Counting outcomes, coverage and quality for early child development programmes

Abstract

Improved measurement in early child development (ECD) is a strategic focus of the WHO, UNICEF and World Bank Nurturing Care Framework. However, evidence-based approaches to monitoring and evaluation (M&E) of ECD projects in low-income and middle-income countries (LMIC) are lacking. The Grand Challenges Canada®-funded Saving Brains® ECD portfolio provides a unique opportunity to explore approaches to M&E of ECD programmes across diverse settings. Focused literature review and participatory mixed-method evaluation of the Saving Brains portfolio was undertaken using an adapted impact framework. Findings related to measurement of quality, coverage and outcomes for scaling ECD were considered. Thirty-nine ECD projects implemented in 23 LMIC were evaluated. Projects used a ‘theory of change’ based M&E approach to measure a range of inputs, outputs and outcomes. Over 29 projects measured cognitive, language, motor and socioemotional outcomes. 18 projects used developmental screening tools to measure outcomes, with a trade-off between feasibility and preferred practice. Environmental inputs such as the home environment were measured in 15 projects. Qualitative data reflected the importance of measurement of project quality and coverage, despite challenges measuring these constructs across contexts. Improved measurement of intervention quality and measurement of coverage, which requires definition of the numerator (ie, intervention) and denominator (ie, population in need/at risk), are needed for scaling ECD programmes. Innovation in outcome measurement, including intermediary outcome measures that are feasible and practical to measure in routine services, is also required, with disaggregation to better target interventions to those most in need and ensure that no child is left behind.

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…”

“…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…”

Frühe Förderung und Frühe Hilfen in Deutschland

“…Die Begrifflichkeiten Frühe Hilfen (FH) und frühe Förderungen/Frühförderungen werden im internationalen Sprachgebrauch überwiegend als "early intervention services" zusammengefasst. Es findensichjedochauchinternational verschiedene Interventionen, die als "early childhood development (ECD) programs" bezeichnet werden, häufig auch mit dem Zusatz "inclusive" (IECD) versehen, wenn die Förderung und der Einschluss von Kindern mit Behinderungen betont werden sollen [9,10]. Gemeinsame Kriterien der Programme für Kinder mit und ohne (drohende) Behinderungen sind, dass sie individualisiert und an die Entwicklungsbedürfnisse des Kindes angepasst erbracht werden, eine ausreichende Intensität erreichen, familienorientiert gestaltet werden, transoder interdisziplinär durch ein Team erbracht werden sowie wissensbasiert und ergebnisorientiert sind [20].…”

Strengthening Health Systems to Support Children with Neurodevelopmental Disabilities in Fiji—A Commentary

“…The model of care ( Figure 2) developed in this collaboration follows the evidence-based recommended tiered approach to supporting children with NDDs [11,12,25,26]. The developmental paediatric services sits within a broader universal framework of early identification.…”

“…Finding feasible and accurate screening and diagnostic assessment tools in the LMIC context is a challenge, as recently outlined in two systematic reviews [25,33]. Our clinics originally used the GMDS [27] to assess a child's developmental age, which was done by the visiting developmental paediatrician.…”