Early Childhood Development
The Context
In Europe, more than 5 million children under five years old are at risk of developmental difficulties. There is growing momentum towards more integrated Early Child Development (ECD) systems, with 10 out of 30 countries already having a strategic multisectoral policy in place.
The early years of life are a critical window for brain development, when children are most sensitive to the environments that shape their lifelong health and well-being (Nurturing Care framework, WHO - 2018). Optimal development is supported by good health, adequate nutrition, responsive caregiving, opportunities for early learning and play, and safe, secure, and nurturing environments. Strengthening ECD systems across these areas is a strategic investment in children’s development and their futures.
In this toolkit, early childhood refers to the period from conception to 8 years of age, in line with the UN Committee on the Rights of the Child’s working definition (General Comment No. 7, 2005). Where tools, services or data cover narrower age ranges, these are specified.
A multisectoral response
Preventing promoting health and preventing disease throughout life begins in early childhood. Key measures include immunisation; routine child health visits in primary care facilities or at home; support for healthy lifestyles, adequate nutrition and responsive relationships; and action to reduce exposure to environmental hazards and toxic stress and to develop essential life skills.
The health sector plays a vital role in protecting overall child health, supporting immunisation, nutrition, and maternal health. A robust ECD system depends on key provisions being embedded within the health sector. Building on recent evidence and growing awareness of children's developmental needs, primary health care is well placed to broaden and strengthen its support to young children and their families. As the community’s first point of contact within the health system, primary health care can offer a valuable access point for children and families, while also having a role to play in shaping multisectoral ECD policy and facilitating collaboration across sectors.
Entry points for evidence-based health system support for ECD
involving the use of standardised and evidence-based approaches to identify children at risk of or with developmental difficulties and enable timely access to support, with a linked robust data surveillance system to enable population-level monitoring of ECD and resource allocations.
that provides evidence-based and coordinated multi-sectoral support to all young children at risk of, or identified with, developmental difficulties and their families.
that meet diverse family needs and empower parents to help their children thrive.
building cross-sector partnerships and governance structures to ensure coherent, joined-up support for children and families across health, education, social protection and other sectors.
There is a strong evidence base for interventions and practices that support ECD , as well as examples of efficient policy action across Europe. The challenge is to translate this evidence into coherent ECD systems across sectors and levels of governance.
This toolkit provides structured guidance and practical steps to assist this process and strengthen systems that can support children's early development.
Phase 1
Identifying the Problem
The development of ECD strategic policy and integrated ECD services requires a comprehensive understanding of the national context. This includes a clear picture of:
(1) the public health problem: what is the status of young children in the country, what are the key issues affecting them, why, and with what consequences; and
(2) a situation and gap analysis of the national ECD landscape, documenting what systems and structures are in place and their performance at individual, systemic, and policy levels.
Combining epidemiological data with system performance analysis supports the identification of balanced policy priorities, clear targets for improvement, and a strong case for investment.
Step 1.1
Define the problem and build your evidence base
Why it matters
How a problem is framed shapes everything that follows: from the interventions selected and the sectors involved, to the way success is defined and measured. For early child development, adopting a systemic perspective that considers social, structural and environmental determinants can reveal a broad range of entry points for effective policy action on early child development.
What to do
- Gather data on the prevalence and distribution of young children at risk of suboptimal development (i.e. affected by challenges in providing responsive parenting, poverty, violence, malnutrition, prematurity, neonatal and congenital risks, and chronic diseases).
- Assess the prevalence of developmental difficulties and delays among children aged 0-8 years and define developmental domains particularly affected.
- Assess the prevalence of children developmentally on track.
- Identify which groups are disproportionally affected, paying attention to gender, age, socioeconomic status, and migration status.
- Look at trends over time: is the situation improving or deteriorating, and for whom?
- Map the key determinants shaping early child development outcomes: family environments, early childhood education and care settings, digital exposure, economic circumstances, and access to essential services.
- Identify both protective factors that strengthen development early in childhood and risk factors that may undermine it.
- Develop a multisectoral situation analysis to capture the range of determinants influencing early child development outcomes.
- Identify where there is room for improvement to reach those who need support most: geographic service coverage, marginalised groups and access patterns, particularly across the three entry points that can optimise health system support for ECD (developmental monitoring and early detection, early childhood intervention services, and parenting support).
- Systematically identify how different groups of children aged 0-8 years are affected by current policies and gaps in provision, particularly across the three entry points for health system support for ECD (developmental monitoring and early detection, early childhood intervention services, parenting support).
- Use a child rights impact assessment to ensure your analysis captures children in the most vulnerable and marginalised situations.
Questions to guide your work
- Which children aged 0-8 years in our country are experiencing suboptimal developmental outcomes? Which areas of development are of the greatest concern? And what is driving this?
- What data do we have on trends over time - and where are the gaps?
- How well are our current systems equipped to prevent and respond to early developmental concerns?
- Who is not being reached by existing services, and why?
Step 1.2
Review European and international frameworks
Why it matters
European and international frameworks provide guidance for action on early childhood development.Understanding these key frameworks and guidelines, including wider ECD frameworks (such as the Nurturing Care Framework for ECD), can help align national action with broader regional commitments and draw on shared evidence and tools; strengthening the case for investment in early childhood development and reform at home.
What to do
- Review key European frameworks and identify how they apply to your national context.
- Use them to strengthen the evidence base and legitimacy of your objectives on early child development.
- Identify obligations and commitments your country has already made.
- Look for alignment between proposed actions and regional priorities - this can support advocacy for resources.
Renewed attention to family policies and services became apparent following the publication of the European Pillar of Social Rights, proclaimed in 2017, which underlines the importance of childcare and support to children. The European Child Guarantee recognises the role of family and parenting support in ensuring children’s access to essential services. The Council of Europe has long advocated for positive parenting, and for parenting support to be available to all parents as a public service.
Step 1.3
Define your policy objectives
Why it matters
Clear objectives give direction for what follows: they guide the design of interventions, support coordination across sectors, and provide a basis for monitoring progress. By contrast, objectives that are too broad or focused primarily on treatment can lead to fragmented and reactive responses. Objectives that prioritise prevention and encourage action across sectors are more likely to drive sustained change.
What to do
- For each identified need, define an appropriate objective, considering available evidence on what works
- Frame objectives to enable coordination across health, educational settings, social services and other relevant sectors, and across strategic multi-sectoral ECD policy and entry points for health system support for ECD (i.e. developmental monitoring and early detection, early childhood intervention services, parenting support).
- Ensure objectives are measurable by defining the expected changes and how progress will be assessed.
- Balance short-term, deliverable actions with longer-term structural goals.
- Ensure objectives encompass health promotion and prevention, alongside treatment.
A useful way to organise objectives is over short, medium and long-term timescales:
Phase 2
Identifying Solutions and Entry Points
Once you have a clear picture of the problem, this phase helps you assess what is already in place, identify evidence-based solutions, and plan how to address gaps. The goal is a coherent, set of actions, not a collection of disconnected programmes.
Step 2.1
Review existing national policies and frameworks
Why it matters
Before developing new policies, it is essential to understand what is already in place and if this is working or not. A structured review helps identify gaps in coverage, coordination challenges, underserved populations, and lessons from previous implementation. It also avoids duplicating effort or undermining existing effective programmes
A structured review of the current ECD landscape can help to:
- Map existing policies and gaps in relation to the objectives defined in Step 1.3.
- Avoid duplicating effort or undermining existing effective programmes.
- Reveal opportunities to strengthen existing services and coordination between them, for example by integrating developmental monitoring into routine primary health care, formalising referral pathways to early childhood intervention, and expanding parenting support.
For each entry point for health system support for ECD, (multisectoral policy, developmental monitoring and early detection, early childhood intervention services, and parenting support) assess:
- Whether existing policies include key transferable principles (integration across sectors, family-centred practice, and – where appropriate - primary health care as an entry point) and aim to reduce inequalities, through proportionate universalism.
- Gaps in coverage, coordination or implementation (e.g. which population groups are not being adequately reached) and what has helped or hindered implementation in the past.
- The extend to which existing policies align with European and international frameworks.
- Whether quality standards are available, and whether the workforce has the skills and capacity to meet them.
An Overview of Country Policy and Systems for Early Childhood Development in Europe sets out minimum and promising practice standards for each of the four entry points, which you can use to assess your current ECD policies and services
What to do
Review your ECD policies and practices against these criteria, as well as national and international frameworks.
1 - Multi-sectoral ECD policies
- Identify if there is an existing national, multi-sectoral ECD policy in place, which departments or ministries are responsible for delivery, whether there is a clear role defined for the health sector, and which stakeholders are involved
- Identify whether engagement with young people and families was used to inform existing policies
- Identify whether existing policy/policies have been evaluated against ECD outcomes, and any key learning.
- Assess whether existing policies consider health equity and review strategies for “proportionate universalism”.
- Use policy briefs and frameworks such as the global Nurturing Care Framework and WHO European Framework on Early Childhood Development to support creation of entry points.
- Identify the services for children aged 0-8 years that are accessed through the health system.
- Map access pathways to services provided through other sectors such as parenting education or support services for new parents and preschool education.
- Assess the professionals involved in coordinating different types of support (such as primary health care services, home visiting, preschool education, parenting support, early intervention, social services etc.).
- Identify gaps in reach, particularly for vulnerable and marginalised families.
- Identify delivery platforms, and whether primary health care can act as a universal entry point to embed developmental monitoring, early childhood intervention, and parenting support or coordination and referral pathways are needed with other sectors.
2 - Developmental monitoring and early detection systems
Assess the available data and capacity for developmental monitoring and early detection, identify who is responsible to identify gaps in coordination and inform the design of services that respond to identified needs.
- Assess the level of involvement of the health system in early detection - is early detection standard practice within primary health care services?
- Map the health contacts available from birth and the health professionals involved.
- Assess whether developmental monitoring enables referrals to early intervention services.
- Identify gaps in provision, coordination, staff capacity, or training.
- What data is being collected - for example, is a standardised developmental instrument used, and how was it selected?
- Do the data provide insight into marginalised groups, or inequalities across areas that may require greater support?
- What data infrastructure is available?
- What data is available at a service, regional, or national level?
- How is data currently being used to inform policy?
3 - Early childhood intervention (ECI) services
Assess the coverage and intensity of ECI service provision, the sectors responsible for delivery, and the groups that may face barriers to access, to enable identification of gaps, and ensure ECI is delivered effectively.
- Assess the role of the health sector and primary health care services in ECI provision.
- Identify what kind of support is provided to young children with developmental difficulties, and the type of need they address.
- Assess how interventions take a family-centred approach.
- Explore whether the effectiveness of existing interventions or services has been evaluated, and any learning from this.
- Identify barriers to engagement, especially in populations who have the greatest need.
- Identify whether quality standards are available and whether the skills and capacity of the workforce match them.
- Assess whether there is an interdisciplinary team involved.
- Identify whether there is a single ECI service and entry point available, or whether provision varies by sector and geography.
- Assess the role of the health sector and primary health care services in ECI provision.
4 - Parenting support
Review what parenting support is available, alongside coverage, any gaps in services which affect engagement, and the level of integration across services and sectors.
- Examine the levels of parenting support available. For example, a core package of parenting support offered to all families (universal), targeted interventions to families with specific needs or identified risks, or more intensive forms of support for families with more complex needs.
- Examine the resource commitment (such as active outreach, complexity of needs and length of support) at each level of parenting support.
- Identify the role of the health system, and other sectors and organisations, in delivering different levels of parenting support or referring families to services.
- Identify whether services signpost to broader support (e.g. housing services).
Questions to guide your work
- What do we already have that is working well and should be protected or scaled?
- Where are the biggest gaps - in provision, coordination or population reach?
- What can we realistically build on within existing systems, rather than creating from scratch?
Step 2.2
Identify good practice solutions
Why it matters
A strong, evidence-based early childhood system requires interconnected services across health, education, social protection and other sectors to ensure comprehensive support for children and their families. The key areas highlighted here, early detection, early intervention, and parenting support, could also benefit from multi-sectoral engagement with clarity on the role of each sector and institution.
What to do:
- Address four key areas for ECD in the health system: multisectoral policy, developmental monitoring and early detection, early childhood intervention, and parenting support.
- For each area, promising practices have been identified across Europe, which can inform the development of policy solutions and implementation approaches. Follow the suggested actions below to develop your policy solutions based on evidence from the promising practices across the region.
1 - Multisectoral ECD policies
A multisectoral policy prioritising healthy child development requires a holistic focus on all aspects of nurturing care, including the environmental factors that support every child’s health, well-being and development.
Example of good strategic multisectoral ECD policy:
- Uses an evidence-based approach to integrate health, nutrition, early learning, protection, and family support, to address all aspects of young children’s development.
- Promotes strong coordination across sectors such as health, education, and social protection through clear roles, shared goals, and accountability mechanisms.
- Prioritises equity and inclusion, especially for vulnerable children and families.
- Supports caregivers through parenting, mental health, and social support services.
- Includes practical implementation plans with sustainable financing, quality standards, trained workforces, and robust monitoring systems to track progress and outcomes.
- Is rooted in children’s rights, community-driven, culturally responsive, and focused on prevention and early intervention from pregnancy through the early years.
- Link each objective to the problem it aims to solve, and the root causes identified in step 1.1
- Map objectives to the Nurturing Care components (health, nutrition, responsive caregiving, early learning, safety) and life course stages.
- Consider a wide range of solutions, relating to services, workforce, financing, governance, information systems, regulation, and community demand. Look for ways to embed ECD into existing health system contacts (antenatal care, immunisation, well-child visits, community health workers).
- Learn from promising practice examples. Identify the problem addressed, what was done, what enabled success, and the results. Note what could be adapted locally.
- Clarify the health sector’s role. Define whether the Ministry of Health leads, supports, or enables each option, and identify opportunities to integrate ECD into maternal and child health services.
- Identify multisectoral partners and coordination needs. Map the roles of other sectors, key referral points, coordination mechanisms, and any gaps in responsibility.
- Assess and compare options. Use agreed criteria such as effectiveness, equity, feasibility, cost, acceptability, sustainability, and speed. Consider risks, trade-offs, and resource implications.
- Select a balanced set of interventions that covers all Nurturing Care components and combines short- and long-term actions.
- Check the package of solutions against objectives, policies, and frameworks
- Review identified solutions with partners and communities to ensure they are feasible and supported.
- Generate buy-in through shared vision and accountability, across health, education and social protection.
- Develop legislation, governance arrangements, workforce models and data systems that enable integration of ECD services.
- Identify referral pathways, with health as a central coordinator, and establish an integrated single-access point for services.
Good and innovative practices — Multisectoral ECD Policy
The following practices offer concrete, tested models for action for multisectoral policy:
2 - Developmental monitoring and early detection
Good policy solutions for developmental monitoring should:
- Observe development across at least three time points;
- Make developmental monitoring a universal service;
- Ensure a standardised/validated tool is used;
- Create conditions to ensure developmental monitoring is completed by health professionals with participation from caregivers; and
- Provide a link and referral to ECI services and other levels of health care.
Policy solutions should include breakdowns of the data available (e.g. by geography, sex, ethnicity, deprivation) and provide updated data in an accessible format.
- Include universal developmental monitoring as an integral component of routine child health care and secure the necessary resources (financial, human resources, mandates, incentives) to facilitate implementation
- Use standardised tools to improve early detection of developmental risks.
- Establish referral pathways from early detection to early intervention.
- Introduce training for child health professionals in developmental monitoring within existing curricula or in-service trainings, with sufficient resources for the training to support uptake
- Ensure training curricula deliver clinical competencies related to child development and are aligned with bioecological theory, nurturing care and family centred, strengths-based care, as well as the World Health Organisation International Classification of Functioning, Disability and Health.
- Recognise developmental monitoring as a core primary health care service and include reimbursement codes where appropriate. Use balanced incentives to ensure developmental monitoring is not overlooked.
- Accelerate discussions within and between ministries on intra- and inter-sectoral coordination and collaboration to promote early childhood development, early identification of young children with developmental difficulties, and early intervention
- Build data infrastructure to provide a publicly available, routinely updated, national-level picture of early childhood development.
- Allocate resources for procuring user-friendly, standardised and validated tools for developmental monitoring. Follow best practices and ensure resources for adaptation and training
- Monitor inequalities, such as by geography, sex, ethnicity, and deprivation, to enable responsive policies and effective allocation of resources.
- Strengthen collection of developmental monitoring data through Health Management Information Systems. Monitor implementation, gather feedback, and use data to inform planning and decision-making.
Good and innovative practices —Developmental monitoring and early detection
The following practices offer concrete, tested models for monitoring and early detection:
3 - Early childhood intervention services
This area focuses on facilitating access, through a single point of contact, to coordinated early childhood intervention services delivered by professionals working together to support the development of infants, toddlers, and pre-school-age children. ECI services have shifted from focusing on the child alone to supporting children and their families together.
ECI emphasises building families' capacity to support their child's development.
Effective ECI services should:
- Include a transdisciplinary team providing coordinated support and integrated referrals;
- Respond to the needs of children at risk, with developmental delays or disabilities;
- Be based on the social model of disability;
- Be family-centred and individualised; and
- Offer service provision in the child’s natural environment (home, preschool).
- Working with other relevant ( sectors, such as education and social services), develop a single ECI service model that provides coordinated, evidence-based support to all young children with identified developmental difficulties and their families.
- Define the roles and responsibilities of the health system (at primary, secondary and tertiary levels) and health professionals in the provision of community-based, familycentred ECI services based on the national ECI model and standards.
- Ensure that legislation, procedures and standards governing health care, as well as financing arrangements, support the role of the health care sector in the provision of ECI services.
- Support the establishment of appropriate structures at national and local level to facilitate inter-sectoral collaboration in ECI and ECI system development.
- Adopt and promote within the health care system an evidence-based, family-centred approach to address developmental difficulties in early childhood, including in the provision of early childhood intervention services.
- Engage primary health care services in delivering community-based, family-centred ECI services, grounded in intersectoral collaboration and aligned with the national ECI model and standards (e.g. assign professionals to ECI teams, host ECI teams in primary health care facilities).
- Allocate qualified human resources for the provision of community-based, family-centred ECI services.
- Ensure ongoing training and professional support to hone the competencies of health practitioners for evidence-based, family-centred ECI practice.
- Ensure access for children with more complex conditions to secondary and tertiary levels of specialised diagnostic and therapeutic procedures as needed.
- Refer children identified as at risk or with developmental difficulties to local, communitybased ECI services.
- Ensure each child and family receiving ECI has an Individualised Family Service Plan developed jointly with caregivers and reviewed regularly.
- Assign a key worker or primary service provider to coordinate support for each family.
- Involve caregivers in interventions, building on family strengths and addressing the needs of the whole family, not just the child’s development.
Good and innovative practices — Early childhood intervention services
The following practices offer concrete, tested models for action for ECI:
4 - Parenting support
Extensive evidence shows that responsive, nurturing parenting is among the strongest protective factors for child health and well-being, and one of the most effective means of breaking intergenerational cycles of disadvantage. Parenting support covers the services, programmes, activities, resources and information that help parents in their role, by building their knowledge, skills and social support and promoting the well-being of the whole family. Services aim to strengthen three dimensions of parenting: responsive caregiving, supportseeking behaviours and self-care.
Parenting support programming should ideally encompass three tiers of support: universal support (broad, population-based preventive services accessible to all parents), targeted support (services for families with specific needs or identified risks), and intensive support (comprehensive, individualised services for families with complex needs).
Parenting support should be offered in three tiers:
- Universal: preventive services open to all parents;
- Targeted: for families with specific needs or identified risks;
- Intensive: Individualised support for families with complex needs.
Effective parenting support services are:
Rights-based, equity-focused and context-specific Evidence-based, using proven social and behavioural change strategies
- Family-centred and strength-based;
- Gender-transformative, promoting equitable parenting roles
- Inclusive, accessible and affordable
- Integrated into routine services, with multi-agency involvement
Universal parenting support can be delivered as a stand-alone intervention or built into existing services across multiple sectors, for example through key messages, counselling or skills-building. It is most effective within a multisectoral approach, where coordination ensures continuity of support, avoids gaps and addresses different parenting needs.
- Support availability of parenting information through media and digital platforms, including parenting apps
- Promote and support positive parenting through the provision of information, counselling, guidance and behaviour modelling (including through demonstration and practice sessions) through health facility-based services and universal home visiting programs
- Ensure monitoring and identification of needs, strengths and risks at individual, family and community levels when in contact with children and caregivers.
- Link parents to other services or resources (targeted services, parenting apps).
- Organise mother-baby and parent group activities and parent/peer support groups.
- Set up baby- and child-friendly spaces in health facilities where parenting support can be provided
- Train frontline healthcare workers to provide consistent parenting messages
- Promote gender-equitable caregiving
- Use social and behaviour change approaches to encourage positive caregiving
- Ensure services actively promote responsive caregiving, caregiver self-care, and help-seeking behaviour
Targeted parenting support builds on universal services by providing interventions tailored to families' specific needs or risks. It aims to reduce harmful risk factors while strengthening protective factors for children and parents.
- Ensure parents with specific needs or identified risks are recognised through routine services and offered additional support.
- Offer targeted support for groups such as adolescent parents, families experiencing poverty or social exclusion, refugee, migrant and displaced families, and families exposed to violence.
- Targeted programmes might include nutritional/breastfeeding counselling for low-birth-weight infants, programmes supporting positive discipline and positive parenting for caregivers with identified risk of violence against children.
- Provide support for the mental health and psychosocial well-being of parents through routine antenatal and postnatal services, including home visits, with follow up through more specialised services where needed.
- Make support available for parents of children with disabilities.
Some parents and caregivers may need comprehensive, individualised and intensive support, usually from multiple professionals or services across different sectors. One example of such intensive parenting support is an early childhood intervention service.
- Ensure families with complex needs (for example, a child with a disability alongside parental mental health problems or poverty) are identified early through routine services and referred to intensive, multidisciplinary support.
- Provide access to early childhood intervention services for children with developmental delays or disabilities, or at significant risk of them.
- Deliver intensive home-visiting, case management, and family support programmes for families whose needs cannot be met by universal or targeted services.
- Strengthen referral pathways and case coordination between health, social protection, education, disability, and child protection services.
- Ensure continuity of support through regular follow-up, progress monitoring, and transition planning across services and developmental stages.
- Provide specialist parenting support for families affected by severe mental health conditions, substance misuse, violence, disability, child protection concerns, or other high-risk circumstances.
- Ensure services are integrated with child protection and family strengthening services, including prevention of family separation.
- Ensure equitable access to intensive services for disadvantaged and underserved populations, including through outreach and home-based models where needed.
- Establish quality standards, workforce competencies, and sustainable financing arrangements for intensive parenting and early intervention services.
To ensure families receive the right level of support at the right time, parenting support should be delivered through coordinated systems that link universal, targeted, and intensive services across sectors.
- Establish formal national or regional coordination mechanisms.
- Establish a shared vision and cross-sectoral approach to parenting support involving health, education, social protection, disability, child protection, and community services.
- Clearly define the roles and responsibilities of different sectors and service providers in delivering and supporting parenting programmes.
- Develop and maintain referral pathways between universal, targeted, and intensive parenting support services to ensure families can access additional support when needed.
- Strengthen coordination and information-sharing mechanisms between services
- Promote integrated service delivery through common entry points and coordinated case management.
- Engage parents, caregivers, and communities in the design, delivery, and evaluation of parenting support services.
- Establish quality standards, monitoring systems, and indicators across all levels of parenting support to track coverage, quality, equity, and outcomes.
- Invest in sustainable financing and governance arrangements to support the long-term delivery and scale-up of parenting support services.
- Promote continuity of support across the life course
Good and innovative practices — Parenting Support
The following practices offer concrete, tested models for action for parenting support:
Step 2.3
Identify stakeholders, tools and coordination structures
Why it matters
Even well-designed policies may fail when key stakeholders are not involved, responsibilities are unclear or coordination is ineffective. This step ensures your policy has the governance, partnerships and participation structures it needs to be implemented effectively.
Effective ECD policies and services depend on cooperation between the ministries responsible for health, education and social support, with the perspectives of professionals across these sectors reflected in decision-making. Meaningful participation by children, in ways appropriate to their age and development, and by parents and caregivers is also essential to understand their needs and to design ECD services that respond to those needs.
Designing solutions requires clarity on roles and responsibilities across sectors, alongside collaboration around shared objectives. Co-designed legislation, quality standards and coordination structures ensure stakeholders are well-equipped to fulfil their role and have effective platforms for cross-working.
What to do:
- Identify who needs to be involved and in what role.
- Think beyond the health sector: education authorities, social services, local government, civil society, children and families all have a role to play.
- Determine what structures will enable sustained cross-sector working.
- These might include joint planning groups, shared data platforms, or co-located services.
- Learn from coordination mechanisms that have worked in other ECD country contexts
- Determine what combination of legislation, strategies, programmes and guidance is right for your context and level of governance.
- Ensure children, young people, caregivers and service providers across sectors have a genuine voice - not just in consultation events, but embedded in governance, co-design and evidence and policy review processes.
Questions to guide your work
- Who needs to be at the table for this policy to succeed and who is currently missing?
- How will we ensure that children, young people and caregivers have a real voice?
- What coordination structures already exist that we could use or strengthen?
- Who will lead developmental checks, or coordinate more complex needs across different sectors?
Phase 3
Implementation and Monitoring
Having a good policy on paper is not enough. This phase focuses on how to make it work in practice - through existing systems, with clear accountability, and with monitoring built in from the start.
Step 3.1
Implement through existing systems
Why it matters
Implementation translates ECD policy solutions into everyday practice by professionals supporting children and families. Sustainable implementation requires integrating these measures into existing health, and social service systems, with particular emphasis on primary health care.
- Define who is responsible for each intervention across national, regional and local levels.
- Establish clear lines of accountability within each sector and across sectors.
- Agree on how decisions will be made and how disputes will be resolved.
- Set up regular coordination between health, education and social services - including shared referral pathways and data-sharing agreements.
- Identify a lead coordinating body with the mandate and capacity to drive implementation.
- Build in mechanisms for joint problem-solving when things go wrong.
- Ensure political commitment and alignment across sectors.
- For the workforce, ensure frontline staff in health, education and social services have the training, tools and time to address early childhood development.
- For financing, map current spending, identify gaps, and advocate for sustained investment — including for prevention, not just treatment.
- Provide practical implementation support and technical guidance at every level of the system.
Questions to guide your work
- How will this policy be funded - and is that funding sustainable?
- What workforce capacity is needed and what gaps exist?
- How will we maintain cross-sector coordination when there is pressure to work in silos?
Step 3.2
Monitor performance, equity and system functioning
Why it matters
Monitoring is how you learn whether your policy is working, and for whom. Without it, you cannot identify what needs to change, demonstrate impact, or hold systems accountable. Monitoring should be built into policy design from the beginning, not added on at the end.
What to do
- Set up monitoring across four dimensions: (1) who is being reached by services and where gaps persist; (2) whether early child development outcomes are improving at population level; (3) whether inequalities in outcomes and access are narrowing; and (4) whether the system itself - workforce, financing, services - is strengthening over time.
- Draw on established indicators and measurement tools to enable comparison over time and across countries.
- Build in regular review cycles where monitoring evidence can trigger adjustments to policy and implementation.
- Track outcomes disaggregated by gender, age, socioeconomic status, migration status, developmental domain, and other relevant factors, as average improvements can mask growing inequalities.
Questions to guide your monitoring
- Are the children who need support most actually being reached?
- Are inequalities in developmental outcomes narrowing or widening?
- Is our monitoring data feeding into real decisions, or just being collected?
- Are we tracking the inputs (services, workforce) as well as the outcomes?