ACKNOWLEDGMENTS MEASURE Evaluation has many people and organizations to thank for their support and contribution to this scale-up assessment. First, we acknowledge the United States Agency for International Development (USAID) for its ongoing support and guidance over the course of this activity. We thank USAID staff Damilola Walker, Christine Fu, Joshua Volle, and especially Brenda Yamba, for seeing this activity through. We acknowledge the researchers and their teams conducting the impact evaluations in Eswatini, Lesotho, and Zimbabwe. We are also indebted to the implementing partners (IPs) for sharing their expertise, insights, and time. For Eswatini, we thank mothers2mothers Eswatini and mothers2mothers South Africa—especially Fiona Burtt. For Lesotho, we thank Management Sciences for Health, Stellenbosch University, and mothers2mothers, with a special appreciation for Nathene Morley for her additional assistance with data on costing. For Zimbabwe, we thank World Education, Inc./Bantwana and World Education, Inc. staff in Boston, Massachusetts, USA. We greatly appreciate the time and energy these IPs shared with us; they are truly dedicated to improving care for orphans and vulnerable children (OVC) and advancing early childhood development (ECD). We also offer our appreciation and thanks to respondents from government ministries, multilaterals, other nongovernmental organizations (NGOs), and civil society who participated in interviews. Without their input, our assessment would not be complete. We thank Dr. Richard Kohl for providing technical support and guidance throughout this assessment. We also thank Erin Luben, of MEASURE Evaluation, for her continued support on this activity and MEASURE Evaluation’s knowledge management team for editorial, design, and production services. Cover Mother and child in rural Lesotho. Photo: Courtesy of James Walsh, Sinamatella Productions Suggested citation Cannon, A., Charyeva, Z., Millar, E., Gobin, S., & Morris, L. (2019). Integrating Early Childhood Development and Health in Eswatini, Lesotho, and Zimbabwe: A Scale-Up Assessment. Chapel Hill, NC, USA: MEASURE Evaluation, University of North Carolina Integrating Early Childhood Development and Health in Eswatini, Lesotho, and Zimbabwe 5 CONTENTS Acknowledgments ........................................................................................................................................................ 5 Abbreviations ................................................................................................................................................................ 9 Executive Summary ................................................................................................................................................... 11 Introduction ................................................................................................................................................................ 13 Background ............................................................................................................................................................ 14 What Is Scale-Up? ............................................................................................................................................... 14 Objectives of the Scale-Up Readiness Assessment ................................................................................................... 15 Methods ....................................................................................................................................................................... 16 Analysis ................................................................................................................................................................... 18 Qualitative Data .................................................................................................................................................. 18 Costing ................................................................................................................................................................. 18 Results—Eswatini ...................................................................................................................................................... 19 Describe the Intervention .................................................................................................................................... 19 Intervention Strengths and Challenges .............................................................................................................. 22 Intervention Strengths ............................................................................................................................................ 22 Implementation Challenges .................................................................................................................................... 22 Characteristics of the Intervention that Present Both Strengths and Challenges ....................................................... 23 Scale-Up Scenarios and Costing ......................................................................................................................... 24 Scalability ................................................................................................................................................................ 25 Country Context .................................................................................................................................................... 26 Strategies for Scaling ............................................................................................................................................. 28 Recommendations ................................................................................................................................................. 30 Results—Lesotho ....................................................................................................................................................... 33 Describe the Intervention .................................................................................................................................... 33 Mphatlalatsane Project Facilitators ....................................................................................................................... 33 Project Training Materials .................................................................................................................................... 34 Project Outreach Events ........................................................................................................................................ 34 Intervention Strengths and Challenges .............................................................................................................. 34 Intervention Strengths ............................................................................................................................................ 34 Implementation Challenges .................................................................................................................................... 35 6 A Scale-Up Assessment Scale-Up Scenarios and Costing ......................................................................................................................... 36 Scalability ................................................................................................................................................................ 37 Country Context .................................................................................................................................................... 38 Strategies for Scaling ............................................................................................................................................. 40 Recommendations ................................................................................................................................................. 41 Results—Zimbabwe .................................................................................................................................................. 43 Describe the Intervention .................................................................................................................................... 43 ECS Parenting Sessions ....................................................................................................................................... 44 ISAL Group Activities ........................................................................................................................................ 45 Case Management ................................................................................................................................................. 45 Project Training ..................................................................................................................................................... 45 Project Personnel .................................................................................................................................................. 46 ECS Facilitators .................................................................................................................................................. 46 ECS Coordinators ................................................................................................................................................ 46 Community Health