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Original research
Human resources and curricula content for early child development implementation: multicountry mixed methods evaluation
  1. Maya Kohli-Lynch1,2,
  2. Victoria Ponce Hardy1,
  3. Raquel Bernal Salazar3,4,
  4. Sunil S Bhopal5,6,
  5. Alexandra Brentani7,
  6. Vanessa Cavallera8,
  7. Esther Goh9,
  8. Jena D Hamadani10,
  9. Rob Hughes5,11,
  10. Karim Manji12,
  11. Kate M Milner1,13,
  12. James Radner14,15,
  13. Sonia Sharma16,
  14. Karlee L Silver17,
  15. Joy E Lawn1,
  16. Cally J Tann1,18,19
  1. 1Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Population Health Sciences, University of Bristol, Bristol, UK
  3. 3Economics Department, Universidad de Los Andes, Bogota, Colombia
  4. 4Centro de Estudios de Desarrollo Economico (CEDE), Universidad de Los Andes, Bogota, Colombia
  5. 5Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London, UK
  6. 6Northern School of Paediatrics, Newcastle upon Tyne, UK
  7. 7Departamento do Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
  8. 8Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
  9. 9Bernard Van Leer Foundation, The Hague, Netherlands
  10. 10Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
  11. 11Children's Investment Fund Foundation, London, United Kingdom
  12. 12Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  13. 13Murdoch Children's Research Institute, Melbourne, Victoria, Australia
  14. 14Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
  15. 15Center on the Developing Child, Harvard University, Cambridge, Massachusetts, USA
  16. 16Sector IV, Mobile Crèches, New Delhi, India
  17. 17Grand Challenges Canada, Toronto, Ontario, Canada
  18. 18Neonatal Medicine, University College London Hospitals NHS Foundation Trust, London, United Kingdom
  19. 19Social Aspects of Health across the Life Course, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
  1. Correspondence to Dr Cally J Tann, MARCH Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom; Cally.Tann{at}


Objective The WHO recommends responsive caregiving and early learning (RCEL) interventions to improve early child development (ECD), and to achieve the Sustainable Development Goals’ vision of a world where all children thrive. Implementation of RCEL programmes in low and middle-income countries (LMIC) requires evidence to inform decisions about human resources and curricula content. We aimed to describe human resources and curricula content for implementation of RCEL projects across diverse LMICs, using data from the Grand Challenges Canada Saving Brains ECD portfolio.

Setting We evaluated 32 RCEL projects across 17 LMICs on four continents.

Participants Overall, 2165 workers delivered ECD interventions to 25 909 families.

Intervention Projects were either stand-alone RCEL or RCEL combined with health and nutrition, and/or safety and security.

Primary and secondary outcomes We undertook a mixed methods evaluation of RCEL projects within the Saving Brains portfolio. Quantitative data were collected through standardised reporting tools. Qualitative data were collected from ECD experts and stakeholders and analysed using thematic content analysis, informed by literature review.

Results Major themes regarding human resources included: worker characteristics, incentivisation, retention, training and supervision, and regarding curricula content: flexible adaptation of content and delivery, fidelity, and intervention duration and dosage. Lack of an agreed standard ECD package contributed to project heterogeneity. Incorporation of ECD into existing services may facilitate scale-up but overburdened workers plus potential reductions in service quality remain challenging. Supportive training and supervision, inducement, worker retention, dosage and delivery modality emerged as key implementation decisions.

Conclusions This mixed methods evaluation of a multicountry ECD portfolio identified themes for consideration by policymakers and programme leaders relevant to RCEL implementation in diverse LMICs. Larger studies, which also examine impact, including high-quality process and costing evaluations with comparable data, are required to further inform decisions for implementation of RCEL projects at national and regional scales.

  • early child development
  • implementation
  • health systems
  • child health
  • evaluation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Twitter @mayakohlilynch, @vponcehardy, @sunilbhop, @R_Hughes1, @KateMcMilner, @karleesilver, @joylawn, @callytann

  • Contributors The first draft of the paper was undertaken by CJT, MKL and VPH. Other specific contributions were made by RBS, SB, AB, VC, EG, JH, RH, KM, KMM, JR, SS, KS and JEL. All authors reviewed and agreed on the final manuscript.

  • Funding This paper has been made possible by funding support from the Bernard van Leer Foundation. The Saving Brains impact and process evaluation was funded by Grand Challenges Canada. Grand Challenges Canada is funded by the Government of Canada.

  • Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institution with which they are affiliated.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the London School of Hygiene and Tropical Medicine Ethics Committee (16001/RR/11202). Deidentified data were used in this analysis.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Supplementary data have been published online and may also be accessed by emailing

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