You are here

Article Text

Article menu

Download PDFPDF

Global child health: Design and implementation for early child development programmes P2
Paper 2
Counting outcomes, coverage and quality for early child development programmes
  1. Kate M Milner1,2,
  2. Sunil Bhopal3,4,
  3. Maureen Black5,
  4. Tarun Dua6,
  5. Melissa Gladstone7,
  6. Jena Hamadani8,
  7. Rob Hughes3,9,
  8. Maya Kohli-Lynch1,10,
  9. Karim Manji11,
  10. Victoria Ponce Hardy1,
  11. James Radner12,13,
  12. Sonia Sharma14,
  13. Fahmida Tofail15,
  14. Cally Tann1,16,
  15. Joy E Lawn1
  1. 1 Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
  2. 2 Murdoch Children’s Research Institute, Melbourne, Australia
  3. 3 Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
  4. 4 Northern School of Paediatrics, Newcastle upon Tyne, UK
  5. 5 Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
  6. 6 Department of Mental Health and Substance Abuse, World Health Organisation, Geneva, Switzerland
  7. 7 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  8. 8 Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
  9. 9 Children’s Investment Fund Foundation, London, UK
  10. 10 University of Bristol, School of Social and Community Medicine, Bristol, UK
  11. 11 Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  12. 12 Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Canada
  13. 13 Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
  14. 14 Mobile Crèches, New Delhi, India
  15. 15 Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
  16. 16 Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Kate M Milner, MARCH Centre, London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK; kate.milner{at}lshtm.ac.uk

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

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2018-315430

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    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.