Table 16. Monitoring building blocks 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 System (Supervisor Workforce): Supervisors can employees recruited from other ECD programs. If the program is delivered by an existing workforce, that workforce’s existing supervisory staff may be used.	Infrastructure: Logistical challenges result when supervisors are responsible for implementation agents across a wide geographic area and cannot easily conduct site visits.	IS6.1	Supportive Mentoring: Supportive mentoring and support of implementation agents (i.e., praise, encouragement) by supervisors during site visits, regular in-person meetings, telephone calls, etc., are critical to satisfaction, intervention fidelity and quality, and implementation agent engagement. Supervisors often used fidelity checklist tools to tailor their guidance for individual implementers based on weak areas. This helped guarantee program quality and expand the implementation agent’s skill set. Supervisors can inform and participate in the improvement of the formal implementation agent training to address performance weaknesses, challenges, or gaps in training that they observe in the field and support the success of future implementation agents.	(25)	Appropriateness Feasibility Acceptability Adoption Fidelity Adaptation Penetration Sustainability Implementation Cost Scaling	(5) (7) (1) (1) (17) (2) (0) (6) (0) (3)
Program Scale: Smaller pilots had more informal, less developed supervision structures, whereas larger-scale implementation requires more advanced supervisory infrastructure.		IS6.2	Standardized Data Collection Tools: Tools such as attendance sheets, data collection forms, and audiotapes of sessions were used by supervisors and implementation agents to monitor intervention delivery, caregiver participation, and ECD outcomes. These tools must be designed to facilitate detailed data collection while not over-burdening implementation agents and supervisors. Electronic monitoring systems can be used to store program data and provide easy access to data to program leaders to inform future program decisions.	(31)
		IS6.3	Data-Informed Decision Making: Program data are organized and managed by senior leadership to inform stakeholders and make evidence-based programmatic decisions.	(20)
		IS6.4	Supervisor Training: Supervisors should be trained intensively on the program as well as their supervisory role of collecting and managing data, supporting implementation agents, and disseminating program information as needed.	(18)
		IS6.5	Supervisor Caseload: Supervisors who are responsible for too many implementation agents or too many tasks (i.e., too large a caseload) are ineffective. A manageable caseload was influenced by the existing responsibilities of the supervisor and the geography of their catchment area.	(11)
		IS6.6	Impact Measurement: The impact of the program on ECD can be measured by integrating child development indicators into existing national health surveillance systems, such as data collected by public health facilities.	(30)