World Bank DocumentApril 2021
LESSONS FROM A REVIEW OF INTERNATIONAL EXPERIENCE IN EARLY CHILDHOOD DEVELOPMENT PROGRAMMING Part 2: Tackling Implementation Challenges
ADVANCING EARLY CHILDHOOD DEVELOPMENT IN TAJIKISTANP
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April 2021
LESSONS FROM A REVIEW OF INTERNATIONAL EXPERIENCE IN EARLY CHILDHOOD DEVELOPMENT PROGRAMMING Part 2: Tackling Implementation Challenges
ADVANCING EARLY CHILDHOOD DEVELOPMENT IN TAJIKISTAN
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ACKNOWLEDGMENTS
This report was written by Lorna Benton, Naomi Rupasinghe, Kate Mandeville, and Mutriba Latypova. The team is grateful for the peer review provided by Adelle Pushparatnam and Sarah Coll-Black, as well as the guidance of Marcelo Bortman, Jakub Kakietek, Tania Dmytraczenko, Kathleen Krackenberger, Sara Giannozzi, Veronica Silva Villalobos, Saodat Bazarova, Gabriel Francis, ian Forde and Angela Mazimba. The team would also like to thank Shahlo Norova and Parvina Mahmadziyoeva for their excellent administrative support and guidance.
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CONTENTS
CHAPTER 1: What can be learnt from a review of international experience about common challenges and solutions to implementing early childhood development (ECD) programs? 1
CHAPTER 2: How did we conduct this review? 5
CHAPTER 3: The framing and sectoral entry points for ECD programs 8
CHAPTER 4: Workforce challenges 13
CHAPTER 5: Scaling up interventions 17
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CHAPTER 1: WHAT CAN BE LEARNT FROM A REVIEW OF INTERNATIONAL EXPERIENCE ABOUT COMMON CHALLENGES AND SOLUTIONS TO IMPLEMENTING EARLY CHILDHOOD DEVELOPMENT (ECD) PROGRAMS?
1 The scope of this review largely focused on workforce management across the spectrum of ECD workers, for more focused analysis on selecting, preparing, supporting and motivating teach- ers, this resource may be helpful for readers: https://blogs.worldbank.org/impactevaluations/ successful-teachers-successful-students-new-approach-paper-teachers
KEY POINTS
• We reviewed 14 Early Childhood Development (ECD) programs from 10 countries, by drawing on 17 peer-reviewed studies identified in a systematic search.
• Three common challenges of ECD programs include: the framing and sectoral entry points for ECD programs, workforce management1, and scale up of interventions with quality.
This report presents findings from a scoping review of 17 published studies reporting on 14 ECD programs across 10 countries; at the start of each section we have identified key takeaways for Tajikistan. We identified publications that evaluated ECD interventions with both an education and a nutrition component. Figure 1 overleaf provides an illustration of the global reach of programming reviewed in this report (the following chapter provides details on how these programs were selected) and Table 2 provides a list of the programs. This set of programs drew from 17 studies, including: 4 studies from Bangladesh, 3 studies from Colombia, 3 studies from Pakistan, 2 studies from Kenya, 1 study each from Mexico, Malawi, China and Australia and 1 covering both Brazil and Zimbabwe. The search was not limited by geography or region and identified studies from diverse geographical settings, including 9 rural studies, 1 urban study, and 7 studies from mixed settings.
Successful ECD programs facilitate a multisectoral approach across the life course. Programs can include the sectors outlined in Figure 2 overleaf: nutrition, social protection, health, education, and water and sanitation. Black et. al. (2017) have highlighted the importance of adopting a life course approach in improving the quality of ECD programs and in realizing the economic benefits of ECD investments. The life course approach is an effective way of understanding how to maximize a multisectoral approach. As programs often straddle multiple sectors and can be challenging to
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design, a life course approach can often be helpful as a guiding framework. Moreover, the lifecycle approach can help to get to the question of what works or what services are needed from the perspective of the beneficiary and not a particular ministry of agency, allowing a government to move beyond silos.
FIGURE 1: Geographical coverage of 17 peer-reviewed studies identified in a systematic search for this review
FIGURE 2: A range of sectors can be involved in ECD programs
Nutrition Social Protection
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Program Countries
Alive and Thrive Program Bangladesh
PLA cycle with women’s groups Bangladesh
GDMP Colombia
Action Against Hunger - cash transfer programs Pakistan
Lady Health Worker Program Pakistan
Oportunidades (now Prospera) Mexico
Right@Home Program Australia
Note: CCD = Care for Child Development; GDMP = Growth and Development Monitoring Program; iECD = integrated Early Childhood Development; PLA = Participatory Learning and Action; WASH = Water, Sanitation and Hygiene.
In this context, the life course conceptual framework highlights to the importance of sustained intervention at several life points. This includes preconception and pregnancy, parenting and caregiving, newborn, early childhood, mid-childhood and adolescence, and adulthood. it builds on the nurturing care framework, highlighting the cross-sectoral importance of health, nutrition, security, caregiving, and learning interventions, as well as the broader enabling environment and socioeconomic and cultural context. The life course approach highlights the interface between protective and risk factors that influence health and other socioeconomic outcomes over a lifetime. it considers the way in which family planning, preconception nutrition, and maternal health lay the foundation for healthy pregnancies. it can also be used to guide implementation by assessing a given context. For example, by identifying a sector that has built strong links with parents and families and focuses on defining a package of services and developing referrals and links to services from that sector.
We identified three key areas of implementation challenges: the framing of ECD interventions and sectoral entry points, workforce challenges, and scaling up interventions. Within the first area, challenges included defining the focus and scope of programming and building strong leadership and strategy approaches. Within the second area, selecting, training and motivating a workforce was identified as one of the critical elements of success in ECD programs. in considering the scape-up of ECD programs, key challenges included establishing and maintaining effective monitoring and evaluation
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(M&E) systems across diverse settings and retaining the quality and integrity of approaches. These themes are also reflected in the eight critical aspects identifeid by Nores and Fernandez, as noted in Box 1.
BOX 1: Nores and Fernandez: Eight ‘critical aspects’ of enabling systemic support
• Establishing strong collaboration arrangements and/or centralized leadership
• Vertical alignment—from national to local capacity building
• Horizontal alignment—coordination of services
• Evidence-based programs and policies
• investing in the early childhood workforce and meeting standards of care
• Linking program inputs to program outputs and outcomes
• Creating continuous improvement cycles
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CHAPTER 2: HOW DID WE CONDUCT THIS REVIEW?
2 in their systematic review of studies examining the effect of interventions combining a child development component with a nutrition intervention, Grantham-McGregor et. al drew on eleven efficacy and two nonran- domized trials, and eight program evaluations. Nutritional interventions usually benefited nutritional status and sometimes benefited child development. Stimulation consistently benefited child development. There was no significant loss of any effect when interventions were combined, but there was little evidence of synergistic interaction between nutrition and stimulation on child development.
KEY POINTS
• We used a two-stage scoping review to provide policy makers with a practical overview. This was intended to provide guidance on the key characteristics of an ECD program design and drew on an umbrella review and a systematic search.
• The study did not seek to be exhaustive, opting to focus on practical insights. Therefore, there are important limitations, as systematic steps assessing risk of bias and providing critical appraisal were not conducted, leading to a variation in the quality of included studies.
In the first stage grey literature publications were reviewed and the search criteria were tested. A range of ECD landmark series publications (Arregoces et al. 2019; Banerjee et al. 2019; Boggs et al. 2019; Britto et al. 2017; Center on the Developing Child 2016; Daelmans et al. 2015; Milner et al. 2019a, 2019b; Perkins et al. 2017; Richter et al. 2017; UNiCEF 2017; WaterAid et al. 2016; World Health Organization 2015) were identified. in addition, several systematic reviews focusing on different program participants and testing different ECD components also informed our approach (Baudry et al. 2017; Grantham-Mcgregor et al. 2014; Rayce et al. 2017; Smith et al. 2018a). A broad search of the literature informed thematic areas of interest to this review and structured the inclusion and exclusion criteria for step two. Sources include the World Bank, Google Scholar, and United Nations Children’s Fund (UNiCEF) evaluation database.
A second stage, which involved a systematic search of the peer-reviewed literature, was conducted to scope the strength of existing evidence and to capture any major studies that were not included in the latest available systematic review. We identified publications that evaluated ECD interventions with both an education and a nutrition component (Box 2), published since February 1, 2013, in continuation of the work of Grantham-McGregor et al.2 Sources include Medline and ProQuest (Agriculture Science Database, Education Database, Engineering Database, Psychology Database, Public Health Database). inclusion and exclusion criteria are presented in Box 3.
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The approach had important limitations, as it did not seek to be exhaustive but intended to focus on practical insights. The requirements of a scoping/ umbrella review do not include systematic steps such as critical appraisal or risk of bias assessments that are usually found in a systematic review, leading to variation in the quality of included studies. Furthermore, it can be difficult to establish boundaries within a broad scope on a discipline as large as ECD and related fields such as early childhood education and care (ECEC). There can also be variation in the terminology and definitions used between study areas. Search terms may have excluded some topics, if they did not include both nutrition and education components (hence social protection or cash transfer studies may be underrepresented in this discussion). Finally, date and language limitations may have excluded studies published in a non-English language or before 2013. To extend this review further, a more systematic review of empirical studies could be undertaken to evaluate the current evidence for integration and implementation of high-quality ECD ‘life
BOX 2: Search terms and inclusion
Education - ECD OR parenting OR preschool OR preprimary OR early learning OR stimulation OR educational intervention AND evaluation OR assessment OR early childhood education OR early childhood care
Nutrition - Nutrition OR breast feeding promotion OR responsive feeding OR micronutrient OR macronutrient OR nutritional supplementation
Mental development - Child development OR cognition OR language OR behavior OR behavior OR physiology OR socio-emotional development OR motor development
Health - Health OR nutrition OR micronutrient OR malaria OR integrated OR morbidity OR worms OR human immunodeficiency virus (HiV)
Life course elements - Mental health OR depression OR sanitation OR hygiene OR poverty OR (cash transfer OR WASH adapted from Grantham-Mcgregor et al. (2014))
BOX 3: Inclusion and exclusion criteria for a systematic approach to reviewing ECD studies published since 2013
Inclusion Exclusion
• Published after February 1, 2013
• Contains both nutrition and education components AND/ OR is one of our ECD program types across the life course
• Evaluates the efficacy or the implementation of the program
• Presents data on evaluation tools in an ECD setting
• Assess factors affecting ECD implementation (that is, ECD quality)
• Evaluating specific tools or individual components rather than a program itself
• Focus on a specific vitamin or supplement intervention
• Focus on obesity or physical activity programs
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course’ programs. A more systematic search may have identified empirical research that could hold further evidence on the efficacy of programmatic components and implementation lessons.
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CHAPTER 3: THE FRAMING AND SECTORAL ENTRY POINTS FOR ECD PROGRAMS
SUMMARY OF THE CHALLENGES
• Defining the focus and scope of a multisectoral ECD program: ECD is often an interdisciplinary undertaking so it can be difficult to build consensus on its definition and how to operationalize an initial commitment or interest in ECD.
• Building strong sectoral leadership and strategic approaches: Clarity of leadership and strategic direction is needed to support quality implementation and integration across sectors and levels. Sectors face specific challenges when serving as the entry point for ECD interventions, including ownership and leveraging finance and identifying a common language for shared problems and solutions.
SUMMARY OF RESPONSES
• Identify the most contextually relevant and effective sectoral entry point: The sectoral entry point is an early decision and strengthening existing systems can support vertical and horizontal integration. There is no universal approach; however, building programmatic logic models, planning across the life course, or adapting existing international models to the local context can all be useful.
• Establish strong communication between sectors: Developing communication channels between sectors is critical to effectively draw upon and maximize the scope offered by each sector. ECD programs should seek to foster buy-in from government, caregivers, civil society, and private sector stakeholders. Decentralized implementation, quality training, and lobbying can encourage ownership across the different sectors.
• Establish a cross-sectoral representative body: Establishing a new representative body has also been an effective way to engage multisectoral stakeholders and provide clear strategic leadership and financing for ECD in some countries, whilst decentralized planning encourages common use of local resources and cultural sensitivity.
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CHALLENGES
It can be difficult to achieve multisectoral buy-in if a program does not address a ‘critical need’, as viewed through the lens of all participating governmental sectors. For example, maternal dietary intake may not be a critical need of the education sector but the links between school meals and class performance are clearer. A well-defined critical need can be further translated into a clear programmatic goal and inform the most optimal program design and implementation. Specifically, Kenya illustrated how ‘framing’ can be a challenge at the governmental level, as ECD was explicitly framed as a programmatic priority at a time that previous initiatives focused only on child survival. The implications of identifying a clear critical need can have an impact on accountability and oversight, training workforce curricula, and evaluation of service delivery.
Different sectors face specific challenges in serving as the entry point for ECD interventions.3 Encouraging ownership of ECD by individual sectors can be a challenge, as in the case of scale up of PATH’s ECD program, which was introduced through the health system in Kenya, Mozambique, and South Africa. The education sector is a common entry point for ECD policy development; for example, Zimbabwe’s Ministry of Education introduced a number of context-specific ECD policies. Emerging models for integrated health, nutrition, WASH, and social protection illustrate that non-traditional approaches to learning and training are needed, shifting away from the didactic to the problem solving at the point of service provider and caregivers. The Radio instruction to Strengthen Education (RiSE) program, implemented jointly by the Education Development Center, inc. (EDC) and Zanzibar’s Ministry of Education and Vocational Training (MoEVT), is an example of such integrated ECD. Depending on the established ECD needs of a population, case studies demonstrate that multisectoral is not always required but can be an effective way to pool resources and utilize new or existing cadres of workforce.
The language of ECD can differ across sectors, settings, and stakeholders, so it can be helpful to clarify and agree on terminology at the outset of a program. Different sectors and team members (researchers, program designers, and implementers) can use and understand terminology in different ways. For example, researchers tend to discuss broad intervention types (for example, ‘parenting programs’) or specific curricula, whereas implementers can be keen to talk about specific intervention components. Furthermore, the cultural and social values of a country inform unique pedagogical approaches to curriculum development, teaching styles, and training, which
3 One diagnostic tool that can support governments to identify entry points and to understand the enabling environment for ECD is the SABER ECD Tool. Further details can be found here: http://wbgfiles.worldbank.org/ documents/hdn/ed/saber/supporting_doc/Background/ECD/Framework_SABER-ECD.pdf
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influences what target recipients find acceptable. Understanding differences in terminology at the outset of a program can also play a role in building a common understanding and shared vision for a program.
RESPONSES
Health systems provide an effective way reach to pregnant women, families, and young children and ECD approaches starting at conception can be feasibly integrated into existing health and nutrition services. integration of ECD within existing health programs has been an effective strategy in Bangladesh, where government workers deliver parenting programs through primary health centers, supported by the Ministry of Health. Neighboring india’s integrated Child Development Services (iCDS) program also delivers integrated family health services via village-based Anganwadi Centers. The program is unique in scale and has afforded the creation of a new cadre of frontline worker, the Accredited Social Health Activist (ASHA). However, the scale of implementation has had numerous challenges with regard to quality service delivery and reach. PATH prioritized capacity building in three African countries by adapting the World Health Organization (WHO) CCD approach to build capacity at all levels of the health systems in Kenya, Mozambique, and South Africa, including training health workers, building a cadre of government health workers for supervision and training, and developing information systems. ECD modules were integrated within existing training packages such as integrated Management for Childhood illnesses (iMCi), and frontline workers were encouraged to include ECD messaging in routine service delivery. These examples demonstrate the importance of capacity building at different levels of the health system and potential benefits of training new cadres of frontline and supervisory staff to provide integrated family services through community centers. However, each sector will have different priorities and considerations for implementation.
Establishing a new representative body has been an effective way to engage multisectoral stakeholders and provide clear strategic leadership in some settings. in Liberia, cross-sectoral ECD efforts are led by the Ministry of Education (MoE) following the development of the Education Sector Plan for 2010–2020. Under this plan, Liberia established a multisectoral ECD committee and program: Liberia’s inter-Sectoral Early Childhood Development Committee follows the national Early Childhood Development Community Education and Awareness Program (ECDCEAP) and is comprised of stakeholders from civil society and Ministries of Education, Health, and Gender. in order to focus on support in the early years, the MoE also established a Bureau for Early Childhood Education (BECE), the National inter-Sectoral Policy on Early Childhood Development, and a new Education Reform Act for pre-primary education. Establishing a new representative body provides a platform for multisectoral working and demonstrates political will and clarity of financing.
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Various methods have been used to identify clear programmatic aims, notably by developing a logic model or by following a life course approach. A logic model, or logframe, describes the theory of change or strategy for a program. it often includes descriptions of the inputs, outcomes, impacts, and targets for milestones across the project lifetime. For example, the Right@Home program developed a logic model as an effective way to focus programmatic aims. Quality implementation was enabled by the clear articulation of the program logic and adaptation processes that ensure fidelity to the evidence and a good fit to context. in a different example, an integrated life course approach helped ensure a continuum of care (0–8 years) across different settings and service providers in the Kyrgyz Republic. A program developed by the Kyrgyz Republic and the Asian Development Bank (ADB) (2008–2015) sought to increase coverage of children by preschools, improve parents’ skills, and increase the number of trained preschool teachers (by 40 percent). To achieve this goal, the programmatic cycle uses mixed approaches to target children and parents at the critical stages of prenatal and perinatal, zero to three, three to five and six to eight years. The partnership coordinated nutritional supplementation and home visits in the early years to preschools, kindergartens, and schools. Key to this programmatic cycle was the design of a culturally appropriate program that allowed for transition from home to school environments.
Decentralized and culturally sensitive approaches can encourage local engagement and ownership. The Right@Home program attributes some success to initiatives that foster ownership at the service level. in this example, the Right@Home program developed an ‘implementation team’, including state and local service stakeholders, practitioners, and the technical support team and encouraged equality of ownership between frontline health workers and their managers (Goldfeld et al. 2018). The Reach Up program, implemented in both Brazil and Zimbabwe, sought to identify challenges around building positive supportive relationships between Home Visitors (HVs) and mothers and HVs and supervisors, as a lack of interest from the child or mother was a common reason for not completing objectives. Conversely, authors report that ease of use of the curriculum, time management, preparation before the visit, the relationship and cooperation of the mother, and the positive interaction with the child were factors that facilitated completing the objectives (Smith et al. 2018b). The Criança Feliz (Happy Child) program in Brazil took a different approach still, focusing on awareness raising and mobilization to create support for the program. Decentralized approaches encourage local ownership and problem solving, which is context-specific and culturally sensitive but requires sustainable financing for scale.
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The Jamaica Home Visit (JHV) intervention has been replicated in Bangladesh, Colombia, and Brazil and early research on tailoring key features is an example of how contextually relevant approaches have been built. The JHV intervention is a home-based program which has provided extensive evidence on ECD programming (Sally et al. 1975). JHV has been replicated in Bangladesh and Colombia as well as being adapted and used at scale in the Peruvian Cuna Mas program. The Reach Up and Learn package includes a planning and adaptation manual, a curriculum for children 6–48 months old, a toy manual, a training manual with demonstration videos, and guidelines for supervisors. Formative research is used to gain a detailed understanding of context and inform adaptations to content, delivery strategy, target population, materials, personnel, training, supervision, and sociocultural context to suit their contexts in Bangladesh, Colombia, and Brazil.
Research has also identified that establishing networks and communities of practice can help build ownership and tailoring of programs across countries. A qualitative review of approaches to adaptation in Brazil and Zimbabwe suggests that agency and flexibility to integrate Reach Up within existing ECD programs were key to success (Smith et al. 2018b). Adaptations in these contexts included frequency of home visits, aesthetic of toys and tools for cultural sensitivity, languages included in the curricula, and segmentation of training. The most noticeable difference is the cadre of frontline worker: health care workers and child development agents in Brazil and paraprofessionals in Zimbabwe. Saving Brains4 conducted a situational analysis and collected formative data for intervention adaptation, feasibility, sustainability, and scale-up that emphasizes the importance of implicit knowledge of context rather than a systematic approach. They also found that leadership for ECD can be developed through peer networks and ‘communities of practice’. Common to these examples is the use of local understanding and the encouragement of ownership amongst the service providers to support ongoing adaptations that ensure a culturally sensitive and locally acceptable program.
4 Saving Brains is a partnership of Grand Challenges Canada, Aga Khan Foundation Canada, the Bernard van Leer Foundation, the Bill & Melinda Gates Foundation, The ELMA Foundation, Grand Challenges Ethiopia, the Maria Cecilia Souto Vidigal Foundation, the Palix Foundation, the UBS Optimus Foundation, and World Vision Canada.
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SUMMARY OF CHALLENGES
• Building and sustaining an effective workforce for ECD: Training, supervision, and retention mechanisms are key to an effective frontline workforce. Often, service providers are not supported enough by regular or quality training or mentorship, which reflects inconsistency in financing, training, and monitoring systems. Distance between service provider and manager or supervisor can also limit the efficacy of available support, while the burden of work and limited career opportunities further reduces motivation and retention.
SUMMARY OF RESPONSES
• Building effective training and supervision models: Embedding training and supervision into service delivery models can help ensure regular contact and build the capacity of frontline workers, supervisors, and managers, particularly where it encourages problem solving and ownership.
• Adopting participatory approaches to selection: Participatory approaches can ensure local acceptability during the selection process. It can also help build a sense of prestige to ECD roles and provide motivation beyond financial incentives.
• Human resource planning and role design: Heavy work burdens can be avoided through task shifting or more targeted programs that carefully consider a feasible workload for ECD workers.
CHALLENGES
Frontline workers and supervisors are not supported enough by regular or quality training or mentorship. it is common for supervisors and managers to focus more on compliance than on supporting and coaching frontline workers (Mitter and Putcha 2018). Training should prepare service providers for the practical skills required in the role. As a result, practical materials are likely to be more helpful and enable higher-quality training experiences. The National integrated Early Childhood Development Policy of South Africa called for the integration of early stimulation and home and community visits without ways to ensure that community health workers (CHWs) have the skills and support to effectively carry out these additional tasks. The scale and content of training material is often limited by resources but needs to be tailored to the cadre and qualifications of service providers and skill sets required in their role.
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Early childhood workers have often been undervalued, underpaid, and inadequately prepared, which brings challenges of selection and retention. Low pay, heavy workloads (Peru and South Africa), and challenging working conditions (such as short contracts, extensive travel, safety concerns, non- traditional working hours) affect morale and their ability to carry out their responsibilities effectively. Approaches to remuneration vary across settings, including paid, unpaid, and mixed models. The Organisation for Economic Co-operation and Development (OECD) recognized that improving day-to- day working conditions as well as addressing remuneration and status of the profession would probably boost staff morale and improve the quality of ECD programs (Mitter and Putcha 2018; OECD 2012).
Motivation and retention of service providers are also limited by the burden of work and limited career pathways. An integrated approach can have implications for expanding roles and responsibilities. For example, a policy shift toward the inclusion of children with special education needs within mainstream kindergartens has been challenging for kindergarten teachers in Ukraine, who expressed concerns about the burden of excessive paperwork and large class sizes without training or assistants. Furthermore, limited career pathways have led to problems in recruiting and retaining qualified workers, particularly in urban areas where there are more attractive, better- paid employment alternatives. Despite the existence of pathways for teachers and support staff to advance within the preschool education system, in practice there are few opportunities for career progression.
RESPONSES
Investing in human resources (HR) selection, remuneration, training, and monitoring can optimize quality of services and engagement. A consistent theme in across a range of successful programs has been to select locally acceptable service providers. in addition, the provision of regular and supportive mentorship and evaluation, contextually appropriate to the distance and qualification of service providers, can help optimize service delivery and program engagement. For example, the Right@Home program identified that three specific aspects of engagement with families in adversity ought to be emphasized in the training and support provided to frontline workers. These were the importance of relationships, partnership, and capacity building. The Philani intervention model in South Africa valued the importance of HR and process features of interventions (selection, training, and monitoring) as one of the key aspects of successful ECD program design. Box 4 documents two key principles of workforce management for teachers, based on a recent study on teachers.
BOX 4: Two key principles of workforce management for teachers
Successfully recruiting and retaining a motivated workforce can be enabled through a wide range of tools. Below are two key takeaways from a recent study on teacher retention and motivation:
• Make teaching an attractive profession by improving its status, compensation policies and career progression structures. Teaching isn’t the hottest profession these days. The Global Teacher Status index Survey interviewed 1,000 people in each of 35 countries (including middle- and low-income countries), and teachers came out just ahead of web designers in social status. in the countries where students learn a lot – Finland and Singapore, for example – teachers are well regarded. We find evidence to support a range of factors that diminish the professional status of teachers: teacher salaries, lowering of qualifications, poor working conditions, expansion of the teaching force and limited opportunities for learning and career advancement. in some contexts, these conditions form a vicious cycle with teacher behaviors – such as high absenteeism or expending more effort as private tutors. in the paper, we provide examples of countries addressing these problems.
• Promote meritocratic selection of teachers, followed by a probationary period, to improve the quality of the teaching force. We often hear policy makers complain that they are unable to hire the best students to become teachers. This starts with attracting good candidates, but it also means selecting great candidates. Good teacher working conditions attract not just effective teachers, but also ineffective ones! in many countries, teachers are selected for political reasons or based merely on a certification rather than an actual test of skill or a demonstration class (or a combination). in Mexico, moving from a political teacher selection process to a test-based selection process was associated with a boost in student learning. The striking element here is that the test itself wasn’t great at predicting teacher effectiveness (and we’ve observed the same phenomenon in Ecuador). But just having a test deterred many low effectiveness candidates from applying.
Source: Evans and Beteille https://blogs.worldbank.org/impactevaluations/successful-teachers-successful-students-new- approach-paper-teachers
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Several approaches also exist for the selection of service providers, ranging from methods which draw on government staff, local nomination, and elected representation. in Malawi and Bangladesh, programs draw on centrally recruited and government-paid cadres including health surveillance assistants. Service providers can also be locally nominated, to allow for cultural sensitivity and acceptability, as exemplified by ASHA workers (india) and mother leaders (Colombia), who are elected by a representative group of selected beneficiary families and local program officials.
Programs are diverse in their approaches to remuneration, raising the importance of considering financial and non-financial benefits. Three examples of different programs highlight the variation in approaches. in Pakistan LHWs are paid CHWs. in contrast, mother leaders in the Familias en Acción conditional cash transfer program are unpaid but consider the role prestigious. A two-tiered approach was tested by The Alive and Thrive program in Bangladesh. Salaried health workers and unpaid health volunteers receive a performance-based cash incentive based on the number of home visits and uptake of new behaviors amongst mothers. This approach was
Early childhood workers have often been undervalued, underpaid, and inadequately prepared, which brings challenges of selection and retention. Low pay, heavy workloads (Peru and South Africa), and challenging working conditions (such as short contracts, extensive travel, safety concerns, non- traditional working hours) affect morale and their ability to carry out their responsibilities effectively. Approaches to remuneration vary across settings, including paid, unpaid, and mixed models. The Organisation for Economic Co-operation and Development (OECD) recognized that improving day-to- day working conditions as well as addressing remuneration and status of the profession would probably boost staff morale and improve the quality of ECD programs (Mitter and Putcha 2018; OECD 2012).
Motivation and retention of service providers are also limited by the burden of work and limited career pathways. An integrated approach can have implications for expanding roles and responsibilities. For example, a policy shift toward the inclusion of children with special education needs within mainstream kindergartens has been challenging for kindergarten teachers in Ukraine, who expressed concerns about the burden of excessive paperwork and large class sizes without training or assistants. Furthermore, limited career pathways have led to problems in recruiting and retaining qualified workers, particularly in urban areas where there are more attractive, better- paid employment alternatives. Despite the existence of pathways for teachers and support staff to advance within the preschool education system, in practice there are few opportunities for career progression.
RESPONSES
Investing in human resources (HR) selection, remuneration, training, and monitoring can optimize quality of services and engagement. A consistent theme in across a range of successful programs has been to select locally acceptable service providers. in addition, the provision of regular and supportive mentorship and evaluation, contextually appropriate to the distance and qualification of service providers, can help optimize service delivery and program engagement. For example, the Right@Home program identified that three specific aspects of engagement with families in adversity ought to be emphasized in the training and support provided to frontline workers. These were the importance of relationships, partnership, and capacity building. The Philani intervention model in South Africa valued the importance of HR and process features of interventions (selection, training, and monitoring) as one of the key aspects of successful ECD program design. Box 4 documents two key principles of workforce management for teachers, based on a recent study on teachers.
BOX 4: Two key principles of workforce management for teachers
Successfully recruiting and retaining a motivated workforce can be enabled through a wide range of tools. Below are two key takeaways from a recent study on teacher retention and motivation:
• Make teaching an attractive profession by improving its status, compensation policies and career progression structures. Teaching isn’t the hottest profession these days. The Global Teacher Status index Survey interviewed 1,000 people in each of 35 countries (including middle- and low-income countries), and teachers came out just ahead of web designers in social status. in the countries where students learn a lot – Finland and Singapore, for example – teachers are well regarded. We find evidence to support a range of factors that diminish the professional status of teachers: teacher salaries, lowering of qualifications, poor working conditions, expansion of the teaching force and limited opportunities for learning and career advancement. in some contexts, these conditions form a vicious cycle with teacher behaviors – such as high absenteeism or expending more effort as private tutors. in the paper, we provide examples of countries addressing these problems.
• Promote meritocratic selection of teachers, followed by a probationary period, to improve the quality of the teaching force. We often hear policy makers complain that they are unable to hire the best students to become teachers. This starts with attracting good candidates, but it also means selecting great candidates. Good teacher working conditions attract not just effective teachers, but also ineffective ones! in many countries, teachers are selected for political reasons or based merely on a certification rather than an actual test of skill or a demonstration class (or a combination). in Mexico, moving from a political teacher selection process to a test-based selection process was associated with a boost in student learning. The striking element here is that the test itself wasn’t great at predicting teacher effectiveness (and we’ve observed the same phenomenon in Ecuador). But just having a test deterred many low effectiveness candidates from applying.
Source: Evans and Beteille https://blogs.worldbank.org/impactevaluations/successful-teachers-successful-students-new- approach-paper-teachers
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associated with an improvement in language and gross motor development in children aged 6–48 months, as well as an improvement in the minimum dietary diversity and consumption of iron-rich food.
Embedding models for training of frontline workers, supervisors, and managers builds capacity and encourages problem solving and ownership. Evidence shows that frontline workers benefit from regular, effective support from supervisors and mentors in the field and refreshers or follow-up training is common (for example, Familias en Acción, Reach Up, WASH benefits). Ongoing support, including supportive supervision, coaching, and mentoring, is particularly important for paraprofessionals who may have limited education and initial preparation (Mitter and Putcha 2018). Different training models that exist globally reflect differences in need, pedagogy, and resources. Peru offers a potential model for training and support, with a focus on continuous support and supervision from regional staff. Regional supervisors accompany HVs on two visits each month to observe their work, discuss any challenges, and provide feedback and guidance (Early Childhood Workforce initiative).
Motivation can also be challenging to sustain, particularly in the face of heavy work burdens, and in this area task-shifting or a more targeted program design can be beneficial. An adapted CCD model in Malawi found that task-shifting would be required for scale-up due to a high workload. Another option identified by authors was to only include certain children that are more at-risk (for example, have lower nutritional indices and less enabling socioeconomic indices), targeted through the training of health surveillance assistants.
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SUMMARY OF CHALLENGES
• Maintaining the quality of intersectoral initiatives can be challenging when scaling up ECD programs and encountering limitations of resources or co-operative partnerships amongst multiple sectors.
• Measurement across the diversity of ECD programming is hard in itself and it can be difficult to understand success: Measurement across diverse settings and during scale-up remains another key challenge. Data collection is challenging due to the lack of standardized or embedded approaches to M&E, as well as the distance between program managers and rural settings, which can be large in some context.
SUMMARY OF RESPONSES
• Developing adaptation manuals to support contextually appropriate scale-up: Established ECD approaches provide adaptation manuals to ensure that ECD features are contextually appropriate. In this process, local needs are identified to make sure that the program is contextually sensitive before scaling up.
• Investing in staff early on can ease implementation challenges when scaling up: Investment in local capacity and training is an important feature during scale-up. Working within existing structures and decentralized problem solving can help ease resource and funding bottlenecks.
• Drawing on standardized tools and establishing clear roles and responsibilities can make data collection and monitoring easier: M&E is an effective tool to identify critical barriers and solutions when bringing a program to scale. Successful approaches include the use of standardized tools for routine data collection through a clearly identified cadre of M&E teams.
CHALLENGES
A key challenge to scale-up is continuing to expand while maintaining the minimum quality of intersectoral initiatives. Maintaining quality appears to be particularly challenging in the following areas: women and children’s health; food and nutrition security; and providing social support to the most vulnerable families or children who need particular attention, such as children affected by violence or conflict. Britto et al. (2017) identified ‘fidelity and program quality improvement’ as an emerging issue in ECD implementation
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research and emphasized the need for feasibility studies to inform scale-up and capacity building. The Early Learning Partnership identified some cautionary tales of scaling up on quality of ECD programming in Cambodia and South Africa. For example, the Government of Cambodia scaled up both formal and informal preschools and home-based programming after piloting, but found no effect on indicators of child development or school readiness. indeed, a subset of children in formal preschool performed less well than the control group in cognitive development. An evaluation attributed these findings to a series of challenges at scale, including costs incurred by parents, lack of information for parents, retention of teachers, and lack of community space. Such case studies encourage caution to ensure that the quality of ECD programs is not lost with scaling-up.
Multisectoral partnership can be a challenge at scale, particularly with regard to finding focus. Brazil’s national home visiting program Criança Feliz was successfully scaled to reach 500,000 babies after 18 months of implementation. Challenges along the way centered on bringing together different governmental sectors to finance the program and encouraging attendance from program participants. The challenge was to establish new funding routes between partnering sectors and the Ministry of Social Development.
Access to and quality of resources can be a challenge at scale. Zanzibar introduced the RiSE mass communication program to improve literacy, math, and life skills to over 35,000 Zanzibari children (Yousafzai and Aboud 2014). However, scale-up faced significant challenges. These included the management of hardware resources, thoughtful integration of the programs into the increasingly dense school timetable, the provision of continuous support and professional development for teachers and mentors, and sufficient and effective M&E of programs. in addition, logistical challenges included the difficulty of maintaining and replacing radios and broadcasting equipment, which compromised reach. A lack of printing and distribution of new materials and limitations on the resources committed to regular trainings and monitoring also affects the quality and fidelity of implementation.
M&E across diverse settings and during scale-up remains a major challenge. As emphasis shifts to implementation at scale, there is a growing need to explore, describe, and measure the process of implementation (Hurley et al. 2016; Yousafzai and Aboud 2014). A number of challenges for measurement have been noted in the literature, including over-reliance on parental reports for measuring outcomes, inconsistent processes for the use of measurement tools across settings, and limitations in the range of outcomes measured (Banerjee et al. 2019; Boggs et al. 2019; Milner et al. 2019a). Another challenge is linking the measurement of child developmental outcomes across different stages of life.
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RESPONSES
It is critical to identify local needs for scale-up and invest in local capacity and training, particularly when the quality of ECD curriculum delivery relies heavily on frontline workers. in Peru, Cuna Mas was the first program in the country to reach remote populations and was well regarded for its rapid scale-up at a rate of 50 percent between 2012 and 2015, with promising effects on cognitive and language development. Cuna Mas’ initial implementation at scale provides lessons for workforce and quality, including the need for strong supervision, education materials, and solutions to travel barriers in a rural context (Earlychildhood Workforce initiative n.d.).
M&E can be facilitated using standardized tools early on, as it can help develop a regular culture of feedback and improvement and to course correct well in advance of scale-up. Continuous improvement throughout implementation and scale-up can be supported by using Plan-Do-Study-Act (PDSA) methods. The AeioTU study provides a case study of a program that progressively scaled up while carefully increasing quality. The study shows that while quality was quite low in the first year of observations, continuous measurement and feedback helped increase quality significantly over a period of three years.
Implementation can be supported by a range of different tools, which serve different purposes. The SiEF toolkit provides an overview of tools 5. One tool, the international Development and Early Learning Assessment (iDELA) captures early learning and development status as well as the factors that influence outcomes. it has been used in a range of countries including Colombia, Bhutan, Bulgaria, and Ukraine. The Criança Feliz (Happy Child) program in Brazil utilized a computerized platform to facilitate states and municipalities enrolling in the program. implementation monitoring was carried out daily and weekly, with the use of a computerized system called Prontuário SUAS. Where implementors can carefully assess different tools and select the most appropriate to suit their needs and purposes, the scope for learning from M&E stands to be higher.
5 https://www.worldbank.org/en/programs/sief-trust-fund/publication/a-toolkit-for-measuring-early-child-de- velopment-in-low-and-middle-income-countries
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