• Coordinated and integrated policies and services help to ensure that children and their families can access a continuum of services that support child development.
  • Existing health or nutrition programs often integrate early stimulation materials and messages and educators typically follow a structured curriculum and daily routine that integrates healthy and hygienic practices with academic content.
  • Coordinated program activities rely on regular communication mechanisms among partners and connections across various levels of partnering organizations.
  • Research indicates that service integration in early childhood can lead to improved child development outcomes, more children and families receiving services, and better use of financial and human resources.

In Practice

Greater coordination and integration of policy frameworks and services nationally is necessary to provide all young children and their families, particularly the most vulnerable, access to the continuum of comprehensive services essential in supporting young children’s development. However, the extent to which early childhood services and interventions are coordinated or integrated varies across contexts.

Here are some ways that programs in each sector partner or coordinate services:

Coordination & Integration: Birth to age 3

Most key interventions supporting children from birth to age three and their families are managed by the health and nutrition sectors and are administered at hospitals and health clinics, via home visiting programs, through group meetings led by trained facilitators, or through a combination of strategies.

One important starting point for multi-sector coordination is promoting birth registration at hospitals or the nearest administrative body for births not in hospitals to ensure children’s right to a name and nationality. Stationing civil registry personnel at hospitals can help with this.

A common way to integrate sectors for very young children is to incorporate early stimulation materials and messages into existing health or nutrition programs at the community level. Messages aimed at honoring children’s right to protection from violence, abuse, and exploitation can also be integrated into parenting programs through emphases on how to deliver positive discipline, how to bond and effectively communicate with young children, and how to set appropriate behavioral expectations of their young children. To do this, service providers, who are often community health workers, receive additional training and materials for incorporating child development messages into their regular home visits with families. See also Responsive & Stimulating Caregiving

Less common, are models that integrate child development messages and materials into the health sector at clinics and hospitals. Examples include parents going to the local health clinic for individual play sessions, physicians advising parents and caregivers on positive parenting practices with young children, and health professionals conducting developmental screenings with follow-up referrals for at risk cases.

Coordination & Integration: Ages 3 to 6

Often, education is prioritized over health and nutrition for children age 3-6, as adults seek to prepare children for entrance into the formal education system. Formal and non-formal pre-primary programs routinely support children ages 3-6 and their families. 

Typically, educators work with groups of children on a regular basis following a structured curriculum and daily routine that integrate healthy and hygienic practices (such as hand washing or brushing teeth) into the educational content of the program (including early literacy and math skills). Many programs incorporate healthy and nutritious meals made with locally available foods into the program model. High quality early education programs should also ensure access to separate latrines for girls, boys, and adults and clean drinking water.

Tips

Understand when and where each sector has contact with children from birth to age 6 and their families.

This is important for identifying entry points for service coordination or integration. When mapping service contact points, pay attention to gaps in coverage by age, geographic region, home language, child disability status, and other markers of marginalization so that the most vulnerable children, who stand to benefit the most from early intervention, have access to services.

Establish regular communication mechanisms across all partners.

Partners may include government ministries, non-governmental organizations, and departments within your own organization.

At each partner organization, establish connections at multiple levels from managerial staff at the central level to technical staff at the local level.

Such connections can ensure continuity of coordinated or integrated programming in cases of staff turnover. In many contexts, a formal Memorandum of Understanding is necessary to solidify a partnership.

Establish a detailed monitoring and evaluation plan.

The plan should include indicators related not only to outcomes for children and parents across domains, but also regarding the effectiveness of the partnership itself (e.g., can individuals involved in the partnership articulate the goals of the partnership).

Coordinate messages across sectors and offer simple and concrete ways for families to support their children’s development.

When common themes are reinforced across sectors, uptake is promoted.

Development of an integrated early childhood policy framework may be necessary in contexts where such policies do not exist.

Policy development should be participatory and build upon existing strengths in early childhood programming, while filling in gaps in service provision. In addition, early childhood policy frameworks should clarify the roles and responsibilities of the multiple actors and agencies involved in protecting and promoting young children’s development.

Tools

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Advanced Search

Integrated ECCD: Working towards a seamless early childhood system

This brief report presents a synthesis of information regarding integration of services in early childhood programming with policy recommendations.
Asia-Pacific Regional Network for Early Childhood (ARNEC), 2011
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WASHplus Learning Brief: Integrating WASH and nutrition

This brief shares evidence, practice and challenges regarding integrating WASH and nutrition programming.
WASHplus Project, 2015
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Early experiences matter: Resource package for serving children up to age three

This report is a compilation of recent program efforts and experiences that integrate early childhood services for children younger than 3 and operate in the Asia Pacific region.
Asia-Pacific Regional Network for Early Childhood (ARNEC)
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Building partnerships map

This is a template for developing a plan to work with partners.
Development Impact & You (DIY)
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Stakeholder analysis matrix template

This tool is useful for identying important stakeholders and assessing their level of influence of the issue a program is trying to address and then planning how you will engage with them.
tools4dev
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Collaboration multiplier

This is a template for planning how to engage with multiple stakeholders from diverse sectors.
Prevention Institute, 2011
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Policy implementation matrix template

This is a planning tool that allows users to define how each step of a policy will be implemented in practice.
tools4dev
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Partnership building: Practical tools to help you create, strengthen, assess and manage your partnership or alliance more productively

This is a compilation of tools that are intended to help organizations plan for and manage alliances across multiple partners.
Gormley, W. & Guyer-Miller, L., 2007
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Partnering with governments navigator

This booklet is a practical tool to navigate partnership development across public and private organizations with a focus on Africa.
Stott, L., 2011
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12 steps towards successful cross-sector partnership

This overview describes 12 steps in establishing a successful cross-sectoral partnerhip.
The Partnering Initiative, 2014
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Measures and indicators for assessing the impact of interventions integrating nutrition, health and early childhood development.

This paper lists commonly used measures and assessments for early childhood programs across multiple sectors.
Frongillo, E.A., Tofail, F., Hamadani, J. D., Warren, A. M., & Mehrin, S. F., 2014
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Holistic Early Childhood Development Index (HECDI) Framework: A technical guide

This is a guide provides targets and indicators for monitoring child well-being at country and sub-country levels.
UNESCO, 2014
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Care for Child Development Package

This is the suite of materials that comprises the Care for Development Package which integrates health, nutrition and development in early childhood programs. It includes the participants' manual, facilitator notes, facilitator guidelines for conducting a planning workshop, a planning handbook for program managers and planners and counseling cards.
WHO & UNICEF, 2015
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Clean, Fed & Nurtured : Joining Forces to Promote Child Growth & Development. A report on a Consultative Meeting

This report synthesizes the discussions held at a consultative meeting across nutrition, WASH, and early childhood development sector representatives that aimed to review the evidence, gaps and best practices in integrating this sections with implications for future work.
Alive & Thrive, fhi360, Save the Children, USAID, WASHplus Project, 2013
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Parenting Cards

These are sample child development cards from Save the Children's early childhood program in Bangladesh.
Save the Children Bangladesh
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FRESH 2000 Overview

This resource provides an overview of the FRESH school health and nutrition framework with 4 core components and offers supporting activity guidelines.
FRESH Framework
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Child protection resource pack: How to plan, monitor and evaluate child protection programmes

This comprehensive guide presents information regarding planning, monitoring and evaluating child protection programs.
UNICEF, 2015
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Philani Mentor Mother Programme

This is a guide that documents the mentor mother model with the aim of supporting program developers in adapting this approach.
Philani South Africa
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WASH in Schools Posters

This resource gives examples of posters that can be used to raise awareness about the importance of WASH at schools. These could be adapted for early childhood settings.
UNICEF
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Planning Policies for Early Childhood Development

This resource provides guidlelines for planning early childhood policies.
Vargas-Barón, Emily, 2005.
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Featured Case Studies

These case studies provide examples of programs integrating services for young children.

Integrated Child Development Program

The Integrated Child Development Program in Bangladesh seeks to combat low birth weight and stunting by supporting holistic child development for children under 3 and their families. Over the course of 15 visits to a community clinic or through receiving home visits, parents learn effective practices related to health, nutrition and early stimulation that support their child’s healthy development.

Save the Children Bangladesh

aeioTU

aeioTU works to expand access to high quality ECD programs for children in Colombia through 3 primary strategies: direct service implementation, technical assistance, and advocacy. In 2015, aeioTU operated 28 ECD centers, and trained and supported 315 centers that operate with the funding of Colombia’s welfare institute (ICBF); these centers reach a total of 53,000 children.

aeioTU Colombia

Additional Programs

Click the links below to view profiles of programs integrating services.

Early experiences matter: Resource package for serving children up to age three

This report is a compilation of recent program efforts and experiences that integrate early childhood services for children younger than 3 and operate in the Asia Pacific region.
Asia-Pacific Regional Network for Early Childhood (ARNEC)
View

Philani Mentor Mother Programme

This is a guide that documents the mentor mother model with the aim of supporting program developers in adapting this approach.
Philani South Africa
View

GRADIF-K Early Childhood Development Program

The GRADIF-K Early Childhood Development (ECD) Program promotes early learning for children by assisting ECD centers to develop cost-effective learning and teaching tools using available materials, providing health and nutritional support for children, and supporting capacity building for community members.
Grassroots Development Initiatives Foundation-Kenya (GRADIF-K) Kenya
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Mobile Creches

Mobile Creches provides free education, nutrition, and healthcare for the young children of migrant construction workers at urban construction sites and slums around Delhi.
Mobile Creches India
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Sobambisana Initiative

This initiative supported the development and testing of innovative, integrated early childhood development (ECD) projects in under-served rural communities. Ilifa Labantwana uses findings from this initiative to build an evidence base for effective, scalable ECD projects and improve access and quality of ECD across South Africa.
Ilifa Labantwana South Africa
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Research findings emphasize the holistic nature of children’s early development. Children develop best when they are healthy, well-nourished, cared for by sensitive and responsive adults, stimulated to explore and interact with their surroundings, and protected from the potentially harmful effects of poverty and more extreme situations of abuse, violence or neglect.

Service integration in early childhood can lead to improved child development outcomes, more children and families receiving services, and better use of financial and human resources.

Interventions aimed at supporting young children are effective when they address the family and home context in addition to providing direct services to the child. For example, programs that improve families’ income levels through safety nets (e.g., cash or in-kind transfers) or support maternal mental health have positive effects on young children.

The evidence: Birth to age 3

Integrating early stimulation materials and messages into home visits conducted as part of nutrition programs, positively impacts children’s cognitive and linguistic development. These integrated programs also maintain nutrition gains seen in interventions focused only on nutrition. Rates of maternal depression can be reduced through home visiting programs delivered by community health workers.

Early stimulation messages given to parents by health professionals as part of well-baby visits or visits to the local health clinic for mild illnesses can result in parenting practices and home environments that are more supportive of children’s development.

Children are most at risk for experiencing abuse and violence in their own homes. Incorporating child protection messages such as positive discipline techniques into home visits conducted by health or nutrition service providers can be effective at reducing abuse and violence in the home.

The evidence: Ages 3 to 6

Participation in high quality pre-primary education programs that integrate health, nutrition, and/or hygiene components into their models results in important cognitive, linguistic, social, and emotional gains, particularly for the most vulnerable children around the globe.

Integrating services across education, protection, and health in pre-primary programs at national scales is challenging due to varied levels of service quality, but can yield positive results for children, as happened with the Integrated Child Development Services program in India and De Cero a Siempre (website in Spanish) in Colombia.

There is consensus that lessons learned from successfully integrating water, sanitation and hygiene (WASH) and School Health and Nutrition (SHN) programs in primary school settings are relevant for pre-primary programs. These lessons include:

  • Children who are healthy and well-nourished are more effective learners. Frequent illnesses or disease episodes such as bouts of malaria negatively impact children’s cognitive development and school attendance.
  • When clean drinking water, and adequate sanitation and hygiene are provided at school, children’s attendance at school and school performance improve.
  • Schools and ECD centers can offer opportunities for children to receive effective treatments for parasite infections (deworming treatments), vaccines, and nutrition interventions that promote health and school attendance.

 

  • Filter by
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  • Report/Research
  • Toolkit
  • Video & Tutorials
  • Audio
Advanced Search

Early Childhood Development: Delivering inter-sectoral policies, programmes and services in low-resource settings.

This document provides a synthesis of the research evidence related to early childhood development across multiple sectors, a mapping of service entry points during the early childhood developmental stage and identification of opportunities and challenges in coordinating and integrating early childhood services.
Health & Education Advice & Resource Team (HEART), 2014
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Advantages and challenges of integration: Opportunities for integrating early childhood development and nutrition programming

This paper details the opportunities and challenges of integrating early childhood services in practice.
DiGirolamo, A. M., Stansbery, P., & Lung'aho, M., 2014
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Review of implementation processes for integrated nutrition and psychosocial stimulation interventions.

This paper is a systematic review of research studies on integrated early childhood programs with a focus on implementation processes such as duration and intensity of programs and includes recommendations for integrated programs based on findings.
Yousafzai, A. K. & Aboud, F., 2014
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Effects of integrated child development and nutrition interventions on child development and nutritional status.

This paper is a systematic review of research studies that examined the impact of integrated nutrition and child development programs on children's outcomes.
Grantham-McGregor, S., Fernald, L.C.H., Kagawa, R.M.C., Walker, S., 2014
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Delivering Parenting Interventions through Health Services in the Caribbean

This is an original study that presents evidence regarding the impact of a group intervention model using health professionals and community workers to deliver integrated early childhood messages and materials to parents of young children.
Walker, S., et al., 2015
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Delivering Parenting Interventions through Health Services in the Caribbean (Spanish)

This is an original study that presents evidence regarding the impact of a group intervention model using health professionals and community workers to deliver integrated early childhood messages and materials to parents of young children.
Walker, S., et al., 2015
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The Promise of Preschool in Africa: A Randomized Impact Evaluation of Early Childhood Development in Rural Mozambique.

This paper is an impact evaluation study of an integrated, community-based preschool model implemented in Mozambique with a focus on child and family outcomes.
Martinez, S., Naudeau S., & Pereira, V., 2012
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School-based health and nutrition programs.

This chapter compiles research evidence on school-aged children's health, nutrition, and education and explores programs that can support positive outcomes for children with relevance for early childhood and the trasition to formal schooling.
Bundy, D., et al., 2006
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Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: Making the links.

This is a review paper that draws links between WASH and early childhood development.
Ngure, F. M., Reid, B. M., Humphrey, J. H., Mbuya, M. N., Pelto, G. & Stoltzfus, R. J., 2014
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Integrating maternal psychosocial well-being into a child-development intervention: The five pillars approach.

This paper presents original research on integrating maternal psychosocial well-being support into an existing program that utilized community health workers to deliver maternal and child health messages to families with young children in Pakistan.
Zafar, S., et al., 2014
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Social protection programs and early childhood development: Unexplored potential.

This study is a systmatic review of the impact of social protection programs on young children's development.
Britto, P., Williamson, A., Snow, T., & Mankad, K., 2013
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Effect of maternal mental health on infant growth in low income countries: New evidence from South Asia

This paper presents recent evidence from South Asia that links maternal depression with failure to thrive and makes the case for incorporating mental health into child focused programs.
Patel, V., Rahman, A., Jocab, K. S., & Hughes, M., 2004
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The foundations of lifelong health are built in early childhood.

This paper summarizes scientific evidence related to early childhood and subsequent development with a focus on health in the early years.
Center on the Developing Child, 2010
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Maternal depression and early childhood growth in developing countries: Systematic review and meta-analysis

This study presents results of a meta-analysis that drew on research articles that documented the link between maternal depression and child growth in developing countries.
Surkan, P. J., Kennedy, C. E., Hurley, K. M., & Black, M. M., 2011
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Care for Development in three Central Asian Countries: Report of a process evaluation in Tajikistan, Kyrgyz Republic, and Kazakhstan

This study presents results of a process evaluation of the Care for Development program in 3 Central Asian countries to assess the extent to which it was incorporated into health systems as well as the impact on health workers, parents and children.
Engle, P., Najimidinova, G., Agency of Sociology and Marketing Surveys, Faromuzova, K., 2011
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WASHplus Learning Brief: Integrating WASH and nutrition

This brief shares evidence, practice and challenges regarding integrating WASH and nutrition programming.
WASHplus Project, 2015
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Strengthening systems for integrated early childhood development services: A cross-national analysis of governance

This paper maps governance structures in 4 countries and highlights themes regarding scaling up programs.
Britto, P. R., et al., 2014
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A job analysis of community health workers in the context of integrated nutrition and early childhood development.

This paper looks at the promising policy environment yet limited capacity of community health workers in Malawi to deliver integrated nutrition and early childhood services.
Phuka, J., Maleta, K., Thomas, M. & Gladstone, M., 2014
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