1. Platforms to Reach Children in Early Childhood
Maureen M. Black, Amber Gove, and Katherine A. Merseth
In Disease Control Priorities, Vol. 3, World Bank

2. How (and Why) to Reach Children in Early Childhood?
Three significant advances: 1. 2. 3.
Recognition that adult health and well-being are based on prenatal and early-life genetic and environmental interactions
Urgent call for strategies to promote early childhood development
Economic growth in the 1990s and success of the Millennium Development Goals in combating poverty and stunting, which have increased optimism

3. Nurturing Care, with Associated Risk and Protective Factors
Epigenetic processes
Biological embedding
Accumulated risks
Co-occurrence of risks has spurred recommendations for integrated interventions
Poverty
Maternal Education
Nutrition
Maternal Stress
8-9 Years
Beyond
Nurturing care attenuates risks…
Lancet citation….

4. Integrated Interventions and Multi-Sectoral Coordination
Integrated interventions refers to services that address multiple issues with shared messages, the use of shared or existing platforms, and opportunities for synergy
Multi-sectoral coordination refers to coordinated services across sectors, with either sector-specific or unifying policies
Issue
Benefit
Cautionary Note
Impact of integrated intervention may be stronger than single sector models
Impact of nutrition intervention is strongest in the first 1,000 days.
Impact of child development interventions continues beyond the first 1,000 days.
Economy of effort
One community worker may be able to deliver multiple messages.
Additional time per visit may be required to deliver multiple messages.
Financial support
Economy of sharing community workers across sectors.
Clarity needed in balancing financial investment and administrative coordination across sectors.
International organizations are promoting integrated multi-sector policies
Strong policies may result in better quality and more programs that address the comprehensive needs of children.
Policy support from international agencies requires program, training, and evaluation support.
Existing delivery platform
Delivery platforms may vary across sectors, providing additional opportunities to reach participants.
Limited data on the impact of varying platforms (such as individual versus group).
Evaluation
May be efficient to conduct evaluation across multiple domains.
Evaluation demands from two sectors.
Governance
Governance structure may facilitate cross-sectoral coordination.
Sectors have separate budgets, priorities, and management targets.
Training and supervision
Training and supervision could be coordinated across sectors to develop comprehensive, integrated messages.
Specialized training and supervision may be necessary to adequately meet the needs of differing domain and sector priorities.
Implementation science
Principles of implementation science, including stakeholder involvement, can assist with program sustainability and scaling.
Additional costs may be incurred to apply principles of implementation science across two sectors.

5. Equitable Delivery Platforms and the Social Gradient
Universal, Selective, Indicated delivery Proportionate universality: “….programs, services, and policies that are universal, but with a scale and intensity that is proportionate to the level of disadvantage” (Marmot, 2010)
Universal, when they are available to all
• Selective, when targeted to subpopulations at risk
• Indicated, when available to children identified by screening (Gordon 1983).
• Child vulnerability exists in every socioeconomic strata of our society;
• Children in the lowest SES range are proportionately more likely to be vulnerable; but
• The majority of vulnerable children are in the middle SES range.
Vocabulary Study
Human Early Learning Partnership Policy Brief 2015, University of British Columbia

6. Platforms by sector

7. Mind the Gap!
Age gap in early childhood development (ECD) services between health and education sectors
MIND THE GAP

8. Preconception to Two Years
Introduce adolescent education, often a missed opportunity
Promote development during infancy
Use clinics, home visits, community groups
Successful Models
Care for Child Development
Reach Up Early Childhood Parenting Program (Jamaica)
Community groups – Plan Uganda

9. Preprimary and Primary Schooling
Global enrollment up
MICS data
SDG 4.2
Successful models
Madrasa Early Childhood Programme-East Africa Mozambique
Primary
Expansion of UPE
Low levels of learning
Lack of global measures

10. Conclusions Promising gains have been made, but major gaps remain:
Workforce development
Cost-effectiveness data
Population-based indicators
Improved coordination/governance
Nurturing care as guiding framework
Age 0-2 activities should incorporate responsive caregiving/early learning
Age 2-4 services could be provided through integrated programs and multisector approaches
Standards for quality pre-primary are lacking

11. Thank You!
The contents of this presenta-tion are based on the chapter of the same name in Disease Control Prevention, copyright International Bank for Reconstruction and Develop-ment/The World Bank (in press).
Contact:
Katherine A. Merseth
Team Lead, ECD
RTI International
Mudze community in Tete, Mozambique

12. References
Marmot Review Team. (2010, February). Fair society, healthy lives: Strategic review of health inequalities in England post-2010 (The Marmot review). London, UK: Department of Health. University of British Columbia (UBC). (2015). Proportionate universality: 2015 policy brief. Vancouver: Human Early Learning Partnership, UBC.