Early Childhood Development Friendly Index (IMAPI): Assessing the Enabling Environment for Nurturing Care in Brazilian Municipalities

Abstract

Investing on Nurturing Care for Early Childhood Development (ECD) during the first 1,000 days is a major window of opportunity to increase health, productivity, and social cohesion along the life course. Nurturing Care is defined as a stable environment sensitive to children's health and nutritional needs, with protection from threats, opportunities for early learning, and interactions that are responsive, emotionally supportive, and developmentally stimulating. In Brazil, the diversity in environmental, political, and socio-economics aspects among the 5,570 Brazilian municipalities are likely to be linked with ECD inequities. Thus, assessing the ECD landscape of each Brazilian municipality is key to successfully identify priorities and allocate investments to enhance ECD, as well as to inform a monitoring system. Deploying an ECD index at the municipality level is an unprecedented approach in Brazil, as well as globally. Our aim is to operationalize an ECD friendly index (ECD-FI) to assess the enabling environment for Nurturing Care at the municipality level in Brazil. Three methodological steps were undertaken to create and operationalize the ECD-FI. Identification and selection of indicators. The ECD-FI is grounded on the solid Nurturing Care framework composed of five evidence-based domains (Good Health, Adequate Nutrition, Opportunities for Early Learning, Responsive Caregiving, and Safety and Protection); thus, a review of existing indicators to translate each domain of the Nurturing Care was conducted. These findings guided the identification of a set of existent indicators in the Brazilian dataset. The initial set of 54 indicators was reviewed and discussed with stakeholders and experts based on a set of objective criteria (availability, quality, importance, and periodicity) to come to a consensus in the final core indicators (n= 32) and additional indicators (n= 19). The final set included 32 core indicators: (a) Good Health: 14 indicators including prenatal and post-natal care, infant morbidity and mortality, prematurity and low birth weight, primary health care, maternal mortality, and immunization; (b) Adequate Nutrition: four indicators including nutritional status, breastfeeding and food consumption, and household food insecurity; (c) Opportunities for Early Learning: four indicators including access to early care, education centres structure, and teachers/caregivers education; (d) Responsive Caregiving: six indicators including participation in parenting programmes, early child stimulation, and maternal mental health; (e) Safety and Protection: four indicators including violence, social programmes, alcohol abuse, and air pollution. A set of 19 additional municipal-level indicators are being used to explore specific analytics scenarios (size of the municipality, human health development index, semi-arid or Amazonia geographic location, and higher indigenous population), to control the analysis (XXX), and 11 indicators for municipality description. Consultation with experts. Indicators' weight were defined through a consultation process following criteria developed based on the SMART methodology. Specific (S) indicates the expert's opinion if the indicator truly belongs to the Nurturing Care domain that was originally assigned by the research team. Measurable (M) ranks the expert's opinion on the importance of attributes to measure the quality of each indicator. Achievable (A) assesses the expert's opinion on the municipality's ability (governance) in changing the indicators. Relevant (R) indicates the expert's opinion on how close the indicator is to the outcome (ECD) following a socioecological approach. Finally, Time-Bound (T) indicates the expert's opinion on the time necessary to change the indicator. Operationalizing and analysing the ECD-FI index. We are using statistical and machine learning methods to build a multivariate analytical model and compute the ECD-FI. As result, each of the 5,570 Brazilian municipalities will have a unique overall ECD-FI and specific indices for each of the five Nurturing Care domains. These indices will be categorized as reflecting weak, moderate, or strong enabling Nurturing Care environment (s) for enhanced ECD outcomes. The ECD-FI will facilitate SMART-based policy decisions and give support to local level stakeholders prioritize investments to enhance ECD during the first 1,000 days of life. © 2020 The Authors. Maternal and Child Nutrition Published by John Wiley & Sons, Ltd.