The South African National Integrated Early Childhood Development

Policy was approved by the South African Cabinet in 2015. Given

capacity and financial constraints, all services outlined cannot be

implemented in a single step. Priorities must be set. We examine

the budget implications (total cost and cost per child) and benefits of

the four largest components of the Policy: interventions to improve

pregnancy outcomes; home visits for at-risk mothers of children

under 2 years of age; community-based playgroups for mothers

and children, and center-based early childhood development services.

Further, we identify which services are based on the strongest

evidence, the value-based trade-offs that characterise the prioritising

decisions, and which logistical factors favour alternative orderings of

services. The interventions to improve pregnancy outcomes are low

cost, based on sound evidence and would make use of the established

healthcare infrastructure. Home visits for at-risk mothers are

associated with improved development for targeted children and

consequential benefits for caregivers and broader society.

Playgroups are a promising low-cost intervention, but further evidence

is required to determine their effectiveness. Centre-based

services are expensive and generate smaller developmental returns,

but provide childcare. The results highlight the value judgements

required to determine the appropriate sequencing of interventions.

Priority setting in the roll out of South Africa s National Integrated ECD Policy