The global development community hasrecognized holistic investments in early years as a soundfoundation to achieve at least seven Sustainable DevelopmentGoals (SDGs) on poverty, hunger, health, education, gender,water and sanitation, and inequality. In Nepal, the2005–2015 Early Childhood Development (ECD) Strategy, aThematic Working Group on ECD in the National PlanningCommission (NPC), and a Parliamentary ECD Caucus—allindicate a strong political will to prioritize the ECDagenda. Recent programming from development partners hasalso provided a substantive push toward a holistic,integrated approach to ECD in the country. However, ECD isstill understood by stakeholders mainly as an'education' agenda, and programs that comprise thevarious ECD dimensions, including nutrition, stimulation,and social protection, are not coordinated. A transition tofederalism offers unprecedented opportunities forintegrating and packaging ECD interventions at the locallevel. As such, this review aims to (a) build a commondefinition and framework to guide the integrated approach ininvesting in early years (b) identify current successes andgaps in current programming, and (c) explore actionableopportunities to integrate services in early childhood toensure that every child gets a healthy start in life. Thestudy consisted of four phases, starting with a desk study,followed by national-level discussions and field-leveldiscussions and then evidence synthesis to design aframework for synergizing investments in early years. Ananalytical framework (AF) was formulated based on thefindings of desk reviews to guide the consequent discussionsand selection of respondents for national-levelconsultations from relevant government agencies, donorpartners, and nongovernmental organizations (NGOs). The teamconducted field visits to further deep dive into specificcases, challenges, and potential opportunities in scopingfor work in ECD. Field visit sites were chosen throughpurposive sampling aimed at iteratively filling theinformation gaps in the AF and improving the accuracy ofdata already collected. To this end, about 18 key informantinterviews (KIIs) and nine focus group discussions (FGDs)were conducted in Mahottari, Mugu, Lalitpur, and KathmanduDistricts. The consultations at both the national and fieldlevel generated critical lessons, considerations, andpotential entry points for increasing delivery efficiency ofECD services offered across the three thematic pillars ofhealth and nutrition, learning and stimulation (L&S),and social protection. The study offered critical insightsinto the current policies, priorities, and programming,including a spectrum of interventions in ECD and care. Italso provided the necessary background to explore currentdefinitions and scope of 'integration'. Forconsistency purposes, hereafter, the report defines theconcept as a synergy of (a) goals (objectives that can bemet only through multisectoral approaches); (b) processes(implementation modalities, client-engagement models,communication activities, and information systems); and (c)resources (financial, human, and technical) to enableholistic development of the individual child over the life course.
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