September 2016 What Do We Know About Early Childhood Development Policies in Low Countries? and Middle Income Countries? Amanda E. Devercelli, Rebecca Sayre, and Amina Denboba An initial review from the Systems Approach for Better Education Results- Early Childhood Development (SABER-ECD) In this brief note, we present information on the early childhood development (ECD) policy environment in 35 low- and middle-income countries. This is the first in a series of notes that will examine data from SABER-ECD1. Background A child’s earliest years are a critical period of development, laying the foundation for future success. Neurological studies have shown that synapses develop rapidly during a child’s first few years, forming the basis of cognitive and emotional functioning (Shonkoff and Phillips, eds., 2000). Adequate nutrition and stimulation, especially during a child’s first 1,000 days, play a critical role in brain development. Malnutrition and a lack of stimulation can lead not only to poor physical growth but also to impeded brain development, resulting in delayed cognitive development and poor health outcomes and low academic achievement throughout a child’s life (Engle et al., 2011). To fully benefit from future opportunities in life and become productive members of society, by the end of early childhood young children should be healthy and well-nourished; securely attached to caregivers; able to interact positively with families, teachers, and peers; able to communicate in their native language; and ready to learn throughout primary school (Naudeau et al., 2011). Early gaps in early childhood development (ECD) jeopardize a child’s capacity to reach these important milestones and achieve full potential in life. By contrast, positive early investments can have long-term impacts on the individual, the community, and society as a whole. Quality early childhood experiences ensure that children can learn the skills necessary to succeed throughout life, from primary school through tertiary education and into the labour market (Heckman and Masterov, 2007; Heckman 2006). Investments in early childhood are critical for countries seeking to reduce inequality and promote shared prosperity and economic growth. In many countries, public policies remain deeply inadequate to provide all children with opportunities to fully develop and thrive. ECD presents a particular challenge to policymakers due to its multi-sectoral nature and the necessity of reaching a variety of stakeholders to influence outcomes, including parents and caregivers, a range of service providers, and the young children themselves. Despite clear evidence of the benefits of investing in ECD, countries struggle to establish effective enabling environments and 1 For a complete introduction to the SABER-ECD framework, including an extensive literature review and explanation of the indicators included, please see Neuman and Devercelli (2012) and visit the SABER-ECD website http://saber.worldbank.org/index.cfm?indx=8&pd=6&sub=0 for access to country reports, available data, and further background information. 1 policy solutions and to ensure a coordinated approach to ECD services. Given these challenges, the World Bank launched the Early Childhood Development module within its Systems Approach for Better Education Results (SABER) initiative in 2011. SABER-ECD is an effort to identify what policies matter most for developing strong ECD systems and to collect information on how various countries approach this challenging task (Neuman and Devercelli, 2013). What is Systems Approach for Better Education Results Early Childhood Development (SABER-ECD)? The World Bank launched the SABER initiative to help countries assess their education policies in a systematic way and achieve the ultimate goal of learning for all. SABER allows countries to conduct a thorough diagnostic of their education policies and institutions based on global best practices. It produces data on these policies and institutions, analyzes and evaluates policies and practices, and provides decision makers and stakeholders at all levels with a tool for structured and effective policy dialogue. Within this initiative, education policy domains have been identified to cover the span of the education systems from early childhood to entry into the workforce. SABER-ECD helps policymakers, World Bank staff, and development partners identify gaps and areas in need of policy attention and to learn how countries address similar policy challenges to promote healthy and robust development for all children during their early years. In short, the SABER-ECD initiative collects, analyzes, and disseminates comprehensive information on ECD policies around the world. In each participating country, extensive multi-sectoral information is collected on ECD policies and programs through a desk review of available government documents, data and literature, and interviews with a range of ECD stakeholders, including government officials, service providers, civil society, development partners and scholars. Figure 1: SABER-ECD Analytical Framework At the heart of SABER-ECD is an analytical framework that aims to provide a holistic and integrated assessment of how the overall policy environment in a country affects young children’s development. The framework identifies three core policy goals that countries should address to ensure optimal ECD outcomes: (1) Establishing an enabling environment; (2) Implementing widely; and (3) Monitoring and assuring quality. Improving ECD requires an integrated approach to address all three goals. As displayed in Figure 1, for each policy goal a series of policy levers are identified, through which decision makers can 2 strengthen ECD. Strengthening ECD policies can be viewed as a continuum: countries can range from a latent to an advanced level of development within the different policy levers and goals. Currently, complete SABER-ECD data are available in 35 countries: Albania, Armenia, Belize, Bulgaria, Burkina Faso, Colombia, Democratic Republic of Congo, Gambia, Guinea, India, Indonesia, Iraq, Jamaica, Kiribati, Kyrgyz Republic, Macedonia, Malawi, Mauritius, Nepal, Nigeria, Samoa, Senegal, Seychelles, Solomon Islands, Sri Lanka, Swaziland, Tajikistan, Tanzania, Togo, Tonga, Tuvalu, Uganda, Vanuatu, Yemen, and Zanzibar. It should be noted that participation in SABER-ECD is driven by country demand, so we cannot present the data from these 35 countries as a robust globally representative sample. What do we know about early childhood development policies? SABER-ECD data indicate that the level of ECD policy development varies across countries, but generally in most countries there is room for improvement before the holistic development of children can be guaranteed. Here we present findings for the three main policy levers that comprise an enabling environment for ECD and provide a brief snapshot on the status of these policy levers in countries with available data. Within the SABER-ECD framework, the Establishing an Enabling Environment policy goal includes an analysis of a country’s legal framework to promote optimal child development, intersectoral coordination within the ECD system, and ECD financing. Establishing an enabling environment can be the foundation for effective ECD policies, providing the mechanisms and means to design and implement ECD policy, deliver services, and monitor outcomes. Many of the features of an enabling environment relate to the function of government concerned with the production of “public goods” and reliant on the basic rationale for public-sector intervention (Brinkerhoff, 2009). A country’s enabling environment can encourage diverse service provision, promote service uptake, facilitate efficient service delivery, and ensure adequate financing and institutional capacity. In the context of ECD, establishing an enabling environment entails developing an adequate legal and regulatory framework to support ECD provision. Coordination within sectors and across institutions is necessary to ensure effective service delivery (OECD, 2011; UNESCO, 2006). Finally, the availability of adequate fiscal resources and systems to allocate financing will determine the extent to which the enabling environment supports the ECD system. Legal Framework The legal framework of an ECD system comprises all of the laws and regulations that can affect young children’s development. These laws and regulations are diverse, both because of the wide array of sectors that influence ECD and because of the different constituencies that ECD policy must target, including pregnant women, young children, and parents and caregivers of young children (Britto, Yoshikawa and Boller, 2011; UNESCO, 2006). Countries approach this challenge in different ways. In some countries, a holistic ECD policy or law is enacted to ensure that all children are guaranteed access to essential interventions to promote healthy development. In other countries, rights and services are guaranteed through individual laws and policies in separate sectors (Vargas-Barón, 2005). Table 1 displays selected SABER-ECD indicators related to countries’ legal frameworks in health, nutrition, education, child protection, and social protection. For some laws, such as mandates for birth registration and childhood immunizations, nearly all countries have established strong policies. In other policy areas, such as pre-primary education or antenatal care, there is much more variation. 3 Table 1. SABER-ECD Indicators for Legal Framework Percent of Indicator No. of countries countries responding No 7 23% Is there a policy that guarantees pregnant Only one free service (either antenatal or skilled women free antenatal visits and skilled delivery) 4 13% delivery? (n=30) Both free antenatal visits and skilled delivery 19 63% Are young children required to receive a No 3 9% complete course of childhood immunizations? (n=35) Yes 32 91% No 21 60% Does the education law mandate the Less than one school year 4 11% provision of free pre-primary education before primary school entry? (n=35) One to 2 school years 8 23% More than 2 school years 2 6% Is there a policy mandating the registration No 2 6% of children at birth? (n=35) Yes 33 94% No policy 11 32% Policy exists and services provided within one sector 13 38% Is there a policy to provide orphans and vulnerable children with a range of ECD Policy exists and services provided in 2 to 3 sectors 9 26% services? (n=34) Policy exists and services provided in the Education, Health, Nutrition, and Child/Social Protection sectors 1 3% Intersectoral Coordination Because children’s development cannot be adequately addressed by interventions through any single sector alone, intersectoral coordination is an important policy lever for influencing a country’s enabling environment. Reviews and case studies point to several important components for multi-sectoral ECD frameworks, including a high-level political endorsement to ensure the prominence of ECD on the national agenda; a defined institutional anchor; and the inclusion of stakeholders from a range of sectors with clearly delineated responsibilities (Naudeau et al., 2011). Policy decisions and interventions in ECD often span multiple ministries. While specific ministries vary by country, the ministries most typically involved include those overseeing health, education, gender, community development, and social protection/welfare. As such, mechanisms to coordinate across 4 multiple ministries are needed. In many countries, the Ministry of Health is the primary agency of relevance for children below the age of three, with prenatal care, childbirth, immunizations, and growth monitoring programs being the principal entry points for service delivery and contact. Once children reach preschool age (ages 3 to 6 in most countries) the Ministry of Education often becomes the most relevant ministry. The ECD roles and responsibilities of different government institutions often are not clearly delineated, which can lead to overlap and inefficiencies (Kamerman, 2005; UNESCO, 2006). Table 2 displays selected indicators on the coordination of ECD policies and programs. Countries approach processes and institutional arrangements for cross-sector coordination differently. In general, in many countries ECD interventions are not coordinated across sectors, either among implementing agencies or at the level of service delivery. Also, interventions are rarely aligned with policies, due to either the limits of policy planning or divergent management mechanisms. Table 2. SABER-ECD Indicators on Inter-sectoral Coordination Percent of No. of Indicator countries countries responding No multi-sectoral ECD strategy OR recognition of the importance of a multi-sectoral approach to ECD 13 37% exists, and a multi-sectoral ECD strategy has not been endorsed Does the government have an explicitly ECD strategy endorsed by at least 3 relevant sectors 8 23% stated multi-sectoral ECD strategy? (n=35) ECD strategy endorsed by 3 or 4 sectors and 10 29% includes an implementation plan ECD strategy endorsed, including 3 or 4 sectors, and 4 11% an implementation plan that is costed No 11 31% Has an institutional anchor been established Yes 11 31% to coordinate ECD across sectors? (n=35) Yes, and staff officially appointed 13 37% Is there any integrated service delivery No 17 59% manual/guideline (i.e., any sort of common plan of action)? (n=29) Yes 12 41% There are no coordination mechanisms 10 33% Is there a mechanism for collaboration There are consultation meetings involving non-state between state and non-state stakeholders? 12 40% stakeholders (n=30) There are strong coordination mechanisms 8 27% In recent years, there has been a move toward establishing intersectoral ECD policies. According to a review by Torkington (2001), in sub-Saharan Africa, only Mauritius and Namibia had established ECD policies as of 2001 (cited in Vargas-Barón, 2008). The situation has changed dramatically. A recent review commissioned by UNESCO revealed that 23 out of 47 sub-Saharan countries have adopted national ECD policies. Another 13 countries have policies under development or drafted, but not yet approved (Vargas- 5 Barón and Schipper, 2012). Table 3 summarizes the current status of national ECD policy development in sub-Saharan Africa. Table 3. Current Status of ECD Policies in Sub-Saharan Africa Status Name of Countries Dem. Rep. of Congo Somalia Rep. of Congo South Sudan Equatorial Guinea No national intersectional ECD policy Sudan Gabon Togo Guinea-Bissau Zimbabwe Sao Tome and Principe Angola Mozambique Cameroon Sierra Leone Cape Verde National intersectional ECD policy already Swaziland Chad drafted or being drafted Tanzania Cote d’Ivoire Uganda Lesotho Zambia Madagascar National intersectional ECD policy approved Benin Malawi Burkina Faso Mali Burundi Mauritania Central African Republic Mauritius Comoros Namibia Eritrea Niger Ethiopia Nigeria Gambia Rwanda Ghana Senegal Guinea Seychelles Kenya South Africa Liberia Source: Neuman and Devercelli, 2013 (adapted from Vargas-Barón and Schipper, 2012). 6 ECD Finance Monitoring and comparing the level of ECD financing across countries is difficult, because ECD expenditure is linked to different sectoral budgets and domains. In many countries the sectoral budgets are not managed in a way that allows tracking of ECD investments. In addition, ECD interventions range widely in content and intensity (Naudeau et al., 2011). Government prioritization of ECD finance can also be linked to other long-run government priorities, such as increasing female labor participation; this feature of ECD policy further complicates the task of how to define spending to be “counted” as ECD spending. Table 4 displays selected indicators for ECD finance and demonstrates that, in general, financing mechanisms for early childhood policies are inadequate. Countries are not using explicit criteria to determine ECD spending, and the majority of governments cannot accurately report ECD expenditures across all relevant sectors. Only four countries with available data allocate 5 percent or more of their annual education budgets toward pre-primary education. Remuneration for the ECD workforce, including pre-primary teachers, community-based childcare providers, and extension health service professionals remains inadequate in many countries. This has important implications for efforts to improve the quality of services provided to young children (especially early childhood education) and for efforts to scale. Many countries’ plans to scale access to early childhood education include reliance on volunteer or otherwise underpaid workforces; while this may be attractive from a fiscal perspective, it may come with negative implications for sustainability, retention and quality. Table 4. Selected SABER-ECD Indicators for Finance Percent of No. of Indicator countries countries responding To what extent does the budget use explicit No Criteria 13 37% criteria at the national or sub-national level Criteria are used in one sector 8 23% to decide ECD spending? (n=35) Criteria are used in 2 or 3 sectors 12 34% Criteria are used in all sectors 2 6% Can the government accurately report public No 12 35% ECD expenditures? (n=34) Expenditures on ECD are reported in 1 sector 11 32% Expenditures on ECD are reported in 2 sectors 6 18% Expenditures on ECD are reported in 3 or more sectors 5 15% What percentage of the annual education Less than 1% 17 61% budget is allocated toward pre-primary 1% to 5% 7 25% education? (n=28) 5% to 9% 2 7% 10% or more 2 7% 40% or more 18 55% 25% to 39% 8 24% 7 What is the level of out-of-pocket 15% to 24% 3 9% expenditures as a percentage of total health expenditures? (n=33) Less than 15% 4 12% Is the remuneration for pre-primary teachers Less than 50% of primary teacher salary 13 50% entering the field competitive? (n=26) 50-74% of primary teacher salary 4 15% 75% but less than 100% of primary teacher salary 5 19% Parity in pay with primary teachers 4 15% Are community-based childcare center No 20 71% professionals paid by the government? (n=28) Yes 8 29% Are extension health service professionals No 10 42% paid by the government? (n=24) Yes 14 58% What do we know about policy intent vs. implementation and whether or not policies lead to better outcomes for young children? The existence of laws and policies alone does not guarantee desired ECD outcomes. In many countries, policies on paper and the reality of access and service delivery on the ground are not aligned. Table 5 summarizes a range of ECD policy provisions in select countries across regions, along with related outcomes. While many governments have strong legal frameworks and have mandated several key policies, outcomes for young children are lagging. For example, despite the fact that all five countries profiled in the table mandate birth registration, actual levels of birth registration range from 17 percent in Yemen to 100 percent in Bulgaria. Similarly, in pre- primary education we see a range of policy approaches and outcomes. Even without mandatory pre- primary attendance and fees charged at many programs, in Indonesia almost half of eligible children attend some kind of early childhood care and education program, while in Burkina Faso the figure is 3 percent. In Yemen, the government has been successful in implementing its policy mandating immunizations for young children, resulting in high levels of coverage throughout the country. On the other hand, the rate of exclusive breastfeeding in Yemen is just 30 percent, in spite of laws complying with International Code of Marketing of Breastmilk Substitutes. Failure to implement these policies and achieve outcomes may be related to systemic shortcomings with governance, accountability, and financing. Cultural differences and norms in different countries are also a strong influence on family behavior and child outcomes. Further research is required to consider these issues in individual country contexts. While there will always be some disparity between policy and implementation, the existence of laws does suggest some commitment on the part of the government to these issues. While not a sufficient condition for a strong ECD system, a sound legal framework is usually a necessary condition for one. Table 5. Comparing Policy Intent with ECD Outcomes in Select Countries Across the Regions 8 Comparing Policies with Outcomes Bulgaria Burkina Faso Indonesia Jamaica Yemen Salt Iodization Salt Iodization Policy Mandatory Mandatory Voluntary Voluntary Mandatory Population Consuming Iodized Salt 100% 34% 62.3% N/A 30% Appropriate Infant Feeding and Breastfeeding Promotion Compliance, Code of Marketing of Some provisions Some provisions All provisions Law Law Breast Milk Substitutes law law law 13.3% (0- 2 months) Exclusive Breastfeeding until 6 38% 41.5% 40% 12% Months 6% (2-3 months) 2% (4-5 months) Childhood Immunizations Mandatory (except for Immunizations Policy Mandatory meningitis and Mandatory Mandatory Mandatory Mumps) Immunizations Rate (Complete Course 95% 88% 85% 93% 88% of DPT3) Pre-primary Education Compulsory two- Not Not Not compulsory; year preparation compulsory; Not compulsory; publicly funded before entering not free of compulsory; Pre-primary Education Policy often not free pre-primary primary; state- charge free of charge provided free education provided free of in theory of charge provision charge Pre-primary Enrollment Rate 79% 3% 46% 113% 1% Birth Registration Birth Registration Policy Mandatory Mandatory Mandatory Mandatory Mandatory Birth Registration Rate 100% 77% 67% 98% 17% Further research required This note is just a first step in our ongoing efforts to draw lessons learned from the SABER-ECD data. In future notes we will look more closely at the question of how to design effective ECD policies. Currently a great deal of time and effort is going into ECD policy development in many countries, with a range of outcomes. In some countries the process has led to an effective and functioning multi-sectoral policy environment, while in others the process has stalled or been completed with less stellar results. We are 9 also working with a group of colleagues to do more extensive analysis comparing different policy approaches to learn more about what works and leads to better outcomes for young children and their families. References Britto, P., H. Yoshikawa, and K. Boller. 2011. “Quality of Early Childhood Development Programs: Rationale for Investment, Conceptual Framework and Implications for Equity.” Social Policy Report 25 (2): 1-31. Engle, P. L., L. C. H. Fernald, H. Alderman, J. Behrman, C. O’Gara, A. Yousafzai, M. Cabral de Mello, M. Hidrobo, N. Ulkuer, and the Global Child Development Steer Group. 2011. “Strategies for Reducing Inequalities and Improving Developmental Outcomes for Young Children in Low-Income and Middle- Income Countries.” The Lancet, 2011. Doi:10.1016/S0140-6736(11) 60889-1. Heckman, J. 2006. “Skill Formation and the Economics of Investing in Disadvantaged Children.” Science 312 (5782): 1900–02. Heckman, J. J., and D. V. Masterov. 2007. “The Productivity Argument for Investing in Young Children.” Applied Economic Perspectives and Policy 29 (3): 446–493. Kamerman, S. 2000. “Early Childhood Education and Care: An Overview of the Developments in OECD Countries.” International Journal of Education Research 33: 7-30. Naudeau, S, N. Kataoka, A. Valerio, M. J. Neuman, and L. K. Elder. 2011. Investing in Young Children: An Early Childhood Development Guide for Policy Dialogue and Project Preparation. Washington, DC: World Bank. Neuman, M .J., and A. Devercelli. 2012. Early Childhood Policies in Sub-Saharan Africa: Challenges and Opportunities. ICEP 6: 21. doi:10.1007/2288-6729-6-2-21 Neuman, M., and A. Devercelli. 2013. Investing Early: What Matters Most for Early Childhood Development: A Framework Paper. Washington, DC: The World Bank. OECD (Organisation for Economic Co-operation and Development). 2011. “Starting Strong III: A Quality Toolbox for Early Childhood Education and Care.” Paris: OECD Publications. Shonkoff, J. P., and D. A. Phillips (eds.). 2000. “From Neurons to Neighborhoods: The Science of Early Childhood Development.” Washington, DC: National Academy Press. Torkington, K. 2001. WGECD Policy Project: A Synthesis Report. Paris: ADEA/Netherlands Ministry of Foreign Affairs. UNESCO (United Nations Educational, Scientific and Cultural Organization). 2006. Education for All Global Monitoring Report 2007: Strong Foundations: Early Childhood Care and Education. Paris. Vargas-Barón, E. 2005. “Planning Policies for Early Childhood Development: Guidelines for Action.” Paris: UNESCO/ADEA/UNICEF (United Nations Educational, Scientific and Cultural Organization/Association for the Development of Education in Africa/United Nations Children’s Fund). Vargas-Barón, E. 2008. “Observations on the Financing of Early Childhood Development at the National Level.” Coordinators Notebook 30. Toronto: The Consultative Group on Early Childhood Care and Development. 10 Vargas-Barón, E., and J. Schipper. 2012. The Review of Policy and Planning Indicators in Early Childhood. Commissioned by UNESCO within the framework of the Holistic Early Childhood Development Index. Paris: UNESCO. 11