BACKGROUND: Evidence supports the importance of Early Childhood Development (ECD) interventions to improve children's health, lifelong productivity, and human capital. However, ECD programs are not scaled sufficiently to reach many of the 250 million young children globally who are not meeting their developmental potential. Practical guidance is limited on how to scale ECD programs effectively. This mixed-method study explored the contextual and implementation determinants of scaling up ECD programs in Zambia, using one large-scale, community-based parenting group program (Scaling Up Early Childhood Development in Zambia (SUpErCDZ) program) as a case study. The goal was to generate recommendations for policymakers and implementers in Zambia and other LMICs.
METHODS: This study was guided by the WHO/ExpandNet scale-up framework and the Intervention Scalability Assessment Tool (ISAT). A total of 30 key informant interviews were conducted with program staff, government officials, academic partners, implementing partners of other ECD programs, and donors. Qualitative transcripts were analyzed using thematic analysis according to the framework method. A budget impact analysis (BIA) was conducted using prospectively collected program cost and implementation data supplemented by online sources and interviews with program staff. The total cost of scale-up over five years using three scenarios (low, medium, and high intensity) was modeled.
RESULTS: According to government officials, donors, and partners, the most common contextual factors influencing scale-up ECD programs are political commitment, availability of an overarching or multisectoral ECD policy, availability of resources, and integration of ECD programs into existing government structures. In addition, multisectoral collaboration, stakeholders’ engagement, and sociocultural factors emerged as themes essential to scale-up.
From the perspective of the program staff, the key facilitators of ECD implementation were stakeholders’ engagement, sociocultural factors (cultural norms and beliefs), adaptation of the intervention to the context, integration into existing government structures, and intervention characteristics. In addition, providing incentives to Community-Based Volunteers (CBVs) emerged as critical to sustainability. The main barriers to implementation identified by the program staff were the use of culturally inappropriate activities within the ECD curriculum, lack of incentives (financial or in-kind) to caregivers and CBVs, and unforeseen contextual circumstances (COVID-19 pandemic and insecurity).
The budget impact analysis showed that the total cost and budget for scaling up SUpErCDZ or a similar ECD program depends on the magnitude of the scale-up in terms of geographic breadth and depth (coverage within specific geographic areas). Based on our scale-up scenarios, the estimated cost of scaling up this program over five years ranged between US$1.74M to US$4.3M depending on the breadth (how many provinces) and depth (how many health facilities, CBVs, and caregivers) of implementation.
CONCLUSION: Multiple complex and interrelated contextual and implementation factors influence the scaling up of ECD programs in Zambia. To ensure equitable access to ECD programs for children under five in Zambia, policymakers and implementers will need to consider these when planning to scale up ECD interventions in Zambia. / 2025-08-04T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/46518 |
| Date | 04 August 2023 |
| Creators | Alade, Mayowa Oluwatosin |
| Contributors | Scott, Nancy A. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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