Translation of evidence to practice to promote early childhood development programs

The 2018 special issue of Annals of the New York Academy of Sciences on implementation research and practice for early childhood development brings together emerging evidence on implementing effective nurturing care programs, addressing issues of quality and scale. Translating evidence to practice requires addressing the barriers perceived by policy makers, which have been highlighted in the published literature. Here, I describe how UNICEF and other global partners are addressing these barriers.

The Lancet three-part series 1-3 on early childhood development summarized the latest interdisciplinary science on child development, and firmly asserted that "early moments matter." Investment in the early years of a child's life impacts his/her survival, growth, and development. Children who have access to adequate health care, nutrition, appropriate stimulation, and protection have reduced inequities and increased productivity. 1,4 A child who has had a good foundation-from preconception through early childhood-acquires capacities associated with skills and learning found later in life. 1 The scientific evidence makes a compelling case for investment in young children that has persuaded governments around the world to use the evidence to inform policy and programs. A growing number of policy makers in low-and middle-income countries (LMICs) have begun to examine the essential needs of young children across the developmental life span and across conventional sectors. For example, UNICEF and other development partners have identified key health, nutrition, education, and protection needs of children, including those of adolescents, prior to gestation, into pregnancy, infancy, toddler, and then preschool. Many children in LIMCs confront extreme poverty and multiple adversities; hence, government leaders are exploring ways to introduce holistic protective interventions in low-resource, high-adversity contexts.
How governments implement, scale-up, and sustain integrated early childhood development (ECD) programming will vary by country based upon existing services, political will, geography, and available human and financial resources. Black and colleagues identified barriers perceived by decision makers, and it is important to consider these in supporting the emerging demand from governments; the following illustrates key ways in which UNICEF and other partners are working with government on these challenges.

Agenda setting
In LIMCs, policy makers must be transformed by the latest science of human development Below are three case studies of how policy makers are being guided toward "how" to implement holistic ECD services. Each exemplifies how to increase funding for ECD programs and to link science with political commitment.
During the last few decades, China has seen remarkable improvements in under-five mortality, literacy rates, access to basic education, life expectancy, and gross domestic product because of expansion of public-funded social services. the Chinese government have crafted an emerging economic paradigm, "cognitive capital", which highlights how the continued investment in young children will accelerate China's economic development, as well as the future of its children. 5 In September 2017, 15 Pacific Island countries gathered in Fiji for the first conference "Moving Forward with Sustainable Development Goals for Early Childhood," organized by UNICEF in collaboration with the World Bank and the Pacific Regional Council for Early Childhood Care and Education. Based upon the evidence presented on the benefits of ECD investments, Pacific leaders endorsed the Pacific Roadmap for Sustainable Development and committed to focusing their national and regional efforts to ensure that "no one is left behind," and to secure requisite resources to impact child outcomes.
At the 20th Conference of Commonwealth Education Minsters (20CCEM, February 2018), 54 Ministers of Education and/or their designees signed the Nadi Declaration that included three key ECD advocacy items: (1) increase the education sector budget allocation to preprimary education subsector, (2) coordinate services for children with other line ministries, and (3) create an ECD toolkit to serve Commonwealth member states.

Implementation
As governments seek to expand ECD programs, they are tasked with considering scalability and sustainability at conceptualization, as well as ensuring the most vulnerable children gain access.
One illustration of this is new attention in providing child cash grants which tends to target the youngest and most vulnerable children. Many LMICs have initiated child cash grants to address their exposure to extreme poverty and associated adversities. 6 UNICEF and partners across Africa, Asia, Latin America, and the Pacific work with governments to create child cash programs that prioritize the most vulnerable families. China has reported noteworthy reduction in household poverty levels, yet there remain pockets of poverty. China is committed to addressing inequities and eliminating poverty and its current policy focuses on targeted interventions.

Policy formation
Many countries have developed national ECD policies in the last 5-10 years. Many aim to be integrated, moving beyond education sector. In September 2017, UNICEF and the World Bank organized a preschool costing workshop to help governments in Sub-Saharan Africa explore cost-effective projections to maximize investment in young children. In general, governments must be certain to adopt high-quality costed policies, with adequate funding to support implementation. To achieve this, greater costing information on interventions is required as highlighted by Gustaffson-Wright and Bogglid-Jones in their paper 7 in the 2018 Ann. N.Y. Acad. Sci. special issue. 8

Evaluation
In the last decade, a number of rigorous and systematic impact evaluations have been conducted by the global ECD community, yet there remains considerable need for data collection and systems accountability. There has been a tendency to focus on expensive, randomized control trial studies to measure the impact on children's outcomes typically following a short period of implementation. Few studies include a closer examination of the process of implementing ECD programs-including what facilitated or impeded program implementation. The World Bank's Strategic Impact Evaluation Fund has been particularly helpful in studying the contributions of integrated programing in lowresource contexts. 8 The Fund also reminds us of the challenge of collecting data in remote contexts, with less familiarity with conventional research protocols. Further, there is a dramatic need to work closely with researchers from within the target communities to increase local and regional research capacity. Identifying local and/or regional researchers from LMICs to work and scaffolding their role in research is essential as we explore cultural relevant (and sustainable) solutions to ensuring all children reach their full potential.

Leadership and partnership
There is growing recognition of the importance of national and regional ECD networks and academic hubs. In Africa, the Aga Khan University has opened the Institute of Human Development in Nairobi. It has taken bold steps to expand the quality of ECD research in Africa. Shanghai Normal University, led by Professor Zhang Minxuan, are providing new regional leadership in research and leading advocacy efforts. In addition, regional and global ECD networks must expand their role in providing leadership in ECD for their respectful regions. ECD networks such as International Step by Step Association (ISSA), Asia-Pacific Network on Early Childhood (ARNEC), African Early Childhood Network (AfECN), and Arab Network on ECD (ANECD) offer continued regional guidance for ECD and reflect cultural values and political will. The Early Childhood Development Action Network (ECDAN) is a new global network designed to stimulate constructive dialogues and in-depth analysis of how early childhood development programs and policies may be enhanced through partnerships.
In sum, the evidence on effective interventions cannot be taken to scale without leveraging advocacy efforts and bringing partners together. These components need attention if research evidence, highlighted in the Ann. N.Y. Acad. Sci. special issue 8 on implementation research and practice for ECD, is to ensure that children reach their potential and that every child has a fair chance in life from the start. Together, we can improve children's lives and transform the future.

Acknowledgment
This paper was invited to be published individually and as one of several others as a special issue of Ann. N.Y. Acad. Sci. (1419: 1-271, 2018). The special issue was developed and coordinated by Aisha K. Yousafzai, Frances Aboud, Milagros Nores, and Pia Britto with the aim of presenting current evidence and evaluations on implementation processes, and to identify gaps and future research directions to advance effectiveness and scale-up of interventions that promote young children's development. A workshop was held on December 4 and 5, 2017 at and sponsored by the New York Academy of Sciences to discuss and develop the content of this paper and the others of the special issue. Funding for open access of the special issue is gratefully acknowledged from UNICEF and the New Venture Fund.