From silos to systems: a retrospective application of the measurement for change (M4C) framework to Grenada's intersectoral early childhood development strategy

Background Public health systems are often organized around single-sector mandates even when population needs span multiple sectors. Measurement for Change (M4C) was developed within early childhood development (ECD) to position monitoring, evaluation, and learning as a continuous process of adaptation, organized around five aspirations: Dynamic, Inclusive, Informative, Interactive, and People-centered. Whether these aspirations usefully describe national, intersectoral policy development remains largely untested. Methods We conducted a retrospective qualitative case study examining the development of Grenada's Intersectoral Early Childhood Development (IECD) Strategy 2026–2030. Over 24 months, the process combined a desk review, 55 key-informant interviews, 34 focus groups, and eight parish-level consultations engaging over 400 participants, together with thematic and SWOT analysis, Theory of Change development, governance design, and costed implementation planning. Qualitative coding combined independent human coding with large-language-model-assisted comparison. M4C was not used prospectively to structure this process; rather, the completed process was examined afterward through the five M4C aspirations to assess convergence, tension, and implications for national-level application. Results The process showed strong convergence with all five aspirations, particularly through iterative stakeholder engagement, cross-sector and geographic participation, and translation of evidence into a costed Theory of Change and governance architecture. However, national-level application also exposed limits not evident at program scale. Political favoritism and institutional turf-protection constrained interactivity even where formal governance structures existed. Dynamism depended on institutional capacity to sustain ongoing review and adaptation after external technical support ended. Inclusion required disaggregation fine enough to reveal sub-national inequity. Some politically sensitive priorities, once surfaced, proved harder to act on than to identify. Conclusion M4C provides a useful analytic lens for national systems-building, but at this scale its aspirations depend on enabling conditions such as political neutrality, institutional continuity, data harmonization, and decision authority that program-level applications can more readily assume. We offer recommendations for policymakers and researchers applying M4C to national policy design elsewhere, particularly in other small island developing states.