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Smart investment in global childcare requires local solutions and a coordinated research agenda
  1. Alex Aliga1,2,
  2. Tefera Darge Delbiso3,
  3. Patricia Kitsao-Wekulo4,
  4. Monica Lambon-Quayefio5,
  5. Rachel Moussié6,
  6. Amber Peterman7,
  7. Natan Tilahun8
  1. 1Department of Economics, Muni University, Arua, Uganda
  2. 2Research Department, Ace Policy Research Institute, Kampala, Uganda
  3. 3Department of Public Health Nutrition and Dietetics, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
  4. 4Early Childhood Development Unit in the Human Development Theme, African Population and Health Research Center, Nairobi, Kenya
  5. 5Department of Economics, University of Ghana, Legon, Ghana
  6. 6Women in Informal Employment: Globalizing and Organizing, Port Louis, Mauritius
  7. 7Department of Public Policy, University of North Carolina, Chapel Hill, North Carolina, USA
  8. 8Programs Department, ChildFund Ethiopia, Addis Ababa, Ethiopia
  1. Correspondence to Dr Amber Peterman; amberpeterman{at}

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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.


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 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

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.


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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We thank Annet Abenakyo Mulema and Martha Melesse for helpful discussion and comments at the inception of this commentary. The ideas expressed in this commentary benefited from discussions and expertise of broader research teams at Ace Policy Research Institute, the African Population and Health Research Center, Addis Ababa University, ChildFund Ethiopia, Kidogo, the Institute of Policy Analysis and Research, Women in Informal Employment: Globalizing and Organizing and from participants at the GrOW midterm workshop held in Nairobi in October 2022.



  • Handling editor Seye Abimbola

  • Twitter @Monica_Lambon, @RMoussie, @a_peterman

  • Contributors AA, PK-W, AP and NT contributed to conceptualisation. TDD, PK-W, AP, RM and NT contributed to writing—original draft. All authors contributed to writing—reviewing and editing. Authors are listed in alphabetical order to denote equal contribution. All authors approved the final version.

  • Funding No explicit funding was received for this commentary. However, authors thank the GrOW East Africa, a multi-funder initiative, for providing open access fees associated with the publication of this commentary and for funding the evaluation portfolio on childcare, with which numerous authors are affiliated.

  • Competing interests The views expressed in this commentary are those of the authors alone and do not represent the views of their affiliated institutions. All authors report no conflicts of interest.

  • Provenance and peer review Not commissioned; externally peer reviewed.