Scaling up Integrated Early Childhood Development programs: lessons from four countries

Abstract

Background There is still limited knowledge regarding the translation of early child development (ECD) knowledge into effective policies and large-scale programmes. A variety of frameworks that outline the key steps in scaling up exist, but we argue that taking a complex adaptive systems (CAS) approach assists in understanding the complex, dynamic processes that result in programmes being taken to scale. Objectives The objective of this study is to examine the process of scaling up four major countrylevel ECD programmes through the application of a CAS framework. Methods Nine key informants with a deep knowledge of how each ECD programme was established and brought to scale were interviewed via Skype or phone by using open-ended interviews. The interviews were tape recorded and then transcribed verbatim for subsequent coding by using CAS domains. The coding and integration of the results to identify unique and common CAS scaling up features across the case studies involved an iterative process of reaching consensus. Results The scaling up of all four programmes behaved as a CAS including as follows: (i) positive feedback loops (five themes) and negative feedback loops (two themes); (ii) scale-free networks (two themes); (iii) phase transitions (four themes); (iv) path dependence (two themes); and (v) emergent behaviour (six themes). Five additional themes were identified for sustainability, which was repeatedly mentioned as an important consideration when deciding how to scale up programmes. Conclusions CAS analysis is likely to improve our understanding of how effective ECD programmes become scaled up. Prospective CAS implementation research is needed to continue advancing the knowledge in the field.

Building capacity in health and education systems to deliver interventions that strengthen early child development

“…In Bangladesh, BRAC and donors worked together to streamline donor support through a donor consortium . Bangladesh's child development center (Shishu Bikash Kendra) is a public–private partnership focused on early screening, assessment, intervention, treatment, and management of development disorders or delays . In Colombia, aeioTU is a social enterprise that, through public–private partnerships, currently provides services in 13 cities to nearly 13,300 children, delivering high‐quality early childhood services to children under the age of five.…”

“…Also, context matters in translating descriptive research to policy . Developmental sciences have shown that context makes a difference and renders findings from one context invalid in other contexts and flexibility may be central for local adaptations to occur and be sustainable given country‐specific and local‐specific constraints and characteristics . Therefore, a prescriptive approach to early childhood health and education systems would be inadequate.…”

Advancing Early Childhood Development and Prevention Programs: A Pan‐Canadian Knowledge Transfer Initiative for Better Beginnings, Better Futures

“…Knowledge transfer theory and practice is focused on tailoring messages to specific audiences and contexts to promote learning and application of knowledge (e.g., Jacobson, Butterill, & Goering, ). This is challenging for prevention programs for children as implementation often requires collaboration among stakeholder groups at various systems levels, such as policy makers, service provider organisations, schools, staff, and families (Barwick et al., ), sometimes spanning across sectors (Perez‐Escamilla, Cavallera, Tomlinson, & Dua, ). Research conducted using community‐based, participatory methods generates findings that are more directly applicable to community settings (Miller & Shinn, ; Wilson, Lavis, Travers, & Rourke, ), though researchers aiming to share findings with other jurisdictions must tailor messaging to the learning needs of stakeholders in the target communities.…”

“…The presence of ‘champions’ at various systems levels is a key factor facilitating the uptake and implementation of evidence‐based practices promoting children's mental health and development (Danseco, Barber, Brown, & Carter, ; Perez‐Escamilla et al., ). Champions provide local leadership and help facilitate stakeholder connections necessary to advance implementation of evidence‐based practices, but how to identify and support these champions is an area requiring further exploration (Barwick et al., ; Berta et al., ).…”

“…Research indicates that successful implementation of evidence‐based programs for children is influenced greatly by the alignment of factors and the right timing (Perez‐Escamilla et al., ). Despite the complexities and challenges described, it is important for researchers to continue to engage in knowledge transfer with community stakeholders to advance programs promoting wellness for children and families.…”