Peer-reviewed article
Pathways to scale up early childhood programs: A scoping review of Reach Up and Care for Child Development
Gabriela Buccini, Lily Kofke, Haley Case, Marina Katague, Maria Fernanda Pacheco et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This scoping review examined how two evidence-based early childhood development programs—Reach Up and Care for Child Development—have been implemented across low- and middle-income countries. The review analyzed 75 records covering 33 programs in 23 countries to identify the pathways and strategies used to scale these programs. The study found that implementation success depends heavily on contextual factors like local infrastructure, social norms, and community demand, alongside six key implementation building blocks. The authors recommend using an implementation checklist to guide planning and decision-making for scaling up early childhood programs.
Key points
- 37 implementation strategies were identified across six building blocks: program emergence, intersectoriality, intervention characteristics, workforce, training, and monitoring systems
- Implementation outcomes vary greatly globally despite the programs being evidence-based
- Contextual factors including infrastructure, social norms, and target population demand significantly shape implementation pathways
- Careful consideration of context and evidence-based planning increase the likelihood of implementation success
- An ECD Implementation Checklist for Enabling Program Scale Up is recommended to guide decision-making
Limitations
This is a scoping review synthesizing existing literature rather than conducting new research, so it cannot establish causal relationships or provide definitive evidence of what works best in specific contexts. The review does not evaluate the effectiveness of the programs themselves on child outcomes, only their implementation strategies.
Abstract
Evidence-based early childhood development (ECD) programs that strengthen nurturing parenting skills and promote early stimulation, such as Reach Up (RU) and Care for Child Development (CCD), are critical investments for interrupting cycles of intergenerational poverty; however, the implementation impact of these programs varies greatly globally. Analyzing systematically the evidence on the implementation pathways based on contexts (i.e., external and internal influences on intervention implementation), implementation strategies (i.e., mechanisms used to promote program initiation, design, and delivery with existing systems), and implementation outcomes (i.e., related to the implementation goals) can increase the likelihood of implementation success. Our scoping review aimed to identify implementation pathways of RU and CCD programs in low- and middle-income countries. A search in English, Spanish, and Portuguese of grey literature and five databases of peer reviewed literature; from inception through July 16, 2022, yielded 2,267 publications. Using predetermined eligibility criteria, 75 records yielded implementation details for 33 programs across 23 low- and middle-income countries. Two reviewers independently extracted program data on context, implementation strategies, and implementation outcomes following a program theory. A thematic analysis identified 37 implementation strategies across six "building blocks of implementation": program emergence, intersectoriality, intervention characteristics, workforce, training, and monitoring systems. Implementation pathways across building blocks are highly influenced by contextual factors, such as infrastructure, social norms, and the target population's demand and interest, which may shape different implementation outcomes. Six 'building blocks' shaping implementation pathways of CCD and RU in LMICs were identified. The careful consideration of context and use of intentional evidence-based planning can enable the successful implementation of ECD nurturing care interventions. We recommend the use of the ECD Implementation Checklist for Enabling Program Scale Up to guide decision-making regarding context and implementation strategies to support implementation outcomes and subsequent ECD program success.