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Experiences during early childhood shape biological and psychological structures and functions in ways that affect health, well-being and productivity throughout the life course. The science of early childhood and its long-term consequences have generated political momentum to improve early childhood development and elevated action to country, regional and global levels. These advances have made it urgent that a framework, measurement tools and indicators to monitor progress globally and in countries are developed and sustained. We review progress in three areas of measurement contributing to these goals: the development of an index to allow country comparisons of young children’s development that can easily be incorporated into ongoing national surveys; improvements in population-level assessments of young children at risk of poor early development; and the production of country profiles of determinants, drivers and coverage for early childhood development and services using currently available data in 91 countries. While advances in these three areas are encouraging, more investment is needed to standardise measurement tools, regularly collect country data at the population level, and improve country capacity to collect, interpret and use data relevant to monitoring progress in early childhood development.
Keywords: early childhood development, measurement, accountability, sustainable development goals, countdown to 2030, country profiles
New knowledge of the extent to which experiences during early childhood shape health, well-being and productivity throughout the life course has prompted action to improve early childhood development at the country, regional and global levels.
Advances have been made in three areas of measurement needed to achieve these goals: population-level child assessments, population proxies of children at risk of poor childhood development, and country and regional profiles of drivers and supports for early childhood development.
Regular, country-comparable, population-level measurements of childhood development, as well as threats to development and available supports and services, are needed to drive progress and accountability in efforts to improve early childhood development.
Scientific findings from diverse disciplines are in agreement that critical elements of lifelong health, well-being and productivity are shaped during the first 2–3 years of life, 1 beginning with parental health and well-being. 2 The experiences and exposures of young children during this time-bound period of neuroplasticity shape the development of both biological and psychological structures and functions across the life course.
Adversities during pregnancy and early childhood, due to undernutrition, stress, poverty, violence, chronic illnesses and exposure to toxins, among others, can disrupt brain development, with consequences that endure throughout life and into future generations. 3 4 Children whose early development is compromised have fewer personal and social skills and less capacity to benefit from schooling. These deficits limit their work opportunities and earnings as adults. 5 A corollary of early susceptibility to adversity includes responsiveness to opportunities during these early years. As a result, interventions during the first 3 years of life are more effective and less costly than later efforts to compensate for early adversities and to promote human development. 6
It is estimated that, in 2010, at least 249 million (43%) children under the age of 5 years in low-income and middle-income countries (LMICs) were at risk of poor early childhood development (ECD) as a consequence of being stunted or living in extreme poverty. 7 This loss of potential is costly for individuals and societies. The average percentage loss of adult income per year is estimated at 26%, increasing the likelihood of persistent poverty for these children, families and societies. 5 Assuming 125 million children are born each year with a global average of poor infant growth, 8 the estimated annual global income loss is US$177 billion. 9 These impacts have serious consequences on economic growth. Recent World Bank estimates suggest that the average country’s per capital gross domestic product would be 7% higher than it is now had stunting been eliminated when today’s workers were children. 10 At the global level, human capital accounts for as much as two-thirds of the wealth differences between countries. ECD is the foundation of human capital. 11
Supported by a growing body of evidence and increasing global interest in this field, ECD is included in the 2015 United Nations Sustainable Development Goals (SDGs). Target 4.2 is ‘improved access to quality early childhood development, care and pre-primary education’. Progress towards achieving this target is measured by indicator 4.2.1, ‘the proportion of children under 5 years of age who are developmentally on track in health, learning and psychosocial well-being, by sex’. ECD is closely linked to other SDGs as well, for example, eradicate poverty (1), end hunger and improve nutrition (2), ensure healthy lives (3), achieve gender equality (5), reduce inequality in and among countries (10), and promote peaceful societies (16), and it is implied in several more. 5
The United Nations Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016–2030 synthesises the 17 SDGs in three strategies: survive, thrive and transform. Survive refers to sustained and increased reductions in preventable deaths of women, newborns, children and adolescents, as well as stillbirths; thrive refers to children receiving the nurturing care necessary to reach their developmental potential; and transform refers to comprehensive changes in policies, programmes and services for women, children and adolescents to achieve their potential. 12
ECD has also become an important component of other global agendas, including Scaling Up Nutrition, the Global Partnership for Education, the Global Financing Facility for Every Woman Every Child, the Every Woman Every Child movement, the work plans of the WHO, Unicef and the World Bank Group, the G20, 13 international funding agencies, and philanthropic foundations. 7
These multifaceted findings have generated political momentum to improve ECD as a critical phase in the life course, making it urgent to develop measurement tools and indicators to monitor progress globally and in countries. Advances in measurement are needed to support efforts to motivate and track political and financial commitments, and to monitor implementation and impact. This means that we must be able to determine how many and which children are thriving, and on track in health, learning and psychosocial well-being.
Measurement of children’s progress in childhood is acknowledged to be challenging because development is by nature dynamic and children have varying individual trajectories. Well-validated instruments of individual development are complex and require extensive training and expertise. These challenges are amplified in efforts to make measurements across populations of children. Taking these limitations into account, we review progress in three areas of measurement that are contributing data to the current political momentum for ECD and efforts to monitor implementation and impact. Progress is being made to construct a feasible country-comparable measure of young children’s development that could be incorporated into national surveys, to improve proxies of population levels of young children at risk of poor early development, and to generate country profiles of determinants, drivers and coverage for early childhood development and services, using currently available data.
A direct measure of the development of children 0–5 years that could be administered globally and used both within and across countries is urgently needed. Efforts have been made since the 1980s to develop a globally applicable measure of ECD, with the major challenges being individual and cultural variations in the onset of early skills. 14
Currently, the Early Child Development Index (ECDI) is included as the indicator of SDG goal 4, target 4.2. It is a composite index, first introduced in Unicef’s fourth Multiple Indicator Cluster Survey (MICS) in 2010. It is derived from 10 caregiver-reported questions designed for children aged 36–59 months to assess four domains of development: literacy-numeracy, learning/cognition, physical development and socioemotional development. Some items are acknowledged to be unsuitable for assessing development, 15 and efforts are under way to revise the index, as well as to include items applicable to children younger than 3 years of age.
Three research efforts have collaborated to create the Global Scale for Early Development (GSED): the Infant and Young Child Development from the WHO, 16 the Caregiver-Reported Early Development Instrument from the Harvard Graduate School of Education, 17 and the Developmental Score from the Global Child Development Group at the University of the West Indies. 18 The goals of the GSED are to develop two instruments for measuring ECD (0–3 years) globally: a population-based instrument and a programme evaluation instrument, as described in table 1 .
Global Scale for Early Development: population and programme measures