Table 6. Program emergence building block of Care for Child Development (CCD) and Reach Up (RU) implementation pathways.

Context		Implementation Strategies (Number of programs reporting)			Implementation Outcomes (number of programs reporting)
Facilitators	Barriers
ECD Disparities: Gaps in ECD services and resources widen inequities in children’s developmental outcomes; few governmental sectors reach the nation’s youngest children.	Capacity: Some ECD sectors may be overloaded at the time of implementation while others may have infrastructure that can be scaffolded.	IS1.1	Program Governance and Leadership: Individuals and groups with regional and/or national influence who are early advocates of CCD or RU can help drive early program support and sustain program activities. This can be achieved through formal and informal ECD policy, advocacy, and issue awareness-raising.	(24)	Appropriateness Feasibility Acceptability Adoption Fidelity Adaptation Penetration Sustainability Implementation Cost Scaling	(5) (9) (1) (5) (1) (1) (4) (5) (1) (13)
ECD System (Legislation): The presence of an existing public infrastructure providing services to children and families. ECD support is codified in legislation as a policy commitment.	Communication: If program leaders do not have formal platforms to communicate with one another there is a risk of ineffective leadership and poor planning.	IS1.2	Multi-Level Networks: Joint planning among inter-and intra-sectoral partners, including community leaders and members, is crucial to implementation and planning. Having a local community champion supports acceptance and local buy-in.	(28)
Community: Community interest in improving child health and development drives adoption.		IS1.3	Funding: The use of local, state, and/or federal funding sources ensures sustainability (as opposed to the unpredictability of funding from external organizations) and ensures the potential for implementation with fidelity and scaling. Continued and expanded program funding can be dependent on evidence of program effectiveness and implementation cost analyses collected via monitoring systems.	(32)
Curriculum: CCD and RU are evidence-based methodologies for responsive caregiving interventions promoted by UNICEF/WHO and international partners.		IS1.4	Scaling Process: Conducting a feasibility trial before scaling allows implementers to adapt the program. It may be necessary to take pauses in program scaling up to ensure the quality of the program. Scaling may be regional or national.	(20)
		IS1.5	ECD System Integration: Government ownership of the program from the beginning allows for the integration of the program with social services or the health system using existing workforces.	(25)