Smart investment in global childcare requires local solutions and a coordinated research agenda

Summary Box

• The COVID-19 pandemic has re-emphasised the critical role of accessible, affordable and quality childcare to reduce and redistribute the gender unequal distribution of unpaid care work as an investment towards the well-being of children, women, families and society.

• Smart investment in childcare and care systems in Africa requires context-specific and culturally appropriate local solutions driven by national stakeholders—including commitment by national governments to resource and build systems of public provision.

• These investments must be guided and matched by nationally led evidence generation to fill research gaps and contribute to a coordinated agenda on childcare.

• We propose four themes to build the foundation of a regional research agenda: (1) understanding the landscape of childcare coverage and demand; (2) unpacking ‘what works’ for whom over time; (3) building knowledge on implementation of scalable and locally adapted solutions and (4) answering macro-questions on policy, financing, systems and sustainability.

• Coordinated national-led investment in childcare is needed in the Africa region and beyond—however, this alone is not a silver bullet and must be part of a larger effort to address structural barriers and catalyse systematic change across sectors to promote women’s social and economic empowerment.

Introduction

Childcare is a smart investment and key for advancing gender equity. An emerging body of evidence demonstrates that providing childcare services contributes to improved health, well-being and economic opportunities for children, women, families and communities with potential for intergenerational impacts.^1–4 For these reasons, investment in care systems is said to result in a ‘triple dividend’: facilitating women’s entry into the labour market, promoting child development and boosting employment in the care sector, a predominantly female workforce.³ Nonetheless, attention to and investment in accessible, affordable, context-specific and high-quality care services still lag behind other forms of social protection. For example, despite an unprecedented global response to the pandemic, out of 3099 social protection and labour market measures enacted or planned by governments through July 2021, less than 20% took gender into account, and only 7% supported unpaid care.⁵ Support of unpaid care was particularly low in sub-Saharan Africa, representing only 2% of all measures.

Recognising the critical role of robust care systems in catalysing changes in gender norms around women’s participation in economic activities (and men’s role in care work), childcare is high on the post-pandemic agenda.^{4 6–8} The Generation Equality Forum in Paris in 2021 galvanised commitment to address the care crisis, launching the Childcare Incentive Fund. The fund mobilises $180 million in new investment to support the design and implementation of childcare programmes, and to improve evidence generation and policy designs in low/middle-income countries.⁹ While this is a welcome step, efforts are needed to ensure an approach that prioritises locally led and culturally adapted implementation, systems-building and evidence-generation by national scholars. Without these efforts, the agenda on childcare risks misalignment with local realities and national policy priorities.

In this commentary, we highlight the value of a coordinated research agenda taking an African regional perspective. In discussion with childcare implementers and researchers involved in the Growth and Economic Opportunities for Women (GrOW) cross-country childcare research and programming portfolio, we propose four key areas and corresponding questions which could serve as a starting point for such a research agenda. We highlight innovative local solutions to the childcare crisis as examples and inspiration for how investment can be nationally led and lay the groundwork for systems-building. In closing, we discuss broader issues linked to unpaid care work, as well as policy and structural barriers which must be addressed to advance the childcare agenda and women’s social and economic empowerment in Africa and beyond.

A regionally led research agenda

Recent years have seen an increase in rigorous studies examining dynamics around unpaid care, including childcare, as well as ‘what works’ to reduce and redistribute it. Studies increasingly answer more complex questions and examine impacts beyond the health and well-being of children, to include impacts on women’s engagement in the labour market, social and economic empowerment and growth of economies, among others. For example, a systematic review of childcare and mothers’ labour market outcomes published in 2023 found 22 rigorous studies—virtually all of which found at least some impact on women’s work or earnings.² Nonetheless, only one study, which examined the impacts of subsidised childcare on women’s economic empowerment in Nairobi, Kenya was from the African region.¹ Thus, large regional gaps exist, which means, among others, the understanding of impacts and dynamics around local solutions remains limited.

Since the aforementioned systematic review was compiled, several other working papers have emerged, examining the impacts of community-based daycare in rural Democratic Republic of Congo, ‘mobile creches’ in Burkina Faso and childcare vouchers alongside cash transfers in Uganda.^10–12 Despite producing promising results underscoring the value of childcare in rural settings, author teams are nearly exclusively based outside the region, reinforcing inequalities in knowledge generation and missing opportunities to decolonise research on unpaid care.^{13 14} The GrOW portfolio of mixed-methods impact evaluations underway on childcare and women’s economic empowerment in Ethiopia, Kenya and Uganda seeks to reverse this trend, with nationally led evaluation teams. With a growing momentum on childcare evidence generation, there is value in gaining consensus and coordinating key research questions and building synergies on measurement and methodology. We reflect on four themes we believe are critical for the future research agenda on childcare services and systems: (1) understanding the landscape of childcare coverage and demand; (2) unpacking ‘what works’ for whom over time; (3) building knowledge on implementation of scalable and locally adapted solutions and (4) answering macro-questions on policy, financing, systems and sustainability. Table 1 summarises these themes and provides illustrative associated research questions. While not exhaustive, these questions provide a starting point to think about commonalities and priorities for future research.

Table 1.

Key themes and research questions for a regional research agenda on childcare

Theme		Why is it important?	Illustrative research questions
1	Understanding the landscape of childcare coverage and demand	We still know relatively little about basic service coverage, as well as what factors matter for demand and take-up of services across contexts—which is the first step in stocktaking where, what and how to make ‘fit for purpose’ and locally adapted investments	What is the coverage of childcare services and childcare models at the national, regional and local levels, including traditional forms of kinship and family-based care—and how is this changing over time? What factors affect market demand for childcare services, including supply-side aspects (eg, service models, quality, accessibility, flexibility, costs, perceived trust in providers) across diverse target populations (eg, rural vs urban, family structure, socio-economic, ethnic diversity, workers in formal vs informal employment)? What are the main barriers to uptake of childcare, including the role of gender norms or costs, and how can these be reduced or equalised via messaging, targeting of subsidies (including sliding scales), system linkages or location of services, among others? What are the opportunities to develop a standardised module or iterations of context-specific modules of childcare model coverage, as well as indicators of demand and barriers, to integrate into routine data collection at the national or regional level?
2	Unpacking ‘what works’ for whom over time	We have few rigorous studies examining what works for different service models and populations in relation to a broad range of impact outcomes, particularly beyond the child-level	What are the impacts of access to childcare services on children, women and families—in relation to existing models of traditional kinship or family-based care? Continued measurement of women’s economic empowerment is needed, including engagement in the labour market, earnings, quality of work, financial resiliency and other economic status outcomes. In addition, of particular interest are under-researched areas: Are there impacts on children’s safety and development, women’s mental health and emotional well-being, intra-household outcomes including time use trade-offs (including for older siblings) and outcomes for men, including on gender attitudes and norms? Are there potential negative or adverse effects across different levels, particularly in settings where children accrue benefits from traditional forms of family-based care? What are the behavioural underpinnings or mechanisms leading to these impacts, setting the foundations for understanding generalisability across settings? How do impacts evolve over time, particularly beyond the short term (<12 months)? How do impacts vary by target populations which may be less-well placed to benefit from childcare (eg, children with disabilities, refugees or displaced populations) or have greater need (eg, single and/or adolescent mothers, informal workers, families with chronically ill or disabled prime age adults)? How do we trade-off impacts across different service models, including but not limited to: institutional vs residential models, part-time vs full time care (flexible), models that incorporate early childhood education or other plus components (gender norm social behaviour change, safe transport, infant and child health)?
3	Building knowledge on implementation of scalable solutions	There is high value in opening up the ‘black box’ of implementation to understand both how to best support childcare workers, as well as ensure quality for children and families	What are promising models to train, support and finance childcare workers, as well as facilitate their visibility and ability to organise to protect their rights? What measurement tools can be used to monitor and assess quality of childcare, including availability of infrastructure, compliance with regulations, quality of workforce, child development (objective measures) and engagement—as well as collect parent satisfaction with services (subjective measures)? What are barriers and challenges to quality and successful implementation of childcare services across contexts, including the tension between quality vs capacity vs accessibility of childcare centres, particularly in high-risk or informal environments (eg, informal settlement and slum areas, informal work places, post-disaster, displacement settings, pandemics and other health emergencies)? What promising strategies and implementation models encourage involvement and engagement of men in childcare?
4	Answering macro-questions on policy, financing, systems and sustainability	A policy view will facilitate real-time advice and advocacy towards a systems-level approach and coordination for sustainable childcare	What political economy factors influence and facilitate the adoption of childcare policies, regulatory frameworks and standards and financial commitment by governments? What is the ‘return on investment’ of childcare and how can sustainable financing be obtained to make sufficient investments in quality childcare for all? What by-laws and regulatory frameworks are needed to support local government to regulate childcare providers—with attention to context-appropriate models considering the living and working conditions of informal workplaces? How can childcare systems be linked and integrated (or coordinated) with complementary family-friendly systems and policies, both care-focused (eg, family leave, care for elderly)—as well as other sectors, including early child development and education? What is the role of formal sector firms in childcare provision for employees and in building the childcare workforce?

Theme 1 relates to better understanding the basics: service coverage, what drives demand and how to reduce barriers to childcare uptake. This is important as large-scale population-based surveys currently do not capture information on comparable indicators on childcare service availability or use, nor do they include information on informal or kinship-based care arrangements, obscuring understanding of coverage of different types of care models, over time and across contexts. In addition, studies on access to new forms of childcare services in the region suggest uptake rates are far from universal, varying from 25% to 73%, indicating a need for a better understanding of what drives demand and preference across contexts vis-à-vis existing traditional childcare models.^{10 12} For example, family or kinship-based models of childcare, which women and families may prefer to low-quality centre-based services, are widely used across the continent, particularly in rural areas.^{15 16} Nonetheless, as family structures change due to rapid urbanisation, research should address these trade-offs to better understand targeting of services and how to close gaps in access due to cost, gender norms and other factors. Answering these questions lays the groundwork for more complex questions around programming and policy. In addition, experimentation with survey modules could lead to the development of standardised measures to harmonise childcare indicators and serve as a starting point for integration into routine national and regional data collection efforts.

Theme 2 unpacks ‘what works’ in terms of different service models for different populations across a broad range of outcomes, particularly beyond the child level. We highlight the need to continue demonstrating impact on women’s economic outcomes, but also to measure under-examined outcomes, including intra-household power measures, spillover effects on other household members (including siblings), potential adverse effects and mechanisms attached to these impacts. Further, we emphasise the importance of understanding how impacts may vary for families who are less able to traditionally take advantage of childcare, including for carers of children with disabilities or for teenage mothers. Again, to better understand impacts in relation to the myriad of cultural settings across the continent, these impacts should be understood in relation to diverse forms of informal, ‘distributive’ and kinship-based caregiving, which may confer benefits to children and caregivers via socialisation, development and safety, among others.^15–17 While impact evaluation evidence lends itself to answering these questions, equally important is rigorous qualitative evaluation evidence, facilitating understanding of the mechanisms and enablers of impact, while allowing cultural nuance to findings. As the research frontier advances, evidence around sustainability of impacts (5 years or longer) will be critical to understand the full scope and evolution of impacts over time.

Theme 3 focuses on opening up the ‘black box’ of implementation to understand both how to best support childcare workers, as well as ensure the quality of care for children. Childcare models are diverse, including public provision, home and community-based, social franchising, cooperatives, market-based solutions, partnerships, employer-supported and more, each with unique implementation challenges.^{18 19} Yet, all models would benefit from an increased understanding of how to better recruit, train and support childcare workers, as well as how to better regulate, monitor and ensure quality of childcare adapted to caregivers’ and children’s needs. In many settings, including in Africa, there is a tension (trade-off) between capacity constraints and quality of service provision, as well as questions about how quality should be defined and monitored across contexts. Table 2 includes examples of innovative local models of childcare in Ethiopia, Ghana, Kenya and South Africa, in particular, how unique implementation challenges have been approached. For example, ChildFund in Ethiopia has developed a set of training manuals and implementation guidelines, audio-visual social and behaviour change communication materials alongside coaching and supportive supervision tools. These have been influential in opening discussions with the government and communities regarding the need for designing quality services. A unified understanding of key implementation aspects to test and improve, including barriers and challenges to engaging men in successful implementation of childcare, can help deliver better outcomes for workers and families.

Table 2.

Innovative locally led childcare implementation models in the Africa region

Model (organisation)	Description
Community-based childcare centres in Ethiopia (ChildFund Ethiopia)	ChildFund Ethiopia, with partners Children Believe and Tesfa Berhan Child and Family Development, is piloting a scalable solution for affordable, quality and sustainable community-based childcare. Childcare services target mothers of young children in urban centres of Addis Ababa, Adama and Debre Birhan with the objective of encouraging their engagement in paid work, income generation and overall economic well-being. In collaboration with the Addis Ababa University, the project will generate evidence for revising Early Childhood Development (ECD) policies, frameworks and implementation in Ethiopia, showcasing holistic impacts on children, women and families. Each childcare centre, of around 20 children, is managed and run by a facilitator selected from the community and supported by parents on a rotational basis. Facilitators and parents receive intensive training by project field coordinators and ECD specialists from ChildFund Ethiopia, on holistic ECD and management of daily facility activities. Field coordinators conduct regular supportive supervision visits at each childcare centre and provide coaching to community facilitators to ascertain the quality of the childcare centres and improve interaction with the children. The project also includes an economic empowerment component for mothers, through the organisation of self-help groups, which include a savings and loans and backstopped by a women economic empowerment specialist from ChildFund Ethiopia. The pilot builds on ChildFund’s experience of establishing childcare centres for the government-run flagship social protection programme, the rural and urban Productive Safety Net Programme (PSNP) in collaboration with the World Bank and UNICEF, whereby centres provide holistic ECD services to children while parents are engaged in public work activities.
Market-based daycare in Ghana and South Africa (Women in Informal Employment: Globalising and Organising, WIEGO)	In Accra, Ghana, Women in Informal Employment: Globalising and Organising (WIEGO) established a multi-stakeholder forum including the Ministry of Gender, Children and Social Protection, local municipal officials from the Social Development Department responsible for ECD regulation and provision, city planners, market trader and street vendors organisations, and ECD providers to co-create guidelines for childcare provision in and around markets. Street vending and market trading represents 44% of women’s employment in the Greater Accra area as compared with 11% of men’s employment.24 It is a highly feminised sector and women face specific childcare challenges due to their place of work and commuting time, including obstacles to breastfeeding young children. Markets and city streets also present many hazards for young children. The co-created guidelines are intended to outline these challenges and propose solutions that will be included in the revised national ECD policy to provide a set of principles for childcare provision in markets. Clearer guidelines set the foundation for the expansion of childcare services in markets for street vendors and market traders’ children. In Durban, South Africa, Asiye e Tafuleni is piloting childcare spaces for 6–8 children each in a market and street vending zone following negotiations with street vendors and market traders associations and municipal officials. The childcare centres apply the ECD municipal by-laws and are an innovative approach of creating safe spaces for young children in and around markets. The lack of government subsidies for childcare services is an important obstacle for street vendors and market traders to register their children as they cannot afford the user fees. The pandemic coupled with the cost-of-living crisis led to a significant drop in earnings among these workers. However, recent regulatory changes in South Africa are now making it easier for childcare service providers to benefit from the existing ECD subsidy. This can expand uptake of these services among women in informal employment whose earnings tend to be lower than the minimum wage. Across Africa, street vending and market trading represent an important source of employment for women, and many bring their young children to work with them as no viable childcare alternatives exist. Both examples demonstrate how it is possible to extend childcare services in or near informal economy workers’ place of work, including city markets and streets. They emphasise the need for broad consultations with local and national government officials alongside women workers who are the primary users of these services.
‘Mamaprenuers’ social enterprising in Kenya (Kidogo)	Kidogo is a social enterprise operating an innovative ‘Hub and Spoke’ model for low-income communities in Kenya and the Africa region. ECD best-practice hubs are established with trained caregivers using a holistic play-based curriculum, nurturing the growth and development of children—referred to as ‘The Kidogo Way’. In addition, Kidogo micro-franchises ‘mamapreneurs’ or local women running informal childcare centres within the community as ‘spokes’. Mamapreneurs receive a business-in-a-box, including relevant training materials, resources and support. The Kidogo hubs operate as model centres of excellence for the spokes, continually testing and innovating to improve the quality and availability of childcare in the community. Kidogo hubs also offer ongoing training for mamapreneurs. Since 2014, Kidogo has supported over 130 centres serving approximately 2900 children daily in 12 different informal settlements across Nairobi. Preliminary findings from an ongoing quasi-experimental study in Nakuru County, in western Kenya showed that improving the quality of childcare services can improve labour outcomes for women in resource-poor settings, thereby improving their families’ economic prospects.25 The results also demonstrated that the training and mentorship components of the Kidogo model were transferable, acceptable and feasible. These two aspects could form the basis for the development of a peer-to-peer mentorship model where centre providers, trained as ‘champions’, would support others through a community of practice model to achieve and maintain quality of childcare provision and enhance sustainability of the programme.

Theme 4 focuses on macro-level factors, including policies, systems, financing and sustainability. For example, which political economy factors influence and facilitate adoption of childcare policies, adherence to regulatory frameworks and commitment by governments? What is the ‘return on investment’ of childcare services and how can sustainable financing be obtained to ensure quality childcare for all?²⁰ Childcare systems must be linked and integrated (or coordinated) with complementary care-related and family-friendly systems, as well as sectoral policies—and a better understanding of these synergies can facilitate improved outcomes in multiple sectors. Coordination with businesses in the formal sector is also important, as it can be one way to extend childcare services as an employee benefit.²¹ Policy and political analysis will ensure we are taking a macro-view with the objective of providing relevant strategic advice to governments regarding sustainable growth of a quality childcare sector with dividends for society at large.

Conclusion

Childcare is a smart investment and everyone’s concern—not a ‘sunk cost’ or a women’s issue.⁶ The pandemic highlighted the cost of inaction in addressing childcare and raised the need to advocate for a change in narrative globally.²² We are encouraged by recent attention to childcare infrastructure and investment, but highlight the necessity of a locally led research and implementation agenda. Without this approach, the movement risks imposition of western ideas and models of care, which may fail to realise the potential triple dividend to children, women and society. Within this approach, government ownership at all levels is critical for financing, regulation and responsibility for pushing this agenda forward in a sustainable way. The Nairobi Childcare Facilities Act is one example of a promising step by local government; however, there is a need to have implementation guidelines in place, with funding attached.²³ Moreover, childcare is just one piece of the puzzle and tackling it alone is insufficient. Changes must be part of a larger effort to establish comprehensive social protection and sector-specific policies that enable women’s economic and social empowerment in Africa and beyond.

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