LAO PDR EARLY CHILDHOOD EDUCATION PROJECT SNAPSHOT FOUR: SERVICES AND FACILITIES This is the fourth in a series of snapshot reports presenting results from a large-scale Early Childhood Education (ECE) Study conducted in the northern provinces of Lao PDR. The ECE Study was initiated to evaluate the Early Childhood Education Project. The results presented here represent data collected on the availability of, and community access to, services and facilities, and how these relate to early child development, prior to the implementation of the project. Data will be collected again after the project has finished to see if the project has improved outcomes for children. This snapshot highlights that while the coverage of and access to early education services are not sufficient, where they are available these services are related to better levels of early child development. Universal health care and education coverage is crucial in supporting the health and development of a nation. Access to quality health care services, as well as the opportunity to participate in quality ECE, gives children the best start in life and the foundation they need to enjoy learning at school. Lao PDR has made significant improvements in the coverage, quality, infrastructure, delivery and financing of health and education services throughout the past decade. Early education services, such as kindergarten and pre-primary class, have received less attention. Further efforts are needed for the country to achieve targets under the United Nations Sustainable Development Goals 3.8 and 4.2. SDG 3.8 is "by 2030 achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all". SDG 4.2 is "by 2030, ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education". LAO PDR EARLY CHILDHOOD EDUCATION PROJECT  SNAPSHOT FOUR: SERVICES AND FACILITIES 1 THE EARLY CHILDHOOD EDUCATION PROJECT The ECE Project seeks to support the expansion of quality ECE services with the objective of improving the overall development and school readiness of children aged 3-5 in disadvantaged villages across the northern provinces of Lao PDR (for further information, refer to Snapshot One: Project Background and Baseline Data Demographics). Up to 250 pre-primary classrooms will be built, more than 70 community child development groups will be created, and the quality of ECE services will be improved through training for teachers, caregivers and community members, the development of training materials, and the provision of support services such as disability screening and school lunches. Baseline data was collected to provide information on the current status of child outcomes, and to provide information on the existing levels of service provision and facilities available to a child’s family. Below are the findings on the availability of village facilities, health services and early education services on child development, derived from data collected from 7,520 children and their caretakers throughout Northern Lao PDR. 2 LAO PDR EARLY CHILDHOOD EDUCATION PROJECT  SNAPSHOT FOUR: SERVICES AND FACILITIES VILLAGE ACCESS, ELECTRICITY, WATER FIGURE 1 . RELATIONSHIP BETWEEN VILLAGE ACCESS, ELECTRICITY, DRINKING WATER, WATER AND SANITATION AND SANITATION AND LEVELS OF CHILD DEVELOPMENT The heads of each village in the study were asked No Electricity 0.515 to provide information on a number of amenities in their village, as well as how accessible villages were Solar Cell 0.521 (for further information, please refer to Snapshot One: Electricity Mini Hydropower 0.504 Project Background and Baseline Data Demographics). Battery Generator 0.554 Villages were relatively remote, and while almost all could be accessed by car in the dry season (97%), just Private Generator 0.606 over half could be accessed by car in the wet season Government Grids 0.561 (53%). More than half of the villages accessed electricity Container Water 0.574 from government electrical grids (55%), and a small Drinking Water number of villages (4%) did not have access to electricity. Trenches & Drainage Pipes 0.537 The majority of villages were using drinking water from River Water 0.542 trenches/drainage pipes (90%), but many also had some Well Water 0.562 households using river water for drinking (39%). Villages Water Sanitation often used a combination of water sanitation processes; No Toilet 0.523 most villages had some households using pit toilets Dry Pit 0.523 with a water flush (93%), however some villages had Flush Toilet 0.566 households that were still using dry pits (21%). Access Can access in wet season 0.513 These amenities are important for basic hygiene and Cannot access in wet season 0.516 health, and are likely to influence the development of 0 0.2 0.4 0.6 0.8 children in the village. Figure 1 indicates the relationship Average child development score LAO PDR EARLY CHILDHOOD EDUCATION PROJECT  SNAPSHOT FOUR: SERVICES AND FACILITIES 3 between village access, electricity, water and sanitation HEALTH CARE SERVICES with levels of child development. The indicator used to Village heads also reported on the availability of health measure overall child development was based on the services in their village. The majority of villages had a Early Human Capability Index which has been used village nurse (70%), however fewer villages had a health internationally. The index provides a score for each center (13%), pharmacy (12%), district hospital (5%), child ranging from 0 to 1, (where 1 is the best result) provincial hospital (2%), private clinic (2%) or private and is calculated on the basis of questions asked to the hospital (<1%). primary caregiver about their child’s physical, social and emotional development as well as their communication, Table 1 details the distance of each of these health early literacy and early mathematics skills. services from villages. Caregivers reported that 22% of children had received some form of health service in the Results demonstrate that children living in more past month – most often a health check-up, treatment accessible villages that utilize more sophisticated or vaccination. Only 13% of children had visited a health electricity and sanitation processes are developing center, 9% a district hospital, 1% a provincial hospital, and better than children from villages with poor access, less than 1% had visited a private clinic, traditional healer villages that do not have electricity and villages that do or village health volunteer. not use toilets. TABLE 1. TRAVEL TIME TO NEAREST HEALTH SERVICE FROM VILLAGES Please note that the numbers within the table represent percentage of children, i.e. 63% of children live less than 30 minutes away from the village nurse. SERVICE PERCENTAGE OF CHILDREN LIVING DIFFERENT TRAVEL TIMES FROM SERVICES ≤ 30 mins > 30 ≤ 60 mins > 60 ≤ 120 mins > 2 hours Village nurse 63% 22% 10% 5% Health center 55% 24% 11% 11% Pharmacy 34% 19% 24% 23% District hospital 25% 22% 27% 27% Province hospital 16% 2% 11% 70% Private clinic 30% 14% 17% 38% Private hospital 45% 2% 10% 43% 4 LAO PDR EARLY CHILDHOOD EDUCATION PROJECT  SNAPSHOT FOUR: SERVICES AND FACILITIES Information was collected regarding whether health FIGURE 2 . RELATIONSHIP BETWEEN HEALTH SERVICE professionals visit or live in the villages. The majority of AVAILABILITY AND CHILD DEVELOPMENT villages either had a nurse living in the village or were Naturopath lives in Yes 0.555 visited by a nurse (68%), and more than half of villages or visits village either had a doctor living in the village or were visited by No 0.529 a doctor (55%). Many villages also either had a midwife or 0.566 Midwife lives in Yes naturopathic doctor living in or visiting the village (both or visits village No 0.523 37% each). Nurse lives in Yes 0.535 While the majority of villages did not have a health or visits village No 0.508 center, results indicate health service coverage appears moderate due to doctors and nurses either living in or Doctor lives in Yes 0.545 or visits village visiting the village. The availability of health services No 0.530 Health Serveice was shown to have a positive relationship with child Yes 0.584 development, as demonstrated in Figure 2. Pharmacy No 0.532 Yes 0.580 EARLY EDUCATION SERVICES Hospital No 0.536 Village heads reported on the available early education services in their village. Part of the selection criteria for Yes 0.611 Private clinic the ECE Study was that the village had an existing primary No 0.537 school, so all had primary schools. Additionally, many of Yes 0.537 the villages selected for the study had a kindergarten Village nurse No 0.543 (39%). Few villages had any other ECE services, such as a preschool playgroup (2%), nursery school (1%), or Yes 0.570 Health center any other form of ECE (2%). Not all villages had a lower No 0.534 secondary school (20%) and very few had an upper 0 0.2 0.4 0.6 0.8 secondary school (7%). Average child development score LAO PDR EARLY CHILDHOOD EDUCATION PROJECT  SNAPSHOT FOUR: SERVICES AND FACILITIES 5 Caregivers reported that 25% of children had attended positive relationship with children’s literacy, and their some form of ECE at some point in their lives – either early numbers and concepts skills. It is important to a baby care center (<1%), group learning through play note that this does not take into account how much (<1%), kindergarten (23%) or pre-primary class (1%). ECE children have attended. It is likely that the amount of time children attend ECE would have an impact on Although ECE attendance is low, Figure 3 below shows their development. The graph below shows whether a that those children who had attended ECE were child had attended any ECE at all, and does not take into developing better across all domains of development account the “dose” or length of time that he/she might when compared to children who had never attended. have attended. ECE attendance appears to have had a particularly FIGURE 3. RELATIONSHIP BETWEEN HAVING ATTENDED ECE AND CHILD DEVELOPMENT 1.0 0.894   n  Attended ECE 0.9 0.824   n  No ECE 0.792 0.8 0.734 Average child development score 0.7 0.681 0.653 0.621 0.605 0.6 0.563 0.538 0.512 0.506 0.5 0.455 0.4 0.324 0.3 0.257 0.2 0.105 0.1 0 Overall Perseverance Cultural Social and Approaches Numbers Literacy Communication Development Knowledge Emotional Skills to Learning and Concepts 6 LAO PDR EARLY CHILDHOOD EDUCATION PROJECT  SNAPSHOT FOUR: SERVICES AND FACILITIES KEY FINDINGS AND RECOMMENDATIONS support services such as disability screening and school lunches. The associated ECE Study will determine if the Access to quality health care and early education various aspects of the project have an impact on the promotes good child health and prepares children for health, development and skills of the children living in continued learning at school. Results indicate that ECE the project villages; the results presented in this snapshot coverage in Northern Lao PDR is insufficient. While health provide confidence in being able to show positive service coverage is better than that of ECE, further work impacts. For the ECE Project to be successful, it will be is needed for Lao PDR to achieve both universal health extremely important that the education of parents, coverage and access to quality ECE for all children, as per teachers and community members is implemented SDGs 3 and 4. effectively, and that the key messages around improving Consistent with international literature, ECE attendance child development are delivered clearly and successfully seems to be positively related to each of the different to families living in the communities of Northern Lao PDR. aspects of child development. The ECE Project will increase coverage of ECE and seek to improve the quality of ECE services through training teachers, caregivers and community members. The ECE Project will also provide LAO PDR EARLY CHILDHOOD EDUCATION PROJECT  SNAPSHOT FOUR: SERVICES AND FACILITIES 7 FUNDING FOR THIS INITIATIVE: Funding for the ECE Project is provided by the World Bank Group through an International Development Association (IDA) Grant and Credit under the Early Childhood Education Project (P145544). Further funding to support the production of this series of snapshot reports has been provided through a partnership between the World Bank, Plan International and Save the Children International as part of the Lao Educational Access, Research and Networking (LEARN) Project, with funding from Dubai Cares under Externally Financed Output (EFO) Agreement EFO 990. The findings, interpretations and conclusions expressed in this brief do not necessarily represent the views of the Government of Lao PDR or the World Bank Group. Prepared by: Dr Sally Brinkman, Ms Alanna Sincovich, Mr Pedro Cerdan-Infantes, Mr Plamen Nikolov Danchev For more information about the ECE Project, visit: http://www.worldbank.org/projects/P145544/lao-prd-early-childhood-development- project?lang=en For more information about the study results, please contact Sally Brinkman: sally.brinkman@telethonkids.org.au For more information about the ECE Project, please contact Plamen Nikolov Danchev: pdanchev@worldbank.org The World Bank Country Office Education Global Practice Patouxay Nehru Road The World Bank P.O. Box: 345 1818 H Street, NW Vientiane, Lao PDR Washington D.C. 20433, USA Tel: (856-21) 266 200 Tel: (202) 4731000 Fax: (856-21) 266 299 Fax: (202) 4776391 www.worldbank.org/lao www.worldbank.org 8 LAO PDR EARLY CHILDHOOD EDUCATION PROJECT  SNAPSHOT FOUR: SERVICES AND FACILITIES