Scaling up of Brazil's Criança Feliz early childhood development program: an implementation science analysis,Annals of the New York Academy of Sciences

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Scaling up of Brazil's Criança Feliz early childhood development program: an implementation science analysis
Annals of the New York Academy of Sciences ( IF 4.1 ) Pub Date : 2021-03-18 , DOI: 10.1111/nyas.14589
Gabriela Buccini ₁ , Sonia Isoyama Venancio ₂ , Rafael Pérez-Escamilla ₃

Affiliation

To address inequities that prevent socioeconomically vulnerable young children from reaching their full developmental potential, Brazil implemented Programa Criança Feliz (PCF) (“Happy Child” early childhood development program) in 2934 of its 5570 municipalities. A qualitative case study was carried out on the basis of in-depth interviews with 22 key informants, employing purposive sampling, from past or current national and state coordination teams. Thematic analysis followed the RE-AIM framework, and complex adaptive system constructs mapped how barriers and enablers influenced scale-up. One overarching theme related to PCF emergence, and 18 subthemes were identified within the RE-AIM. An enabling national political environment favored PCF emergence through a top-down approach that led to governance challenges. Changes in the enrollment criteria for families facilitated reach, and evidence-based methodology favored the designing of the home visits. However, operationalizing the intersectoral actions remains a barrier for effectiveness, while intrasectoral resistance across levels delayed adoption. WhatsApp facilitated networking, capacity building, and adoption. Rushed scale-up generated barriers for quality delivery and led to different implementation pathways across municipalities. Legal institutionalization is critical to assure permanent funding and maintenance. PCF has enhanced early childhood services in Brazil, but strong negative feedback loops need to be addressed for effective sustainability.

中文翻译：

扩大巴西 Criança Feliz 幼儿发展计划：实施科学分析

为了解决阻碍社会经济弱势幼儿充分发挥其发展潜力的不平等现象，巴西实施了Programa Criança Feliz(PCF)（“快乐儿童”幼儿发展计划）在其 5570 个城市中的 2934 个。在对来自过去或现在的国家和州协调小组的 22 名关键信息提供者进行深入访谈的基础上，进行了定性案例研究，采用了有目的的抽样。主题分析遵循 RE-AIM 框架，复杂的自适应系统构建映射了障碍和促成因素如何影响扩大规模。在 RE-AIM 中确定了一个与 PCF 出现相关的总体主题，以及 18 个子主题。有利的国家政治环境有利于 PCF 通过自上而下的方法出现，这导致了治理挑战。家庭入学标准的变化促进了接触，基于证据的方法有利于设计家访。然而，跨部门行动的实施仍然是有效性的障碍，而跨级别的部门内阻力延迟了采用。WhatsApp 促进了网络、能力建设和采用。仓促的扩大规模对质量交付产生了障碍，并导致不同城市的实施途径不同。法律制度化对于确保永久资助和维护至关重要。PCF 加强了巴西的幼儿服务，但需要解决强大的负面反馈循环以实现有效的可持续性。法律制度化对于确保永久资助和维护至关重要。PCF 加强了巴西的早期儿童服务，但需要解决强大的负面反馈循环以实现有效的可持续性。法律制度化对于确保永久资助和维护至关重要。PCF 加强了巴西的幼儿服务，但需要解决强大的负面反馈循环以实现有效的可持续性。

更新日期：2021-03-18

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