This is the old United Nations University website. Visit the new site at http://unu.edu
Abstract
Introduction
Situation analysis of the development status of children
Situation analysis of existing programmes
Project objectives
Project components, coverage, and costs
Monitoring and evaluation
Cross-cutting issues and implications for future programmes
Key challenges
References
Jayshree Balachander
The author is with the World Bank Resident Mission Philippines in Pasig City, Philippines.
The World Bank’s portfolio of early childhood development projects is large (more than US$600 million) and is rapidly growing as a result of a recognition that early childhood is a crucial phase of human development, and that integrated health, nutrition, and stimulation of young children can have substantial economic benefit. The current conceptual framework underlying the World Bank’s support for early childhood development is loosely defined as including all interventions directed at children or their caregivers to promote child development, preferably integrated as a package of health, nutrition, and early education services and targeted (but not exclusively) to the poorest households and including partnerships with other providers of such services. This paper analyses three World Bank-financed early childhood development projects in Kenya, India, and the Philippines and the issues arising from the design and approach to early childhood development in the projects. The key challenges for World Bank support to early childhood development are the following processes: developing a strong conceptual framework, delivering properly sequenced and truly integrated services at the level of the beneficiary, assuring that the poorest families are reached, providing adequate support to community-based workers, designing optimal, cost-effective interventions, measuring effectiveness, ensuring sustainability, and making partnerships work.
Since the 1980s, World Bank lending for health, education, nutrition, and other social services has increased dramatically and now averages about US$3 billion a year. About a third of the investment in the social sectors has been estimated to benefit children directly. In the 1990s, the Bank began focusing more particularly on human development [1]. This shift, together with demand from client countries, has led to a rapid expansion of Bank funding for projects promoting early childhood development. So far the Bank has lent about US$600 million for freestanding early childhood development projects, with the largest share (about 60%) going to four projects in India. Other early childhood development projects cover the Latin American Region (Bolivia, Colombia, and Mexico) and Africa (Kenya, Uganda, and Nigeria).
Early childhood development projects are recognized as a powerful economic investment. First, this period in the life cycle provides a window of opportunity to break the vicious intergenerational cycle of malnutrition and impaired educability for children from poor families. Second, research has established that the impact of insults suffered in early childhood (resulting in growth failure, for example) is often irreversible or is far more expensive to cure than to prevent. Third, the synergistic effects of health, nutrition, and early stimulation suggest that returns from investments in health, nutrition, and stimulation, as a package, will exceed returns from investments in any of the individual interventions.
The broad conceptual framework currently underlying the Bank’s support for early childhood development [2] maybe summarized as follows:
» Differences in cultural and economic environments make it impossible to prescribe any single programme model for early childhood development. Instead, the following types of intervention have been identified as appropriate in early childhood development programmes: direct provision of health, nutrition, and pre-school services for children; parenting education; training of caregivers; downward extension and reform of lower primary education; and advocacy for policy or legislative reform or information, education, and communication action (IEC) in favour of childrenThe application of the conceptual framework to three early childhood development projects in the Bank’s portfolio in Kenya, India, and the Philippines is discussed below. A brief description of each project, drawn from World Bank project documents [3-5], is provided, followed by an analysis of their application to the conceptual framework. Implications are then drawn for the conceptual framework itself and for future projects.» Although standard definitions of early childhood cover the period from birth to six years of age. Bank programmes have emphasized the importance of foetal development and the transition to primary school, effectively extending the appropriate age of intervention to before birth and beyond six years (usually up to eight years). Some programmes include interventions (e.g., iron supplementation) for adolescent girls as a more efficient means of affecting maternal health and nutrition.» Programmes should provide an integrated package of services addressing health, nutrition, and psycho-social needs for the holistic development of the child. However, the delivery of these services could be as a horizontally integrated package or organized vertically to reach the same target group, depending on the nature of the existing delivery mechanisms
.» Children from poor households need and benefit the most from early childhood development services. Direct provision of services needs to be targeted to the most vulnerable sections of the population. Advocacy and education efforts may be directed more broadly to the population at large
.» Partnerships among governments, non-governmental organizations, the private sector, and donor organizations are considered particularly important in promoting early childhood development, given the wide appeal, broad experience, and inherent interest of diverse groups in the subject.
Kenya
India
Philippines
The situation was assessed to be unsatisfactory in terms of the status and trends in the health, nutrition, and educability of children from birth to six years of age. About 34% of children in this age group were underweight, and the trend of decreasing malnutrition rates seen in the 1980s appeared to be reversing. Morbidity levels were extremely high, with an 80% prevalence of infection with worms and a 50% prevalence of anaemia (UNICEF, personal communication, 1995). The failure rate in primary education was high, with grade repetition rates of 13% in primary school and drop-out rates of 57% by grade 8.
Malnutrition was identified as the fundamental issue and a major constraint to child growth, health, and educability. About 30% of children were born with low birthweight and 50% were underweight by two years of age. At least 50% of pregnant women were anaemic.
Progress in the reduction of mortality and malnutrition, and in the improvement of primary school performance was unsatisfactory, particularly in comparison to the Philippines’ East Asian neighbours. Child mortality in the Philippines, for example, is twice as high as that in Thailand and is higher than in China, a low-income country. Around 30% of children are underweight, and primary school failure is high, with 32% of children dropping out of grade 4.
Kenya
India
Philippines
The demand for early child development services in Kenya resulted in the establishment of a large network of child development centres, mostly in rural areas, by parents of children who did not have access to privately owned nursery schools. About 19,000 centres covering approximately 1 million children (mostly in the three- to six-year age group) have been set up. The community was the most important partner in the development of the centres, taking responsibility for the provision of physical facilities, payment of salaries, organization of feeding programmes, and provision of learning and play materials. Some communities received financial and supervisory support from non-governmental organizations and the local government. In the 1970s the Government of Kenya stepped in to provide training support and supervision for the centres. In 1984 the National Center for Early Childhood Education (NACECE) was established at the Kenya Institute of Education. NACECE was responsible for the training of trainers, curriculum development, research, and coordination. District Centres (DICECE) were responsible for training teachers at the district level, inspection, community mobilization, and the evaluation of local programmes.
Despite some significant gains in enrolment and community initiative, there is wide variation in the type and quality of services provided by these centres. The government evaluated the centres, and the key issues were identified as follows: (1) Access to services was poor, particularly for the lowest-income groups. (2) Wide variations existed between centres in the level of physical facilities, trained personnel, supporting services, and activities. (3) There was a lack of both a policy and services for children up to three years of age, although children in this age group are increasingly using these centres and much developmental damage occurs during this period. (4) There was low public awareness of the importance of early childhood development. (5) The level of caregiver wages varied widely, and payments were irregular. (6) Monitoring and supervision were inadequate. (7) There were no linkages between pre-schools and primary schools. (8) The levels of funding were too low to allow efficient and effective programme implementation.
The ability and willingness of communities to finance and manage their pre-schools was identified as the critical factor affecting quality and sustainability. This is significant because child care costs households, on average, about US$10 per child per year. Studies of child-care costs in Kenya estimate that a minimum adequate package of child development services will cost US$20 per child per year. The Government of Kenya expenditure (based on a centre enrolment of 1 million children) works out to only US$0.50 per child. Corresponding investments at the primary, secondary, and university levels are US$17, US$168, and US$418 for households and US$38, US$107, and US$1,400 for the government [Meyers, personal communication]. Teacher qualifications, motivation, and supervision were other important factors.
The Government of India began implementing the Integrated Child Development Services Programme (ICDS) in 1974. This programme provides an integrated package of health, nutrition, and early education services to children up to six years of age from disadvantaged households. It currently covers 4,214 blocks or 37% of primary development units in the country, providing services to about 100 million individuals.
The services include monthly growth monitoring for children up to six years of age, supplementary feeding for children up to six years of age and pregnant or lactating women, immunization, health referral, pre-school education for children three to six years of age, and nutrition and health education for women 15 to 45 years of age.
The main shortcomings of the existing programme are identified below. First, overall government investment in the programme has been inadequate. In addition, ICDS has focused on quantity rather than quality, expanding rapidly in terms of geographical coverage while underfunding inputs, in particular the training of frontline service providers. The targeting of children up to three years of age has been particularly poor, and the coverage of the most vulnerable households in communities covered by the project has been inadequate. The programme is intended to actively involve beneficiaries and integrate the delivery of services. However, in practice, it has tended to be almost exclusively government owned and managed, with limited involvement of the public and the health and education bureaucracies. Finally, the programme has failed to replicate the successes of other early childhood development programmes of both the government and non-governmental organizations in the country, mainly because of rigidities in personnel and programming approaches.
A number of vertical programmes of the health, social welfare, and education departments provide services to promote early childhood development. These include child survival programmes of the Department of Health (immunization, diarrhoeal disease and respiratory infection control, and nutrition programmes), day-care and parent education programmes of the Department of Social Welfare and Development, and early education programmes of the Department of Education, Culture, and Sports.
The coverage of the child survival programmes, particularly immunization and micronutrient supplementation, is good. However, respiratory infections and diarrhoeal diseases are still leading causes of mortality and morbidity among children under five years of age. Nutrition programmes tend to focus on food distribution rather than growth promotion, and their coverage is inadequate. Moreover, these programmes face funding constraints for equipment and operating expenses.
The programmes of the Department of Social Welfare and Development have limited coverage. The Day-Care Centre programme mandates, by law, the establishment of at least one day-care centre in every barangay (village) to serve 60 children three to six years of age through two daily half-day classes of 30 children each. Not more than half of the country’s barangays currently have a day-care centre. Funds for training and equipment are limited. The Parent Effectiveness Service is intended to provide training for effective parenting to promote the cognitive development of children. The coverage of the programme is extremely low at present, and its impact is uncertain.
Kenya
India
Philippines
The objectives of the project are to improve child cognitive and psychosocial development, improve child health and nutrition, increase school entry and enrolment at the appropriate ages, and reduce repetition and drop-out rates in lower primary school.
The processes by which these are to be achieved include improving the quality of early childhood development services, mainly through the activities of frontline workers who are fully trained and supported, and by providing additional inputs such as health and nutrition; increasing the access and participation of the poor; improving family capacity for child care; and increasing community capacity to organize, manage, and finance early childhood development activities.
The overall objective of the project is to increase the quality, impact, and cost-effectiveness of the ICDS programme in five project states. The project seeks to achieve the following development objectives: to improve the nutrition, health, and psychosocial status of children up to six years of age, with particular emphasis on preventing malnutrition in children up to three years of age; and to improve the nutrition and health of women, particularly pregnant and lactating mothers.
The processes by which these objectives are to be achieved include improving child-care practices, i.e., meeting the nutritional, health, and psychosocial needs of children; empowering women and adolescent girls through increased awareness and improved social and economic status that will enable them to take better care of their own and their household’s health and nutrition needs; strengthening community capacity to participate in and monitor the progress of the ICDS programme; and strengthening the capacity at the central, state, and block levels to provide high-quality support and training to functionaries of the ICDS programme.
The project’s overall goal is to ensure survival and promote the physical and mental development of children, particularly from the most disadvantaged socio-economic groups. The core impact objectives include reducing child mortality and malnutrition and improving school readiness, including motor and cognitive skills. The process objectives include increasing the number of municipalities that implement early childhood development services, increasing the amount of investment in early childhood development by such municipalities, increasing access to early childhood development services, and establishing nutrition improvement programmes in 50% of the targeted municipalities.
Kenya
India
Philippines
The project covers about 1.5 million pre-school children in selected districts throughout Kenya. Districts were selected on the basis of a composite indicator that took into account the availability of early childhood development services, health and nutrition status, school enrolment, drop-out rates, and income. The project initially focused on upgrading the performance and management of about 20,000 existing early childhood development centres through teacher training and community capacity building. The second stage involved implementation of pilot interventions to improve the scope and coverage of early childhood development services.
The core components of the project are an improved Teacher Performance component (US$5 million) to provide initial, orientation, and refresher training for teachers, as well as mechanisms for support, and a Community Capacity Building and Mobilization component (US$3.5 million) to improve parenting skills and strengthen the organization, management, supervision, and quality control of early childhood development services and develop the communities’ capacity to mobilize and manage local resources, as well as monitor their utilization. The pilot components will include the following:
» community grants ($5 million) to assist community-managed early childhood development centres (constrained by low levels of funding) to pay for the salaries of pre-school teachers, school materials, and health and nutrition services; to subsidize fees for the poorest children; and to improve school facilities;A regular monitoring system as well as a mid-term and a final evaluation will be set up to evaluate the impact of early childhood development services and to assess the differential effects of diverse early childhood development packages and delivery systems on child outcomes. The total project cost (including contributions from the government, the World Bank, and other donors) is US$35 million.» health and nutrition services ($4.5 million), which would develop a replicable model, emphasizing prevention and promotion, to optimize the health and nutrition status of pre-school children at the community level;
» pre-school to primary school ($1 million) transition pilot programme, in those primary schools which have pre-schools attached, to provide continuity in both the curriculum and in teaching methodologies between pre-school and primary schools.
The project will cover 18 million children in the five states of Ultar Praden, Rajasthan, Maharashtra, Kerala, and Tamilnadu. The project will focus on improving the quality of services in 100,000 existing centres in the five states and in expanding ICDS into new blocks in each state. The project will also provide state-wide programme support for quality improvement; planning, training; management strengthening; information, education, and communication (IEC); monitoring; evaluation; and operations research. The total project cost, including the government’s contribution, is US$290 million.
The components of the project are described below.
Service delivery strengthening (US$199.4 million)
Service quality improvement (US$46.4 million). Four specific areas are to receive emphasis:
» Nutrition. Activities will include regular monitoring to detect malnutrition and promote growth; supplementary feeding to children up to six years of age (with particular emphasis on those up to three years of age) and pregnant and lactating women; semiannual vitamin A supplement to children aged nine months to six years and an iron folic acid supplement for at least 100 days to pregnant women and adolescent girls.Convergence of services (US$4.0 million) provided by different ministries and agencies on a sustained and predictable basis to increase the impact of early childhood development investments.» Health. Activities will include immunization against six childhood diseases to reduce infant and child mortality; provision of appropriate and timely health care to beneficiaries (including early registration and regular check-ups for pregnant women); use of disposable delivery kits for safe delivery; deworming and oral rehydration therapy; and referral of ill and at-risk pregnant women and children up to six years of age
» Early childhood care and education to promote the overall psychosocial development of the child. Activities will include pre-school education for children three to six years of age, early childhood stimulation for those up to three years of age, promotion of awareness of the importance of early childhood stimulation for all care providers, and opening of public nurseries in selected locations.
» Community mobilization for the involvement of the community in programme implementation and monitoring for long-term sustainability. Activities will include village social mapping and mobilizing resources and monitoring the child-care (Anganwadi) centres.
Women’s empowerment (US$12.5 million): economic empowerment of women and activities for adolescent girls, integrated with ICDS. Activities aimed at building self-reliance and awareness under this component include forming women’s groups, training and building capacities in thrift and credit activities, increasing access to institutional finance, income-generating activities, and convergence of different women’s empowerment activities sponsored by various departments.
Staffing and infrastructure development (US$136.5), including the staffing requirements of all components and construction of new facilities. Staffing activities will incorporate rationalization of the workload for the workers of the Anganwadi centres and better supervisor-worker ratios. Infrastructure development will involve construction of Anganwadi centres and offices and district offices.
Programme support (US$78.7 million)
Management and institutional development (US$13.4 million) to fund additional specialist staff in the areas of nutrition, training, communications, monitoring, and evaluation, who will be key to long-term quality improvement. Quality improvement teams are to be formed at the state, district, and block level with ICDS programme management.
Training (US$49.5 million). This would involve training of functionaries of both the new and old blocks, strengthening or establishing training centres and training teams at the state and district levels for the different categories of functionaries, developing training material, distance education for professional upgrading of ICDS functionaries, and networking with other departments and institutions for requisite training in additional areas.
Information, education, and communication (IEC) (US$10.4 million). IEC resource centres are to be established at the state and district levels for the development of communication strategies and IEC materials (with input from communities and ICDS functionaries).
Monitoring, evaluation, and operational research (US$5.4 million). Activities will include design of a Management Information System by the Government of India with flexibility for state-level innovations, streamlined to reduce the workload of the Anganwadi centres, and with data to be analysed and used as far as possible at the level at which it is generated. Baselines, mid-term reviews, and final surveys will be undertaken by pre-selected institutions with technical guidance, supervision, and quality control provided by a technical panel of experts. In addition, continuous social assessments will emphasize qualitative data collection on community perceptions, needs, and priorities for rapid assessment, analysis, and feedback to the community.
Central component (US$3.9 million)
A Central Project Management Unit (CPMU) will be established at the existing ICDS office at the centre and funding, will provide for overall project management, monitoring, and evaluation.
The project focuses on upgrading and extending existing early childhood development services (such as the child survival, day-care centre, and parent effectiveness programmes) and on piloting new initiatives (such as the new national protein-energy nutrition programme and the day-care mother programme). The project will cover about 2.7 million children in three regions of the Philippines and 169 targeted municipalities that include the greatest number of children at risk. The project consists of the following components:
Component 1: Early childhood development service delivery (US$34.9 million)
Subcomponent 1.A: Programme Support for Provincial Local Government Units (LGUs).
This subcomponent consists of five packages, comprising support for five programmes in all provinces in the three project regions. These are the Expanded Programme of Immunization (EPI), the Integrated Management of Child Illness (IMCI) Programme, the Micronutrient Malnutrition Control Programme, the Parent Effectiveness Service (PES) Programme, and the Grade 1 Early Child Experience/Early Child Development (ECE/ECD) Programme.
Subcomponent 1.B: Financing Facility for Municipal/ City Local Government Unit (LGU) early childhood development sub-projects.
This financing facility, which will operate through the Municipal Development Fund (MDF), will provide matching funds on a flexible cost-sharing basis geared to LGU income levels for LGUs who wish to invest in upgrading their early childhood development services. With technical support from the project, LGUs will submit proposals for three-year investment packages for appraisal and implement them once approved.
The investment packages will need to supplement or upgrade barangay-level early childhood development service providers, including rural health midwives (RHMs), day-care workers (DCWs), day-care mothers (DCMs), barangay health workers (BHWs), and child development workers (CDWs). Facilities, equipment, and supplies such as drugs, food supplements, teaching materials, and IEC materials will also be provided to achieve specified service norms. The team will provide a set of integrated early childhood development services, consisting of child health services (including micronutrient supplementation), a programme to control protein-energy malnutrition, parent effectiveness services to promote psychosocial stimulation for children under three years of age, day-care centre early education, and day care for children of working mothers.
Component 2: Support to service delivery (US$12.3 million)
This component will provide support to LGUs in implementing their investment packages in the areas of communication (advocacy, information, education, and communication for LGU executives, opinion leaders, decision makers, early childhood development providers, and parents), planning, management information systems (MISs), training and human resource development, and institutional development. Support will be provided at the central, regional, provincial, and municipal levels. This subcomponent will be managed by the Department of Social Welfare and Development (DSWD) in coordination with a mix of agencies, including non-governmental organizations, as appropriate.
Component 3: Research and development (base cost US$3.6 million)
This component will finance research and development activities needed to support effective implementation of early childhood development programmes and projects, including initial piloting of new field-level technical interventions proposed under the project. There will be three subcomponents: piloting of project interventions, unprogrammed financing for research and testing of new and innovative approaches to early childhood development services, and monitoring and evaluation of the effectiveness and impact of the project, including baseline and end-project evaluation surveys.
It is too soon to assess the performance of these projects. However, each project operates in an environment of identified strengths, recognized weaknesses (proposed to be addressed by the project), and inherent risks.
In Kenya community ownership of early childhood development centres, an effective teacher training methodology, and institutional capacity nurtured for decades by the Van Leer and Aga Khan Foundations and UNICEF were valuable pre-project strengths. The project was intended to expand the teacher training programme, empower poor communities and households, and add new dimensions such as health and nutrition to the existing cognitive development programme.
In India the government has clearly articulated a vision of an integrated early childhood development programme and had succeeded in creating a large infrastructure for the delivery of services. The project seeks to renew emphasis on the nutrition component, promote the convergence of health and stimulation services, and improve women’s capacity and community participation. The risks include overly ambitious workloads for poorly paid front-line workers and bureaucratization of social services.
The Philippines has the advantage of being a middle-income country with heightened literacy and a social-service infrastructure largely in place. However, the quality and coverage of the services are still far from adequate, particularly in the least well-off areas. The project seeks to fill this gap. The risks include a poor record in the implementation of projects in the social sectors and limited strategies for integrated service delivery at the level of the beneficiary.
Table 1 summarizes the core monitoring indicators identified by each of the projects. Each project includes a baseline, mid-term, and end-of-project evaluation to measure project impact.
Building on home-grown early childhood development models
Targeting the poorest
Delivery of an integrated package of services
Partnerships
Monitoring and evaluation
All three projects focus on improving the efficiency and effectiveness of existing early childhood development programmes rather than creating new ones. In Kenya the National Center for Early Childhood Education has, with external assistance, promoted community-owned pre-schools for over 20 years. In India the ICDS, conceived as an integrated early childhood development model, has been in operation since 1973. The health and other programmes selected for strengthening in the Philippines have likewise existed for several years. Although the projects have focused on improving basic delivery systems, innovation has been important. In Kenya the delivery of health and nutrition services, the transfer of funds to community-managed schools for early childhood development services, and efforts to smooth the transition from pre-school to primary school by reorienting first-grade teachers are three new pilot initiatives. In India promoting convergence and introducing activities for the empowerment of women and adolescent girls are new dimensions to the existing programme. In the Philippines a home-based day-care programme is being introduced for the first time. World Bank support is intended to increase the levels of investment in what are largely underfunded initiatives, promote the holistic model for early childhood development, and transfer technology from successful experiences in other parts of the world.
An issue that arises for future donor involvement is what would be an appropriate approach in countries that have no community-based delivery systems on which to build such projects. In many cases, the delivery systems that do exist (e.g., for health services) may be so weak and overburdened already that it would be unrealistic or counterproductive to add responsibilities to existing staff.
A second issue that arises from this approach is whether the projects promote an optimal mix of services. Within the three technical areas of child health, nutrition, and stimulation, there is growing consensus in the research findings about appropriate intervention packages. For example, IMCI is a major effort to define this package for child health and to move beyond a facility-based to a community-based intervention. Promoting maternal nutritional status, breastfeeding, growth promotion up to 24 months of age, and micronutrient supplementation up to six years of age are recognized as a standard package of nutrition services. Stimulation techniques for children up to three years of age, particularly as part of traditional caring and feeding practices, and scaffolding techniques for stimulating cognitive development are well developed.
TABLE 1. Outcome and process indicators
|
Country |
Outcome indicators |
Process indicators |
|
Kenya |
Motor & cognitive skills |
Enrolment for poorest-income quartile |
|
India |
Malnutrition rates, 0-3 yr |
Coverage of children 0-6 yr & women by health &
nutrition services, e.g.: |
|
Philippines |
Under-5 mortality |
» children fully immunized |
All the projects provide key health, nutrition, and stimulation inputs (see table 2). However, in practice, projects place different levels of emphasis on each of these areas. The emphasis is usually driven by perceived priority needs or the absorptive capacity of existing delivery mechanisms. For example, in Kenya the major investment is in psychosocial and cognitive development, because parents have already identified this as a priority, and the existing delivery system exists solely for that purpose. In India the investment is largely geared towards improving the nutrition component, primarily because it is considered a high priority in the Indian context, but also because the ICDS delivery mechanism was primarily intended for nutrition services and separate health and delivery networks are in place. In the Philippines most of the allocated expenditures are for health services, although local governments could skew investments in favour of nutrition or day care through the LGU packages. It would be useful to develop a conceptual framework identifying the relative weights required for the different types of interventions and reasonable unit costs of each.
Poverty alleviation is one of the objectives of World Bank involvement in early childhood development, and early childhood development services have been shown in much of the research to have the greatest impact on children from the poorest households.
The Kenya and Philippines projects adopted geographical targeting, selecting, on the basis of composite income and other criteria, the most backward districts for project implementation. For some components, such as nutrition supplementation, growth monitoring is used as a screening mechanism. Beneficiaries are also thought to self-select, largely because the poor quality of publicly funded facilities meant that anyone who could afford to pay for private services did so.
TABLE 2. Early child development projects: Key inputs
|
Project |
Kenya |
India |
Philippines |
|
Maternal health & nutrition |
None |
Supplementary feeding for pregnant & lactating women, iron
folk acid tablets, antenatal care |
None |
|
Children 0-3 yr |
|
|
|
|
Health |
Immunization Prevention & treatment of common childhood
illnesses |
Immunization |
Integrated management of childhood illnesses (immunization,
control of acute respiratory & diarrhoeal diseases) |
|
Nutrition |
Breastfeeding promotion |
Monthly growth monitoring |
Monthly growth monitoring |
|
Psychosocial/ stimulation |
Training of parents & care providers |
Training of care providers |
Training of parents & care providers |
|
Children 3-6 yr |
Pre-school |
Pre-school |
Pre-school |
|
Other features |
Community owned & managed early child development
centres |
Convergence improvement strategies |
Day-care mothers (home) |
The Kenya project attempted to target the poorest by providing scholarships through community-managed schools. In India several targeting strategies, such as locating schools in hamlets dominated by the weaker castes, selecting workers from these castes, and identifying families at risk during household surveys and targeting services to them, have been proposed. Overall, however, it is not clear that the projects will effectively reach the poorest. In developing-country situations, where income can rarely be used as a screening criterion for participation in public services, it is necessary to develop effective targeting strategies to ensure the participation of the most vulnerable households.
All three projects work within an integrated package framework, in that they recognize the need for interventions covering nutrition and psychosocial and cognitive development. The Kenyan and Indian models attempt to achieve integration through the early childhood development centre, which becomes the focal point for the delivery of all three services. Both projects also have a primary early childhood development worker who receives training in all three areas, although she is dependent on the health worker to deliver certain health inputs, such as immunization. In the Philippines project, separate workers are responsible for health, nutrition, and stimulation activities, although there is an attempt to achieve coordination in the context of a decentralized management of social services.
In practice, integration has been an area of identified weaknesses in these projects. The Kenya project has tried to ensure the successful integration of health and nutrition services by involving non-governmental organizations in service delivery. Non-governmental organizations are given the option of using any service delivery mechanism that works, including collaboration with the public health service delivery system, and of purchasing necessary supplies. In most countries, however, non-governmental organization coverage is not extensive. The India project has spelled out a variety of mechanisms to promote the convergence of services at the early childhood development centre, including joint planning, training, and supervision by health and ICDS workers. These measures are likely to have some positive impact, but the inertia of two large and strictly vertical bureaucratic delivery systems cannot be underestimated. The early childhood development centre as the focal point for service delivery still offers the greatest promise, but coverage of vulnerable children via centre-based programmes must first be improved through effective targeting mechanisms.
In the Kenya project, the World Bank collaborated effectively with non-governmental organizations and foundations, helping to maintain the non-bureaucratic approach that characterized early childhood development efforts in Kenya from the beginning. In the India and Philippines projects, the Bank collaborated extensively with UNICEF, particularly for technical assistance during project preparation. The Philippines project is also jointly funded by the Asian Development Bank.
The Human Development Department of the World Bank has initiated a global partnership effort in early childhood development. In April 1996, a conference entitled “Early Childhood Development: Investing in the Future” was held for early childhood development researchers and practitioners. Subsequently, the Bank organized two regional seminars, one in Africa and one in Latin America, to articulate region-specific issues and strategies. A similar meeting has been proposed for the Asian region. Early childhood development offers great promise as an area for cooperation among not only government donors and non-governmental organizations, but also with the private sector. There is obviously great scope for sharing of information and collaborating in the delivery of services.
As the portfolio of early childhood development projects supported by the World Bank grows, extensive data are being collected on the effects of early childhood development interventions. The age of enrolment in primary school, indicators of school readiness (a combination of health, nutrition, and cognitive indicators), and grade progression and performance in early primary school are generally cited as key outcome indicators. The Bank’s research department will be undertaking an evaluation of the impact and cost-effectiveness of a small sample of early childhood development projects in the portfolio. The proposal identifies several limitations in such a study (difficulty in randomly assigning individuals to treatments, unobserved family and community characteristics, etc.), and researchers have cautioned that outcomes from such evaluations could exaggerate the role of early childhood development interventions and lead to simplistic models of child development. However, the results of such an evaluation, substantiated by other research findings, could help to define better the essential elements of cost-effective early childhood development programmes.
The key challenges for early childhood development programme design may be summarized as follows:
» developing a strong conceptual framework (what inputs are critical, at what stage, in what sequence, of what quality and intensity, for what outcomes?);» delivering properly sequenced and truly integrated services at the level of the client (what integrating mechanisms? e.g., centre-based child development worker, joint training, fixed-day service, joint planning, supervision, monitoring, record keeping?);
» assuring that the poorest families who need the services the most are reached (what outreach or targeting strategies, demand-side mechanisms?);
» adequately supporting community-based workers to orchestrate a complex sequence of inputs for a large number of clients with limited measures (what skills, salary, training, and supervision?);
» designing optimal cost-effective interventions (what are the trade-offs among quality, cost, and impact?);
» measurement issues (what, how, and when?);
» sustainability (do governments sustain interventions? can interventions overcome serious environmental handicaps? what is needed to sustain impact over subsequent phases of human development?);
» making partnerships work (common framework, common jargon, same advice!).
1. World Bank. World development report. Oxford: Oxford University Press, 1990.
2. Young ME, ed. Early childhood development: investing in our children’s future. Amsterdam: Elsevier, 1997.
3. World Bank, East Africa Department, Human Resources Development Division. Staff Appraisal Report, Kenya Early Childhood Development Project. Washington, DC: World Bank, 1996.
4. World Bank, East Asia Department, Health Sector Unit. Project Appraisal Document, Philippines Early Childhood Development Project. Washington, DC: World Bank, 1998.
5. World Bank. Project Appraisal Document, India Women and Child Development Project. Washington, DC: World Bank,1998.
