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Child Care Health Dev. 2018 Jan;44(1):50-61. doi: 10.1111/cch.12480.

Scaling up Integrated Early Childhood Development programs: lessons from four countries.

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Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.
Department of Mental Health and Substance Abuse, World Health Organization (WHO), Geneva, Switzerland.
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.



There is still limited knowledge regarding the translation of early child development (ECD) knowledge into effective policies and large-scale programmes. A variety of frameworks that outline the key steps in scaling up exist, but we argue that taking a complex adaptive systems (CAS) approach assists in understanding the complex, dynamic processes that result in programmes being taken to scale.


The objective of this study is to examine the process of scaling up four major country-level ECD programmes through the application of a CAS framework.


Nine key informants with a deep knowledge of how each ECD programme was established and brought to scale were interviewed via Skype or phone by using open-ended interviews. The interviews were tape recorded and then transcribed verbatim for subsequent coding by using CAS domains. The coding and integration of the results to identify unique and common CAS scaling up features across the case studies involved an iterative process of reaching consensus.


The scaling up of all four programmes behaved as a CAS including as follows: (i) positive feedback loops (five themes) and negative feedback loops (two themes); (ii) scale-free networks (two themes); (iii) phase transitions (four themes); (iv) path dependence (two themes); and (v) emergent behaviour (six themes). Five additional themes were identified for sustainability, which was repeatedly mentioned as an important consideration when deciding how to scale up programmes.


CAS analysis is likely to improve our understanding of how effective ECD programmes become scaled up. Prospective CAS implementation research is needed to continue advancing the knowledge in the field.


complex adaptive systems; early childhood development; programme evaluation; scaling up

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