INNOVATIVE APPROACHES TO IMPROVE EARLY CHILDHOOD DEVELOPMENT (0-3 YEARS) Robert Scherpbier & Margo O'Sullivan Chief of Health, Nutrition & WASH Chief of Education & Child Development UNICEF China Office
Presentation Outline Early Childhood Development (ECD) Global situation and evidence UNICEF China s innovative Integrated ECD 0-3 approach Future: SDGs
200 million children under age 5 (>15 million in China) do not reach their full development potential China ranks 3rd Source: Grantham-McGregor, S., et al. (2007). Lancet. 369:60-70.
Key brain functions develop before age 2 and synaps formation depends on experience Hearing and sight ------- 3-4 months (peak at 3.5 mo) Language 6 months-2 yrs (peak at 9 mo) Resolving problems 7 months-10 yrs (peak at 1.5 yrs)
Early stimulation and nutrition supplementation have similar and additive effects Source: S Grantham-McGregor et al. Lancet 1991; 338 (8758):1-5
Child maltreatment, bad hygiene, illness and poverty cause toxic stress and affect brain development Impairment of brain functioning = reduction in human capacity Excessive and repeated stress causes the release of chemicals that impair cell growth and interfere with the formation of healthy neural circuits in the brain Toxic stress can damage the brain s stress response system and contribute to premature ageing of the body
Early childhood development has five sets of determinants/risk factors 1. Maternal & child nutrition - brain s building blocks
Early childhood development has five sets of determinants/risk factors 2. Early stimulation enhances synaps formation 8
Early childhood development has five sets of determinants/risk factors 3. Child protection stress toxins if ignored RON/ZHOU YE PLEASE INSERT RELEVANT PICTURE(S) IF NOT GOOD 9
Early childhood development has five sets of determinants/risk factors 4. Hygiene, sanitation and health toxins if ignored 10
Early childhood development has five sets of determinants/risk factors 5. Family socio-economic status - toxic stress if poor 11
The more risk factors children face, the more delays will occur in their development 12
Presentation Outline Early Childhood Development (ECD) Global situation and evidence UNICEF China s innovative Integrated ECD 0-3 approach Future: SDGs
UNICEF China s innovative approach to ECD 0-3 builds on globally identified success factors Focuses on whole child, i.e. her progression in physical, social, emotional, cognitive and language domains Focuses on first 1000 days, i.e. from pregnancy to age 2 Focuses on China s most disadvantaged children Jointly engages parents and children
UNICEF China s innovative approach to ECD 0-3 builds on globally identified success factors Engages all stakeholders, especially government Explores and combines different service models to support family to reach children s full potential Uses the same tools in all project sites Where possible promotes a multi-sectoral approach Ensures rigorous monitoring and evaluation 15
Community based complementary delivery models to improve ECD in children 0-3 years of age Establish ECD Centres in rural and urban communities Establish home based play groups through outreach Provide integrated services supported by Mobile Resource Units 16
Integrated Early Childhood Development (IECD) for children 0-3 years in China s poverty battle fields Fenxi and Lin Counties in Shanxi province Songtao county in Guizhou province Liping county in Guizhou province 17
Integrated Early Childhood Development (IECD): a demonstration project in 4 poverty counties Integrates services: health services, home visits, home-based playgroups, ECD centres, child protection and social services are combined to support families to reach children s full potential Uses Mobile Resource Units to bring expertise to villages 18
Integrated Early Childhood Development (IECD): a demonstration project in 4 poverty counties Uses a multi-sectoral appr. National Health & Family Planning Commission Ministry of Civil Affairs China National Children s Council (CNCC) All China Women s Federation State Council Leading Group Office on Poverty Alleviation and Dev. UNICEF China
IECD 0-3 baseline survey findings: 40% of rural children U3 have suspected development delays at least in one domain Most children face multiple risk factors: 78% of children <6 mo are not exclusively breastfed 96% of children do not get minimal acceptable diet 71% of households do not have at least 3 picture books 45% of household do not have at least 2 toys 62% of caretakers performed violent discipline 93% of households do not have sanitary latrine 50% of children are left behind 60% of households are below the poverty line Source: UNICEF IECD survey, PKU and HNWASH, 2013
Service providers and their roles All village providers Adequate nutrition Early stimulation Protective, safe and caring environments Screening to assess dev t risks Referral to specialist providers Specialist providers Early detection, referral and interventions for children with suspected developmental delay Support of children at risk of violence, abuse or family issues Social assistance for the economically poorest Village health workers Assessment of developmental milestones Psychosocial support for depressed parents Routine health services 21
Role of Mobile Resource Unit (MRU) Technical training Verification and Referral On-site technical support Data collection MRU Link resources for special cases
Health Centre services: ECD services complement routine health care Counsel for appropriate infant feeding Monitor growth Detect and treat anaemia Asses dev t milestones Identify children at risk Psychosocial support Refer when needed 23
Social worker services: Identify child protection risks, follow up, refer 1 Social Worker at county level covering 20 villages Home visits, family support and referral - Home visits conducted by Social Worker to assess family situation and develop plan depending on the situation and/or refer children to other MRU service providers - Village-based providers (village health worker, Women s cadres) refer children with protection risks and child welfare needs to Social Worker for follow up visits and further action depending on the issue - Social Worker works with county Civil Affairs Bureau to help families apply for hukou registration and social assistance schemes to which they are entitled - The village conference attended by service providers and village leaders discusses the identified cases for further planning and support - Social Worker provides support and advice to parents on child protection, child welfare policies, positive discipline, etc. 24
Social worker services: Identify child protection risks, follow up, refer Capacity development three types: Training of social workers in MRU to improve their professional skills Awareness raising of service providers to identify and report potential child protection/welfare cases to the social worker Training of parents and other caregivers on child protection, child welfare policies, positive discipline, etc. 25
ECD centres: Early Stimulation for children 0-3 years Volunteer led parent-child games, story book reading to enable the parent to learn and play at home with children Parent classes Focus group discussion Story book borrowing Parent-child free play Identify/refer child neglect/abuse to social worker
Home-based: Early Stimulation for children 0-3 years In villages that cannot provide ECD centre space, home-based play groups are set up: 5-6 families in a group Two times per week Liping county Dazhai Village Home-based activities in Daidong village of Panshi Town, Songtao County of Guizhou province, May 2015
Specialised capacity building: the example of Early Stimulation Workers Devise training materials and programme Training programme for volunteers Ongoing support by ECD expert in MRU ECD centre manual 29
Integrated capacity building: bringing together different service providers Modules in the Training Resource Package for community volunteers and women s cadre Understanding the basic principles of CRC and child protection Understanding the importance of early childhood development Setting up and managing a community ECD center Home visits and working with parents Organizing and managing parent-child activities Organizing and managing a parentchild story reading Basic knowledge on communication for development Using house materials to make toys and play with children On-site real time practice training Conducting parent classes Conducting community activities to promote the utilization of ECD services Around 350 ES volunteers and community women s cadre completed the training module 30
ECD 0-3 tools for all service providers 31
ECD 0-3 tools for all service providers Child care for development Parents Booklet 32
ECD 0-3 tools for all service providers 33
ECD 0-3 tools for Health Workers Monitoring child dev t Counselling cards 34
ECD 0-3 tools for Early Stimulation 12 Story Books Puppets Puzzles Reading together ECD training manuals
ECD 0-3 tools for Social Workers Insert pictures of tools, even if only checklists 36
Early impact of IECD project Increased government commitment to IECD IECD project welcomed and acknowledged by the local government and communities Project-developed IECD counseling cards and Parents Booklet adopted by NHFPC for national scale up Improved IECD service coverage in project counties Improved knowledge and capacity of service providers on providing IECD services
Early impact of IECD project Improved caregivers awareness, understanding and practices for nutrition, early stimulation and child protection Increasing attention to children s social, emotional and psychological development, in addition to physical development which traditionally receives attention 38
Early impact of IECD project An estimated 4,000 children under 3 years of age are in the 80 project villages Village doctors provided micronutrient supplements (Ying Yan Bao) to 1,709 children age 6-24 months, increasing the coverage from 30% at baseline to 70% in 2015 Village doctors conducted growth monitoring 5,564 times 29,459 early stimulation interactions were facilitated between children with their parents Social workers and volunteers conducted 1,364 home visits, and provided 256 training sessions to rural families and caregivers MRU provided ECD services 4,852 times, and assisted in follow up and referral services 2,648 times (55%) 39
CONCLUSIONS Over 200 million children globally do not reach their development potential: 16 million (8%) live in China Maternal & child nutrition; early stimulation; child protection; hygiene, sanitation, child health; and family wealth are key determinants for early childhood development Building brains starts early. Returns on investment are largest before age 3, thus a focus on ECD is needed 40
CONCLUSIONS Some risk factors cannot be corrected after age 2. Accumulation of risk factors leads to development delays, thus an integrated approach is needed Parents are key to early childhood development All stakeholders need to work together for ECD, and a multi-sectoral approach is key to addressing all risk factors Investing in ECD is good for children and the economy 41
Presentation Outline Early Childhood Development (ECD) Global situation and evidence UNICEF China s innovative Integrated ECD 0-3 approach Future: SDGs
Towards SDGs: empower the future early Investing in ECD improves individuals and societies economic productivity, and reduces inequalities Investing in Integrated ECD helps to achieve SDGs: SDG 1 (end poverty), target 1.3: % children receiving a child or social grant SDG 2 (end malnutrition), target 2.1 and 2.2: % children exclusively breastfed, stunting prevalence, anaemia prevalence in WRA SDG 3 (healthy lives and wellbeing) target 3.8: coverage of tracer interventions (immunization, pneumonia & diarrhea care)
Towards SDGs: empower the future early SDG 4 (quality education) target 4.2: % children U5 who are developmentally on track in health, learning and psychosocial wellbeing SDG 6 (water and sanitation) target 6.1 & 6.2: % health care facilities with basic water, sanitation and hygiene; population with handwashing facility in household, % population using basic sanitation facilities SDG 16 (peaceful society) target 16.2: % children aged 1-14 years experiencing any physical punishment in the last month Investment in ECD is the child s right to life, survival, and development
Special thank you to Porsche 45
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