A Governance-Oriented Municipal Index for Monitoring Early Childhood Policies in Brazil
1
Health Management, State University of Ceara, Fortaleza, Brazil
2
Business Administration, State University of Ceara, Fortaleza, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Effective early childhood policies require coordinated action across health, nutrition, education, and social protection systems, supported by transparent governance and accountability mechanisms. In Brazil, municipal governments play a central role in policy implementation, yet comparable tools to monitor the performance of early childhood policies remain limited. To address this gap, a multidisciplinary research group developed an early childhood index, a composite indicator designed to support public health governance, policy evaluation, and institutional oversight, aligned with the Nurturing Care Framework.¹
METHODS:
The index was constructed using secondary data from official national information systems for all municipalities in the state of Ceará. Twelve indicators were selected across four policy sectors: health, nutrition, social assistance, and education and were organized along three analytical axes: coverage, quality, and outcomes. Variables were standardized using z-scores and aggregated into sectoral and process indices, then min–max normalized to ensure comparability across municipalities and over time. Indicator selection and aggregation were informed by empirical evidence on the effects of primary healthcare, maternal care, nutrition, and social protection on child health and development.²⁻⁶
RESULTS:
The results of this early childhood index revealed substantial intermunicipal disparities in the implementation of early childhood policies, particularly in primary healthcare coverage, prenatal care, nutritional surveillance, and access to early childhood education. The index structure enables disaggregated analysis by sector and policy process, thereby supporting the identification of governance gaps, territorial inequalities, and public investment priorities. Its design also allows integration with fiscal and expenditure analyses, strengthening its use in policy monitoring and audit processes.
CONCLUSIONS:
Therefore, it provides a governance-oriented tool for municipal public health management and policy evaluation. By translating multidimensional early childhood policies into a transparent and comparable metric, the index enhances decision-making capacity, supports accountability, and contributes to evidence-informed public action in decentralized health and social policy systems.¹⁻⁷
Effective early childhood policies require coordinated action across health, nutrition, education, and social protection systems, supported by transparent governance and accountability mechanisms. In Brazil, municipal governments play a central role in policy implementation, yet comparable tools to monitor the performance of early childhood policies remain limited. To address this gap, a multidisciplinary research group developed an early childhood index, a composite indicator designed to support public health governance, policy evaluation, and institutional oversight, aligned with the Nurturing Care Framework.¹
METHODS:
The index was constructed using secondary data from official national information systems for all municipalities in the state of Ceará. Twelve indicators were selected across four policy sectors: health, nutrition, social assistance, and education and were organized along three analytical axes: coverage, quality, and outcomes. Variables were standardized using z-scores and aggregated into sectoral and process indices, then min–max normalized to ensure comparability across municipalities and over time. Indicator selection and aggregation were informed by empirical evidence on the effects of primary healthcare, maternal care, nutrition, and social protection on child health and development.²⁻⁶
RESULTS:
The results of this early childhood index revealed substantial intermunicipal disparities in the implementation of early childhood policies, particularly in primary healthcare coverage, prenatal care, nutritional surveillance, and access to early childhood education. The index structure enables disaggregated analysis by sector and policy process, thereby supporting the identification of governance gaps, territorial inequalities, and public investment priorities. Its design also allows integration with fiscal and expenditure analyses, strengthening its use in policy monitoring and audit processes.
CONCLUSIONS:
Therefore, it provides a governance-oriented tool for municipal public health management and policy evaluation. By translating multidimensional early childhood policies into a transparent and comparable metric, the index enhances decision-making capacity, supports accountability, and contributes to evidence-informed public action in decentralized health and social policy systems.¹⁻⁷
| eISSN: | 2654-1459 |
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