Counting outcomes, coverage and quality for early child development programmes
Counting outcomes, coverage and quality for early child development programmes
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DOI：
10.1136/archdischild-2018-315430
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发表时间：
2019-04-01
影响因子：
5.2
通讯作者：
Lawn, Joy E.
中科院分区：
文献类型：
--
作者：
Milner, Kate M.;Bhopal, Sunil;Lawn, Joy E.
改进儿童早期发育（ECD）测量是世界卫生组织、联合国儿童基金会和世界银行养育照护框架的战略重点。然而，低收入和中等收入国家 (LMIC) 缺乏基于证据的幼儿发展项目监测和评估 (M&E) 方法。加拿大大挑战 (R) - 资助的 Saving Brains (R) ECD 组合提供了一个独特的机会来探索跨不同环境的 ECD 项目的 M&E 方法。使用经过调整的影响框架对“拯救大脑”项目进行了重点文献综述和参与式混合方法评估。考虑了与扩展 ECD 的质量、覆盖范围和结果相关的调查结果。对 23 个中低收入国家实施的 39 个 ECD 项目进行了评估。项目使用基于“变革理论”的监测与评估方法来衡量一系列投入、产出和结果。超过 29 个项目测量了认知、语言、运动和社会情感结果。 18 个项目使用发展筛选工具来衡量结果，并在可行性和首选实践之间进行权衡。在 15 个项目中测量了家庭环境等环境投入。定性数据反映了衡量项目质量和覆盖范围的重要性，尽管在跨环境下衡量这些结构存在挑战。扩大幼儿早期发展计划需要改进干预质量的衡量和覆盖范围的衡量，这需要定义分子（即干预）和分母（即有需要/面临风险的人口）。还需要在结果衡量方面进行创新，包括在日常服务中衡量可行且实用的中间结果衡量标准，并进行分类，以便更好地针对最需要的人进行干预，并确保不让任何儿童掉队。
Improved measurement in early child development (ECD) is a strategic focus of the WHO, UNICEF and World Bank Nurturing Care Framework. However, evidence-based approaches to monitoring and evaluation (M&E) of ECD projects in low-income and middle-income countries (LMIC) are lacking. The Grand Challenges Canada (R) - funded Saving Brains (R) ECD portfolio provides a unique opportunity to explore approaches to M&E of ECD programmes across diverse settings. Focused literature review and participatory mixed-method evaluation of the Saving Brains portfolio was undertaken using an adapted impact framework. Findings related to measurement of quality, coverage and outcomes for scaling ECD were considered. Thirty-nine ECD projects implemented in 23 LMIC were evaluated. Projects used a 'theory of change' based M&E approach to measure a range of inputs, outputs and outcomes. Over 29 projects measured cognitive, language, motor and socioemotional outcomes. 18 projects used developmental screening tools to measure outcomes, with a trade-off between feasibility and preferred practice. Environmental inputs such as the home environment were measured in 15 projects. Qualitative data reflected the importance of measurement of project quality and coverage, despite challenges measuring these constructs across contexts. Improved measurement of intervention quality and measurement of coverage, which requires definition of the numerator (ie, intervention) and denominator (ie, population in need/at risk), are needed for scaling ECD programmes. Innovation in outcome measurement, including intermediary outcome measures that are feasible and practical to measure in routine services, is also required, with disaggregation to better target interventions to those most in need and ensure that no child is left behind.