15…”