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

Lead Research Organisation: University College London
Department Name: Institute for Global Health


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.

Planned Impact

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.


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Description The work is testing the effects of creches and participatory group meetings on child development in rural Jharkhand and Odisha, eastern India.
Despite ODA funding cuts and COVID-19, we were able to complete our preparatory research and start testing creches and participatory group meetings.
Our preparatory research helped us understand who should be invited to participatory groups, how frequently, and what the group activities should be.
We also began enrolling caregivers and children for the evaluation of creches and group meetings. We expect enrolment to finish this year.
Exploitation Route To date, our findings suggest that holding group meetings on early childhood development in rural, largely indigenous communities of Jharkhand and Odisha is feasible and acceptable. A fuller range of outcomes will be available when the award is completed in 2023-4.
Sectors Education,Healthcare

Description Community Prevention of Acute Malnutrition
Amount £514,918 (GBP)
Funding ID 2002-04502 
Organisation Children's Investment Fund Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 07/2021 
End 07/2025
Description GCRF Early Child Education: Creches and participatory nurturing groups to improve early childhood development among children aged 0-36 months in rural Jharkhand and Odisha, India
Amount £1,878,824 (GBP)
Funding ID ES/T004029/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 02/2020 
End 12/2023
Description Partnership with Ambedkar University Delhi 
Organisation Ambedkar University Delhi
Country India 
Sector Academic/University 
PI Contribution Ambedkar University Delhi are parners in this grant through Co-Investigator Dr Monimalika Day.
Collaborator Contribution Dr Day and colleagues are leading on adapting a participatory parenting group intervention to be tested in the study.
Impact The project is still in its formative phase due to COVID delays, so there are no outputs from this collaboration yet.
Start Year 2020
Description Partnership with the World Health Organisation on the Global Scale for Early Development 
Organisation World Health Organization (WHO)
Country Global 
Sector Public 
PI Contribution We initiated contact with WHO to obtain information on the the Global Scale for Early Development (GSED) to measure child development for children at birth to age three. We are currently seeking funding to work with them to use the GSED in this award.
Collaborator Contribution WHO have provided us with access to training materials on the GSED and are willing to join a funding application to help us use the GSED in the current award.
Impact There are no outputs or outcomes from this collaboration yet.
Start Year 2020
Title Participatory nurturing care groups to improve development among children under the age of three years 
Description As part of this grant, Ekjut (Indian civil society organisation), Ambedkar University Delhi and University College London developed a manual for lay facilitators to convene participatory group meetings with caregivers of children aged under three years. These meetings enable caregivers to prioritise aspects of nurturing care (nutrition, health, early learning, protection) which they find challenging, then develop and implement solutions to address these challenges. At the end of each meeting, caregivers are invited to participate in developmentally appropriate, stimulating play activities with their young children. The development of this intervention was solely funded by this UKRI/ESRC grant. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Refinement. Non-clinical
Year Development Stage Completed 2022
Development Status On hold
Impact This intervention is currently on hold as we re-apply for approval from India's Health Ministry Screening Committee to test it fully. 
Description Participatory intervention workshops 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Study participants or study members
Results and Impact India-based partner Ekjut conducted several socially distanced group meetings to discuss the interventions to be tested in the study: creches and participatory nurturing groups. They met with parents who had previously used creches to understand the effects that access to creches has had on their ability to work, mental health and wellbeing, as well as child wellbeing and safety. They also met with grand-parents and community leaders to understand perceptions of early childhood play as a learning opportunity, what families do to stimulate learning with young children and when, and preferences related to attending participatory nurturing groups in the community.
Year(s) Of Engagement Activity 2021