THE WEST AFRICAN CONTEXT

Her Excellency Niale Kaba, minister of planning and development for Côte d'Ivoire, described the favorable and conducive environment that Côte d'Ivoire lends as the backdrop for the forum's workshop on innovations in investing in young children, particularly given the presence of technical and financial partners in the field. She informed workshop participants that the country has made a strong commitment to investing in the development of its young children, emphasizing that these investments are the key to children reaching their full developmental potential, which leads to productive adults, cohesive societies, and thriving economies. As evidence of Côte d'Ivoire's commitment to ensuring the well-being of its young children, Kaba presented several policy actions recently undertaken by the government. Actions included intersectoral coordination among ministries, establishment of a multisectoral plan for children under age 5, introduction of compulsory education for children ages 6–16, and creation of a national child protection strategy. Kaba concluded by stating that while it is no longer necessary to demonstrate the importance of the early years, the integration of investments in early childhood has not yet been fully achieved.

RESEARCH INNOVATIONS

PRACTICE AND DELIVERY INNOVATIONS

Frank Baiden, head of epidemiology at the Ensign College of Public Health in Kpong, Ghana, illustrated the challenges in the practice and delivery of rectal artesunate (RA) for early prereferral treatment of severe malaria. He cited evidence from the Lancet series that established that RAs administered to a child with symptoms of high fever, convulsions, vomiting, and/or refusing to feed substantially reduces the risks associated with severe malaria (Gomes et al., 2009). He noted that while many countries, particularly throughout sub-Saharan Africa, have integrated guidelines from the World Health Organization (WHO) for the treatment of malaria, which recommend the use of RA, there is very little production of the drug to match the existing demand. More specifically, there is currently no product with WHO prequalification or marketing authorization by a stringent regulatory authority, which prevents international donors from funding the procurement of this potentially life-saving treatment. Discussing the example in Ghana, Baiden described the many towns and villages beyond the reach of the health system or mobile clinics, which are run with infrequency. Moreover, RA drugs are not found in pharmacies. Baiden stated that while the evidence has been developed, there is a gap between innovation and actual delivery of RA to treat severe malaria. Baiden called for translating the knowledge surrounding treatment of children with malaria and distributing it to the right populations in a timely manner.

Marjolein Meande-Baltussen, inclusive child development advisor from CBM, discussed inclusive child development practices embedded in health and education services in Ghana. She pointed to the high burden of development impairments across rural sub-Saharan Africa, where 26 percent of children have moderate to severe developmental disabilities (Couper, 2002). In Ghana, the numbers are below the regional percentage at 17 percent (UNICEF, 2007), yet 72 percent are related to risk factors in neonatal and postnatal periods (WHO, 2010). Meande-Baltussen highlighted evidence by way of introducing the development of an inclusive training curricula for nurses and midwives in Ghana, which was built off the guidelines and strategies of the Ministry of Health and intended to look beyond the medical model of disability by linking to activities and participation in the community. The Inclusive Child Development in Practice curricula includes training and creating capacity across all levels of stakeholders, health education to reduce preventable conditions, early detection and early intervention, and evidence-based practice by integrating findings from a 2-year study done in collaboration with the London School of Hygiene & Tropical Medicine on community-based training for children with cerebral palsy. Given the overwhelming lack of knowledge on disability in Ghana, Meande-Baltussen stated that the curricula have improved the working definition and they have bolstered prevention measures, early detection, and health staff attitudes toward families and communities caring for children with disabilities. Meande-Baltussen noted that a bottom-up approach has been made more sustainable by integrating disability within the curricula and Ministry of Health policies. Furthermore, she urged research be used as a strong advocacy tool for policy makers and in raising awareness. She also cautioned that inclusive data collection is needed across all levels to integrate disability issues into the existing early childhood platform.

TECHNOLOGY AND PRODUCT DEVELOPMENT INNOVATIONS

If innovation models are integrated into early childhood science, business, and program implementation, there are several different pathways by which innovation can influence early childhood outcomes and have a sustained effect, stated Dominique McMahon, program officer of targeted programs at Grand Challenges Canada. Kaja Jasinska, assistant professor at the University of Delaware and research scientist at Haskins Laboratories, presented her research in rural, largely impoverished cocoa-growing communities in Côte d'Ivoire where children have inconsistent access to education systems, which are plagued by poor quality. She stated the specific effects of such aspects of poverty as lack of educational resources, poor nutrition, and an understimulating environment during sensitive and critical periods for language, cogitative, and literacy development are largely unknown. Using both the behavioral assessment of children's development and portable neuroimaging to measure patterns of neural activation during reading, Jasinska is using the technology to explore how neuroscience can yield new insights into children's developmental outcomes. Portable neuroimaging is able to track the neurodevelopmental changes in the brain that underlie skilled literacy processes impacted by an environment that carries a high risk of illiteracy. As a basic scientist, Jasinska made the call for building partnerships to ensure that basic science research can be translated into practice, especially in resource-challenged locales. She argued that with the increasing sophistication and affordability of neuroimaging technology, there is no reason why LMICs should not be involved in advancing the field of educational neuroscience while creating opportunities to build scientific capacity among the next generation of researchers at the same time.

ECONOMIC INVESTMENTS IN CHILDREN, FAMILIES, AND SYSTEMS

Ted Miller, principal research scientist at the Pacific Institute for Research and Evaluation, outlined several steps to improve the use of economic evidence to inform investments in young children globally across programs, practices, and policies, drawing from a recent National Academies of Sciences, Engineering, and Medicine report on this topic (NASEM, 2016). As guiding principles, Miller argued that quality and context matter, where lasting improvements require process reforms that enable producers and consumers to work together from the start. He added that there should be similar measures to the heath sector's disability-adjusted life years (DALYs) for children and youth and that the WHO's Quality of Life (WHOQoL) scoring is getting close as a proof of concept. The challenge, he stated, is that QoL scoring has to be in dollar terms for cost–benefit analyses to be run, and doing so makes some people uncomfortable. He concluded with several reporting requirements and best practices when using economic evidence to inform investments: carefully considering and disclosing assumptions, decisions, and practices; clearly defining perspectives, reporting all costs, and pricing and/or counting intangibles such as quality of life and fear; analyzing uncertainty; and considering who benefits and who pays. Miller placed importance on greater data collection in the developing world to better inform economic models for making decisions.

Jennifer Brooks, senior program officer at The Bill & Melinda Gates Foundation, continued this thread by exploring the uptake and use of economic evidence in the decision-making process when several different stakeholders are involved. She revealed two major impediments to using economic evidence to inform policy. The first is that empirical evidence is just one of many factors affecting decision making. Most decisions are influenced by values and what can realistically be implemented. To this end, Brooks suggested that empirical evidence be paired with compelling stories. The second finding revealed that the degree to which evidence speaks to a decision maker's context affects how the evidence will be absorbed. Brooks argued that it is not enough to point to returns on investments. In addition, there is often limited capacity in some contexts to access and interpret empirical and economic evidence because of variable community capacity and challenges transferring evidence from one country to another for comparable outcomes. Brooks proposed a model based on support, accountability, and performance incentives that rewards domains that are most likely to generate positive outcomes. This type of model fosters greater collaboration among decision makers, knowledge brokers, intermediaries, and implementers. Brooks listed efforts to translate economic evidence into policy and practice: giving more attention to the relevance of evidence for end users if scalability and sustainability are the end goal; government reporting on the use of evidence; training institutions; and that funders pay for the implementation of evidence-based practices.

In her remarks, Eva-Maria Hempe, manager at Bain & Company, continued the thread of multistakeholder collaboration. Because different stakeholders define their values in very different ways, Hempe suggested that the private sector's involvement in investment decisions for children, youth, and families is key to multistakeholder collaboration, given that neither governments nor businesses can act alone to drive sustained large-scale change. She proposed that in order to effectively engage the private sector, societal values need to align with financial benefits to ensure health is a positive business case. Having a more comprehensive definition of health will help with this alignment. Aligned values will ensure returns on investments overlap with returns on health. To be sustainable, a venture has to be financially viable, with Hempe arguing that even a social enterprise has to cover its costs. Stimulating the uptake of business cases for health can start either with creating demand or ensuring supply—and ideally both.

CAPACITY BUILDING AND INNOVATIVE PARTNERSHIPS

Alan Pence, United Nations (UN) Educational, Scientific and Cultural Orgainzation chair for Early Childhood Education, Care, and Development at the University of Victoria, provided a historical account of how capacity has evolved in the African context, beginning with the mounting interest in early childhood that emerged in the 1990s with the UN Convention on the Rights of the Child,¹ where particularly in Africa, research agendas moved beyond survival to investigate how to ensure children thrive in specific contexts. Yet, at that time in West, Central, and East Africa there were only a few university-level programs in early childhood development. Amid an emerging community of scholars and political leaders, various education and training initiatives were undertaken in the mid- to late 1990s into the 2000s with key intersectoral participants in an early effort to move away from the silos that had been deemed a barrier to moving the early childhood agenda forward. Pence noted that the complexity of capacity development cannot be addressed in a singular activity, but requires a multipronged approach targeting diverse groups of stakeholders. Different vehicles (seminars, online learning, conferences) were developed to address and bring in key players (from frontline to political leaders), and those initiatives became an effective mechanism to promote new policies, networks, programs, education, and training and enhanced south-south collaboration.

Marfo delved into the African Early Child Development/Child Development (ECD/CD) Workshops Initiative, which was one particular initiative formed in this era described by Pence. The initiative aimed to advance child development knowledge that was to be inclusive of the African perspectives, priorities, and values. He went on to say that while Africa has contributed important theoretical frameworks that are considered part of the global knowledge base on human development today, most of the research has been conducted by outsiders. The African ECD/CD Workshops Initiative was intended to be a mechanism to bring African scholars together and to provide mentorship, while developing channels to have African research be presented at international venues.

Juliana Seleti of the sub-Saharan Africa Early Childhood Network (AfECN) noted that young children in Africa should grow up in a safe, healthy, stimulating, and happy environment where they are able to thrive and achieve their full potential. Yet different contexts provide different possibilities for happiness in children, and these contexts have different effects on children. AfECN is focused on developing policies that are appropriate and relevant for children, yet also take into account how diverse Africa is.

Hirokazu Yoshikawa, Courtney Sale Ross University Professor of Globalization and Education at New York University, continued the conversation of capacity building by illustrating how the mounting trajectory of activities, initiatives, and formalized networks described by Marfo, Pence, and Seleti can inform early childhood development within the context of the SDGs. He argued that the innovation in the SDGs lies in the global thematic indicators where the language itself opens up a broader agenda for early childhood. The thematic indicators of the SDGs are a product of national indicators that have global contextual application. Yoshikawa pointed to examples in mental health, skills development outside of formal education, and an emphasis on disparities and equity—all of which hold particular meaning in the African context. Yoshikawa went on to describe the work of Education, Quality, and Learning for All (EQUAL), which was developed to address these connections linking the research-to-policy continua by aligning robust global alliances with regional networks. Such networks that hold convening power and collaborative potential buttress research skills that have regional relevance, because they are grounded in culture, learning, human development, impact development, implementation science, and psychometric skills. In doing so, there is the potential to develop new measures that tap constructs and contextual assessments of integrated service delivery programs, which Yoshikawa argued can simultaneously keep an eye toward the effects of policy and practice.

To demonstrate the relevance of policy and to create an environment where there is access to information, in the context of Africa, Seleti noted that AfECN seeks to use advocacy as a tool where practices can be demonstrated and shared, and this information is accessible to others. She said that the goals of AfECN are to support policy implementation, strengthen partnerships, generate and disseminate knowledge, and improve practices. Seleti went on to state that many countries in Africa have early childhood policies, but the disconnection lies in how countries are implementing these policies. Paul Oburu of Maseno University stated that through innovative partnerships, the voices that have not been heard can become known in research, particularly referencing the contribution African scholars have made on early childhood development in the region, but not necessarily on a global stage. Marfo said that moving African research forward is not about promoting research that is idiosyncratic to Africa; rather, it is about expanding prevailing conceptions of human development to include the different contexts in which children develop and thrive in sub-Saharan Africa and other low-income regions of the world, thereby imparting a spirit of excitement and commitment for the children of the continent and around the world.

REFERENCES

• Couper J. Prevalence of childhood disability in rural Kwa-Zulu-Natal. South African Medical Journal. 2002;92(7):549–552. [PubMed: 12197199]
• Gomes MF, Faiz MA, Gyapong JO, Warsame M, Agbenyega T, Babiker A, Baiden F, Yunus EB, Binka F, Clerk C, Folb P, Hassan R, Hossain MA, Kimbute O, Kitua A, Krishna S, Makasi C, Mensah N, Mrango Z, Olliaro P, Peto R, Peto TJ, Rahman MR, Ribeiro I, Samad R, White NJ., Study 13 Research Group. Pre-referral rectal artesunate to prevent death and disability in severe malaria: A placebo-controlled trial. Lancet. 2009;373(9663):557–566. [PMC free article: PMC2646124] [PubMed: 19059639]
• NASEM (National Academies of Sciences, Engineering, and Medicine). Advancing the power of economic evidence to inform investments in children, youth, and families. Washington, DC: The National Academies Press; 2016. [PubMed: 27536749]
• UNICEF. Multiple Indicator Cluster Survey (MICS). New York: UNICEF; 2007.
• WHO (World Health Organization). Community-based rehabilitation guidelines. 2010. [January 20, 2017]. http://apps​.who.int/iris​/bitstream/10665​/44405/9/9789241548052_introductory_eng​.pdf.

Forum on Investing in Young Children Globally (iYCG)

• Zulfiqar A. Bhutta (Co-Chair)
  SickKids Centre for Global Child Health, Toronto; University of Toronto Center of Excellence for Women and Child Health; Aga Khan University
• Ann Masten (Co-Chair)
  Institute of Child Development, University of Minnesota
• J. Lawrence Aber
  New York University
• Amina Abubakar
  Lancaster University
• Lola Adedokun
  African Health Initiative, Doris Duke Charitable Foundation
• Constanza Alarcón
  Fundación Alpina
• Raquel Bernal
  Center for Research on Economic Development, Universidad de los Andes
• Pamela Y. Collins
  Office for Research on Disparities & Global Mental Health and Office of Rural Mental Health Research, National Institute of Mental Health, National Institutes of Health
• Tracy Costigan
  Research-Evaluation-Learning Unit, Robert Wood Johnson Foundation
• Gary Darmstadt
  Stanford University School of Medicine
• Angela Diaz
  Icahn School of Medicine at Mount Sinai
• Rana Hajjeh
  National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention
• Jody Heymann
  Fielding School of Public Health, University of California, Los Angeles
• Gillian Huebner
  Maestral International
• Venita Kaul
  School of Education Studies and Center for Early Childhood Education and Development, Ambedkar University Delhi
• Sarah Klaus
  Early Childhood Program, London, Open Society Foundations
• Vesna Kutlesic
  Office of Global Health, National Institute of Child Health and Human Development
• Albert Lee
  The Jockey Club School of Public Health & Primary Care and Centre for Health and Education and Health Promotion, The Chinese University of Hong Kong
• Joan Lombardi
  Bernard van Leer Foundation
• Florencia Lopez Boo
  Inter-American Development Bank
• Stephen Lye
  Fraser Mustard Institute for Human Development
• Kofi Marfo
  Institute of Human Development, Aga Khan University
• Mark Miller
  Division of International and Population Studies, Fogarty International Center/NIH
• Helia Molina Milman
  University de Santiago, Chile; Past Minister of Health, Chile
• Ariel Pablos-Méndez
  U.S. Agency for International Development
• Janna Patterson
  The Bill & Melinda Gates Foundation
• Alan Pence
  School of Child and Youth Care, University of Victoria
• Ruth Perou
  Centers for Disease Control and Prevention
• Cheryl Polk
  HighScope Educational Research Foundation
• Eduardo de Campos Queiroz
  Maria Cecilia Souto Vidigal Foundation
• Pia Rebello Britto
  Early Childhood Development Unit, UNICEF
• Jose Saavedra
  Nestlé Nutrition
• Lorraine Sherr
  University College London
• Andy Shih
  Autism Speaks
• Karlee Silver
  Grand Challenges Canada
• Simon Sommer
  Jacobs Foundation
• Taha E. Taha
  Bloomberg School of Public Health, Johns Hopkins University
• Susan Walker
  Tropical Medicine Research Institute, The University of the West Indies
• Sara Watson
  ReadyNation
• Amalia Waxman
  Teva Pharmaceuticals Industries
• Hirokazu Yoshikawa
  New York University

DISCLAIMER:

This Proceedings of a Workshop—in Brief was prepared by Jocelyn Widmer as a factual summary of what occurred at the meeting. The statements made are those of the rapporteur or individual meeting participants and do not necessarily represent the views of all meeting participants, the planning committee, or the National Academies of Sciences, Engineering, and Medicine.

The National Academies of Sciences, Engineering, and Medicine's planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop—in Brief rests with the rapporteur and the institution.

REVIEWERS:

To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Eva-Maria Hempe, Bain & Company; Cheikh Mbacké, Centre for Research in Applied Economics and Finance of Thiès (CREFAT); and Anselme Siméon Sanou, Centre MURAZ Research Institute. Lauren Shern, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

SPONSORS:

This workshop was partially supported by Autism Speaks; the Bernard van Leer Foundation; The Bill & Melinda Gates Foundation; the Doris Duke Charitable Foundation; the Fraser Mustard Institute for Human Development; Grand Challenges Canada; HighScope Educational Research Foundation; the Inter-American Development Bank; the Jacobs Foundation; the Maria Cecilia Souto Vidigal Foundation; the National Institutes of Health—Fogarty International Center, National Institute of Child Health and Human Development, and National Institute of Mental Health; Nestlé Nutrition Institute; the Open Society Institute–Budapest Foundation; ReadyNation; the Robert Wood Johnson Foundation; the Society for Research in Child Development; UNICEF; U.S. Agency for International Development; and the U.S. Centers for Disease Control and Prevention.

For additional information regarding the meeting, visit nationalacademies.org/iYCG.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Innovations in investing in young children globally: Proceedings of a workshop—in brief. Washington, DC: The National Academies Press. doi: 10.17226/24679.

Health and Medicine Division

Rapporteur: Jocelyn Widmer.