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Early Childhood Development Delivering inter‐sectoral policies, programmes and services in low‐resource settings Topic Guide

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Acknowledgements We thank the DFID inter‐sectoral steering group on ECD for their support and advice in development of this Topic Guide, and the feedback on earlier drafts from a panel of expert reviewers.
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    Early   Childhood   Development   Delivering   inter ‐ sectoral   policies,   programmes   and   services   in   low ‐ resource   settings   Topic   Guide   November   2014   Prepared   by:   Martin   Woodhead   Emeritus   Professor    of    Childhood    Studies,   The   Open   University;    Associate   Research   Director,   Young   Lives,   University    of    Oxford;   Vice ‐ Chair    of    Trustees,   UNICEF    UK    With:   Laura   Bolton,   Imogen   Featherstone   and   Penny   Robertson   Acknowledgements   We   thank   the   DFID   inter ‐ sectoral   steering   group   on   ECD   for   their   support   and   advice   in   development   of    this   Topic   Guide,   and   the   feedback   on   earlier   drafts   from   a   panel   of    expert   reviewers.     2 Table   of    Contents   Executive   Summary   .......................................................................................................   4   1.   Introduction............................................................................................................   8   1.1   Early   childhood   development   matters   ...............................................................   8   1.2   Goals   for   the   Topic   Guide   .................................................................................   10   1.2.1   A   lifecycle   perspective   on   ECD.   .................................................................   10   1.2.2   Multi ‐ sectoral   and   comprehensive   ...........................................................   12   1.2.3   Integrated   ECD   systems   ............................................................................   12   1.3   Conceptual   framework   .....................................................................................   13   1.4   Scope   and   organisation   of    the   Topic   Guide   ......................................................   15   1.5   Assessment   of    Evidence   Strength   .....................................................................   17   1.6   Related   resources   .............................................................................................   19   1.7   References   for   Section   1   ...................................................................................   20   2.   What   is   integrated   ECD?   .........................................................................................   25   2.1   A   brief    history   of    integrated   ECD   ......................................................................   25   2.2   Building   effective   integrated   ECD   systems   .......................................................   28   2.3   References   for   Section   2   ...................................................................................   30   3.   Before   Conception   to   Birth   .....................................................................................   33   3.1   Social   protection   and   poverty   reduction   ..........................................................   35   3.2   Family   planning   .................................................................................................   37   3.3   Health   and   nutrition   for   adolescent   girls   and   mothers ‐ to ‐ be   ..........................   37   3.4   Antenatal   preparation   ......................................................................................   38   3.5   Mother ‐ to ‐ child   infection   prevention   ..............................................................   38   3.6   Birthing   practices   ..............................................................................................   39   3.7   Newborn   care   ...................................................................................................   39   3.8   Breastfeeding   ....................................................................................................   41   3.9   Early   interactions   and   ‘stimulation’   ..................................................................   41   3.10   Summary   for   age   phase   ‘Before   conception   to   birth’   ....................................   43   3.11   References   for   Section   3   .................................................................................   43   4.   Infancy:   from   birth   to   two   years   .............................................................................   49   4.1   Birth   Registration   ..............................................................................................   50   4.2   Parental   leave,   child   care   and   social   protection   ...............................................   50   4.3   Infant   nutrition   .................................................................................................   51   4.4   Reducing   disease   ..............................................................................................   52   4.5   Healthy   environments   ......................................................................................   53   4.6   Parenting   interventions   including   home ‐ visiting   .............................................   55   4.7   Community ‐ based   programmes   including   day   care   .........................................   57   4.8   Summary   for   age   phase   ‘From   birth   to   2   years   (infancy)’   ................................   59   4.9   References   for   Section   4   ...................................................................................   59   5.   The   pre ‐ school   years:   three   to   five   years   ................................................................   66   5.1   Centre ‐ based   preschool   education   ..................................................................   68   5.2   Home   and   community ‐ based   programmes   ......................................................   70   5.3   Parenting   support   and   training   .........................................................................   70   5.4   Integrating   nutrition,   health   and   WASH   within   pre ‐ school   programmes   ........   71   5.5   Comprehensive,   scaleable   ECD   initiatives   ........................................................   72   5.6   Inclusive   programmes   and   equity   ....................................................................   75     3   5.7   Summary   for   age   phase   ‘3   to   5   years’   ..............................................................   76   5.8   References   for   Section   5   ...................................................................................   77   6.   Transition   to   school:   six   years   onwards   ..................................................................   82   6.1   Children’s   readiness   for   school   .........................................................................   84   6.2   Families’   readiness   for   school   ...........................................................................   86   6.3   Schools’   readiness   for   children   .........................................................................   87   6.4   Inclusive   practices   in   the   transition   to   school   ..................................................   88   6.5   WASH   programmes   in   schools   ..........................................................................   90   6.6   Health   programmes   in   schools   .........................................................................   91   6.7   Nutrition   programmes   in   schools   .....................................................................   93   6.8   Summary   of    age   phase   ‘6   years   onwards’   ........................................................   94   6.9   References   for   Section   6   ...................................................................................   94   7:   Conclusion:   towards   more   integrated   ECD   ...........................................................   102   7.1   Holistic   early   childhood   development   ............................................................   102   7.2   Multiple   entry   points   and   delivery   platforms   .................................................   102   7.3   Horizontal   integration   .....................................................................................   103   7.4   Vertical   integration   .........................................................................................   103   7.5   Integration   at   all   levels   of    governance   ...........................................................   104   7.6   Effective   coordination   beyond   public   services   ...............................................   104   7.7   Inclusive   and   equitable   ...................................................................................   105   7.8   Continuity   across   age   phases..........................................................................   105   7.9   Capacity   building   .............................................................................................   106   7.10   Pragmatic,   innovative   and   sustainable   .........................................................   107   7.11   References   for   Section   7   ...............................................................................   107   Follow   HEART   on   Twitter:   @HEART_RES   Discuss   this   Topic   Guide   using   the   hashtag:   #ECD4dev   This Topic Guide was produced by The Health & Education Advice & Resource Team (HEART), which is funded by the British Government’s Department for International Development (DFID). For any further enquiry, please contact info@heart‐resources.org Further HEART reports are published online at www.heart‐resources.org  Disclaimer  ‐ The   Health   &   Education    Advice   &   Resource   Team   (HEART)    provides   technical    assistance   and    knowledge   services   to   the   British   Government’s   Department     for    International    Development    (DFID)   and    its    partners   in   support    of     pro ‐  poor     programmes   in   education,   health   and    nutrition.   The   HEART    services   are    provided    by    a   consortium   of    leading   organisations   in   international    development,   health   and    education:   Oxford    Policy    Management,   CfBT,   FHI360,   HERA,   the   Institute   of    Development    Studies,   IMMPACT,   the   Liverpool    School    of    Tropical    Medicine   and    the   Nuffield    Centre    for    International    Health   and    Development    at    the   University    of    Leeds.   HEART    cannot    be   held    responsible    for    errors   or    any    consequences   arising    from   the   use   of    information   contained    in   this   report.    Any    views   and    opinions   expressed    do   not    necessarily    reflect    those   of    DFID   or    HEART    or    any    other    contributing   organisation.   HEART    Topic   Guides   are   licensed    under    a   Creative   Commons    Attribution   4.0   International    License.   This   means   that     you   are    free   to   share   and    adapt    this   information    for    any     purpose,   even   commercial.   However,    you   must     give   appropriate   credit,    provide   a   link    to   the   license,   and    indicate   if    changes   were   made.   You   may    do   so   in   any    reasonable   manner,   but    not    in   any    way    that    suggests   the   licensor    endorses    you   or     your    use.   You   may    not    apply    legal    terms   or    technological    measures   that    legally    restrict    others    from   doing   anything   the   licence    permits.   Photo on front cover: A mother plays with her young son in the Kenyan village of Mwea © Bill & Melinda Gates Foundation     4 Executive   Summary   Early   childhood   development   (ECD)   has   become   a   priority   for   research,   policy   and   programming,   at   national   and   global   level,   with   increasing   recognition   of    the   interconnections   between   a   nation’s   development   goals   and   the   quality   of    services   for   all   young   girls   and   boys,   and   their   families.   The   term   ‘ECD’   is   increasingly   being   used   to   reflect   the   evidence   that   young   children’s   survival,   health,   care   and   learning   involves   interconnected   and   dynamic   growth   processes   from   well   before   the   infant   is   born   through   into   their   early   school   years.   ECD   is   thus   a   broad   and   complex   field,   covering   multiple   policy   sectors,   and   diverse   research   traditions,   but   with   the   aspirations   of    constructing   more   inter ‐ sectoral,   and   more   integrated   models   of    services   delivery.   The   Topic   Guide   offers   brief    summaries   of    key   research,   evaluations   and   case   studies,   as   well   as   links   to   more   specialist   resources   relevant   to   this   vision   for   ECD.   It   draws   on   a   very   broad   range   of    published   research   and   policy   studies,   spanning   health;   nutrition;   water,   sanitation   and   hygiene   (WASH);   social   protection;   and   education.   It   includes   experimental   trials   of    innovative   programmes   as   well   as   policy   reports   on   systemic   reform.   Despite   the   ambitious   scope,   inevitably   the   Topic   Guide   is   not   exhaustive,   and   for   example   has   limited   coverage   of    child   protection   issues   that   are   also   at   the   heart   of    an   integrated   vision   for   ECD.   Specialist   services   for   specific   groups,   notably   young   disabled   children   are   also   essential   within   an   integrated   and   inclusive   vision,   but   detailed   discussion   is   beyond   the   scope   of    the   guide.   The   case   for   working   towards   more   coordinated,   more   integrated   policy,   programming,   capacity   building   and   research   is   not   new.   Early   childhood   pioneers   have   emphasised   the   importance   of    respecting   children’s   holistic   development   for   at   least   two   centuries;   and   flagship   national   programmes   have   been   built   up   around   service   integration   principles   since   the   1960s.   There   are   many   lessons   to   be   learned.   Introducing   effective   inter ‐ sectoral   integration   can   be   a   very   positive   step   forward,   but   can   also   be   very   challenging   to   deliver   in   practice,   especially   in   contexts   with   low   resources   and   weak   governance.   The   priority   is   to   support   practical   steps   towards   quality   holistic   ECD   in   low ‐ and   middle ‐ income   countries   where   services   for   young   children   and   families   are   growing   rapidly,   but   not   always   coherently.   ECD   is   not    just   inter ‐ sectoral.   It   is   also   dynamic.   Just   as   the   foetus,   infant,   young   child   and   school   student   experience   multiple   transformations   during   their   early   years,   so   too,   policy   and   programming   must   be   sensitive   to   changing   needs   and   priorities   at   different   ages   and   stages,   all   embraced   within   the   concept   of    ‘ECD’.   The   significance   of    early   childhood   can   hardly   be   overstated.   Chronologically,   it   spans   nearly   the   first   half    of    childhood.   Developmentally,   it   is   even   more   significant,   shaping   all   that   follows.   ECD   encompasses   several   quite   distinct   early   developmental   phases.   In   this   Topic   Guide   we   distinguish   the   period   ‘from   conception   to   birth’   from   ‘birth   to   2   years’,   followed   by   the   ‘preschool   years’   and   the   ‘early   school   years’.   These   are   not   precise   phases.   They   are   shaped   by   cultural   beliefs   and   institutional   structures,   as   well   as   development   changes   in   children’s   capacities,   vulnerabilities   and   emerging   autonomy;   their   needs   for   care,   ways   of    communicating,   playing   and   learning;   as   well   as   the   patterns   of    their   daily   lives   in   modern   societies,   including   access   to   ECD   services   and   schools.     5 The   Topic   Guide   has   three   specific   goals:   1)   to   summarise   evidence   across   the   full   age   span   of    ECD,   identifying   key   developmental   phases   and   transitions,   beginning   before   conception   through   to   early   grades   of    school,   and   also   recognising   intergenerational   and   life   cycle   issues   2)   to   map   the   various   sectoral   entry   points   for   delivering   comprehensive   holistic   ECD   services,   and   highlight   the   distinct   research   traditions,   key   evidence,   policy   priorities   and   programmatic   expertise   associated   with   each   sector   3)   to   identify   opportunities   and   challenges   in   achieving   more   integrated   ECD   at   every   level:   building   inter ‐ sectoral   policies,   management,   programming,   professional   training,   service   delivery   and   research.   Section   1   and   Section   2   introduce   the   topic   and   the   concept   of    integrated   ECD,   with   an   extended   case   study   of    one   of    the   longest   running   national   programmes,   Integrated   Child   Development   Services,   in   India,   which   was   initiated   in   1975   (see   Case   Study   1   in   Section   2).   Section   3   covers   the   period   before   conception,   through   pregnancy,   and   including   the   first   weeks   after   birth.   The   impacts   of    a   mother’s   health,   well ‐ being   and   education   on   their   infant   is   well   documented.   Recent   research   now   identifies   specific   epigenetic   pathways   from   maternal   nutrition   at   the   time   of    conception   through   to   long   term   development.   Section   3   includes   brief    summaries   of    evidence   on   family   planning,   maternal   nutrition   and   disease   prevention,   antenatal   preparation   and   birthing   practices,   breastfeeding,   neonatal   care   and   early   attachment   relationships.   Social   protection   and   poverty   reduction   is   an   overarching   policy   priority   during   pregnancy   and   the   neonatal   period,   within   which   specific   initiatives   can   improve   the   health,   well ‐ being   and   prospects   for   mother   and   infant.   An   extended   case   study   describes   the   large ‐ scale   federal   Oportunidades   programme   in   Mexico,   introduced   in   1997,   which   combines   conditional   cash   transfers   with   coordinated   health,   nutrition   and   education   interventions   (see   Case   Study   2   in   Section   3).   Section   4   focuses   on   the   period   from   0   to   2   years,   when   WASH,   health   and   nutrition   interventions   have   traditional   prominence,   along   with   early   learning   support   via   parenting   programmes   which   are   increasingly   recognised   as   crucial   within   a   comprehensive   approach.   One   of    the   major   research   insights   for   this   early   life   phase   is   that   combining   nutrition   interventions   with   play ‐ based   learning   and   psychosocial   support   can   have   major   long ‐ term   benefits   for   children.   Section   4   also   considers   how   employment   opportunities,   laws   and   practices   around   parental   leave,   and   access   to   quality   community ‐ based   childcare   all   impact   on   parents’   capacities   and   children’s   well ‐ being.   Birth   registration   is   identified   as   a   crucial   first   step   in   children’s   and   parents’   entitlement   to   social   protection   and   ECD   services,   especially   for   marginalised   groups.   Section   5   looks   at   the   3   to   5   age   group,   commonly   referred   to   as   the   ‘preschool   years’,   which   anticipates   enrolment   into   primary   school    –   now   a   major   transition   for   most   of    the   world’s   children.   There   is   a   marked   shift   in   the   emphasis   of    policy   and   research   for   this   age   group,   with   much   stronger   engagement   from   the   education   sector,   and   a   strong   tradition   of    research   evaluating   the   impact   of    experimental,   mainly   centre ‐ based,   programmes.   Multiple   replications   demonstrate   the   potential   impact   on   educational   and   psychosocial   outcomes   through   the   life   course,   in   a   few   cases   tracked   through   into   middle   age.   Several   of    these   ‘classic’   studies   have   provided   the   underpinning   data   of    economic   analyses   on   the   investment  
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