Children at risk

Advancing Early Childhood Development: from Science to Scale

 Burden of risk

2004 data REVISED 2004 data

• 279 million
children

2010 data
11% Decline

Advancing Early Childhood Development: from Science to Scale

Evidence-based interventions
for nurturing care

Advancing Early Childhood Development: from Science to Scale

New evidence:
longitudinal outcomes

• Interventions
• Birth cohort studies
 Long-term follow ups show that growth
failure in the first two years of life has
extensive effects
 Deficits and disadvantages are carried over
into the subsequent generation

Advancing Early Childhood Development: from Science to Scale

Evidence-based interventions

Advancing Early Childhood Development: from Science to Scale

Multi-sectoral intervention packages to improve child development

Family Support & •Access to quality services, skills building, support

Strengthening Package

Multigenerational •Care and protection of mothers’ and fathers’ physical and mental
health and wellbeing, and their capacity to provide nurturing care
Nurturing Care Package

Early Learning & •Integrates support for young children with parental and caregivers’
support to create a nurturing learning environment
Protection Package

Advancing Early Childhood Development: from Science to Scale

The cost of inaction

Advancing Early Childhood Development: from Science to Scale

The personal cost of inaction in grades and earnings lost

Grade Deficit Income Loss Children

Stunted
only 4.67 42.3% 106.5m (18.5%)

Poor only 0.71 5.8% 75.6m (13.1%)

Stunted and
poor 6.56 32.4% 67.2m (11.7%)

Advancing Early Childhood Development: from Science to Scale

The personal cost of inaction in grades and earnings lost

43% of children in LMICs (249 million)

lose 26.6% of average adult income

Advancing Early Childhood Development: from Science to Scale

Societal costs of inaction
Early childhood risks Outcomes to age 2y
Growth, health, wellbeing
Poverty
Poor maternal health
Outcomes to preschool
Pregnancy & birth complications
+ School readiness
Under-nutrition
Infections
Lack of learning opportunities
Outcomes late childhood
+ School achievement
Exposure to violence
Outcomes adolescence,
Family and public adulthood
investments, interventions + Health, wellbeing, earnings

Advancing Early Childhood Development: from Science to Scale

Societal cost of not reducing stunting
Region Country GDP/capita US$ Govt health expenditure Cost of inaction (%GDP)
(%GDP)

Ethiopia 505 5.1 7.9

Kenya 1245 4.5 5.4
Sub- Madagascar 463 4.2 12.7
Saharan Nigeria 3005 3.9 3.0
Africa Tanzania 695 7.3 11.1
Uganda 572 9.8 7.3

Bangladesh 958 3.7 5.6

India 1499 4.0 8.3
South Asia Nepal 694 6.0 3.4
Pakistan 1275 2.8 8.2

Advancing Early Childhood Development: from Science to Scale

Societal cost of not improving child development

Country GDP/capita US$ Govt education Cost of inaction (%GDP)

expenditure (%GDP)
Home visits Preschool

Guatemala 3478 3.2 1.4 3.6

Nicaragua 1851 6 2.1 4.1
Colombia 7831 3 0.2 0.9
Peru 6662 3.2 0.1 0.4
Ecuador 6003 4.7 0.3 0.2

Advancing Early Childhood Development: from Science to Scale

 Improving ECD is key to achieving the SDGs
GOAL CONTRIBUTION OF ECD TO ACHIEVING THE GOAL
1 Eradicate poverty ECD interventions increase school grades and earnings
2 End hunger and improve nutrition ECD and nutrition interventions help to improve early growth & development

ECD interventions improve quality of home practices, increase health service use and
3 Ensure healthy lives
decrease chronic disease and mental ill-health

4 Ensure lifelong learning ECD interventions promote learning, grade achievement and productivity

5 Achieve gender equality ECD interventions increase learning motivation, especially for girls

10 Reduce inequality among and ECD and nutrition interventions help children at risk to attain their developmental
between countries potential

16 Promote peaceful societies ECD interventions improve emotional regulation and social behaviour
17 Strengthen the means of
ECD interventions can strengthen coordination across sectors
implementation

Advancing Early Childhood Development: from Science to Scale

Pathways to scale

Advancing Early Childhood Development: from Science to Scale

Pathways to scale
1. Effective interventions
2. Delivery platforms to reach families
3. Country case studies of scale
4. Conducive policy environment
5. Affordable action

Advancing Early Childhood Development: from Science to Scale

1. Effective interventions

Advancing Early Childhood Development: from Science to Scale

Effective interventions:
UNICEF/WHO Care for Child Development (CCD)

• Initially Developed as a Module of IMCI

• To be compatible with health service
delivery in LMICs
• Community workers trained to
encourage, model, prompt and praise
mothers/caregivers
• Expanded to 23 sites in 19 countries;
translated into 17 languages

Advancing Early Childhood Development: from Science to Scale

Evidence of effectiveness
• China (2007) – two
counselling sessions
• Turkey (2008) – sick
child visit
• Pakistan (2010-2013)
–home visits and
mother groups
Advancing Early Childhood Development: from Science to Scale
2. Delivery platforms to reach
families

Advancing Early Childhood Development: from Science to Scale

Nurturing care is fostered by a supportive
environment – the ecological model

Health, nutrition, education, Capacity Nurturing care

National
social and child protection to provide by parents and
policies
services nurturing care caregivers

Advancing Early Childhood Development: from Science to Scale

Delivery platforms to reach families through
health and nutrition services

• Well-developed platform
• Extensive reach to women and children
• Existing MCH services benefit child development
• Child development interventions successfully delivered in
collaboration with health services
• Effective and affordable

Advancing Early Childhood Development: from Science to Scale

Examples of MCH interventions that benefit
child development

Iodine supplementation, before and during pregnancy and iron and folate supplementation

Antenatal corticosteroids for preterm risk

Psychosocial support during childbirth

Kangaroo mother care for small infants

Breastfeeding

Multiple micronutrient supplementation for at risk children

Advancing Early Childhood Development: from Science to Scale

Other platforms to reach families,
young children
Social Child
Education protection protection WASH

• Women’s
• Reduction of
education
• Family health harsh • Access to
• Early
insurance punishment clean water
learning
• Cash • Prevention of • Sanitation
opportunities
transfers child • Hygiene
• Child daycare
maltreatment
• Preschool

Advancing Early Childhood Development: from Science to Scale

3. Country case studies of scale

Advancing Early Childhood Development: from Science to Scale

Four country case studies
India Chile South Africa Bangladesh
Integrated Child Chile Crece Grade R Shishu Bikash
Development Contigo (ChCC) Kendra (SBK)
Services (ICDS)

Started in 1975 Started in 2007 Started in 2005 Started in 2008

2014 2014 2015 2009 – 2016

104.5 million 80% target 80% of children 200,000 child
beneficiaries population enrolled visits

Advancing Early Childhood Development: from Science to Scale

Country case studies of scale
Chile Crece Contigo (ChCC)

• Goal: enable children to reach their potential

• Implemented in 2007, came into law in 2009
• Funded by federal government
• Combines health services, parenting support and preschool
• Universal and targeted services
• From pregnancy to age 4
• Scale – reaches 80% of target population

Advancing Early Childhood Development: from Science to Scale

Common features of large-scale programs

1. Political concerns about poverty, equity, social exclusion

2. Informed by scientific and economic evidence
3. Vision of comprehensive and integrated services
tm e nt
4. Founded by statute or government strategy
om m i
5.
c al c
Funded and led by government
ti
6.
Pol i
Different entry points – most often health,
starting from pregnancy

Advancing Early Childhood Development: from Science to Scale

4. Conducive policy environment

Advancing Early Childhood Development: from Science to Scale

Nurturing care is fostered by a supportive
environment – the ecological model

Health, nutrition, education, Capacity Nurturing care

National
social and child protection to provide by parents and
policies
services nurturing care caregivers

Advancing Early Childhood Development: from Science to Scale

Examples of national policies
To enable families to provide nurturing care

Time Resources
•Breastfeeding breaks •Cash transfers
at work •Health insurance
•Parental leave
•Leave to look after •Minimum wage
sick children •Free pre-primary education

Advancing Early Childhood Development: from Science to Scale

5. Affordable action

Advancing Early Childhood Development: from Science to Scale

Affordability
• Costed the addition of two feasible
and effective interventions to the standard
RMNCH package of services
 Intervention to promote nurturing care
(6 visits)
 Support for maternal depression (5 sessions)
• Aligned with Global Investment Framework
(GIF) for women’s and children’s health

Advancing Early Childhood Development: from Science to Scale

Simulation Scenarios for
Description
NC and SMD

• 73 high-burden LOW Coverage flat-lined

countries (current coverage) at 2015 levels
• 3 scale-up
scenarios MEDIUM
(continuing trends) 58% coverage

HIGH
(scale-up) 98% coverage

Advancing Early Childhood Development: from Science to Scale

Cost (2015-2030)
• Medium (58%) Countries
HIGH
scenario
MEDIUM
scenario
Incremental
per capita
 US$16 billion (billions) (billions) costs

 20c per capita/ Upper Mid

Income (11) 17.3 8.5 0.30
year Lower Mid
Income (32) 15.5 6.6 0.20
• High (98%) Low Income
 additional 50c (30) 1.6 0.9 0.10

per capita/year TOTAL 34.5 16 0.20

Advancing Early Childhood Development: from Science to Scale

The way forward

Advancing Early Childhood Development: from Science to Scale

Recommendations
1. Science says “start early,” conception-3y
2. Expand political will through the SDGs
3. Create conducive policy environments
4. Adopt a multi-sectoral framework
5. Use the health sector as an entry point
6. Support system enablers in program
organization, administration, evaluation

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. During
the next fifteen years, world leaders have a
unique opportunity to invest in the early years
for long-term individual and societal gains and
achievement of the SDGs.”
– Excerpt from Executive Summary

Advancing Early Childhood Development: from Science to Scale

Nuestros niños y
niñas son nuestro
futuro -- el futuro
del mundo y de
Perú

Advancing Early Childhood Development: from Science to Scale