Integrate Early Childhood Development (ECD) into Maternal and Child Health (MCH) Programming

Authored by Catholic Relief Services


The first 1,000 days of a person’s life are crucial to crucial developmental processes related to cognition, language, social-emotional development and physical health. An estimated 250 million children, or 43 percent, younger than 5 in low- and middle-income countries continue to fall short of their potential due to adversities they face in their formative years, and 5.9 million children under 5 still die each year, almost 1 million of them on their first day of life. In addition, 303,000 women die annually during childbirth. The vast majority of these deaths are caused by complications and illnesses for which affordable treatments are known.

Integrated early childhood development (ECD) interventions have shown positive impacts on such outcomes for children in high-risk, low-resource settings.1 Since 1990, the lives of an estimated 100 million children have been saved by the global community from preventable disease and malnutrition. Through USAID’s new emphasis on equitable access to maternal and child health services, 8 million lives can be saved in the bottom 2 wealth quintiles alone – the poorest 40 percent of the population – by 2020.

CRS Experience

CRS and other faith-based organizations are already doing some of the most effective, holistic and impactful maternal and child health (MCH) work in some of the most difficult to reach places in the world. CRS promotes a holistic approach to mothers and child health and wellbeing, not only to eliminate preventable deaths but also to optimize children’s physical, emotional and cognitive development. Interventions are evidence-based, age- and stage-appropriate, and operate across multiple levels and actors. They seek to strengthen families and communities, and support health and social systems. In order to protect young girls and boys to be valued by family and community in an environment that enables them to thrive and grow, we work with parents, care providers and others who influence children’s upbringing. This integration of ECD into our MCH work can be used as a resource for USAID going forward.

Our notable approaches include:

  1. Reaching the last mile of the health system for increased coverage and impact through building and maintaining strong partnerships. CRS’ vast local, national and international networks of faith- based, civil society and NGO, government, private sector, university and research partners form a robust platform from which to ensure program impact, exercise influence and strengthen national health systems. For example, CRS provides support for 15,000 children under age two in Kenya, Malawi and Tanzania. CRS supports caregivers to form stable and responsive relationships with children, builds safe and stimulating physical environments and emphasizes proper health and nutrition and maternal mental wellbeing. Capacity strengthening addresses the gaps in the ability of community-based organizations to lead and expand ECD services for vulnerable children.

  2. Ensuring evidence-based technical excellence: CRS bases its programming on internal and industry evidence, and best practices to ensure high impact MCH interventions that support national health policies and guidelines to improve MCH outcomes. In Ghana, CRS partnered with Ghana Health Services to implement innovative community-based approaches to implement high impact interventions that led to statistically significant increases in maternal and child health indicators. CRS’ learning agenda includes piloting innovative ideas, conducting original research and documenting lessons learned and best practices to scale up.

  3. Ensuring sustainability and transition to local partners: CRS works with health ministries starting at the project design phase, and establishes processes to effectively graduate facilities and faith-based organizations/networks to be sustainable. CRS is currently working in partnerships with governments, sister congregations and national associations of Catholic women in Kenya, Malawi and Zambia to improve technical capacity, organizational sustainability, networking and learning to expand quality ECD services.

Recommendations to the U.S. Government

Based on our experience reaching remote areas around the world with effective ECD and MCH approaches, we make the following recommendations to the U.S. government:

  1. Make Early Childhood Development a key funding priority within Maternal and Child Health and nutrition programming.

  2. USAID should integrate Early Childhood Development (ECD), especially early stimulation and parenting interventions into its MCH work. For example, through the President’s Malaria Initiative, CRS is rolling out integrated community case management and rapid diagnostic tests in Benin, and developing a comprehensive behavior change communication strategy that will inform the National Malaria Behavior Change Strategy.

  3. Allocate more financial resources to Faith-Based Organizations (FBOs) to ensure equitable access to populations located beyond services delivery areas of governments. FBOs are often the only health providers for marginalized or rural populations and therefore well placed to be on the frontlines in the effort to ensure equitable access to MCH services. Our work in remote locations depends on decentralized structures that establish relationships between communities and their districts, and empowers communities to hold these structures accountable for deliverables, budget allocation, and services.

  4. Refrain from requiring the integration of family planning into the majority of USAID Requests for Applications/ Requests for Proposals (RFA/RFPs). Doing so will ensure access to critical services for rural and marginalized populations often only reached by FBOs. The model used by the Child Survival Health Grants Program is recommended.

For more information, please contact Leila Nimatallah at

1 Bentley, Vazir & Engle, 2010; Nahar et al., 2012.


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