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Early child development (ECD) is fundamental for the health, well-being and life opportunities of every child, everywhere.1 2 It is central to many Sustainable Development Goals (SDGs) and the global child health redesign process, led by WHO and UNICEF.1–3 A strong investment case for ECD has been made by academics, as well as large intergovernment investment platforms including G20 and the World Bank.1 3
The Nurturing Care Framework, launched in May 2018, provides a policy roadmap for multiple sectors to enable a world where families and communities can support their children’s developmental needs including health, nutrition, safety and security, responsive care and opportunities for early learning.4 There is a growing evidence base that inputs especially from preconception to 2 years of age, can improve cognitive, motor, language and socioemotional developmental outcomes, although studies are still small scale and short term.2
However, there is a major gap in evidence-based guidance on how to implement at scale, especially in low- and middle-income countries (LMIC).5 While policymakers may now be committed to investing for ECD, they face unanswered questions about what, where and how to scale in programmes and especially how to measure progress. Paediatricians and child health workers are well placed to reach the youngest children through routine health systems; yet, they similarly face challenges in considering where to start, what to do, and how to reach the most vulnerable. Parents, caregivers and communities are also key to involve in programme design.
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