Scaling up of Brazil's Criança Feliz early childhood development program: an implementation science analysis

Abstract

To address inequities that prevent socioeconomically vulnerable young children from reaching their full developmental potential, Brazil implemented Programa Criança Feliz (PCF) (“Happy Child” early childhood development program) in 2934 of its 5570 municipalities. A qualitative case study was carried out on the basis of in‐depth interviews with 22 key informants, employing purposive sampling, from past or current national and state coordination teams. Thematic analysis followed the RE‐AIM framework, and complex adaptive system constructs mapped how barriers and enablers influenced scale‐up. One overarching theme related to PCF emergence, and 18 subthemes were identified within the RE‐AIM. An enabling national political environment favored PCF emergence through a top‐down approach that led to governance challenges. Changes in the enrollment criteria for families facilitated reach, and evidence‐based methodology favored the designing of the home visits. However, operationalizing the intersectoral actions remains a barrier for effectiveness, while intrasectoral resistance across levels delayed adoption. WhatsApp facilitated networking, capacity building, and adoption. Rushed scale‐up generated barriers for quality delivery and led to different implementation pathways across municipalities. Legal institutionalization is critical to assure permanent funding and maintenance. PCF has enhanced early childhood services in Brazil, but strong negative feedback loops need to be addressed for effective sustainability.

A mediation meta‐analysis of the role of maternal responsivity in the association between socioeconomic risk and children’s language

“…Testing a range of mediators for different child outcomes, doing this crossculturally and where possible with meta-analysis will help to identify combined distal and proximal targets for intervention. There are currently many large-scale programs being introduced into low-and middle-income countries to support early development (e.g., Crianca Feliz in Brazil, Buccini et al, 2021 andCuna Mas in Peru, Araujo et al, 2018).…”

Prioritizing nurturing care at the municipal and district level with the Brazilian Early Childhood Friendly Municipal Index (IMAPI)

“…In contrast, most of them have rarely invested in quality control and monitoring systems and in long‐term results (Kofke et al, 2021 ; Pérez‐Escamilla et al, 2018 ). Specifically, in Brazil, the Programa Crianca Feliz (PCF) is an example of a nurturing care programme that has received major investments to become a large‐scale programme within a short timeframe; however, PCF has not had strong monitoring and accountability of its Quality, which could be hampering effective results (Buccini, Venancio, et al, 2021 ). Hence, our findings confirm the critical role of investing in the Quality and result of scaling up nurturing care services to enhance early learning and responsive caregiving.…”

Nurturing care indicators for the Brazilian Early Childhood Friendly Municipal Index (IMAPI)

“…To date, there is no monitoring system of responsive caregiving practices in Brazil. Only one indicator for the Responsive caregiving domain was identified at the municipal level, ‘coverage of Criança Feliz home visiting programme’, that targets the most vulnerable families in Brazil (Buccini et al, 2021 ; Girade, 2018 ). Although other ECD initiatives and programmes are being implemented at the municipal level, there is no national system to collect and monitor this information for all municipalities.…”

“…Furthermore, over the past 33 years, three legal frameworks aimed at guaranteeing the rights of children have been created—the Federal Constitution of 1988, the 1990 Child and Adolescent Statute and the 2016 Legal Framework for Early Childhood. As a result, in recent years, the ECD agenda in the country has expanded greatly, and investments made in programmes focused on ECD, such as Criança Feliz (‘Happy Child’), a home visiting programme that has already reached about 3000 Brazilian municipalities (Buccini et al, 2021 ; Girade, 2018 ). Furthermore, Brazil has a large volume of high‐quality public information databases on health, education and social development (including cash transfer programmes); however, data integration for nurturing care monitoring purposes does not exist at any level of government.…”