Table 8. The intersectoriality 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
Program Governance and Leadership: Establishing clear leadership roles and responsibilities within and between sectors at multiple implementation levels is crucial. Messaging among and from these entities must be consistent and compelling to drive program acceptability. Sectors are willing to create common goals and work together.	Workforce: Intersectoral workforce has existing responsibilities sometimes making it difficult to integrate additional CCD or RU activities	IS2.1	Coordination and Communication: There is a need for clear commitments, roles, and scope of work to be laid out among collaborators to avoid confusion and inefficiencies. This can allow space for intentional adaptation to local contexts and consideration of stakeholder capacities. When relevant, referrals can be easily made from RU or CCD implementers to additional health or social service.	(14)	Appropriateness Feasibility Acceptability Adoption Fidelity Adaptation Penetration Sustainability Implementation Cost Scaling	(3) (6) (2) (3) (1) (1) (2) (4) (1) (5)
ECD System (Existing Services): The existence of established, accessible social services (i.e., healthcare, early education, conditional cash transfer program) that address a broad array of problems and support children and caregivers is beneficial to effective intersectoral collaborations.	Referrals: To address the family’s multiple needs, CCD or RU implementation agents must make referrals to other services; however, this is difficult if there is not a strong network of services in place.	IS2.2	Intervention Characteristics: Program delivery along with other interventions that support child health and development (e.g., nutritional supplements) addresses multiple child health and development threats concurrently.	(25)
Institutional Integration of ECD: From federal policy to local government, ECD is valued and recognized as an important aspect of health care (e.g., all medical students in the country are trained on ECD).	Leadership: The group who should be responsible for ECD based on formal responsibilities may not have the capacity to implement RU or CCD or may not be interested, therefore other groups may need to step in.	IS2.3	Intersectoral Targeting: The use of existing, scaled conditional cash transfer programs or other services that can identify vulnerable families can help program reach and enrollment; however, these systems should not present further bureaucratic barriers for families in need.	(12)
Demand: Families and caregivers welcome user-friendly services, such as new programs that are integrated into existing services.		IS2.4	Intersectoral Workforce: Existing cadres of health workers and providers, educators, or NGO staff can integrate program delivery within their existing jobs or tasks.	(18)
		IS2.5	Delivery Sites and Networks: RU or CCD can use existing facilities to serve as familiar sites for program delivery. A well-established health system network at the community level can be used. Other well-known community sites such as schools or community meeting halls can also serve the same purpose if available.	(15)