Health Care for ECD
Thematic Area :
Developmental Monitoring For Early Child Development

Countries in the Europe and Central Asia region are increasingly recognising the importance of addressing developmental difficulties within routine health care service provision. Regional health systems have already started exploring possible avenues to provide multiple opportunities for the promotion of early childhood development (ECD), prevention, early identification, and management of developmental difficulties — collectively referred to as “developmental monitoring.”

This burgeoning interest is readily observable in the adoption of new legislative acts, participation of country delegates in related international meetings and conferences, assessments of the feasibility of introducing a developmental focus within existing service delivery, and borrowing experience from neighbouring countries “who have been there.” International organisations, such as the United Nations Children’s Fund (UNICEF) and the World Health Organisation (WHO) have played a crucial role in this endeavour, by supporting diverse projects directed at helping regional health systems to initiate and sustain discussions. 

The shared features of the regional health systems enable generalisations to be made about their potential for furthering the introduction of developmental monitoring. For example: 

  • A well-developed primary health care infrastructure — meaning that most of the population can access primary health care facilities within a walking distance or by affordable public transportation — is a key strength. 
  • Coverage of basic primary health care services is high, for example, immunisation rates are over 90% in all of these countries. 
  • The main professionals providing services, i.e. a physician and a nurse, are trusted in the communities. 
  • Many countries have a home-visiting system, which is an excellent opportunity for interactions between healthcare providers and young children and families in their natural environments. 

Impediments to the introduction of developmental monitoring

Besides strengths, the countries in the region also share some common impediments to the introduction of developmental monitoring. The report “Developmental Difficulties in Early Childhood”, authored by Professor Ilgi Ertem and WHO and published in 2012, was among the first to shed light on these barriers. Specifically, that health care providers generally do not possess adequate clinical competencies to address child development. Traditionally, the training of physicians and nurses has been focused on medical issues, while everything related to child development was considered to belong to “other” professionals working in specialised facilities. 

The notion that physical health and development are two inseparable halves of a holistic concept of “health” and that this should be applied in training is slowly emerging among healthcare providers, within academia, and at the advocacy and policy-making level. Indeed, the nature of developmental difficulties, and the huge burden of these on at least 17% of the paediatric population calls for providing universal developmental monitoring at primary healthcare level, and more intensive support when needed. Thus, it is crucial that all of the primary healthcare professionals engaged in care for young children and their families are knowledgeable in child development. 

New curricula grounded in ECD theory

Most of the countries in the region do devote some time to child development within their pre-service and/or in-service curricula. However, the current curricula fall short of teaching a coherent set of competencies required to handle real situations and rather, narrowly focus on skills of limited clinical utility, such as milestones. The curricula must be grounded in contemporary child development theory, which includes bioecological theory, the concepts of risks, protective factors and resilience, family-centred care, and a strengths-based approach. Additionally, the curricula should include instruction on how this knowledge can be translated into an attitude of partnering with families, actively listening to them, asking open-ended questions, being non-judgemental, empowering them, and praising small achievements.

Despite this, countries who have succeeded in taking the necessary steps to train primary healthcare professionals in developmental monitoring and provide them with standardised tools for this process confront systemic factors, such as resource constraints. Successful training and the existence of tools for developmental monitoring does not always translate into actual services for final beneficiaries if health care providers are not afforded sufficient time, mandate or incentives to use the acquired competencies. This underscores the importance of addressing the programmatic aspects of developmental monitoring concurrently with training. The most important of these aspects are adopting policy that values ECD, providing incentives and mandates, and creating time for developmental monitoring. 

Ten years since these barriers were first highlighted, the situation has not changed dramatically, thus it is timely to reiterate specific recommendations to guide the introduction of developmental monitoring in the region.

Countries should:

  • Continue to prioritise efforts to introduce pre-service and in-service training curricula that are grounded in child development theory. 
  • Equip all healthcare professionals who are engaged in caring for children and their families with clinical competencies to address developmental difficulties. 
  • Primary health systems should prioritise delivering universal developmental monitoring, rather than addressing development at specialised facilities.
  • Healthcare policy should value ECD and allocate training, time, funds, reimbursement, and mandates for developmental monitoring.


Ertem IO and World Health Organization. Developmental difficulties in early childhood: prevention, early identification, assessment and intervention in low-and middle-income countries: a review. World Health Organization publications; 2012.

Ertem IO. The International Guide for Monitoring Child Development: enabling individualised interventions. Early Childhood Matters. 2017:83-7. ( accessed 15 December 2022).

Ertem I, Dogan DG, Srinivasan R, et al. Addressing early childhood development in healthcare: putting theory into practice. BMJ Paediatrics Open. 2022;6:e001743. doi: 10.1136/bmjpo-2022-001743

Author bio

Dr. Revan Mustafa is a developmental paediatrician who has devoted his professional career to the implementation and dissemination of services related to supporting early childhood development. He has contributed to supporting UNICEF Azerbaijan, Kyrgyzstan, and Turkmenistan in furthering developmental monitoring in regional health systems. Dr. Mustafa is one of the regional WHO and UNICEF consultants in ECD, and a secretarial board member of the International Developmental Pediatrics Association (IDPA).



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