Article Text
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.
- child development
- disability
- quality
- coverage
- outcomes
- low- and middle-income countries
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Footnotes
Contributors Technical oversight of the series was led by JEL and KMM. The first draft of the paper was undertaken by KMM. Other specific contributions were made by SB, MB, TD, MG, JH, RH, MK-L, KM, VPH, JR, SS, FT, CT and JEL. The Early Child Development Expert Advisory Group (alphabetically: Pia Britto, TD, Esther Goh, Sally Grantham-McGregor, MG, JH, RH, KM, JR, Muneera Rasheed, Karlee Silver and Arjun Upadhyay) contributed to the conceptual process throughout. All authors reviewed and agreed on the final manuscript.
Funding This supplement has been made possible by funding support from the Bernard van Leer Foundation. Saving Brains impact and process evaluation funded by Grand Challenges Canada.
Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institution with which they are affiliated.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
Data sharing statement All data were shared under an agreement with Saving Brains. Further information is available if required.
Patient consent for publication Not required.