Setting the record straight on measuring SDG 4.2.1 – Authors' reply
Authors: Bolajoko O Olusanya, Mijna Hadders-Algra, Cecilia Breinbauer, Andrew N Williams, Charles R J Newton, Adrian C Davis
Journal: The Lancet Global Health (2021)

We appreciate the attention of Mark Hereward from UNICEF to the concerns in our Comment published in The Lancet Global Health,1Olusanya BO Hadders-Algra M Breinbauer C et al.The conundrum of a global tool for early childhood development to monitor SDG indicator 4.2.1.Lancet Glob Health. 2021; 9: e586-e587Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar and wish to clarify some of the alleged omissions and errors. We, and members of the public, are not privy to the internal processes and procedures that have restricted the development of a tool that includes all children younger than 5 years as required by Sustainable Develop Goal (SDG) 4.2.1, and that the component relating to children younger than 24 months is now the sole responsibility of WHO. However, we wish to reaffirm the following facts that have not been refuted by UNICEF. First, as the sole custodian agency, UNICEF is fully accountable for SDG indicator 4.2.1.2UN Statistical Commission (UNSC)Tier classification for global SDG indicators as of 29 March 2021.https://unstats.un.org/sdgs/files/Tier%20Classification%20of%20SDG%20Indicators_29%20Mar%202021_web.pdfDate accessed: April 27, 2021Google Scholar Second, the development of a survey tool for child functioning from birth was commissioned by the UN in 2001 and no appropriate tool has so far been developed by UNICEF for children younger than 24 months.3Loeb M Cappa C Crialesi R de Palma E Measuring child functioning: the UNICEF/Washington Group module.Salud Publica Mex. 2017; 59: 485-487Crossref PubMed Scopus (16) Google Scholar Third, no indication exists as to when the required tool will be available for use. Fourth, SDG 4.2.1 has now been revised to exclude children younger than 24 months.2UN Statistical Commission (UNSC)Tier classification for global SDG indicators as of 29 March 2021.https://unstats.un.org/sdgs/files/Tier%20Classification%20of%20SDG%20Indicators_29%20Mar%202021_web.pdfDate accessed: April 27, 2021Google Scholar Fifth, no published evidence exists of any systematic effort to review all the available population-level survey tools before the monumental decision to amend the SDGs to exclude children younger than 24 months. To suggest that identification of children younger than 24 months with developmental delays is not possible in a survey tool or that individual-level tools and population-level tools are mutually exclusive is misleading. A widely embraced notion in global health, except for communicable diseases, is that where data are not available, there is no problem to warrant policy intervention. However, population-level data drive policy development and political support for investments in individual-level systems and tools for the early identification of children with developmental delays and disabilities. For instance, Chile has implemented an exemplary national early childhood development programme that is underpinned by successful developmental household surveys of children younger than 5 years since 2006.4Molina H Cordero M Palfrey J Bedregal P Arbour MC Chapter 26. Early child development: health equity from the start in Chile.in: Berman S Palfrey JS Bhutta Z Grange AO Global child health advocacy on the front lines. American Academy of Pediatrics, 2013: 285-296Crossref Google Scholar Additionally, the impression that the revised SDG 4.2.1 has been endorsed by the International Disability Alliance is erroneous. The joint statement issued in 2017 only referred to the disaggregation of SDG data by disability for all children and no reference whatsoever was made to children younger than 24 months.5International Disability AllianceJoint statement by the disability sector: disability data disaggregation.www.internationaldisabilityalliance.org/data-joint-statement-march2017Date accessed: April 27, 2021Google Scholar We are still deeply concerned about the collateral damage and far-reaching adverse consequences of the revised SDG 4.2.1 in the 6th year of the SDG because most of the affected families reside in sub-Saharan Africa and south Asia. We share the view that responding to this challenge requires collective action and thus renew the call on UNICEF to use their extensive network of partners and experts to attend to this task as a priority. We declare no competing interests. Setting the record straight on measuring SDG 4.2.1Although we appreciate the visibility the Comment by Bolajoko Olusanya and colleagues (May, 2021)1 has given to the monitoring of early childhood development, it contains serious errors and omissions about Sustainable Develop Goal (SDG) processes and requirements, including failing to draw distinctions among population-level measures, global monitoring, and child-level assessments. Clarifying the scope and limitations of measurement tools is crucial to strengthening data on early childhood development. Full-Text PDF Open AccessThe conundrum of a global tool for early childhood development to monitor SDG indicator 4.2.1The UN's Sustainable Development Goals (SDGs) agenda, by contrast to the Millennium Development Goals, provides a global policy framework to address the quality of life of beneficiaries of the remarkable reduction in mortality in those younger than 5 years since the child survival revolution began in 1982.1 The SDGs explicitly commit all governments and the global health community to actions that will “ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education”. Full-Text PDF Open Access