We suspect that effectiveness is reduced when many topics are included. Evidence is also needed on the impact of increasing program aims and topics on facilitator capacity to deliver and acceptability and effectiveness for parents. More exploration is needed of scaling through other systems or dedicated ECD services and innovations to support implementation quality. In almost all cases, some new staff and resources with sustainable funding is essential. 19 Adding another program to an over-stretched, underperforming system and expecting health workers to deliver ECD activities in addition to their usual workload is unlikely to be successful.

Dillard's memoir is roughly divided along chronological lines, moving from early.

17, 18 However, health systems are often under-resourced and substandard in important aspects of child care. Throughout the world, there has been widespread recognition that children’s development is shaped by the cultural context and interactions that begin prenatally and extend throughout childhood. An American Childhood is about 'waking up'-of a child's emerging awareness that she is part of the larger world. Health systems are often proposed as they reach children below 3 years and there is evidence that with sufficient training, supervision and allocated time, community health workers can successfully deliver ECD programs. Critical to planning for scale is determination of potential systems for delivery and resources and modifications necessary for successful implementation.

From an american childhood