Early Childhood Development
The Context
In Europe, an estimated 5 million children under five are at risk of developmental difficulties. Yet, Early Child Development (ECD) systems are fragmented, and only 10 of 30 countries have a strategic multisectoral policy.
The early years are a critical window for brain development, when children are most sensitive to the environments that shape their lifelong health and wellbeing. 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 all these components is a strategic investment in children’s development and their futures.
The response
Preventing chronic illnesses and supporting lifelong health begins in early childhood, requiring interventions that preserve good health (such as immunisation, or well child visits in primary health care facilities or home settings promoting healthy lifestyles), support optimal nutrition but also reduce harmful environmental exposures and toxic stress, support responsive relationships, and strengthen core life skills.
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1 in 6
children and adolescents aged 0-19 living with a mental health condition
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1 in 2
adult mental health conditions first emerge by age 18
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37%
rise in prevalence among children and adolescents over the past decade
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.
The evidence base on effective interventions and practices to support early child development is strong, and there are examples of effective policy action across Europe. The challenge is to translate evidence into coherent, equitable and scalable policies for a coordinated ECD system across sectors and levels of governance.
This toolkit provides structured guidance and practical steps to support this process and strengthen the systems that can support children’s early development.
Phase 1
Identifying the Problem
The development of ECD strategic policy and integrated ECD services is underpinned by a comprehensive understanding of the national context. This includes a comprehensive 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.
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.
- Use 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
Across Europe, a set of strategic frameworks is being developed to underpin action on early child development.
Understanding these key frameworks and guidelines, as well as wider ECD frameworks (such as the Nurturing Care Framework for ECD), will 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, which catalysed changes in national laws across Member States. The European Child Guarantee explicitly states the role of family and parenting support in ensuring children’s access to essential services. The Council of Europe has long advocated for universal parenting support as a public service.
Step 1.3
Define your policy objectives
Why it matters
Clear objectives can guide the design of interventions, support coordination across sectors and provide the basis for monitoring progress.
Prevention-oriented, cross-sectoral objectives are more likely to drive lasting change, address developmental difficulties and enhance child development outcomes.
What to do
- For each identified need, define an appropriate objective, considering available evidence on what works
- Frame objectives to enable coordination across health, education, 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 - identify what change would look like and how you would know if it has happened.
- Balance short-term, deliverable actions with longer-term structural goals.
- Orient objectives towards health promotion and prevention, not just 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 and your desired objectives, this phase helps you assess what already exists, identify evidence-based solutions, and plan how to address gaps. The goal is a coherent, layered 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, and in order to meet objectives, it is essential to understand what is already in place - and whether it is working.
A structured review to understand the current ECD landscape can:
- Identify existing policies and any gaps in relation to the objectives identified in Step 1.3.
- Help identify coordination failures, underserved populations, lessons from previous implementation, and effective entry points for change.
- Avoid duplicating effort or undermining existing effective programmes.
- Reveal opportunities to strengthen existing services and the connections between them, such as 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 relevant sectors, family-centred practice, and using primary health care as an entry point where appropriate.
- Whether policies focus on reducing inequalities, through a proportionate universalism approach, offering universally available services with increased support for those who need it.
- Any gaps in coverage, coordination or implementation - e.g. which population groups are not being adequately reached.
- What barriers have affected implementation in the past - and what has enabled success.
- How well current policies align with European and international frameworks.
- Whether quality standards are available, and whether the skills and capacity of the workforce match them.
“An Overview of Country Policy and Systems for Early Childhood Development in Europe” includes criteria for minimum and promising practice standards for multisectoral policy, developmental monitoring, early childhood intervention and parenting support. These standards are drawn from existing international frameworks and guidance. They can be used to assess the current ECD policies and services within your system.
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 data and capacity available for developmental monitoring and early detection, and who is responsible, to identify gaps in coordination and inform the design of a responsive service
- 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 this selected?
- Do the data provide insight into marginalised groups, or inequalities across areas who 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 services
Assess the coverage and intensity of ECI service provision, which sector(s) are responsible for delivery, and which groups 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 provided universally, 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
Develop policy solutions informed by promising practices
Why it matters
A strong, evidence-based early childhood system requires interconnected services across health, education, social protection and other sectors to ensure holistic support for developing children and their families. The key areas highlighted here, early detection, early intervention, and parenting support, should also benefit from multi-sectoral engagement with clarity on the role of each sector and institution. While we continue to provide resources relevant from the perspective of the Ministry of Health, it will also be important to identify areas in which engagement and collaboration with other sectors is necessary for effective policy implementation.
What to do:
Develop policy solutions informed by existing promising practices
- 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 all children need to thrive.
- A 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.
- Include 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.
Promising 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 allow 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.
For data surveillance systems, policy solutions should include breakdowns of the data available (e.g. by geography, sex, ethnicity, deprivation) and offer data that is regularly updated and provided 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.
Promising practices —Developmental monitoring and early detection
The following practices offer concrete, tested models for action for monitoring and early detection:
3 - Early childhood intervention services
This area focuses on enabling access to early childhood intervention services, provided by collaborating professionals, to enhance the developmental outcomes of infants, toddlers, and pre-school-age children through a single point of contact. Contemporary ECI services aim to support the child and the family.
ECI emphasises building families' capacity to support their child's development.
Contemporary 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).
- In collaboration with other relevant sectors, develop a single ECI service model, providing evidence-based and coordinated intersectoral support available to all young children identified with developmental difficulties and their families (defining conceptual basis, children eligible for support, service organisation, sectoral involvement and responsibilities, etc.)
- Define the roles and responsibilities of the health system (at primary, secondary and tertiary levels) and health professionals in the provision of community-based, family-centred 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 levels 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 addressing 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. provide 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 for enhancing 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 for specialised diagnostic and therapeutic procedures as needed.
- Refer children identified as at risk or with developmental difficulties to local, community-based 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, not just focusing on the developmental needs of the child but the strengths and wider needs of the family.
Promising 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 wellbeing, and one of the most effective levers for breaking cycles of adversity. Parenting support is understood as “a broad set of services, programmes, activities, resources and information available to parents to help them in their parenting role, increasing child-rearing knowledge, skills and social support, enhancing parenting competencies and promoting the well-being of parents and children.”
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).
Effective parenting support should be rights-based, equity-focused, evidence-informed, inclusive, gender-transformative, strength-based, family-centred and context-specific.
The three core dimensions of parenting that services aim to support are: responsive caregiving, support-seeking behaviours and self-care.
Optimal parenting support services:
- Have multi-agency involvement;
- Are integrated into routine services;
- Are universal services with a layered approach to support, including targeted and intensive support;
- Use evidence-based social and behavioural change strategies
- Are family-centred;
- Promote gender-equitable parenting roles; and
- Are inclusive, accessible and affordable.
Universal parenting support can be delivered as a stand-alone parenting intervention or by integrating parenting support components (e.g., key messages, counselling or skills-building) into existing services across multiple sectors. Universal parenting support is even stronger when coordination of support across different sectors ensures continuity of services, 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 are identified early through routine services and referred to intensive, multidisciplinary support.
- Provide access to early childhood intervention services for children with developmental delays, disabilities, or complex developmental risks.
- Deliver intensive home-visiting, case management, and family support programmes for families facing multiple vulnerabilities.
- 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 subnational 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
Promising 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
Well-designed policies can fail if the right people are not involved, responsibilities are unclear, or coordination breaks down. This step ensures your policy has the governance, partnerships and participation structures it needs to be implemented effectively.
Effective ECD policy and services depend on health, education and social support ministries working together, with their workforces' views represented in decision-making. Ensuring that ECD services meet the needs of children and parents also requires involving them to understand and design solutions around their 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, for children and families. Sustainable implementation involves embedding policy actions within health, education and social service systems - particularly primary health care. When strong ECD interventions are embedded within existing services, they are more likely to reach those who need them, be adequately resourced, and survive changes in political leadership or funding.
- 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 know whether your policy is working, and for whom. Without it, you cannot learn and improve, identify what needs to change, demonstrate impact, or hold systems accountable. Monitoring works best when built into policy design from the beginning, rather than 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?