RT Journal Article
SR Electronic
T1 Counting outcomes, coverage and quality for early child development programmes
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP S13
OP S21
DO 10.1136/archdischild-2018-315430
VO 104
IS Suppl 1
A1 Kate M Milner
A1 Sunil Bhopal
A1 Maureen Black
A1 Tarun Dua
A1 Melissa Gladstone
A1 Jena Hamadani
A1 Rob Hughes
A1 Maya Kohli-Lynch
A1 Karim Manji
A1 Victoria Ponce Hardy
A1 James Radner
A1 Sonia Sharma
A1 Fahmida Tofail
A1 Cally Tann
A1 Joy E Lawn
YR 2019
UL http://adc.bmj.com/content/104/Suppl_1/S13.abstract
AB 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.