Brief introduction to the topic

Integrated early childhood development (ECD) is a comprehensive starting point for research, policy and service development. As the HEART Early Childhood Development Topic Guide (Woodhead et. al., 2014) points out, ECD spans the period from conception through to eight years and covers a range of sectors including early learning and education, nutrition, water, sanitation and hygiene (WASH), health, social protection, and community initiatives. The international evidence that high quality ECD programmes can transform outcomes for disadvantaged children is now overwhelming. After relying for many decades on a small number of experimental longitudinal studies (especially in the USA), well-designed studies have now grown in number, age and programmatic focus as well as geographical context (see key reading 3).

The critical impact of early childhood experiences has been emphasised by scientists for decades, and understood by parents and philosophers for millennia. In his book, The Republic, Plato (428-347BC) wrote, “And the first step, as you know, is always what matters most, particularly when we are dealing with those who are young and tender”. But translating scientific evidence and personal conviction into public policies and services has historically been patchy, very variable between (and sometimes within) countries, and often channeled towards specific sectoral priorities and age phases, such as perinatal health care, early infant nutrition, child care and protection, and pre-school education. ECD initiatives have been delivered by NGOs, parents, private providers and community groups as well as governments. These initiatives continue to play a crucial role in the patchwork of services in many contexts.

The case for more comprehensive policies and services for ECD received a significant boost from three main sources:

1. Human development research increasingly demonstrates: (i) the impact of poverty, disadvantage, deprivation and trauma on the growing child, including advances from neuroscience; (ii) the interdependencies between maternal well-being, healthy environments, infant nutrition, and early learning in shaping life course trajectories; (iii) the multiple entry points for delivery of policy and programmes to achieve long term outcomes; and (iv) the long term impacts of quality programmes which are seen as cost effective public investments.
2. General Comment 7 of the UN Committee on the Rights of the Child (2006) endorses the broad age span for the definition of early childhood (as the period below the age of eight) and outlines the interconnections amongst children’s rights, within numerous articles of the United Nations Convention on the Rights of the Child (UNCRC).
3. The Sustainable Development Goals (SDGs) make specific reference to ECD in education target 4.2, with ECD also recognised as fundamental to delivering at least seven of the SDGs.

Some countries have a long history of integrated ECD initiatives targeted at disadvantaged groups (notably the Federal Headstart programme in USA since 1965; and the national Integrated Child Development Services programme in India since 1975). But effective delivery of a comprehensive vision faces numerous challenges, notably around access, quality and effectiveness. Political and financial considerations as well situation analysis of existing infrastructures and human capacity for ECD shape first (or next) steps. Examples of integrated programmes are provided in the HEART Early Childhood Development Topic Guide, see especially sections 2.1-2.2, as well as case studies throughout the Topic Guide. These examples highlight that there is no single template for delivering integrated ECD. For many countries, investing in well-targeted, well-coordinated, cross-sectoral and multi-professional initiatives (including building on NGOs and the private sector via PPPs) may be more realistic than a formal administrative and programmatic integration.

Key readings

Reading 1: Woodhead, M. (2016). Early Childhood Development in the SDGs. Young Lives Policy Brief 28, Oxford Department of International Development (ODID). https://www.heart-resources.org/doc_lib/early-childhood-development-in-the-sdgs/

This brief introduction to global research and policy argues ECD is at the heart of delivering across the SDGs. Five key research messages are identified, along with their implications for policy. The gulf between the proven case for targeted early investment and the reality of inequities in access is especially striking.

Reading 2: UN Committee on the Rights of the Child (CRC), General comment No. 7 (2006): Implementing Child Rights in Early Childhood, 20 September 2006, CRC/C/GC/7/Rev.1 https://www.heart-resources.org/doc_lib/convention-rights-child/

General Comment 7 (2006) grew out of the UN Committee’s concern that early childhood was (at that time) being neglected in States Parties’ reporting on compliance with the UN Convention on the Rights of the Child (UNCRC, 1989). This a key reference document, with sections on: definition of early childhood and key principles; the responsibilities of government and roles of parents; rights-based multi-sectoral services; children in need of special protection; and capacity building. General Comment 7 is also a valuable reminder that investing in ECD is about every child’s right to survival, identity, development, education, protection etc, and not just about investing in human capital for returns to society.

Reading 3: Martinez, S., Naudeau, S., & Pereira, V. (2012). The Promise of Preschool in Africa: A Randomized Impact Evaluation of Early Childhood Development in Rural Mozambique. Washington, D.C.: The World Bank Group & Save the Children. https://www.heart-resources.org/doc_lib/the-promise-of-preschool-in-africa-a-randomized-impact-evaluation-of-early-childhood-development-in-rural-mozambique/

The case for investment in ECD programmes (as well as evidence on key quality ingredients that produce long term outcomes) has been hugely strengthened by high quality evaluations, especially random controlled trials (RCTs) that have tracked the outcomes for an experimental group who benefitted from early intervention compared with a control group. For many decades, there was over reliance on a small number of classic experimental studies, notably carried out in the USA and especially focused on pre-schools. With the increase in the numbers of well-designed studies, the geographical balance has improved, including parent focused and centre-based programmes, with several systematic research reviews now available. Even so, this reading is one of the very few published RCTs from sub-Saharan Africa, which is the reason for selecting it here. This reading describes the evaluation of a Save the Children initiative to: (a) support community-based preschool centres that were set-up to provide quality early stimulation, psychosocial support, and emergent literacy and numeracy instruction; (b) strengthen positive parenting practices and; (c) facilitate children’s transition to primary school. Note that key reading 3 is about evaluation of a programme mainly focused on early learning for pre-school children. For brief summaries of other well-known studies, and systematic reviews, see key reading 4, especially case study 6 in Jamaica (0-3 focused) and case study 8 in Turkey (parenting focused).

Reading 4: Woodhead, M., Bolton, L., Featherstone I. and Robertson P. (2014) Early Childhood Development: Delivering Inter-sectoral Policies, Programmes and Services in Low-resource Settings, HEART Topic Guide, Sussex: Health and Education Advice Resources Team. https://www.heart-resources.org/topic/early-childhood-development/

One of the major challenges for ECD is to overcome sectoral silos in policy and service delivery, professional training and in research. This Topic Guide offers a very wide-ranging overview of the challenges, spanning the full age range and across all sectoral entry points, with a comprehensive bibliography. Summaries of key research and case studies of policy implementation across diverse country contexts are included. Sections 1 and 2 introduce the concept of comprehensive integrated ECD, while sections 3-6 look at specific evidence and programme examples for each age phase in turn. Section 7 summarises ten key aspects of a more integrated system. The Topic Guide is designed as a reference tool, which can be selectively studied according to one’s interests and priorities.

Reading 5: Britto, P. R., Yoshikawa, H., van Ravens, J., Ponguta, L. A., Reyes, M., Oh, S., Dimaya, R., Nieto, A. M. and Seder, R. (2014), ‘Strengthening systems for integrated early childhood development services: a cross-national analysis of governance’. Annals of the New York Academy of Sciences, 1308: 245–255. https://www.heart-resources.org/doc_lib/strengthening-systems-for-integrated-early-childhood-development-services-a-cross-national-analysis%E2%80%A8-of-governance/

This paper reports on a comparative four country study of strategies needed to implement quality ECD programmes. While different sets of governance strategies and challenges were identified in each country, overarching themes also emerged with implications for systems strengthening. The paper is particularly useful in recognising the governance opportunities and obstacles that can be located at local, regional and/or national levels.

For more on early childhood development see other Reading Packs in this series:

• Paul Lynch on Early childhood development (ECD) and children with disabilities
• Sweta Shah on Early childhood development (ECD) in emergencies