Introduction

Thanks to the generous support of the Women and Public Policy Program at Harvard Kennedy School, this summer I will be collaborating with Aga Khan University to conduct an extensive mixed-methods validation study at an established child development research site in the Naushero Feroze district of Sindh, Pakistan.

To give a brief background of the work, nearly 250 million children under the age of 5 in low- and middle-income countries are at risk of not reaching their developmental potential (Black et al. 2018). Children’s exposure to nurturing and responsive relationships are necessary to developing social and emotional competencies, as well as core cognitive skills needed to communicate, problem solve, and maintain attention. As such, the Nurturing Care Framework (NCF) was developed to provide a roadmap for attaining strategic action to strengthen public policies to ensure (1) children’s good health, (2) adequate nutrition, (3) protection from threats, (4) support responsive care, and (5) to promote opportunities for early learning. A number of indicators already exist to capture the first three domains of the NCF and are widely used at national and subnational levels to track progress in children’s health and nutrition services. Much less attention, however, has been given to the domains of responsive care and early learning. Therefore, creating universal measures for these two indicators is critical for program monitoring and evaluation, to improve access to and quality of services, and to track progress for children’s development.

In collaboration with the WHO, as part of my dissertation research, I lead the efforts to create two evidence-informed measures for assessing responsive care and early learning. For each tool, we reviewed the literature, systematically mapped out any existing tools by their broad constructs, iteratively identified common constructs, short-listed to ensure measurability, and piloted on existing data. The final indicator tools are informed by conceptual and operational definitions that describe responsive care and early learning as two distinct concepts that can be inter-related. Prior to these tools, no existing measure adequately distinguished between these two concepts, leaving programs and governments unable to adequately monitor them as separate and distinct entities. The next step is to thoroughly validate the tools in order to ensure reliability and validity, to update the tool, and ultimately to disseminate the tools worldwide.

The funding from the WAPPP will allow me to validate these tools, quantitatively and qualitatively. Policy makers and program directors throughout the world are pushing to implement programs that promote all aspects of the NCF. There is a dire need for a universally validated tool to measure responsive care and early learning as distinct concepts. This validation study will provide key stakeholders interested in implementing nurturing care programs with the ability to train providers on responsive care and early learning, monitor their delivery, and measure parenting outcomes, leading to a more holistic and nuanced understanding of pathways to improve child development in the first five years of life.