Implementation science for early childhood development in Jharkhand and Odisha, India

Good care, nutrition and opportunities to learn during first three years of life are crucial for children's mental, physical and emotional development. One in four children in the world at risk of not developing to their full potential live in India. Among them, children living in rural areas and those from indigenous (tribal) families are at greatest risk, because they are the poorest.

Creches and parenting groups for children under three and their caregivers are possible strategies to help children get the nutrition, care and stimulation they need in early life. Unfortunately, there is little research on whether, how, and at what cost creches and groups could benefit children's development in rural areas with a large number of indigenous families. We have identified a new source of government funding for creches and groups in Indian states with large indigenous communities; these are called District Mineral Foundations. Funds from District Mineral Foundations are meant to benefit communities affected by mining in 12 states, half of which have large rural and indigenous communities. Funds from District Mineral Foundations could be used to finance creches and groups if our research shows they have benefit for children's development.

In this study, we will adapt an existing model of creches fundable by District Mineral Foundations to make it acceptable to rural, indigenous communities of Jharkhand and Odisha, two states of eastern India where over half of indigenous children are chronically undernourished. We will also adapt a successful model of parenting groups tested in Jamaica and Bangladesh for these same rural, indigenous communities in Jharkhand and Odisha. There are very few tools to measure child development adapted for work with indigenous Indian communities, so we will translate and modify six tools to be able to capture changes in caregivers' knowledge about child development, their interactions with children, and children's own development. Finally, we will test whether creches, either on their own or together with groups can improve the development of children in 60 villages of West Singhbhum and Keonjhar districts, in Jharkhand and Odisha. Twenty of these villages will have creches only, 20 will have creches and groups, and 20 will have normal services provided by government. We will compare the mental, physical and emotional development of children aged two years across these three groups of villages after the interventions.

Throughout the research project, we will engage with advocates for creches and parenting groups at regional and national levels through an existing advocacy network and our own government contacts gained through 10 years of scaling up group interventions in different Indian states. We will aim to increase the number of creches and groups funded by District Mineral Foundations in rural areas of five Indian states with large indigenous communities (Jharkhand, Odisha, Madhya Pradesh, Rajasthan, Chhattisgarh), and where the project's research partners already work.

Our research has the potential to benefit two main non-academic constituencies in the short and medium term:

(a) Communities in the study areas

- All three trial arms will receive an intervention to strengthen the capacity of government-mandated Village Health,
Sanitation and Nutrition Committees (VHSNCs). This intervention seeks to help VHSNCs address inequities in the
provision of health and nutrition services, raise community awareness of rights and entitlements for health, and monitor the
quality of local services. It is likely to lead to immediate gains in community capacity for addressing maternal and child
health and nutrition during the trial period. The intervention will have further, medium-term benefits, through the diffusion of
effective processes and monitoring tools.

- Families with children under three in the intervention areas of our trial will benefit from universal access to creches for children aged 6-36 months, and, in the areas allocated to receiving participatory nurturing (parenting) groups, from universal access to groups. All communities participating in the trial will benefit from an intervention to strengthen Village Health Sanitation and Nutrition Committees.

(b) Policy-makers, implementers, advocacy networks and funders

The study directly responds to the demand from policy-makers and implementers for rigorous operational research on effective interventions to improve early childhood development during the first three years of live. In India, it responds to the specific need to understand whether creches and parenting groups can lead to improvements in child development in rural, underserved areas and what the costs, operational requirements, and possible costs and impact of scale up might be. As such it will contribute
directly to evidence-based policy-making with short-term benefits by 2023 (through the trial results) and medium-term
benefits through improved decision-making on ECD programmes.

We have links with highly active Indian advocacy networks which have been instrumental in achieving key policy changes
for health and nutrition. These networks require data on ECD and effective interventions in underserved areas to mobilise implementers and policy-makers. We will share data from the trial control areas with three networks ( the Public Health Resource Network and People's Health Movement, India, and FORCES) through bespoke powerpoint presentations and materials so that they can use these to raise the issue of ECD in underserved areas through their forums. We have costed time for two policy & advocacy experts at Ekjut (V Nath and R Gope) to ensure the ECD agenda and our research is presented at local, regional and national meetings.

Implementers and funders (especially District Mineral Foundations) will benefit from a manual comprising three items: (a) a one-page summary of trial findings; (b) a creche operating manual and checklist to measure the quality of creche service provision; (c) the participatory nurturing (parenting) group manual, training guide and quality measurement tool. This manual will aid other organisations and funders seeking to support further implementation and scale up and will be free to access via Ekjut and Ambedkar University websites.

In the long-term, if the trial shows benefits of one or more interventions and we succeed in influencing DMF to take them up, the research may benefit larger numbers of rural and indigenous families with young children, and children's educational achievements and earnings later on in the life course.