Improving health and development through play - Evaluation of a comprehensive ECCE programme at scale in Ghana

事实证明，接受优质幼儿保育和教育的儿童更健康，表现更好，在学校呆的时间更长，从而在成年生活中有更好的经济发展轨迹。因此，改善幼儿保育和教育至关重要，特别是在偏远和脆弱地区，如加纳北部，那里的大多数家庭每天的生活费不到2美元，20%的5岁以下儿童发育迟缓，39%的3-4岁儿童在认知方面脱轨。该研究小组成员之前的研究表明，非政府组织LivelMinds(LMNGO)旨在解决幼儿园质量低和不良育儿做法/心态这一双重问题的干预措施，显著改善了加纳北部偏远、贫穷农村地区的儿童健康、认知技能和社会情感发展。这些令人振奋的发现是教育部决定与LMNGO合作在加纳228个地区中的60个地区扩大该方案的一个关键驱动因素，以便在今后四年内覆盖4 000所学龄前学校和多达130万儿童。然而，从以前的研究中我们知道，在较小规模上有效的方案一旦适应并以必要的规模实施，可能就无法保持其效力，以惠及有需要的人。因此，在这个项目中，我们的目标是找出随着覆盖面的扩大和方案的所有权从LMNGO移交给教育部，LivelMinds方案的良好效果是否能够持续下去。我们还将研究该方案与儿童发展成果之间的因果关系。该研究小组对疗效试验结果的分析显示，其中一些途径(特别是对社会情绪发展的影响)、已确定的实质性健康影响的驱动因素仍未得到解释。为了实现这些研究目标，我们组建了一个多学科研究团队，由国内和国际经济学家、流行病学家、洗涤专家和发展心理学家组成。该小组与LMNGO和监督加纳幼儿保育和教育服务的三个部委(教育部、卫生部和性别、儿童和社会保护部)密切合作，将在扩大规模的过程中嵌入随机对照试验，收集有关儿童发展的数据，以及活泼心灵计划在4个暴露期限后可能影响儿童的途径。我们亦会收集学校的日常数据，以评估计划的推行情况。《活生生的头脑》节目不同寻常。幼儿保育和教育方案往往是单向度的，以家长或学龄前儿童为目标，和/或侧重于儿童发展的一个领域。LMNGO开发了一个混合型幼儿保育和教育计划，考虑到可伸缩性，该计划同时改善了家庭和学龄前环境以及儿童的健康，以及认知和社会情感发展，在扩大规模时，预计每个儿童每年的成本为7美元，仅使用当地可用的资源和基础设施，并增强农村社区被边缘化和孤立的母亲的能力。从10年前在加纳和乌干达的几个村庄开始，现在它将被加纳政府接管，并将在未来5年内覆盖100多万儿童。我们将评估它是否通过这一大规模扩展和所有权转移过程保持其效力，以及是否有办法加以改进。这将首先为教育部提供关于其政策有效性的重要证据。然而，它也将帮助广大中小岛屿发展中国家的利益攸关方寻求具有成本效益、创新、跨部门和可扩展的干预方式，以实现可持续发展目标3和4，确保所有儿童，包括最边缘化和最脆弱人口中的儿童，得到抚育照顾和早期学习的机会。

Children who receive quality ECCE are proven to be healthier, do better and stay longer in school, and thereby have better economic trajectories in adult life. Improving ECCE is therefore critical, especially in remote and vulnerable areas, such as northern Ghana, where most families live on less than US$2 per day, 20% of children under the age of 5 are stunted and 39% 3-4 years olds are off-track cognitively. Previous research by members of this research team has shown that an intervention by the NGO Lively Minds (LMNGO), designed to combat the twin problem of low kindergarten quality and poor parenting practices/mindsets, significantly improved children's health, cognitive skills and socio-emotional development in remote, poor, rural areas of northern Ghana. These promising findings were a key driver of the decision by the Ministry of Education (MoE) to work with LMNGO to scale up the programme in 60 of Ghana's 228 districts to reach 4,000 pre-schools and up to 1.3 million children over the next four years.However, from previous studies we know that programmes that are impactful at smaller scale may not maintain their effectiveness once adapted for and implemented at the scale necessary to reach those in need of them. In this project we, therefore, aim to find out whether the promising effect of the Lively Minds programme can be sustained as coverage is expanded and ownership of the programme is handed from LMNGO to the MoE. We will also study the causal pathway between the programme and child developmental outcomes. Analysis of the efficacy trial results conducted by this research team revealed some of these pathways (especially for impacts on socio-emotional development), drivers of the substantial health effects that were identified remain unexplained. To achieve these research aims, we have brought together a multidisciplinary research team, consisting of in-country and international economists, epidemiologists, WASH experts and developmental psychologists. Working in close partnership with LMNGO and the three ministries which oversee ECCE provision in Ghana (MoE, Ministry of Health and Ministry of Gender, Children and Social Protection) this team will embed a randomised controlled trial in the scale-up, collecting data on child development and pathways through which the Lively Minds programme could affect it after 4 terms of exposure. We will also collect routine data in schools to assess how well the programme is being implemented. The Lively Minds programme is unusual. ECCE programs are often one-dimensional, targeting either parents or pre-schools, and/or focusing on one area of child development. LMNGO developed a hybrid ECCE program, designed with scalability in mind, that simultaneously improves the home and pre-school environments, as well as children's health alongside cognitive and socio-emotional development at a projected cost of $7 per child per year when scaled, using only locally available resources and infrastructure and empowering marginalised and isolated mothers in rural communities. From starting in a few villages in Ghana and Uganda ten years ago it will now be taken over by the government of Ghana and will reach over a million children in the next 5 years. We will evaluate whether it maintains its effectiveness through this process of substantial scaling and transmission of ownership and whether there are ways in which it could be improved. This will first and foremost provide important evidence for the MoE on effectiveness of its policies. However, it will also help the wider community of stakeholders in LMICs seeking cost-effective, innovative, cross-sectoral and scalable ways to intervene in order to meet Sustainable Development Goals 3 and 4 ensuring that all children, including those in the most marginalised and vulnerable populations, receive nurturing care and opportunities for early learning.