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Paper 4
Accountability for funds for Nurturing Care: what can we measure?
  1. Leonardo Arregoces1,2,
  2. Rob Hughes3,4,
  3. Kate M Milner5,6,
  4. Victoria Ponce Hardy5,
  5. Cally Tann5,7,
  6. Arjun Upadhyay8,
  7. Joy E Lawn5
  1. 1 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  2. 2 Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
  3. 3 Children’s Investment Fund Foundation, London, UK
  4. 4 Maternal & Child Health Intervention Research Group, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
  5. 5 Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
  6. 6 Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  7. 7 Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, UK
  8. 8 Results for Development Institute, Washington, District of Columbia, USA
  1. Correspondence to Dr Leonardo Arregoces, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK; leonardo.arregoces{at}


Background Understanding donor, government and out-of-pocket funding for early child development (ECD) is important for tracking progress. We aimed to estimate a baseline for the WHO, UNICEF and World Bank Nurturing Care Framework (NCF) with a special focus on childhood disability.

Methods To estimate development assistance spending, the Organisation for Economic Cooperation and Development’s Creditor Reporting System (OECD-CRS) database was searched for 2007–2016, using key words derived from domains of the NCF (good health, nutrition and growth, responsive caregiving, security and safety, and early learning), plus disability. Associated funds were analysed by domain, donor, recipient and region. Trends of ECD/NCF were compared with reproductive, maternal, newborn and child health (RMNCH) disbursements. To assess domestic or out-of-pocket expenditure for ECD, we searched electronic databases of indexed and grey literature.

Results US$79.1 billion of development assistance were disbursed, mostly for health and nutrition (US$61.9 billion, 78% of total) and least for disability (US$0.7 billion, 2% of total). US$2.3 per child per year were disbursed for non-health ECD activities. Total development assistance for ECD increased by 121% between 2007 and 2016, an average increase of 8.3% annually. Per child disbursements increased more in Africa and Asia, while minimally in Latin America and the Caribbean and Oceania. We could not find comparable sources for domestic funding and out-of-pocket expenditure.

Conclusions Estimated international donor disbursements for ECD remain small compared with RMNCH. Limitations include inconsistent donor terminology in OECD data. Increased investment will be required in the poorest countries and for childhood disability to ensure that progress is equitable.

  • early child development
  • official donor assistance
  • nurturing care framework
  • tracking
  • responsive care

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  • Contributors Technical oversight of the series was led by JEL and KMM, and the idea for this paper came from JEL. The methods, data management, analysis and first draft of the paper was undertaken by LA. Other specific technical contributions were made by VPH, AU and JEL, and all authors reviewed the text. The Early Child Development Expert Advisory Group (Pia Britto, Tarun Dua, Esther Goh, Sally Grantham-McGregor, Melissa Gladstone, Jena Hamadani, RH, Karim Manji, James Radner, Muneera Rasheed, Karlee Silver and AU) 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.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Patient consent for publication Not required.