Inter-American Development Bank
facebook
twitter
youtube
linkedin
instagram
Abierto al públicoBeyond BordersCaribbean Development TrendsCiudades SosteniblesEnergía para el FuturoEnfoque EducaciónFactor TrabajoGente SaludableGestión fiscalGobernarteIdeas MatterIdeas que CuentanIdeaçãoImpactoIndustrias CreativasLa Maleta AbiertaMoviliblogMás Allá de las FronterasNegocios SosteniblesPrimeros PasosPuntos sobre la iSeguridad CiudadanaSostenibilidadVolvamos a la fuente¿Y si hablamos de igualdad?Home
Citizen Security and Justice Creative Industries Development Effectiveness Early Childhood Development Education Energy Envirnment. Climate Change and Safeguards Fiscal policy and management Gender and Diversity Health Labor and pensions Open Knowledge Public management Science, Technology and Innovation  Trade and Regional Integration Urban Development and Housing Water and Sanitation
  • Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to footer

Primeros Pasos

IDB

  • HOME
  • CATEGORIES
    • Early Education
    • Family and Children
    • Maternity
    • Measurement and Indicator
    • Nutrition and Lactation
    • Policies and Programs
    • Seminars and Courses
  • Authors
  • English
    • Spanish
    • Portuguese

Balancing Scale and Quality: Insights from a Meta-Analysis on Early Childhood Development Programs

July 3, 2023 por Marta Rubio-Codina Leave a Comment


Early childhood development (ECD) programs play a crucial role in promoting children’s cognition and language. Many programs include home visitors or groups who work with parents and young children through play activities that not only build children’s language and cognitive skills, but also engage children and parents together to experience the joy of playing and learning together. As efforts to scale up these programs continue, it is essential to understand the implications of the size of the program on its effectiveness and implementation strategies. In this blog post, we delve into the findings from a meta-analysis of the Reach Up program, based on the Jamaican home visiting program, recently published in the Special Supplement Promoting Childhood Development Globally Through Caregiving Interventions at the journal Pediatrics. We also explore the enablers of success at scale, shedding light on the complexities involved in achieving both quantity and quality.

Quantity-Quality Trade-off

The meta-analysis examined 18 programs of varying sizes, ranging from small efficacy trials to large-scale implementation efforts in countries like China and Peru.

The pioneering Cuna Mas Program in Peru serves as a prime example of creating an ECD program from scratch. Drawing inspiration from Reach Up, the Inter-American Development Bank promoted the use of local staff and worked with the government to adapt the intervention to suit the diverse needs of Peru. Over a span of three years, by the time of the follow-up of the impact evaluation, Cuna Mas’ home visiting program successfully reached over 67,000 vulnerable families in rural areas.

Significant impacts on cognition and language were observed in rural Peru and in the China REACH program, which served over 1,500 participants in an impoverished region of Western China. When compared to other smaller scale experiences in the meta-analysis, an interesting observation emerged: programs that reached a larger number of children were just as beneficial as programs that targeted a small number of children (<300).

This suggests that significant impacts on populations of children can be attained as programs increase in size. Yet, effect sizes do tend to be smaller as the number of children reached increases, which shows that there is a quantity-quality trade-off.

Challenges of Scaling

Scaling up a program involves not only reaching more children but also considering geographic dispersion. Serving remote and harder-to-reach areas presents challenges that may lead to lower program dosage than intended or reduced program quality. Ensuring regular support to home visitors becomes more difficult as scale increases, potentially compromising fidelity to the original intervention. Additionally, larger scale implementation introduces greater heterogeneity in facilitator characteristics and the quality of implementation, as observed in Cuna Mas or in the FAMI program in Colombia.

Expanding coverage through a feasible implementation strategy that maintains sufficient quality highlights the importance of striking a balance between scale and fidelity to ensure sustained positive outcomes on children’s development.

Download the special issue of Pediatrics on Early Childhood Development here

Enablers of Quality and Success at Scale

a. Invest in the Workforce:

Recognizing the critical role of home visitors and group facilitators, investing in their training, ongoing support, and mentoring is essential. Well-trained and well-supported staff are more likely to generate behavioral changes in parents, leading to improved intentional caregiver-child interactions and play. Moreover, adequate compensation and recognition contribute to staff motivation, reducing turnover rates that can undermine the impact of training investments.

b. Adapt to the Cultural Context:

Structured content, such as play activities and toys that promote ‘scaffolding’—namely, structured support to achieve increasingly difficult tasks—serve as effective tools for home visitors and families. However, considering that child development is complex and influenced by the environment, adapting these materials to fit the local culture is crucial. Contextualizing the content enhances its appropriateness and ensures that interventions are embraced and valued within the community.

c. Flexibility and Compromise:

Navigating the institutional context requires flexibility and compromise. In some situations, there may be a need to accelerate the pace of program introduction or expand rapidly to seize opportunities. Limited human resources may necessitate considering larger family-to-home visitor ratios or shorter training times. Making informed compromises, trying to prioritize quality over quantity, is vital to ensure the best possible outcomes.

d. Experimentation and Rapid Feedback:

To make well-informed compromises and adjustments, attention must be given to implementation processes. Shifting the focus from measuring outcomes towards understanding implementation through rapid, lower-cost evaluations generates timely feedback, allowing for quick adjustments during program design. This approach facilitates continuous learning and improvement as interventions are scaled up.

As countries strive to ensure that their children are thriving, understanding the dynamics of scale becomes paramount. The meta-analysis and the insights presented emphasize the existence of a quantity-quality trade-off. Balancing scale and quality require investment in the workforce, adaptation to cultural contexts, flexibility and continued monitoring and support of quality as programs expand.  

Watch the Launch of Pediatrics Special Supplement on ECD in this video

How do you believe we can effectively invest in the workforce, adapt to cultural contexts, and embrace flexibility to ensure the best possible outcomes? Leave a comment below and join the conversation!


Filed Under: Measurement and Indicator Tagged With: child development, childcare, early childhood, Early Childhood Development, IDB, Inter American Development Bank, meta-analysis, Reach Up, scale

Marta Rubio-Codina

Marta Rubio-Codina is a Senior Economist in the Inter-American Development Bank’s Social Protection and Labor Markets Division, where she works on early child development projects. Previously she was a researcher at the Institute for Fiscal Studies in London. She has a Doctorate in Economics from the Université de Toulouse in France.

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Primary Sidebar

Follow Us

Subscribe

Search

Early Childhood Development

The first years of life are essential to establish the future foundation of a person´s productivity and wellbeing. In this blog, experts from the IDB and thought leaders in the topic, share information and international experiences related to early childhood development. Join us to talk about initiatives implemented in your country in this area

Similar Posts

  • How do we preserve quality as we scale up programs to improve child development and alleviate poverty?
  • Why are economists so interested in ECD and what can they contribute to the field?
  • What’s the status of the global agenda on child development measurement for very young children?

Footer

Banco Interamericano de Desarrollo
facebook
twitter
youtube
youtube
youtube

    Blog posts written by Bank employees:

    Copyright © Inter-American Development Bank ("IDB"). This work is licensed under a Creative Commons IGO 3.0 Attribution-NonCommercial-NoDerivatives. (CC-IGO 3.0 BY-NC-ND) license and may be reproduced with attribution to the IDB and for any non-commercial purpose. No derivative work is allowed. Any dispute related to the use of the works of the IDB that cannot be settled amicably shall be submitted to arbitration pursuant to the UNCITRAL rules. The use of the IDB's name for any purpose other than for attribution, and the use of IDB's logo shall be subject to a separate written license agreement between the IDB and the user and is not authorized as part of this CC- IGO license. Note that link provided above includes additional terms and conditions of the license.


    For blogs written by external parties:

    For questions concerning copyright for authors that are not IADB employees please complete the contact form for this blog.

    The opinions expressed in this blog are those of the authors and do not necessarily reflect the views of the IDB, its Board of Directors, or the countries they represent.

    Attribution: in addition to giving attribution to the respective author and copyright owner, as appropriate, we would appreciate if you could include a link that remits back the IDB Blogs website.



    Privacy Policy

    Derechos de autor © 2025 · Magazine Pro en Genesis Framework · WordPress · Log in

    Banco Interamericano de Desarrollo

    Aviso Legal

    Las opiniones expresadas en estos blogs son las de los autores y no necesariamente reflejan las opiniones del Banco Interamericano de Desarrollo, sus directivas, la Asamblea de Gobernadores o sus países miembros.

    facebook
    twitter
    youtube
    This site uses cookies to optimize functionality and give you the best possible experience. If you continue to navigate this website beyond this page, cookies will be placed on your browser.
    To learn more about cookies, click here
    X
    Manage consent

    Privacy Overview

    This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
    Necessary
    Always Enabled
    Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
    Non-necessary
    Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.
    SAVE & ACCEPT