LRPS-2021-9170609: Designing ECCD models and testing integrated ECCD through Primary Health Care platform

TERMS OF REFERENCE FOR INSTITUTIONAL CONTRACT

Title of the assignment

Designing ECCD models and testing integrated ECCD through Primary Health Care platform

Purpose

To support the development of integrated ECCD models and facilitate the implementation of integrated ECCD 0-3yrs through Primary Health Care Platform

Location

Selected geographic locations, to be finalized as a task in the contract

Estimated Duration

November 2021-December 2023

Reporting to Technical Supervisor of this assignment

Nutrition Specialist, UNICEF Bangladesh and

Research & Evaluation Specialist, UNICEF Bangladesh

 

 

1. Background

 

Nurturing Care Framework (NCF) for early childhood development

There has been convincing evidence and growing recognition that the early years are critical for human development[1]. The period from pregnancy to age 3 lays foundation for health, well-being, learning and productivity throughout a person’s whole life, and has an impact on the health and well-being of the next generation[2],[3]. During this period, brain grows fasters at any other time; 80% of a baby’s brain is formed by this age. For healthy brain development in these years, children need a safe, secure and loving environment, with the right nutrition and stimulation from their parents or caregivers. Most of the children who miss out in early childhood come from the world’s most deprived communities. In low- and middle-income countries, for example, an estimated 43 per cent of children younger than age 5 are at risk of poor development due to extreme poverty and stunted growth.[4]

 

Study reveals that investing in early childhood development is good for everyone – governments, businesses, communities, parents and caregivers, and most of all, children. It is also to help every child realizing the right to survive and thrive. Investing in ECD is found to be cost effective; Every dollar spent on high-quality, birth-to-five programmes for disadvantaged children delivers a 13% per annum return on investment.[5] .

 

Nurturing care is about children, their families and other caregivers, and the places where they interact. Additionally, global experience has shown the multi-sectoral support to early childhood development packages results in better impact for children, when compared to a siloed approach. The nurturing care framework focuses on the period from pregnancy to age of 3, while continuing actions for early childhood development that also covers age >3-8 years. This framework defines five key components: 1) good health, 2) adequate nutrition, 3) responsive caregiving; 4) security and safety, and 5) opportunities for early learning.

 

ECD Policy Framework and Programme in Bangladesh

In Bangladesh context, there is a strong policy environment that supports ECD. The Early Child Care and Development Policy was approved in 2013, with the aim to nurture and raise all children with care, security, dignity, affection and love and to establish a solid foundation for their development, irrespective of ethnicity, geographical location, gender, religion, special needs and socio-economic conditions.  Similarly, in 2014, the Ministry of Women and Children’s Affairs (MoWCA) adopted the Early Learning Development framework in early childhood. Following this, in 2015 under the leadership of Ministry of Women and Children Affairs (MoWCA) and technical support from UNICEF, the Early Learning Development Standards (ELDS) in Bangladesh was developed, However, many of these efforts are primarily linked to school learning outcome and focused on needs of children 3 years and above.

 

Examples of ECD programmes

Although progress has been made with early childhood development-related interventions, however they are at different approaches, scales through varied sectors and distributed across numerous populations and settings. For example, India’s Integrated Child Development Services (ICDS), is one of the earliest and the world’s largest early childhood development programme which followed community-based outreach to promote the early development of children from economically disadvantaged backgrounds. Chile has a scaled-up system of early childhood development provision guaranteed by law and fully funded by government.

 

Similarly, in Bangladesh diverse stakeholders including government agencies have been identified in operating early child care and development (ECCD) programmes or projects in varied extent. Among the government, Ministry of Primary and Mass Education, MoWCA, Ministry of Chattogram Hill Tract Affairs, Bangladesh Shishu Academy, Ministry of Social Welfare, Institute of Child and Mother Health, National Institute of Population Research and Training are the important stakeholders of ECCD policy and programmes in Bangladesh. Bangladesh’s child development centres (Shishu Bikash Kendra [SBK]): a public–private partnership to support young children with disabilities and their families was established in 2008 to ensure early screening, assessment, intervention, treatment, and management of the entire range of developmental delays, disorders, impairments, and disabilities. Furthermore, about 10 international NGOs and 12 national NGOs including BRAC, icddr,b, Save the Children, Plan International, Phulki are found to be active in supporting ECCD interventions. However, most of these agencies are operating their own models of center-based siloed approaches and in limited scales. Most importantly, none of these agencies follow the comprehensive nurturing care components including all five components of Nurturing Care focusing from pregnancy to 3 years of age.[6]

 

Opportunity for Integrated ECCD Programme

Evidences from Documented ECCD Studies

Number of studies and researches on the integrated ECD programme in Bangladesh has also key partner in research, with ongoing national studies that are documenting the impact of poor nutrition and environment on brain development, but also demonstrating possible models by which poor nutrition in early years can be partially reversed with investments in parenting and psychosocial stimulation of children. 

 

The most recently published studies by icddr,b from two large cluster randomized-controlled trials where they trained the frontline health workers to provide sessions on psychosocial stimulation to malnourished children is worth mentioned. The studies found that children substantially benefitted in their development and behavior and their mothers’ knowledge of children rearing and quality of home stimulation was significantly improved. In addition, there was a reduction in their mothers’ depressive symptoms.[7] Further study was initiated to assess the integration of the interventions with the government health system delivery platforms, particularly community clinics that involved building capacity of health care providers of both under Health Services and Family Planning delivery platforms, including Health Inspectors, Assistant Health Inspectors, and Family Planning Inspectors. This study also identified the opportunities and scopes of monitoring, evaluating, and reporting the services aiming at sustainability. Both qualitative and quantitative findings showed that it is possible to develop a pool of trainers within the existing government system with some modifications. The inspectors can conduct the training and supervision the frontline workers. Preliminary analysis findings found that families significantly improved practices for the quality of home stimulation, a proxy for child development. Qualitative assessments also showed positive attitudes of the inspectors in providing training and supervision for frontline workers in delivering the services. Therefore, the study suggested that ECD services can be delivered through the government’s existing health care delivery system, with minor modifications.[8]

 

These studies are critical to move from policy to programs, and to design, and implement programs at scale, with cross sectoral links between MoWCA and MoHFW.  By linking programs and policies across these two ministries, gaps in the operational plan of the ECD Plan that focuses on 0-3 years following Nurturing Care framework and establishes linkage between primary health care delivery system with community- and home-based care can be addressed. 

 

UNICEF has recently supported a systematic review of ECCD policy and programmes in Bangladesh. The review have recommended that ECCD should be addressed through a life cycle approach based on the NCF and multisectoral collaboration. The review confirmed the understanding on the lack of integrated ECCD programme, particularly for 0-3 yrs of age and recommended to demonstrate and generate evidence for potential scale up. The review have also recommended other critical enabling environment towards a strengthened ECCD programming in Bangladesh and have been identified as prioritized actions including identifying gaps for ECCD in operational plans of relevant ministries and advocate for investment and programmatic change; establish multi-sectoral coordination mechanism and accountability system for ECCD (public and private sectors); support the rollout and implementation of the newly enacted Day-Care Act 2021; awareness raising among parents/caregivers (fathers/mothers) on ECCD and positive parenting; and strengthen social and behaviour change communication strategies for demand generation of ECCD services through relevant sectors and platforms.

 

1. Purpose, Objectives and Expected Results

 

The overall purpose of the ToR is to develop and implement three different evidence-based, integrated ECCD models within the government system with strong documentation, monitoring, learning, and evaluability for assessing scalability and/or replication. While the full body of work will be implemented in phases as funding is secured, the specific objectives, applicable across the entire program, include:

 

Phase-1:

To develop designs of integrated ECCD model to be tested/demonstrated for potential scale up with focus on model for 0-3+ years of age; pre-primary education/early childhood education of 4-5 years with a comprehensive package of interventions following the five elements of the nurturing care framework and ‘Family Friendly Policies’ approach, specifying the platforms (Primary Health Care, community-based, workplace, etc.) and geographic locations, and designing the package of interventions, tools, capacity building and supervision guide, and caregiver guide with existing good practices and experiential learnings;

 

Phase-2: To develop implementation plan for the rollout of the demonstration models along with tools, materials/curriculum for implementation of  for integrated ECCD model for 0-3yrs of age through Primary Health Care platform.

 

Description of Assignment

 

Building on the systematic review conducted on ECCD in Bangladesh, these demonstration programmes will assist in providing evidence for models that ensure all children 0-5 years, particularly the most vulnerable, receive nurturing care practices receive nurturing care practices for good health, adequate nutrition, opportunity for learning, and responsive caregiving in a secure, safe, gender-transformative, disability-responsive environment. The contracted institution will collaboratively support UNICEF in the identification of the three models, including their platforms and geographic locations; build out the necessary frameworks and tools; provide oversight and mentoring of the programme’s implementation; conduct programme monitoring, documentation, learning events, and implementation research; and design and provide support to the dissemination, advocacy and scale-up efforts of the models among key stakeholders, with learnings incorporated.

 

The Design Phase and Implementation Phase both include the model or programmatic aspect as well as the implementation research aspect. Resourcing for these two phases for each model need to go hand and hand.

 

While the first stage of contracting will cover only the design of all three models and Y1 of implementation on one model (including the baseline of the implementation research and all monitoring), the applying institutions should present a plan for all models, all years. As resourcing comes in, more years and the other models will be added and rolled out. Specific term of references and soliciting process to recruit . Here is an expected timeline for the full body of work, but note this is depending on securing funds at the appropriate times:

 

Key tasks, by Phase:

The following key tasks for this complete body of work are outlined below, by Phase. The interested institutions must describe the details for each Phase.

 

Phase 1: Designing the integrated ECCD Models

1. Lead ECCD team through decision-making  on models, including platforms and geographic locations (based on systematic review & subsequent recommendations)[9]
2. Create full package of interventions, implementation tools, capacity building guide, supervision guide, and caregiver guide tailored to each of the three models, including any other supplemental curriculum or guide identified as a gap in existing ECCD models in consultation with ECCD Team and key government and development partners
3. Design intervention-level theory of change for the models, results frameworks, evidence plan (template will be provided, inclusive of knowledge register and implementation plan), and sustainability plan (template will be provided) and associated templates and tools
4. Design the methodology and full implementation plan for the implementation research – baseline, midline, and endline for all proposed models

 

Phase 2: Facilitating the roll out of the demonstration programme/implementation researchfor integrated ECCD for 0-3yrs of age through Primary Health Care System

 

Phase 2-A

• Develop detailed plan for the implementation research including baseline, midline, and endline after at least 24months implementation
• Develop tools and guidance for the demonstration programme for the integrated ECCD for 0-3yrs of age through PHC system through consultations with ECCD Team of UNICEF and key government partners
• Conduct baseline assessment and facilitate the implementation of the demonstration programme, including regular monitoring and supportive supervision
• Organize observations of staff engaging in caregivers feedback and provide mentoring related to the engagement
• Produce baseline report, along with monthly update and quarterly reports on the implementation and monitoring data analysis (and implementation research, when relevant) for UNICEF and key stakeholder leadership

Phase 2-B

• Conduct midline and endline assessment and facilitate the implementation of the Year-2 demonstration programme, including regular monitoring and supportive supervision
• Organize observations of staff engaging in caregivers feedback and provide mentoring related to the engagement
• Produce report from midline, endline as well monthly update and quarterly reports on the implementation and monitoring data analysis (and implementation research, when relevant) for UNICEF and key stakeholder leadership

 

Methodology for Implementation Research

 

The methodology for the implementation research will be mixed methods, with both a quantitative survey of key beneficiaries, caregivers, teachers, and stakeholders, and qualitative methods in the form of small focus groups (if possible), in-depth interviews and key informant interviews, and observation. For each model, there will be three collections of data: baseline, midline, and endline. This ToR covers only the baseline of one model. For subsequent mideline and endlines, the primary data collection will be coupled with any monitoring data for triangulation of results.

 

The goal of the implementation research is to provide data, as real-time as possible, back into the programming, to help aid understanding of model implementers in the implementation outcomes and measure progress over time on key beneficiary-specific indicators (children and staff), as a way of understanding model effectiveness and impact. For the purposes of this research, the working definitions of the following implementation outcomes will be utilized:

 

Acceptability

The perception among stakeholders (including private) sector that an intervention is agreeable

Adoption

The intention, initial decision, or action to try to employ a new intervention

Appropriateness/

Relevance

The perceived fit or relevance of the intervention in a particular setting or for a particular target audience or problem

Feasibility

The extent to which an intervention can be carried out in a particular setting or organization

 

Fidelity

The degree to which an intervention was implemented as it was designed in an original protocol, plan, or policy

 

Implementation cost

The incremental cost of the implementation strategy (for example, how the services are delivered in a particular setting). The total cost of implementation would also include the cost of the intervention itself.

 

Coverage

The degree to which the population that is eligible to benefit from an intervention actually receives it

 

Effectiveness

Up to what level the intervention meet the purpose. Time between graduation and placement, quality of work/job, earning, upskilling reskilling opportunities etc.

 

Sustainability (endline)

The extent to which an intervention is maintained or institutionalized in a given setting, including options for coping with any changes

 

The specific objectives of the implementation research of the integrated ECCD for 0-3 yrs of age through PHC platfom is to test whether the proposed model produces the expected outcomes (to be jointly identified by UNICEF and contracted institution), particularly looking at account gender, urban/rural, disability, etc.;

• To understand how each model is benchmarked against Nurturing Care Framework and Family Friendly Policies approach in its essence and implementation;
• To understand the contextual factors that influence implementation, interact with each other, and change over time;
• To describe and understand any differences in socio-demographic characteristics (gender, age, disability, geographic origin, etc.) among ECCD participants in respect to relevant implementation outcome variables;
• To observe and analyze iterative changes to the models or interventions and any unintended positive and negative consequences;
• To understand the key bottlenecks and barriers for successful implementation or buy-in among the various relevant stakeholders (depending on platform and geographic location); and
• To develop learnings and recommendations for staff and UNICEF for immediate uptake in the model implementation, inclusive of supplementary materials.

 

Ethical and other considerations

This body of work, both programmatically and in all evidence generation, will be held to the highest standards employed by UNICEF. This means, the agency will abide by the following:

• UNICEF Procedure for Ethical Standards in Research, Evaluation, Data Collection and Analysis
• UNICEF Strategic Guidance Note on Institutionalizing Ethical Practice for UNICEF Research
• The agency is expected to explain ethical considerations for the implementation research, specifically spelling out how these above guidelines will be followed/met including training of all data collectors and supervisors in terms of guidance on ethics and communication skills.
• Special focus should include ethical considerations/ strategies to prevent or avoid COVID-19 infection and spread. 
• Ethical clearance letters for the implementation research should be attached in the annexure of all evidence generation reports. Each report should include a section that describes the exact way ethical considerations were identified and addressed as part of design, implementation, and analysis/writing.
• Any sensitive issues or ethical concerns arising during implementation should be raised with UNICEF right away. 
• All data collected through this body of work (programme implementation and evidence plan execution) are the intellectual properties of UNICEF and shall not be used for purposes other than those approved by the registered Institutional Review Board during the ethical clearance. 
• Additionally, the evidence generation and programmatic elements should be human rights-based (including child rights) and gender sensitive. All applicable data will be disaggregated by sex, age, and disability.

 

4. Deliverables

 

The following deliverables for this ToR include:

 

No.

Deliverable

Deadline

Phase-1 (3mo)

1

Inception report covering development of design integrated ECCD models and detailed implementation plan for model-1 (ECCD 0-3yr) with Gantt Chart

2 weeks after signing contract

2

Models designs for testing for (1) integrated ECCD for 0-3yr through PHC platform, (2) 4-6yr (ECE/PPE), (3) specific platforms (i.e. Paracenter, workplace),

3 months after signing contract

Phase 2-A (1 year)

1

Evidence plan for integrated ECCD for 0-3yrs of age, including implementation research tools (SoP, capacity building materials, communication materials, monitoring tools, etc)

4 months after signing contract

2

Draft baseline implementation research findings presented in ppt report for integrated ECCD 0-3yrs of age through PHC platform

6 months after signing contract

3

Final baseline implementation research report for integrated ECCD for 0-3yrs of age and internal learnings and incorporation workshop

7 months after signing contract

4

Quarterly programme implementation reports from year-1 implementation, including coverage on documentation, monitoring, and learning

Every 3 months after implementation start

Phase 2-B (1 year)

1

Draft midline assessment implementation research findings presented in ppt report for integrated ECCD 0-3yrs of age through PHC platform

14 months after signing contract

2

Quarterly programme implementation reports from year-1 implementation, including coverage on documentation, monitoring, and learning

Every 3 months during implementation

3

Draft endline assessment implementation research findings presented in ppt report for integrated ECCD 0-3yrs of age through PHC platform

22 months after signing contract

4

Final results of the implementation research of the integrated ECCD 0-3yrs of age through PHC platform

24 months after signing contract

 

5. Reporting requirements

 

All deliverables should be submitted to UNICEF’s focal person, the Nutrition Specialist. These will be accepted only after the ECCD team and SPEAR section (Research & Evaluation Specialist) approves. The agency will have to maintain close liaisoning with the technical coordinator of ECCD Team and Evaluation Specialist of UNICEF. Brief monthly communication on activities will be conducted, with the modality and platform jointly agreed upon between UNICEF and the contracted institution.

 

For any evidence generation report, the suggested format is as follows

• Table of contents, list of annexes/figures/tables, etc.
• List of Acronyms
• Executive Summary (2 – 5 pages)
• Introduction & Background
• Study Purpose and Objectives
• Methodology, including ethical considerations and limitations
• Findings
• Conclusions and Lessons Learned
• Recommendations
• Annex (including data collection tools, IRB approval letter, etc.)

 

6. Payment Schedule

 

Payment will be arranged in accordance with the following schedule by Phase:

 

Phase-1 (USD 50,000)

20% of Phase-1 cost (USD 10,000) upon submission and approval of the inception report;

80% of Phase-1 cost (USD 40,000) upon submission and approval of the models design document

 

Phase-2a (USD 300,000)

20% of Phase-2a cost (USD 60,000) upon submission and approval of evidence plan for integrated ECCD for 0-3yrs of age, including implementation research tools;

30% of Phase-2a cost (USD 90,000) upon submission and approval of draft baseline implementation research findings presented in ppt report for integrated ECCD 0-3yrs of age through PHC platform;

30% of Phase-2a cost (USD 90,000) upon submission and approval of final baseline implementation research report for integrated ECCD for 0-3yrs of age and internal learnings and incorporation workshop;

20% od Phase-2a cost (USD 60,000) upon submission and approval of quarterly programme implementation reports from year-1 implementation, including coverage on documentation, monitoring, and learning

 

Phase-2b (USD 300,000)

30% of Phase-2b cost (USD 90,000) upon submission and approval of draft midline assessment implementation research findings presented in ppt report for integrated ECCD 0-3yrs of age through PHC platform;

20% of Phase-2b cost (USD 60,000) upon submission and approval of quarterly programme implementation reports from year-1 implementation, including coverage on documentation, monitoring, and learning;

30% of Phase-2b cost (USD 90,000) upon submission and approval of draft endline assessment implementation research findings presented in ppt report for integrated ECCD 0-3yrs of age through PHC platform;

20% of Phase-2b cost (USD 60,000) upon submission and approval of final results of the implementation research of the integrated ECCD 0-3yrs of age through PHC platform

 

7. Qualification requirement of the company/institution/organization

 

Overall Qualification of the agency for all Phases: 

• National firm with technical expertise in ECCD concepts, design, and model implementation, including Nurturing Care framework and Family Friendly Policies
• Experience in developing and implementing ECCD models in Bangladesh
• Technical understanding of latest gap analysis in ECCD models, globally and in Bangladesh, and expertise in developing progressive and innovative content in response
• Deep knowledge of adult learning methods, positive caregiving, and coaching of teachers susocial service systems with the focus on social welfare, child protection, community development and social protection/ social assistance;
• Expert in monitoring, evaluation, and learning, including development of their building blocks (theories of change, results framework, monitoring plans and tools, evaluation frameworks) and implementing routine learning practices;
• Strong experience in conducting social science-related implementation research, including including high quality data collection tool design, and feeding back results real-time to programme implementers;
• Extensive knowledge and experience with qualitative and  quantitative  data analysis, and demonstrated competency in analysis using relevant software;
• Experience in developing teacher capacity assessments and plans/guides as well as supportive supervision and caregiver guides;
• Strong experience in successful advocacy and dissemination with evidence/data;
• Track record in design and implementation of sustainability/scalability plans for pilots/demonstration programmes, as well as success in taking a pilot or demonstration programme to scale
• Experience in developing knowledge management plans and subsequent knowledge products for dissemination and advocacy purposes;
• Strong oral and written skills in English and Bangla;
• Familiarity with UN systems and procedures, management and monitoring tools is desirable;
• Experience developing policy recommendations, policy briefs, and accompanying data visualizations for government, community level and technical/academic audiences;

 

Minimum qualifications of the Agency for Phase-1

 

• National firm with technical expertise in ECCD concepts, design, and model implementation, including Nurturing Care framework and Family Friendly Policies
• Experience in developing and implementing ECCD models in Bangladesh
• Technical understanding of latest gap analysis in ECCD models, globally and in Bangladesh, and expertise in developing progressive and innovative content in response
• Deep knowledge of adult learning methods, positive caregiving, and coaching of teachers susocial service systems with the focus on social welfare, child protection, community development and social protection/ social assistance;
• Expert in monitoring, evaluation, and learning, including development of their building blocks (theories of change, results framework, monitoring plans and tools, evaluation frameworks) and implementing routine learning practices;
• Strong experience in conducting social science-related implementation research, including including high quality data collection tool design, and feeding back results real-time to programme implementers;
• Extensive knowledge and experience with qualitative and  quantitative  data analysis, and demonstrated competency in analysis using relevant software;

 

7a. Qualification requirement of the team (optional)

Professional requirements of the individual(s) and/or team(s) for the assignment including required experience, skills and qualifications are required as given below:

• Team members with postgraduate (preferably PhD) degrees in social science, social work, public health, child development, anthropology, sociology, or other relevant disciplines;
• At least one team members with 15+ years of ECCD programme experience;
• At least one team member with 10+ years of experience in designing monitoring, evaluation, and learning systems for integrated programmes;
• At least one team member with 10+ years of experience in conducting implementation research or related evidence generation;
• At least one team member with deep experience and knowledge of adult learning technique and methods, with related coaching/mentoring of adults; and
• At least one team member with 10+ years working with relevant government ministries with successful advocacy on policy changes