Transitioning to a Flexible, Tiered, Developmentally Informed Same‐Day Screening Model for Preschoolers in Low‐Resource Settings

BACKGROUND: The preschool years (ages 3-5) represent a critical window for promoting development and lifelong health. However, in many low-resource settings, developmental delays, sensory impairments and emerging health risks often go undetected. Although early, integrated screening improves outcomes, early childhood care and education (ECCE) platforms in low- and middle-income countries (LMICs) are underutilized for delivering preventive services. Implementation is hindered by limited resources, poor intersectoral coordination, logistical constraints and low caregiver engagement. This study describes the iterative refinement of an initial screening protocol into a proposed flexible, tiered screening model, embedded within a guiding framework tailored to ECCE settings in LMICs. METHODS: An observational, descriptive study was conducted in low-resource urban, peri-urban and rural communities in a central South African province to collect baseline data on preschoolers' development, sensory functioning (vision and hearing), nutrition and health (including blood pressure). The initial multi-indicator protocol was implemented and refined using a Participatory Action Learning and Action Research (PALAR) approach. Feedback from caregivers, ECCE facilitators, interpreters, student fieldworkers and healthcare professionals guided adaptations. RESULTS: Stakeholders identified key barriers, including fragmented caregiver-child scheduling, long assessment sessions, limited interpreter resources, caregiver disengagement and difficulty engaging children with developmental and behavioural challenges. In response, a proposed model was developed to consolidate visits, reduce session duration, enhance interpreter support and streamline screening tools. The flexible, tiered structure of this proposed model allows assessors to tailor screening based on observed functional capacity, improving feasibility, accuracy and cultural responsiveness. It supports scalable application across similar low-resource ECCE contexts. CONCLUSIONS: This developmentally informed, proposed screening model, operating within a flexible framework, offers a context-sensitive, scalable approach to improving early identification and referral in LMIC ECCE settings. Its adaptable structure supports broader implementation, enhances alignment with children's developmental needs and informs future policy and integrated service planning.