Early childhood development is a multidimensional construct, encompassing several aspects of a child’s well-being: physical, socio-emotional, and cognitive-linguistic. In general, development takes place in a series of predictable and common stages. This indicator reflects the cumulative effect of social, economic, and environmental conditions in which children live from pregnancy through the first years of life. Population-level surveys are used to measure early childhood development by assessing children's achievement of age-appropriate developmental milestones, with mothers or primary caregivers providing responses about their children's behavior, skills, and knowledge. 

Twenty countries in the Region reported data for this indicator at various points between 2012 and 2020, not continuously (Figure A.5). Among these 20 countries, the average proportion of children under 5 who are developmentally on track in health, learning, and psychosocial well-being was 84.6%, and only five countries had proportions of children under 5 classifying as developmentally on track in health, learning, and psychosocial wellbeing that exceeded the 90% target for the Region. Given the availability of data for only some countries and considering that these data come from disparate years as well as only up 2020, the first year of the current Strategic Plan, it is not possible to provide a rating for this indicator. 

Challenges in measuring early childhood development include differences in question interpretation due to cultural and language factors, recall inaccuracies, and limited time for questionnaire administration. Efforts at the international level are addressing these challenges, and two countries in the Region are piloting new methodologies or standards for this indicator. 

The United Nations International Children’s Emergency Fund (UNICEF) initiated a process to revise the Early Child Development Index (ECDI) and align it with the domains of the Sustainable Development Goal (SDG) 4.2.1 indicator. This effort resulted in the development of the Early Childhood Development Index 2030 (ECDI2030), approved by the Inter-agency and Expert Group on SDG Indicators (IAEG-SDGs) in February 2022. ECDI2030 will be integrated into the UNICEF Multiple Indicator Cluster Surveys 7 (MICS7) starting in 2022, with expectations that 16 countries in the region will have ECDI2030 data by 2030. 

Since 2022, three countries in the Region—Jamaica, Nicaragua, and Trinidad and Tobago—have successfully completed new rounds of the MICS, generating crucial data on key indicators related to child well-being. Four countries—Belize, Guatemala, Paraguay, and Saint Lucia—are currently in the process of survey design for the upcoming rounds.

In 2023, PAHO, in collaboration with WHO, translated to Spanish user manuals for the Global Scale for Early Development (GSED), a standardized WHO tool to measure and better understand child development globally. Currently, the GSED validation protocol is ongoing in Brazil, with completion expected by the end of 2024. 

Recommendations

• Employ the ECDI, an instrument reflecting literacy-numeracy, physical development, socio-emotional maturity, and learning, as a temporary solution for reporting progress on this indicator. 

• Integrate ECDI-compatible instruments to have similar instruments and measures for early childhood development, making it possible to compare or aggregate results with those using the ECDI2030. For example, the GSED should be adopted alongside the ECDI2030 to provide a more holistic understanding of early childhood development across different age groups. 

• Incorporate navigable, understandable data collection modules into efforts to measure early childhood development. The Pan American Sanitary Bureau (PASB) is collaborating with the World Health Organization (WHO) to translate the data collection modules for the new ECDI2030 into Spanish.