{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:05:17Z","timestamp":1788390317357,"version":"build-2803163510"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The first three years of a child\u2019s life are the most critical to child development and have an impact on the future achievement of the child. Young children\u2019s healthy development depends on nurturing care that ensures health, nutrition, responsive caregiving, safety, and security. Parents &amp;amp; other adult caregivers play a critical role in moderating children\u2019s early experiences, which has a lasting impact be it positive or negative on the children\u2019s future. Parenting education programs are proven to improve parental skills, capacity, and efficacy in a way that supports improved child development outcomes. Yet, most parents in low-middle-income countries such as Rwanda lack access to information and skills on how to support their children\u2019s holistic development. In response, Save The Children implemented the First Steps \u201cIntera za Mbere\u201d holistic parenting education project in Rwanda from 2014 to 2021. This paper reflects on how monitoring, evaluation, accountability, and learning (MEAL) approaches were applied throughout the project cycle and their impact on program improvement and national policy and advocacy. This paper explores how the aspirations for measurement for change, considerations for innovation uptake and frameworks for learning about improvement are reflected in this project.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The project utilized qualitative and quantitative MEAL across the program cycle. Action research at the start of the project identified promoters and inhibitors of high-quality nurturing care and program delivery modalities. The project utilized a randomized control trial to provide insight into components that work better for parenting education. Evidence from surveys done remotely via phones was used to inform COVID-19 adaptations of the program.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The application of MEAL evidence led to the successful development and improvement of the program. At the policy level, evidence from the project influenced the review of the 2016 National Integrated ECD policy and the development of the national parenting education framework.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The regular use of evidence from MEAL is critical for program improvement, scale-up, and policy influence.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1165353","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T09:44:03Z","timestamp":1690451043000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Monitoring, evaluation and accountability evidence use for design, adaptation, and scale-up of an early childhood development program in Rwanda"],"prefix":"10.3389","volume":"11","author":[{"given":"Caroline","family":"Dusabe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique","family":"Abimpaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noella","family":"Kabarungi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Diane","family":"Uwamahoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S0140-6736(07)60032-4","article-title":"Developmental potential in the first 5 years for children in developing countries","author":"Grantham-McGregor","year":"2007","journal-title":"The lancet"},{"key":"ref2","first-page":"e232","article-title":"Committee on Psychosocial Aspects of Child and Family Health, Committee on Early Childhood, Adoption, and Dependent Care, and Section on Developmental and Behavioral Pediatrics","volume-title":"The lifelong effects of early childhood adversity and toxic stress","author":"Shonkoff","year":"2012"},{"key":"ref3","volume-title":"Nurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential","year":"2018"},{"key":"ref4","volume-title":"Rwanda demographic and health survey 2019\u201320","year":"2021"},{"key":"ref5","unstructured":"Lauren Pisani, Monique Abimpaye, Jean Providence Nzabonimpa, Caroline Dusabe; saving brains: first steps 0\u20133 program in Rwanda Endline report2016"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1093\/intqhc\/mzy008","article-title":"A framework for learning about improvement: embedded implementation and evaluation design to optimize learning","volume":"30","author":"Barry","year":"2018","journal-title":"Int J Qual Health Care"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40359-015-0089-9","article-title":"An introduction to implementation science for the non-specialist","volume":"3","author":"Bauer","year":"2015","journal-title":"BMC Psychol"},{"key":"ref8","volume-title":"Early childhood development policy","year":"2011"},{"key":"ref9","volume-title":"Early childhood development policy","year":"2016"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"568677","DOI":"10.3389\/fpubh.2020.568677","article-title":"The aspirations of measurement for change","volume":"8","author":"Krapels","year":"2020","journal-title":"Front Public Health"},{"key":"ref11","first-page":"016502541986117","article-title":"Parenting education and parent support programs are proven to improve parental skills, capacity, and efficacy in a way that supports improved child development outcomes","volume":"4","author":"Monique","year":"2019","journal-title":"Int J Behav Dev"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"jvac070","DOI":"10.35188\/UNU-WIDER\/2020\/829-0","article-title":"Improving parenting practices for early child development: experimental evidence from Rwanda","volume":"21","author":"Justino","year":"2020","journal-title":"J Eur Econ Assoc"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1177\/027112149901900301","article-title":"Parent education in early intervention: a call for a renewed focus","volume":"19","author":"Mahoney","year":"1999","journal-title":"Top Early Child Spec Educ"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1165353\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T09:44:16Z","timestamp":1690451056000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1165353\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,27]]},"references-count":13,"alternative-id":["10.3389\/fpubh.2023.1165353"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1165353","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,27]]},"article-number":"1165353"}}