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This chapter examines the costs and benefit-cost ratios of interventions that incorporate responsive stimulation to achieve better child outcomes in order to develop and cost an essential package of early child development (ECD) interventions appropriate across low- and middle-income countries (LMICs) that will complement health and nutritional interventions. Based on considerations of cost, subjective assessment of feasibility, and benefit-cost, recommendations include (1) group parenting programs covering all first-time parents (at a minimum) and all births (preferably) that remains integrated into the provision of health services or existing home visiting programs providing health services; and (2) preschool programs that help build children’s cognitive, social, and emotional school readiness. Codelivery of health, nutrition, and responsive stimulation programs can benefit child development and remain cost-effective, but evidence on cost and cost-effectiveness remains quite modest, relies heavily on a relatively few longitudinal studies of high-quality programs, and proves insufficient for low-income countries in Sub-Saharan Africa.

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