Advancing Early Childhood Development from Science to Scale

Advancing Early Childhood Development: from Science to Scale

3 Lancet papers and 6 commentaries Advancing Early Childhood Development: from Science to Scale

Authors and Editors Christopher Andersen Jere Behrman Zulfiqar Bhutta Maureen Black Pia Britto Adrian Cerezo Margaret Chan Bernadette Daelmans Gary Darmstadt Pamela Das Amanda Devercelli Ann Di. Girolamo Tarun Dua Lia Fernald Günther Fink Nathaniel Foote Paul Gertler Sally Grantham-Mc. Gregor Keith Hansen Mark Hanson Jody Heymann Richard Horton Patrick Ip Anthony Lake James Leckman Selina Lo Joan Lombardi Florencia Lopez Boo Chunling Lu Jane Lucas Stephen Lye Graca Machel Harriet Mac. Milan Stephen Matthews Dana Charles Mc. Coy Rafael Perez-Escamilla Kerrie Proulx James Radner Nirmala Rao Linda Richter Yusra Shawar Jeremy Shiffman Jack Shonkoff Karin Stenberg Elizabeth Tablante Mark Tomlinson Tyler Vaivada Emily Vargas-Baron Ted Wachs Susan Walker Quentin Wodon Haogen Yao Hiro Yoshikawa Aisha Yousafzai Advancing Early Childhood Development: from Science to Scale

10 HEADLINES from the series … ON E Start Early 2 3 4 5 6 7 8 9 10 Advancing Early Childhood Development: from Science to Scale

Foundations are laid down in first 1000 days (a sensitive period for these developments) Cell division and migration Advancing Early Childhood Development: from Science to Scale

Life course approach Early means early: Putting a focus on Pregnancyage 3 Advancing Early Childhood Development: from Science to Scale

10 HEADLINES from the series … TW O The enormous burden 3 4 5 6 7 8 9 10 Advancing Early Childhood Development: from Science to Scale

Children affected by known risks to development 250 million children (43%) younger than five in low and middle income countries are at risk of not meeting their developmental potential. Advancing Early Childhood Development: from Science to Scale

Middle East and North Africa (2010) • 36. 5 million children under 5 • 25 % at risk of not meeting their developmental potential* *Calculated on number of children jointly exposed to stunting and poverty. Advancing Early Childhood Development: from Science to Scale

Other factors increase percentage of young children at risk for healthy development • • Maternal education Child maltreatment Maternal Depression Exposure to prolonged conflict Advancing Early Childhood Development: from Science to Scale

10 HEADLINES from the series … THRE E Costs of poor early life conditions 4 5 6 7 8 9 10 Advancing Early Childhood Development: from Science to Scale

Costs of poor early development Early childhood risks Poverty Poor maternal health Pregnancy & birth problems Under-nutrition Infections Lack of learning opportunities Exposure to violence Family & public investments, interventions Outcomes to age 2 y Growth, health, wellbeing Outcomes to preschool + School readiness Outcomes late childhood + School achievement Outcomes adolescence, adulthood + Health, wellbeing, earnings Advancing Early Childhood Development: from Science to Scale

The personal cost of inaction through earnings lost 43% of children in LMICs (± 250 million) at risk of losing 26 % of average adult income Advancing Early Childhood Development: from Science to Scale

Some countries will lose a greater proportion of their GDP in poor early development than they currently spend on health Region Country GDP/capita US$ Sub. Saharan Africa Ethiopia Kenya Madagascar Tanzania 505 1245 463 695 Govt health expenditure (%GDP) 5. 1 4. 5 4. 2 7. 3 South Asia Bangladesh India Pakistan 958 1499 1275 3. 7 4. 0 2. 8 Cost of inaction (%GDP) 5. 6 8. 3 8. 2 7. 9 5. 4 12. 7 11. 1 Advancing Early Childhood Development: from Science to Scale

10 HEADLINES from the series … FOUR Nurturing care 5 6 7 8 9 10 Advancing Early Childhood Development: from Science to Scale

Nurturing care – what the young children depend on for healthy development Components of nurturing care promote physical, social, emotional, cognitive development § § § Nutrition Health Safety and security Responsive caregiving Opportunities for early learning Advancing Early Childhood Development: from Science to Scale

What does it mean to nurture children? • Nurturing children means keeping them safe, healthy and well nourished, paying attention, and responding to their interests, encouraging them to explore, and providing them opportunities to learn. Advancing Early Childhood Development: from Science to Scale

10 HEADLINES from the series … FIVE Enabling conditions 6 7 9 10 8 Advancing Early Childhood Development: from Science to Scale

Parenting /caregiving § Responsive parenting- serve and return is critical to child development § But it can break down: § § § Under the chronic stress of poverty, conflict, migration, discrimination etc Illness, depression, mental disorders Substance abuse, social problems Advancing Early Childhood Development: from Science to Scale

Nurturing care is fostered by an enabling environment Enabling policies Supportive Empowered services communities Caregivers’ capabilities Nurturing care

Examples of national policies that enable families to provide nurturing care Time • Maternity & paternity leave • Breastfeeding breaks at work • Leave to look after sick children Resources • • • Cash transfers Health insurance Minimum wage Parenting programs Free early education Advancing Early Childhood Development: from Science to Scale

10 HEADLINES from the series … SIX 7 We can scale up 8 9 10 Advancing Early Childhood Development: from Science to Scale

Country case studies High income countries India Chile South Africa Sure Start United Kingdom Integrated Child Development Services (ICDS) Chile Crece Contigo (Ch. CC) Grade R Head Start USA Started in 1975 Started in 2007 Started in 2005 Every Chance for Every Child Australia 2014 104. 5 million beneficiaries 2014 80% target population 2015 80% of children enrolled Advancing Early Childhood Development: from Science to Scale

Chile Crece Contigo (Ch. CC) • Goal • • To reduce inequality To enable all children to reach their potential Implemented in 2007, came into law in 2009 Funded by federal government Combines health services, community-based parenting support and preschool Universal and targeted services Entry in pregnancy to age 4 Scale – by 2015, reach 80% of target population Advancing Early Childhood Development: from Science to Scale

Common features of large-scale programs 1. 2. 3. 4. 5. Concerns about poverty, equity, social exclusion Informed by scientific and economic evidence Vision of comprehensive and integrated services Political will, leadership and public sector financing Recognition of different entry points Advancing Early Childhood Development: from Science to Scale

10 HEADLINES from the series … SEVEN 8 9 10 Role of the health sector Advancing Early Childhood Development: from Science to Scale

Use health and nutrition platform to reach families • In most countries it is a relatively well-developed platform • Extensive reach to women and young children • Feasible and effective childhood development interventions currently delivered through health services in an increasing number of countries Advancing Early Childhood Development: from Science to Scale

Many health and nutrition interventions have an impact on child development Source: Vaivada T, Gaffey MF, Bhutta ZA. Promoting Early Child Development With Interventions in Health and Nutrition: A Systematic Review. Pediatrics. 2017; 140(2): e 20164308

10 HEADLINES from the series … EIGH T Build on other platforms Advancing Early Childhood Development: from Science to Scale

Other platforms to reach families & young children Education • Women’s education • Early learning • Child care • Preschool Social protection • Family health insurance • Cash transfers Child protection • Birth registration • Reduction of harsh punishment • Parent & child disability WASH • Access to clean water • Sanitation • Hygiene Advancing Early Childhood Development: from Science to Scale

Example: UNICEF/WHO Care for Child Development (CCD) • • Developed as a Module of IMCI Compatible with health service delivery in LMICs Community workers trained Help parents become aware of young children’s emotional and learning needs • Encourage, model, prompt and praise mothers and caregivers to talk to and stimulate their young children Advancing Early Childhood Development: from Science to Scale

10 HEADLINES from the series … NINE Importance of infrastructure Advancing Early Childhood Development: from Science to Scale

Infrastructure for Scaling • Coordinated governance and planning • Data systems • Workforce supports • Financing Advancing Early Childhood Development: from Science to Scale

Stepping up research • What are the essential elements to assure impact when implementing interventions at scale ? • How will cost vary depending on those core elements and platforms used in scaling? • What are the best tools for population based assessments? • What are the cost benefits to long term health, well being and productivity when nurturing care interventions are provided early? • Other questions? Advancing Early Childhood Development: from Science to Scale

10 HEADLINES from the series … TEN We have momentum Advancing Early Childhood Development: from Science to Scale

Momentum is growing … Scientific publications increased 7 -fold Funding increased 2015 2000 ECD actors increased Country policy adoption increased 10 -fold Global support with the SDGs Advancing Early Childhood Development: from Science to Scale

Improving early childhood development is key to many of the SDGs Advancing Early Childhood Development: from Science to Scale

Early childhood linked to SDG targets • Goal 1, target 1. 2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty • Goal 2, target 2. 2: By 2030, end hunger and ensure access by all people to safe, nutritious and sufficient food all year round. • Goal 3, target 3. 2: By 2030, end preventable deaths of newborns and children under 5 years of age • Goal 4, target 4. 2: By 2030, ensure that all girls and boys have access to quality early childhood development, care and preprimary education. • Goal 16, target 16. 2: By 2030, end abuse, exploitation, trafficking and all forms of violence against and torture of children.

Global Strategy 2016 - 2030 Early childhood development- a core goal 1. SURVIVE End preventable deaths 2. THRIVE Ensure health and well-being 3. TRANSFORM Expand enabling environments 39

Regional Early Childhood Networks ARC/ ANECD, ISSA, ARNEC, Af. ECN Advancing Early Childhood Development: from Science to Scale

In summary, we must … • • Start early, from conception Promote the concept of nurturing care Assure an enabling environment for parents Provide feasible, evidence-based programmes Use the health sector and other platforms to scale Expand political will, encourage new champions Keep the momentum going- believe that change is possible Advancing Early Childhood Development: from Science to Scale

“Evidence consolidated in this series points to effective interventions and delivery approaches at a scale that was not envisaged before” Believe that change is possible Keep the momentum going Move the agenda forward… Advancing Early Childhood Development: from Science to Scale