From silos to systems: a retrospective application of the measurement for change (M4C) framework to Grenada's intersectoral early childhood development strategy
- 1The Caribbean Center for Child Neurodevelopment (CCCN), Windward Islands Research and Education Foundation (WINDREF)
Abstract
Background: Public health systems are often organized around single-sector mandates even when population needs span multiple sectors. Measurement for Change (M4C) was developed within early childhood development (ECD) to position monitoring, evaluation, and learning as a continuous process of adaptation, organized around five aspirations: Dynamic, Inclusive, Informative, Interactive, and People-centered. Whether these aspirations usefully describe national, intersectoral policy development remains largely untested.
Methods: We conducted a retrospective qualitative case study examining the development of Grenada's Intersectoral Early Childhood Development (IECD) Strategy 2026–2030. Over 24 months, the process combined a desk review, 55 key-informant interviews, 34 focus groups, and eight parish-level consultations engaging over 400 participants, together with thematic and SWOT analysis, Theory of Change development, governance design, and costed implementation planning. Qualitative coding combined independent human coding with large-language-model-assisted comparison. M4C was not used prospectively to structure this process; rather, the completed process was examined afterward through the five M4C aspirations to assess convergence, tension, and implications for national-level application.
Results: The process showed strong convergence with all five aspirations, particularly through iterative stakeholder engagement, cross-sector and geographic participation, and translation of evidence into a costed Theory of Change and governance architecture. However, national-level application also exposed limits not evident at program scale. Political favoritism and institutional turf-protection constrained interactivity even where formal governance structures existed. Dynamism depended on institutional capacity to sustain ongoing review and adaptation after external technical support ended. Inclusion required disaggregation fine enough to reveal sub-national inequity. Some politically sensitive priorities, once surfaced, proved harder to act on than to identify.
Conclusion: M4C provides a useful analytic lens for national systems-building, but at this scale its aspirations depend on enabling conditions such as political neutrality, institutional continuity, data harmonization, and decision authority that program-level applications can more readily assume. We offer recommendations for policymakers and researchers applying M4C to national policy design elsewhere, particularly in other small island developing states.
Related
- Societal actors' perceptions of intersectoral collaboration and the participation of older adults in the development of age-friendly environments.
- Machine learning and nomogram for predicting severity of acute cholangitis: development and internal validation of a dual-framework model in a retrospective cohort study.
- Innovative application of pressure gradient measurement in internal carotid stenosis in patients undergoing carotid artery stenting (NOTICE-CAS): study protocol for a randomized, assessor-blinded, parallel-group clinical trial
- Addressing Measurement Error of Machine-Learned Physical Activity in Nonlinear Dose-Response Survival Analysis: Development and Evaluation of Accelerated Failure Time, Spline, and Simulation-Extrapolation Method
- A Measurement-Based Care Strategy for Buprenorphine-Naloxone Treatment (Bup-MBC): Development of an EHR-Integrated Intervention
BibTeX
@article{evans2026from,
title = {{From silos to systems: a retrospective application of the measurement for change (M4C) framework to Grenada's intersectoral early childhood development strategy}},
author = {Roberta Evans and Barbara Landon and Toni Murray and Lauren Mohammed and Jesma Noel and Randall Waechter},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1955169},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1955169/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From silos to systems: a retrospective application of the measurement for change (M4C) framework to Grenada's intersectoral early childhood development strategy
AU - Roberta Evans
AU - Barbara Landon
AU - Toni Murray
AU - Lauren Mohammed
AU - Jesma Noel
AU - Randall Waechter
PY - 2026
DA - 2026/10/27
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1955169
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1955169/full
AB - Background: Public health systems are often organized around single-sector mandates even when population needs span multiple sectors. Measurement for Change (M4C) was developed within early childhood development (ECD) to position monitoring, evaluation, and learning as a continuous process of adaptation, organized around five aspirations: Dynamic, Inclusive, Informative, Interactive, and People-centered. Whether these aspirations usefully describe national, intersectoral policy development remains largely untested. Methods: We conducted a retrospective qualitative case study examining the development of Grenada's Intersectoral Early Childhood Development (IECD) Strategy 2026–2030. Over 24 months, the process combined a desk review, 55 key-informant interviews, 34 focus groups, and eight parish-level consultations engaging over 400 participants, together with thematic and SWOT analysis, Theory of Change development, governance design, and costed implementation planning. Qualitative coding combined independent human coding with large-language-model-assisted comparison. M4C was not used prospectively to structure this process; rather, the completed process was examined afterward through the five M4C aspirations to assess convergence, tension, and implications for national-level application. Results: The process showed strong convergence with all five aspirations, particularly through iterative stakeholder engagement, cross-sector and geographic participation, and translation of evidence into a costed Theory of Change and governance architecture. However, national-level application also exposed limits not evident at program scale. Political favoritism and institutional turf-protection constrained interactivity even where formal governance structures existed. Dynamism depended on institutional capacity to sustain ongoing review and adaptation after external technical support ended. Inclusion required disaggregation fine enough to reveal sub-national inequity. Some politically sensitive priorities, once surfaced, proved harder to act on than to identify. Conclusion: M4C provides a useful analytic lens for national systems-building, but at this scale its aspirations depend on enabling conditions such as political neutrality, institutional continuity, data harmonization, and decision authority that program-level applications can more readily assume. We offer recommendations for policymakers and researchers applying M4C to national policy design elsewhere, particularly in other small island developing states.
SN - 2296-2565
ER -