Scaling up Integrated Early Childhood Development programs: lessons from four countries

• Published in: Child : care, health & development Vol. 44; no. 1; pp. 50 - 61
• Main Authors: Pérez‐Escamilla, R., Cavallera, V., Tomlinson, M., Dua, T.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-01-2018
• Subjects: Case studies; Child; Child Development; Child Health Services - organization & administration; Child Health Services - standards; Child, Preschool; Childhood; Chile; Coding; complex adaptive systems; Delivery of Health Care - organization & administration; Delivery of Health Care - standards; Development programs; early childhood development; Early childhood education; Evidence-Based Practice; Feedback; Feedback (Response); Health Plan Implementation - organization & administration; Health Policy; Health Services Research; Humans; India; Organizational Objectives; Path dependence; Program Development; programme evaluation; Prospective Studies; Qualitative Research; Respondents; scaling up; South Africa; Sustainability; Translation; Young Children; complex adaptive systems; early childhood development; scaling up; programme evaluation
• ISSN: 0305-1862; 1365-2214
• DOI: 10.1111/cch.12480

Background
There is still limited knowledge regarding the translation of early child development (ECD) knowledge into effective policies and large‐scale programmes. A variety of frameworks that outline the key steps in scaling up exist, but we argue that taking a complex adaptive systems (CAS) approach assists in understanding the complex, dynamic processes that result in programmes being taken to scale.
Objectives
The objective of this study is to examine the process of scaling up four major country‐level ECD programmes through the application of a CAS framework.
Methods
Nine key informants with a deep knowledge of how each ECD programme was established and brought to scale were interviewed via Skype or phone by using open‐ended interviews. The interviews were tape recorded and then transcribed verbatim for subsequent coding by using CAS domains. The coding and integration of the results to identify unique and common CAS scaling up features across the case studies involved an iterative process of reaching consensus.
Results
The scaling up of all four programmes behaved as a CAS including as follows: (i) positive feedback loops (five themes) and negative feedback loops (two themes); (ii) scale‐free networks (two themes); (iii) phase transitions (four themes); (iv) path dependence (two themes); and (v) emergent behaviour (six themes). Five additional themes were identified for sustainability, which was repeatedly mentioned as an important consideration when deciding how to scale up programmes.
Conclusions
CAS analysis is likely to improve our understanding of how effective ECD programmes become scaled up. Prospective CAS implementation research is needed to continue advancing the knowledge in the field.