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RTI, in collaboration with USAID and other donors, has supported instructional improvement in primary schools, and particularly in reading instruction, in nearly a dozen countries. In the course of these experiences, RTI staff have often confronted the difficult question of when and how to begin integrating fluency and comprehension instruction into the reading curriculum. While researchers and practitioners in the US argue that explicit instruction in fluency and comprehension should begin on the first day of first grade, curricula around the world do not always lend themselves to this integration. In addition, across the global South, the teaching of foundational skills, such as understanding of the alphabetic principle and acquisition of phonetic awareness, is often underemphasized or misunderstood, and responding to these challenges can diminish the attention focused on fluency and comprehension practice. This presentation will draw on RTIs work in reading instruction to provide a conceptual schema for understanding reading skills acquisition and progression, situating the instruction of fluency and comprehension within that larger framework. Experiences in application of this framework to different country and language contexts will be reviewed, and impact evaluation data addressing the effectiveness of different strategies proposed for comprehension and fluency instruction according to context and learner type will be discussed. Overall, the presentation will suggest effective avenues for improving classroom practice and learning outcomes in fluency and comprehension, even in the most difficult of contexts.