Scaling up a home-visiting program for child development in Brazil: a comparative case studies analysis

Area of Science:

• Public Health
• Early Childhood Development
• Program Implementation Science

Background:

• Brazil's Criança Feliz Program (PCF) is a large-scale initiative for early childhood development (ECD).
• Despite its scale, the PCF has faced challenges in achieving its intended impact.
• The study examines barriers and facilitators to PCF implementation outcomes using the RE-AIM framework during the COVID-19 pandemic.

Purpose of the Study:

• To identify barriers and facilitators affecting the implementation of the Criança Feliz Program (PCF).
• To analyze PCF outcomes across the RE-AIM dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance.
• To understand these factors within the context of the COVID-19 pandemic.

Main Methods:

• A comparative case study design was employed, selecting five diverse municipalities in Brazil.
• Data were collected through 244 interviews with program staff, families, and cross-sectoral professionals.
• Rapid qualitative analysis was used to identify themes related to the RE-AIM dimensions.

Main Results:

• Barriers to reach included limited family knowledge and trust in PCF goals.
• Effectiveness was undermined by a lack of referral protocols for social needs.
• Adoption was challenged by questions regarding sector responsibility; implementation faced issues like low salaries, high turnover, and inadequate monitoring, exacerbated by the pandemic. Sustainability was hindered by a lack of institutionalized funding.

Conclusions:

• Complex, intertwined system-level barriers significantly impede the successful implementation of the PCF.
• Addressing these multifaceted barriers is essential to leverage the program's reach and its evidence-based nurturing care principles.
• Recommendations focus on strengthening program infrastructure, intersectoral collaboration, and sustainable funding models.