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This paper used longitudinal data from five studies conducted in Bangladesh, Bhutan, Cambodia, Ethiopia, and Rwanda to examine the links between family stimulation and early childhood development outcomes (N = 4904; M[subscript age] = 51.5; 49% girls). Results from random-effects and more conservative child-fixed effects models indicate that across these studies, family stimulation, measured by caregivers' engagement in nine activities (e.g., reading, playing, singing), predicted increments in children's early numeracy, literacy, social-emotional, motor, and executive function skills (standardized associations ranged from 0.05 to 0.11 SD). Study-specific models showed variability in the estimates, with null associations in two out of the five studies. These findings indicate the need for additional research on culturally specific ways in which caregivers may support early development and highlight the importance of promoting family stimulation to catalyze positive developmental trajectories in global contexts.

Observational data collected prior to the pandemic (between 2004 and 2019) were used to simulate the potential consequences of early childhood care and education (ECCE) service closures on the estimated 167 million preprimary-age children in 196 countries who lost ECCE access between March 2020 and February 2021. COVID-19-related ECCE disruptions were estimated to result in 19.01 billion person-days of ECCE instruction lost, 10.75 million additional children falling "off track" in their early development, 14.18 million grades of learning lost by adolescence, and a present discounted value of USD 308.02 billion of earnings lost in adulthood. Further burdens associated with ongoing closures were also forecasted. Projected developmental and learning losses were concentrated in low- and lower middle-income countries, likely exacerbating long-standing global inequities.

Early childhood development programmes vary in coordination and quality, with inadequate and inequitable access, especially for children younger than 3 years. New estimates, based on proxy measures of stunting and poverty, indicate that 250 million children (43%) younger than 5 years in low-income and middle-income countries are at risk of not reaching their developmental potential. There is therefore an urgent need to increase multisectoral coverage of quality programming that incorporates health, nutrition, security and safety, responsive caregiving, and early learning. Equitable early childhood policies and programmes are crucial for meeting Sustainable Development Goals, and for children to develop the intellectual skills, creativity, and wellbeing required to become healthy and productive adults. In this paper, the first in a three part Series on early childhood development, we examine recent scientific progress and global commitments to early childhood development. Research, programmes, and policies have advanced substantially since 2000, with new neuroscientific evidence linking early adversity and nurturing care with brain development and function throughout the life course.

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.

Objective To estimate the level and trend of development assistance for community health worker-related projects in low- and middle-income countries between 2007 and 2017. Methods We extracted data from the Organisation for Economic Co-operation and Development's creditor reporting system on aid funding for projects to support community health workers (CHWs) in 114 countries over 2007-2017. We produced estimates for projects specifically described by relevant keywords and for projects which could include components on CHWs. We analysed the pattern of development assistance by purpose, donors, recipient regions and countries, and trends over time. Findings Between 2007 and 2017, total development assistance targeting CHW projects was around United States dollars (US$) 5 298.02 million, accounting for 2.5% of the US$ 209 277.99 million total development assistance for health. The top three donors (Global Fund to Fight AIDS, Tuberculosis and Malaria, the government of Canada and the government of the United States of America) provided a total of US$ 4 350.08 million (82.1%) of development assistance for these projects. Sub- Saharan Africa received a total US$ 3 717.93 million, the largest per capita assistance over 11 years (US$ 0.39; total population: 9 426.25 million). Development assistance to projects that focused on infectious diseases and child and maternal health received most funds during the study period. Conclusion The share of development assistance invested in the CHW projects was small, unstable and decreasing in recent years. More research is needed on tracking government investments in CHW-related projects and assessing the impact of investments on programme effectiveness. Objectif Estimer le montant et revolution de l'aide au developpement portant sur des projets relatifs aux agents de sante communautaires dans les pays a revenu faible et intermediate, entre 2007 et 2017. Methodes Nous avons extrait des donnees du Systeme de notification des pays creanciers de l'Organisation de cooperation et de developpement economiques concernant le financement de l'aide apportee a des projets axes sur les agents de sante communautaires dans 114 pays, de 2007 a 2017. Nous avons obtenu des estimations pour les projets specifiquement decrits par certains mots cles et pour les projets dont certaines parties pouvaient concerner les agents de sante communautaires. Nous avons analyse les tendances de l'aide au developpement par objectif, donateurs, regions et pays destinataires, ainsi que son evolution dans le temps. Resultats Entre 2007 et 2017, le total de l'aide au developpement versee a des projets portant sur les agents de sante communautaires s'est eleve a environ 5298,02 millions de dollars des Etats-Unis ($ US), soit 2,5% des 209 277,99 millions de $ US d'aide au developpement totale allouee a la sante. Les trois principaux donateurs (Fonds mondial de lutte contre le sida, la tuberculose et le paludisme, gouvernement du Canada et gouvernement des Etats-Unis d'Amerique) ont verse un total de 4350,08 millions de $ US (82,1%) d'aide au developpement pour ces projets. LAfrique subsaharienne a requ un total de 3717,93 millions de $ US, soit l'aide par habitant la plus importante sur les 11 annees (0,39 $ US; population totale: 9426,25 millions). Durant la periode examinee, la majorite des fonds alloues a l'aide au developpement etaient destines a des projets portant sur les maladies infectieuses et la sante maternelle et infantile. Conclusion La part de l'aide au developpement investie dans des projets axes sur les agents de sante communautaires etait faible, irreguliere et en baisse ces dernieres annees. De plus amples recherches sont necessaires pour suivre les investissements du gouvernement dans des projets concernant les agents de sante communautaires et evaluer l'impact de ces investissements sur l'efficacite des programmes. Objetivo Estimar el nivel y la tendencia de la asistencia para el desarrollo destinada a proyectos relacionados con los trabajadores de salud de la comunidad en paises de bajos y medianos ingresos entre 2007 y 2017. Metodos Se extrajeron datos del sistema de informacion de acreedores de la Organizacion para la Cooperacion y el Desarrollo Economicos sobre la financiacion de la ayuda para proyectos de apoyo a los trabajadores de salud de la comunidad (community health workers, CHW) en 114 paises entre 2007 y 2017. Se elaboraron estimaciones para los proyectos descritos especificamente mediante palabras clave pertinentes y para los proyectos que podrian incluir componentes sobre los CHW. Se analizo la pauta de la asistencia para el desarrollo por finalidad, donantes, regiones y paises receptores, y las tendencias a lo largo del tiempo. Resultados Entre 2007 y 2017, el total de la asistencia para el desarrollo destinada a proyectos de CHW fue de unos 5 298,02 millones de dolares estadounidenses (USD), lo que representa el 2,5% del total de la asistencia para el desarrollo destinada a la salud, que ascendio a 209 277,99 millones de USD. Los tres principales donantes (el Fondo Mundial de Lucha contra el SIDA, la Tuberculosis y la Malaria, el Gobierno de Canada y el Gobierno de los Estados Unidos de America) aportaron un total de 4 350,08 millones de USD (82,1%) de la asistencia para el desarrollo destinada a estos proyectos. El Africa subsahariana recibio un total de 3 717,93 millones de USD, la mayor asistencia per capita en 11 anos (0,39 USD; poblacion total: 9 426,25 millones). La asistencia para el desarrollo de proyectos centrados en las enfermedades infecciosas y la salud materno infantil recibio la mayor parte de los fondos durante el periodo de estudio. Conclusion La contribucion de la asistencia para el desarrollo invertida en los proyectos de los CHW fue pequena, inestable y decreciente en los ultimos anos. Se necesita mas investigacion sobre el seguimiento de las inversiones gubernamentales en proyectos relacionados con los CHW y la evaluacion del impacto de las inversiones en la eficacia de los programas., Introduction To attain universal health coverage for the most vulnerable populations and to prepare against future epidemics, such as Ebola, there have been calls for scaling-up community health worker (CHW) [...]