Early Childhood Development: Global Priorities and National Development Early Childhood Development for nation building in Jamaica: Retrospective and Prospective, March 25-26, 2013 Susan Walker, PhD Child Development Research Group
Why focus on early childhood? Brain development involves interactions of genetic, biological, and psychosocial influences and is most rapid and vulnerable from conception to 5 years Biological and psychosocial risks can lead to deficits in brain structure and function, and in cognitive and social emotional development Interventions can have lasting benefits and are more cost effective than at other ages
Development of inequality Walker et al, 2011
Language scores by country and quintile 1.00SD 0.57SD 0.77SD 1.53SD Engle et al, 2011
Numbers of children affected Poverty and chronic undernutrition (defined by low height for age stunting) are well established risks for poor development with global information routinely collected From this information is was estimated that over 200 million children under 5years in low and middle income countries do not reach their developmental potential Likely an underestimate as other risks to development not considered Grantham-McGregor et al, 2007
Early cognitive ability and behaviour influences school success Country Age in years Later outcome Initial Final Philippines 8 15-16 Grade retention Jamaica 7 17-18 Drop out School achievement Brazil 4.5 18 Grade attainment Guatemala 3-7 13-23 School achievement Secondary school entry (Adapted from Grantham-McGregor et al, 2007)
Goal of investing in young children Children have healthy growth and achieve their cognitive and social-emotional potential Able to benefit from later educational opportunities Successful, productive adults, good parents Benefits for national development
Sectors influencing young child development Nutrition Maternal nutrition & IUGR Stunting Micronutrients Health Access to & quality of MCH services Safe environments Specific diseases Education Stimulating home environment Preschool Parental education Social protection Poverty safety nets/ CCTs Protection from societal/domestic violence Gender equity
Sectors influencing young child development Nutrition Maternal nutrition & IUGR Stunting Micronutrients Health Access to & quality of MCH services Safe environments Specific diseases Education Stimulating home environment Preschool Parental education Social protection Poverty safety nets/ CCTs Protection from societal/domestic violence Gender equity
Priority Global Nutrition and Health Interventions Breastfeeding Promotion of good complementary feeding practices; Food supplementation for young children in populations with insufficient food Micronutrient supplementation for mothers and young children Reduce infections: prevention and effective treatment for malaria, HIV, diarrhea support for children and families affected by HIV
Nutrition and health are important, but Substantial gains in children s development require: Improvements in parenting, home stimulation and early education Increases in protective influences such as maternal education that reduce impact of risks Social protection including reductions in stressful experiences including maternal depression and exposure to violence
Social protection: cash transfer Cash transfers Potential increase in spending on nutritious food, medicine, supplies, other goods Family with low SES Conditions/ services IMPROVED OUTCOMES: Growth, health, development school achievement Health care School attendance, Early Child Development programs
Social Protection conditional cash transfer programs Majority of studies in Latin America Generally positive effects Birth weight, health, prenatal care, growth monitoring, micronutrient supplementation, household food consumption Mixed effects (mostly for younger more disadvantaged children) Growth, cognitive/language development Cash-transfer programs with early childhood conditions such as attendance at parenting sessions now being evaluated in Mexico Fernald, Hidrobo & Gertler, 2011
Early childhood education For children 3 years and older centre-based programs (preschools) are appropriate and effective in improving children's cognitive and socialemotional development and school readiness Impact is greater with higher quality programs but informal and community-based programs can sometimes benefit development
Preschool s lasting positive effects Schooling gap between wealthiest quintile and other quintiles at age 15-19 years for 73 low and middle income countries Engle et al, 2011
Increasing preschool enrolment: Benefit-to-cost ratio of 6.4-17:1 Increasing preschool enrolment reduces gap in attained schooling between higher and lower income groups Estimated economic gain from increased schooling (as present value of added wage productivity) increase in future earnings US $11-34 billion Benefit-to-cost ratio from 6.4 to 17:1, depending on % preschool children enrolled (25% - 50%) and discount rate Engle et al, 2011
Early Childhood education in Jamaica Good access: 98% of 3-6 year age group are enrolled in school in Jamaica Focus on improving quality Led by Early Childhood Commission Setting of minimum standards for early childhood institutions Improving teacher training & curriculum Early Childhood Act banning the use of corporal punishment
Improving quality: Training teachers in behaviour management to promote social & emotional skills and prevent conduct problems Children s behaviour at school is critical for school success Trained teachers reach several high risk children, each year Intervention in 24 basic schools in inner city Kingston Improvement in teacher skills reduced child conduct problems and improved friendship skills More success in grade 1? (Baker-Henningham et al, 2012)
Promising directions: Media Use of media including educational radio and TV for children over 2 years Bangladesh study showed access to educational TV had cognitive benefits
Reaching children 0-3 years Jamaica has been very successful in providing access to early childhood education for children 3-6. Need to expand services for children birth to 3y. Parenting programmes to enable parents to provide the early learning experiences children need Proven benefits Jamaica leader in research
Jamaica supplementation & stimulation trial Study design Stunted children (height-for-age < -2SD) Randomized (n=129) Control Supplement Stimulation Both 33 32 32 32 Non-stunted children height-for-age > -1SD; recruited from same neighbourhoods
Stimulation/parenting: Weekly 1hr home visits by community health aides. Play session with mother and child. Focus on: Enhancing maternalchild interactions Language Praise Showing mother how to promote development through play
Developmental levels (DQ) over 2 years of intervention DQ Non-stunted Both Stimulated Supplemented Control Grantham-McGregor et al, 1991
Benefits of early intervention at 22y Higher IQ Educational attainment Improved mental health (reduced depression and social inhibition, no change in anxiety) Reduced violent behavior Increased earnings -42% higher income No benefits to quality of relationships, drug use, teen pregnancy, arrests & convictions (Walker et al, 2011)
Other evidence for benefits Studies in Jamaica with children from poor neigbourhoods and with children born low birth weight show benefits for development and behaviour (at age 6y) (Powell & Grantham- McGregor, 1989; Walker et al, 2010) Similar research in Bangladesh, with adapted Jamaican programme showed benefits for development (Hamadani et al, 2006)
Peru: Cuna Más Government funded program of home visiting for children in poorest regions as part of devleopment and social inclusion strategy Modified Jamaican programme for use in Peru Launched in 2012 by President Humala, started in 7,000 homes, aims to reach 240,000 children by 2016
Working with health sector Health services most contact with children aged < 3 years Potential logistical advantages of shared delivery mechanisms Financial advantages of shared physical and human resources Feasible to integrate early childhood stimulation/parenting into these services?
Implementation through nutrition clinics Clinic community health aides (CHA s) trained in stimulation programme Weekly home visiting with mothers and children (every 10-11 days achieved) Supervision to maintain quality of visits Improved child development, mothers' child rearing knowledge & practices. Powell et al, 2004
Reaching more children through other approaches to delivering ECD programmes How can evidence-based interventions be effectively delivered to more children and families? Integrated approach across sectors Parenting programmes Individual counselling at health visits (WHO Care for Child Dev) Parenting groups, at health centres or community groups
Challenges Integrating early education with health Few contacts Existing infrastructure (physical & human) stretched, little spare capacity Little contact after 18 months, how to reach children 1-3 years. Need to determine how to integrate and scale up effectively
Returns on investment in early childhood are substantial Early childhood is the most effective and cost-efficient time to ensure that children can benefit from school and later opportunities. Investment in early child development programmes can break the cycle of inequity faced by millions of children and families, globally Government commitment is essential: Unless governments find ways to ensure access to quality early child development programs, especially for lowest income groups, economic disparities will continue and widen.
Jamaica a leader in ECD Near universal access to early childhood education Lead agency with coordinating responsibility (ECC) High quality influential research Important achievements in in nutrition and health care for young children
Still much to be done Improve quality of both teaching and classroom environment in early childhood education Reach children less than 3 years with parenting programmes to improved home stimulation Identify effective ways of delivering these through mix of health centre and community based approaches, home visiting and media