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The Consultative Group on Early Childhood Care and Development

BREAKING DOWN THE BARRIERS:CREATING INTEGRATED EARLYCHILDHOOD PROGRAMMESby Judith L. EvansConsultative Group on Early Childhood Care and Development

Keynote Address at the Conference onThe Holistic/Integrative Concept in EarlyChildhood Education and DevelopmentLarnaca, Cyprus, February 15-18, 1997

INTRODUCTION…1A DEFINITION OF HOLISTIC AND INTEGRATED PROGRAMMING FOR YOUNG CHILDREN…3INTEGRATED PROGRAMMING…4PRINCIPLES IN THE DEVELOPMENT OF INTEGRATED PROGRAMMING…7STRATEGIES IN THE DEVELOPMENT OF INTEGRATED SERVICES…15REFERENCES…23

Introduction

King Solomon was asked to settle a dispute between two women who both claimed to be themother of a young child. He called the two women into his Court, and, on seeing thedetermination of both women to claim the child as their own, suggested that the child be split intwo, so that each woman could take half. Upon hearing this verdict, one woman—the realmother—was horrified at King Solomon's solution, and withdrew her claim. At that point, KingSolomon was able to identify the true mother. It was the woman willing to set aside her ownclaims in support of the child's best interests.

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This story offers a good reminder to the early childhood community to keep in sight the fact thatwe are dealing with whole children, with multi-dimensional and integrated needs. It is oftentempting to claim that our interests—whether it be vitamin A supplementation, school readiness,or religious socialization—are central to a child's life, and to lose sight of what is in the bestinterests of the child: the whole child. Research and common sense both suggest that allprogrammes for young children should be multi-dimensional and seek integration, attending tohealth, nutrition and psychosocial well-being.

But the realities we face when trying to address children's needs often create barriers that lead tocompartmentalizing children's growth and development:

! the division of services along sectoral lines such as welfare, health, education, socialdevelopment, urban development and others have often created competition and one-sidedprogramming where there should be cooperation and integrated programming.

! the great proliferation of academic knowledge about what children need, coming fromsuch diverse disciplines as biology, science, psychology, anthropology, education, andneuroscience can offer insights to strengthen programming, but instead often createsharper—and more limited—lenses through which we view children and, based on that view,plan programmes.

! the allocation of funds through ministries often skews our thinking and guidesprogramming, when in fact it should be the programmatic needs of children that guidefunding.

These and other barriers arise as we try to create integrated programming, but there is a need tobreak them down if we are going to make a difference in the lives of young children and theirfamilies. In this paper, an attempt is made to build a case for bringing the pieces together andbreaking down the barriers that compartmentalize children's growth and development. Thediscussion is set within an integrated view of child development that crosses disciplinary andsectoral lines. In that holistic view, physical, social, emotional and cognitive development areconsidered to be as important as cognitive development. In addition, the child’s nutritional andhealth status is considered to be as important to early and later learning and education as thechild’s mental and social well-being. This implies that non-educational dimensions ofdevelopment should be included in programmes that emphasize educational goals or are locatedwithin the education bureaucracy, just as the educational or psychosocial dimension ofdevelopment should be included in programmes located within the health sector or in nutritionprogrammes. The challenge is how to make that happen.

The paper begins with a summary of the benefits of quality early childhood programmes, followedby a discussion of research on children’s development that illustrates the need for holisticprogramming. There is then a definition of integration and what that means in terms of earlychildhood programmes. The final section includes a delineation of strategies for creatingintegrated programmes.

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A Definition of Holistic and Integrated Programming for YoungChildren

A holistic perspective on children’s growth and development means seeing children as wholebeings, whose growth and development is supported (or inhibited) within the context of thefamily, the community and the nation.

Children enter the world as whole beings. They have a biological system in place that interactswith their environment. Through that interaction the child grows and develops. During the earlymonths children’s physical development is easily observable. What is not so evident are the waysin which the child is growing mentally, socially and emotionally, but all of these dimensions are apart of children’s development, and they are inter-related. Progress in one area affects progress inthe others. Therefore, we need to see children’s development as holistic. What this means is thatin addressing the needs of young children, it is critical to pay attention simultaneously to thechild’s physical development (through health and nutrition), mental development (througheducation and stimulation), social-emotional development (providing affection, andopportunities for social participation), and spiritual development.

Within a holistic approach it is not enough to focus only on the child’s inter-related needs. Asnoted, the child develops in interaction with the environment. A critical part of thatenvironment is the family. Supports from the family are critical to healthy growth anddevelopment. Thus in programming it is important to have an understanding of the child withinhis/her natural environment. The child needs to be understood within the context of the family(however family is defined for the child). If the family is going to provide the best possible care forthe child, then the family needs resources. Thus it is important to know the economic conditionsof the family and to have an understanding of what that means in terms of resources available tosupport the child’s growth and development (e.g., Does the mother work outside the home? If so,who takes care of young children? Is there enough food for all members of the family? How is theavailable food allocated?).

To focus only on the child and family still limits what can be accomplished. The family existswithin a wider environment—that of the community, and ultimately the nation. The economic,social, political and cultural dimensions of the community and nation have an impact on whetheror not children thrive. Thus to provide appropriate programming for young children and theirfamilies, the total context within which the child lives must be taken into account.

Attention can be given to children’s holistic development through integrated programming.Integrated programming means addressing the child’s multiple needs. The evaluation of single-focus programmes has demonstrated their ineffectiveness. For example, growth monitoring thatcharts children’s development is a waste of resources if mothers are not educated on how toprovide the child with better nutrition. Nutrition supplementation programmes bring only short-term gains for the child if they do not work with the family to change the family dynamics thatproduced a child’s malnutrition. Pre-school programmes that try to teach a child who is hungry orwho has suffered abuse at home will not produce a child capable of learning.

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Programmes that are effective see the child as a whole child. They take into consideration achild’s need for a healthy body and for psychological and social support. These programmesprovide a variety of activities that stimulate the development of cognitive skills, imagination andcreativity, and provide opportunities for children to take responsibility for themselves and theirlearning within the context of a social-cultural environment.

Integrated programming can take various forms. Providing for the multiple needs of youngchildren and their families seldom takes place within one setting. Frequently there arepartnerships formed between social welfare, health and education to assure that children’smultiple needs are met. A variety of relationships can be established that build on what existsand help fill the gaps in services in relation to what children need. These can include:

! short-and long-term cooperation in the provision of specific services;

! joint training of health and education workers so they are providing consistent messagesto families;

! the mapping of a community to identify services that exist and the families that are beingserved by those services in order to see where there are gaps and then planning newprogrammes to fill the gaps;

! the creation of coalitions to advocate for increased support for services for young childrenand their families, etc.

Taking a holistic perspective on child development and providing integrated programming thataddresses the multiple needs of children does not always mean providing services directly tochildren in center-based programmes. For the youngest children, in particular, it is important toprovide supports to the family. Thus programmes that support parents in their parenting role andprogrammes that help change the economic situation of the family are important and ultimatelyhave an impact on the child. Similarly, community development (empowerment) efforts areimportant, as they change the environment within which children are being raised. Thestrengthening of the institutions which work with families is another strategy that can be used tosupport the development of quality programmes. Ultimately all of these efforts are supported (orinhibited) by national policy. Thus an appropriate programming strategy is to advocate for theimplementation of national policies supportive of young children and their families.

Integrated Programming

Integration has become a buzz-word, although the concept is not new. An understanding of theneed for integrated services has been around for more than 20 years. Yet as programmes foryoung children and their families are reviewed, there is difficulty in identifying exemplary modelsof integrated programming. So why is it so difficult to create integrated programmes? There areseveral answers. One set of answers has to do with the nature of early childhood developmentand what that means in terms of current programming, and the other has to do with a lack ofcommon understanding of what is meant by integrated services.

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Current Early Childhood Programming

The dynamics of current early childhood programming that create barriers to a more integratedperspective include the following:

! A MULTIPLICITY OF SECTORS IS INVOLVED IN EARLY CHILDHOOD PROGRAMMING

Early childhood care and development, because it is closely intertwined with child rearing, is aphenomenon in which almost everyone feels he or she should have a say, including those withhealth, education, public welfare, social services, community development, and labour concerns.What this means is that no one sector has ownership of early childhood concerns. All the sectorsare in a position to offer appropriate services for young children, and they do. By looking atThailand it is possible to illustrate the issue. In 1983 it was estimated that only 2% of the 0-6 agegroup were being served through some type of early childhood effort. Yet, even with so fewchildren being served at that time, the following programmes had been developed: child nutritioncenters run by the Department of Health; child development centers operated by theDepartment of Community Development; kindergarten, or "head start" centers run by theDepartment of Education; day-care centers operated by metropolitan city municipalities; andprivate enterprises provided services to yet another group of children. (UNESCO 1983, 4) Somechildren could be served by more than one of these programmes, while other children are withoutany services.

! A MULTIPLICITY OF GOALS ARE BEING SET TO GUIDE PROGRAMMES

Related to the fact that there are a variety of sectors concerned with the young child, is that eachof these sectors has its own set of goals that it wants to achieve. The health sector is concernedabout children’s basic survival. From the welfare perspective a concern is to enhance children’saccess to resources. Education is interested in providing children with a variety of experiencesthat will help prepare them to do well in the primary school. Those working with women want tofree women’s time so that they can get involved in income-generating activities; while care forthe child is important, services tend to be only custodial. In addition, public and private sectorsmay have different goals for offering services to young children. While these goals arecomplementary, if programmes are implemented without an understanding of the child’s fullrange of needs, they will have limited utility.

! THERE IS A LACK OF AWARENESS OF WHAT OTHERS ARE DOING

To make things even more difficult, those operating early childhood programmes may not beaware of the ECD programmes offered by other sectors. Furthermore, private sector providersfrequently do not coordinate their efforts with public sector programmes offered by health,education, or social welfare ministries. This has two consequences. First, it is not uncommon forparallel programmes to be developed in one community, each addressing a particular need of thechild without reference to other needs that may or may not be met. Second, in some instancesthis leads to more spaces being available within ECD programmes than there are children in agiven community, while in other communities there are no services.

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! MODELS ARE IMPORTED WITHOUT AN ANALYSIS OF WHAT THEY DO (AND DO NOT) OFFER

In industrialized countries the primary emphasis has been on development of pre-schoolprogrammes that include educational and psychosocial components, with little thought beinggiven to the essential health elements. Models of these pre-school systems have been transposedto Majority World countries where the pressing health needs and problems of infants and youngchildren remain either unattended or are aggravated. Rather than importing models developedelsewhere, in each context there is a need to create an appropriate early childhood programme tomeet the full range of children’s needs as they exist within that context. This does not mean thatprogrammes cannot learn from one another. The principles and guidelines from proven modelscan certainly be taken into consideration in creating new programmes, but the specific designand implementation strategy must be developed with a full awareness of the culture andcommunity to be served.

! THE PERCEIVED SCARCITY OF RESOURCES CAUSES PEOPLE TO FEEL THEY CAN ONLY AFFORD TO OFFERLIMITED SERVICES

Whenever there is a discussion of integration, and attempts are made to bring people togetherfrom the various sectors to discuss how this might happen, there is a fear that the limitedresources currently available to the sector are going to have to be shared with others. There islittle understanding that what people are now doing may not be very cost-effective, and that thecombining of resources would, in fact, lead to synergies that would allow current resources toprovide even greater coverage.

! THE FEAR OF LOSING CONTROL KEEPS PEOPLE FROM PARTICIPATING IN ATTEMPTS TO INTEGRATEPROGRAMMES

As noted, people from different sectors fear they must give up financial resources if they are goingto work in integrated programming. Even more threatening, however, is the notion that they mayalso have to give up power—i.e., control of the programme. People need to feel that they will stillhave a place, and that their place is important, if an integrated programme is to be put in place.In countries where an attempt has been made to bring ministries and departments together tocreate an integrated approach, frequently, rather than giving control for the programme to one ofthe existing ministries, a mechanism has to be created that gives power and authority to either anoutside ministry or a neutral branch of the government (e.g., the Office of the Prime Minister).

In sum, given the nature of child development and the multiplicity of sectors concerned,integration is more likely to be seen as a threat than as a promise of better results.

A Definition of Integration

Integration is also elusive because there is no agreed upon definition of the term. Not only isthere difficulty in defining the term concisely in English, but the need to translate the word intohundreds of different languages, and have all the people involved come up with a commonunderstanding of the concept, is even more difficult. In English, according to the Oxford ConciseDictionary (1987), the word "integrate" has two meanings: (1) complete by addition of parts;

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combine parts into a whole, and (2) bring or come into equal membership. If we were to take thefirst definition, it suggests a variety of strategies that can be undertaken. (These are describedbelow.) What tends to happen, however, is that people assume that the second definitionobtains; there is the implication of "equal" partnership, and experience would suggest that thisapproach to integration is not viable. In developing and implementing ECD programmessomeone has to be in charge, have decision-making power, and be held accountable. Whichagency/ ministry/ organization will take on this role depends on several variables. These include,but are not limited to: the age of the children being served; the goals of the programme; theresources available; who initiates the programme (which sector); government policy in relation towhich sector is given the official mandate; the position of NGOs in the country and theircommitment to ECD, etc. As a result, it is unrealistic to expect that there is going to be onemodel of integration.

However, there are some principles that can be applied in developing integrated programmes. Inthe following section is a set of principles to guide integration.

Principles in the Development of Integrated Programming

First and foremost, integration does not necessarily mean that one single programme will bedeveloped to provide all the appropriate services for all children, or even for a given group ofchildren. A variety of programmes can be offered, where the additive effect of the services canmeet the full range of children’s needs. However, it is important to realize that the more separateservices are offered the less likely it is that the importance of the interaction of the componentswill be recognized and maximized.

Second, a multi-sectoral approach to the integration of early childhood programming is required.Such an approach is consuming of both time and energy and can only be developed with thecooperation of all sectors involved. One sector cannot define a holistic programme on its own.While it may be possible for one sector to define the components to be included (e.g health,nutrition, stimulation, etc.) in terms of the specifics, there needs to be an exchange of knowledge,skills and competencies across the sectors to create an integrated programme.

Third, strategies for integration will differ from one setting to another. This will depend on therange of existing services and the sectors within a given context whose works affect youngchildren. For example, if there is the necessity to develop new services, one set of strategies canbe applied. If there are already a number of services that exist, then the strategy is to bring themtogether in some form. These two sets of strategies will be described in what follows:

When New Services Need to be Developed

In many countries in the Majority World, services are not in abundance. The challenge is to geteven a minimal set of services established in some parts of the country. In other areas, servicesare sparse, but they do exist. The question then becomes, what services should be developed tobest meet the holistic needs of children and how can that be done cost-effectively? There are a

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variety of approaches that can be taken to develop new services that will provide integratedattention to young children and their families. These include:

! IN PLANNING THE PROGRAMME, CREATE AN INTEGRATED FRAMEWORK

As programmes and projects are put together, an attempt should be made to consciously providea full range of services for the child (from health and nutrition to educational activities), theparents and sometimes the community. As the people involved in developing services for youngchildren begin to think about creating a service they need to sit together and conceptually designa programme to meet children’s multiple needs. To make an effort like this effective, it isnecessary to have a general and agreed-upon framework to guide the work. Otherwise activitiesproposed or supported by each participating sector are likely to be presented from a sectoralperspective and activities will be carried out in parallel rather than as contributions to a broader,inter-sectoral and integrated goal. This conceptual planning can happen at various levels. It takesplace within international agencies, as well as in the development of national, regional and evencommunity programmes.

At the international level, an example comes from UNESCO where the Early Childhood andFamily Education initiative has been set up as an inter-sectoral project. It is overseen withinUNESCO by a Task Force involving participants from the sectors of Education, Science, theSocial Sciences, Culture and Communication. To coordinate the Task Force and sectoralparticipation within UNESCO and to develop and oversee Project activities, a Secretariat hasbeen established, which reports directly to the Secretary General.

Nationally, attempts are being made to create a policy framework for the provision of earlychildhood services. The Integrated Child Development Services (ICDS) programme in India is anotable example of a conceptually integrated national programme. The need for massiveprogrammes which address the needs of young children is most evident in a country like Indiawhere in 1971 there were more than 105 million children under the age of 6, constituting 19% ofthe population. It was estimated that in 1996 the number of children under the age of six wascloser to 126 million, constituting 14 % of the total population. (Sharma and Sood 1989, 3-5)The sheer magnitude in terms of the numbers of children to be reached is one dimension of theproblem. The fact is that many of these children are likely to suffer delayed or debilitateddevelopment. It was estimated that in 1990, 52.5 percent of all children under the age of 6 wereaffected by protein energy malnutrition (GOI 1992, 2). Thus there was (and continues to be) adesperate need to create programmes to reach the young population.

In 1974, India adopted a National Policy for Children as an indication of its commitment toensure the delivery of comprehensive child development services to all children. ICDS wasconceptualized as the service-delivery mechanism. The primary constituents for the effort were(and continue to be) the poorest of the poor found in urban slums and urban areas, particularlychildren in scheduled castes and tribes. Those for whom the services are provided includepregnant and lactating women and their children up to the age of school-entry. Health, nutritionand early stimulation are all components of the programme.

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The programme began on a pilot basis in 33 of India's 5000 administrative blocks. By March of1985, 100,000 Anganwadis (centers) were providing services to approximately 3 million children.In 1989 it was estimated to have reached 11.6 million children (Myers 1995), with the ultimategoal being the delivery of comprehensive services to all children under the age of 6 by the year2000. This may be difficult to achieve since the estimated under-six population in 1996 was 126million. (Sharma and Sood 1989, 5)

Several major evaluations of the programme have been conducted. The earliest was in 1978.Others have followed, all of which have indicated positive results in terms of the programme'simpact on children, women, and the community at large. For example, participation in the ICDSprogramme is associated with reductions in infant mortality, severe malnutrition, morbidity andschool repetition (Chaturvedi et al. 1987), and the outcomes are particularly favorable for girlchildren. (Lal and Wati 1986) The evaluations have also demonstrated the difficulties ofimplementing such a comprehensive and wide-spread programme. Although fraught with thecomplexities any large system encounters, there is strong political will to reach those most inneed, and to provide them with a range of services to support the health, nutrition and educationof children from birth to 6 years of age, as well as to attend to the needs of child-bearing women.

In sum, the creation of a framework that brings together the health, nutrition, cognitive, andpsychosocial needs of pregnant and lactating women and their young children makes it possibleto develop a set of fully integrated services. This does not necessarily mean that all the serviceswill be implemented at the same time, nor that a single agency or organization will takeresponsibility for all programming directed toward young children, but the presence of a ‘masterplan’ behind an endeavour that takes all components of children’s development intoconsideration is an excellent place to start. However, the conceptualization and implementationof integrated programmes are two very distinct steps in the process. Guidance on programmeimplementation follows.

! IN CREATING A NEW PROGRAMME, BEGIN WITH ONE COMPONENT, AND BEGIN WITH A COMMUNITY-FELT NEED

While planners may have a vision of a holistic programme, experience indicates that programmeimplementation is most successful when one component of the programme is implemented at atime, and when the component is a felt need within the community. Additional services can beadded to the programme as the initial activities become institutionalized. An example ofbeginning with a community-defined need and building on that is the Sang Kancil projectdeveloped within the squatter settlements of Kuala Lumpur, Malaysia. The project was begun byhealth sector personnel interested in establishing primary health care centers within kampungs(districts) in the settlements. Taking a community development approach, meetings were firstheld with community members to determine their needs and priorities. The community was mostinterested in having a child care system for young children, and in creating income-generatingactivities for women. Health care was not seen as a priority. Those involved in developing theproject listened to the community. Rather than building a health centre, they established a pre-school and an income-generating project. When these were well-established, then it was possibleto introduce primary health care, which is now widely accepted. (Yusof 1982)

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In sum, in instances where few services exist, there is an opportunity to begin the process ofintroducing services by first creating a holistic blueprint for action that will, over time, meet thefull range of child and family needs. Implementation of the components should be undertaken ina measured way, following the lead of the community in terms of service priorities, with timingbased on the community’s capacity to absorb additional responsibilities. When a variety ofservices already exist in a region, a different set of principles is available to guide the work. Thesefollow.

When a Variety of Services Exist

In instances where some, if not all, of the appropriate services are available, then the firstdefinition of integration noted before—complete by addition of parts; combine parts into a whole—isappropriate. There are several ways to proceed. These include the following:

! BRING EXISTING SERVICES TOGETHER

In the creation of early childhood programmes where all of the services required are unlikely tobe offered within one setting, a variety of relationships can be established with and amongagencies and organizations—governmental and non-governmental—offering complementaryservices. Through these connections the needs of young children and the family can be met.Within the English language there are a variety of terms to define the nature of the relationshipsthat actually occur as two or more sectors attempt to work together. Each of these terms suggestsa way for people and organizations to relate to one another. Each has a contribution to make tointegrated programming; no one of them is sufficient on its own. Specifically some of therelationships include:

! COALITION: TEMPORARY COMBINATION OF PARTIES THAT RETAIN DISTINCTIVE PRINCIPLES

This level of working together is generally sporadic and for a specific purpose. For example, avariety of groups might come together for the purposes of advocacy, perhaps around promotingnational policies related to the Convention on the Rights of the Child. The coming togetherwould have a single time-bound focus. When not working together in the coalition the groupsmight be involved in diverse activities, and coalitions formed for one purpose might not beappropriate for another purpose. Thus coalitions are useful for creating an enabling environmentsupportive of young children and their families, but they are not sufficient to assure theimplementation of such programmes.

! LIAISON: CONNECTION

Liaisons are formed when organizations are at least meeting together to learn more about whatthe other can provide. Liaising groups work together over time, but on a sporadic—as needed—basis. Liaisons are frequently established for the purpose of referrals. If those working in an earlychildhood programme identify a child who is possibly malnourished they would be likely to liaisewith someone in the health sector.

While referral systems work in resource-rich environments, they have marginal utility in settingswhere there are few resources, and may even be counter-productive. For example, in recent years

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there has been increasing pressure to provide services for special-needs children. Teachers arebeing trained to identify children with developmental delays, learning and/or social-emotionalproblems. The primary inhibitor to more focused attention for these children is that once theyare identified there are no services within the community to meet their needs. The resourcesinvested in identification programmes are wasted when there is no place to refer the child orwhen referral does not lead to appropriate interventions. Everyone is frustrated when hopes areraised and no services are forthcoming.

Liaisons are not a sufficient form of integration in and of themselves. Services remain piecemealand there is no assurance that overall needs are being met.

! UNIFICATION...REDUCE TO UNITY OR UNIFORMITY

At first glance this term would appear to suggest integration. However, unification is notnecessarily a desired state, since it implies that one type of programming and approach isappropriate for all. While it provides a uniformity of experience, it does not necessarily guaranteethat the children’s full range of needs are being addressed.

Unification is likely to occur in highly centralized governments. This type of ECD programme hasbeen found in countries in eastern Europe where the curriculum was specified in great detail,assuring the Inspector that on a given date, exactly the same activity would be undertaken ineach kindergarten at the same time of day.

Today nations are decentralizing power. This is motivated by a variety of factors, among whichare: economics; a pressure for more local control; cultural differences that are not beingaddressed through centralized programming, etc. As a result of decentralization there is less andless unification of programming, particularly in countries where there are heterogenous cultures.

! FEDERATION: FORMING A UNITY BUT REMAINING INDEPENDENT IN INTERNAL AFFAIRS

Federation occurs when separate sectors accept each others’ goals and work together to achievesome common good. An example of federation building is when ministries or governmentdepartments come together for the purposes of creating an early childhood policy. Malaysiaprovides a case study in this approach. During 1994 a federation of government agencies wascreated for the purpose of creating national policy in support of early childhood activities. Todevelop the basis for and recommendations in relation to the policy a three-phase process wasimplemented. The first phase was a workshop attended by all government agencies currentlyproviding some type of ECD programme. This included the Ministry of Heath, The Ministry ofEducation, The Ministry of Welfare, the Ministry of Community Development, The Ministry ofNational Unity and Social Development, and the Ministry of Human Resources. At theworkshop, Phase 2 was developed. It involved the mapping of what existed in terms of currentservice provision and the supports for such provision (e.g., curriculum, materials, and training); areview of the legislation/policies in place related to ECD programmes; and an assessment ofcurrent coordination of services. While the focus of the Phase 2 review was primarily on what isbeing offered by various government departments, where there was a significant contribution to

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ECD by non-governmental agencies (NGOs), the private sector and those involved in ECDprovision for commercial reasons, these were also included in the study.

Phase 3 consisted of another workshop where the results of Phase 2 were presented andrecommendations were formulated. One of the recommendations was that as an interim measure,a National Early Childhood Development Council be created within the Prime Minister'sDepartment for the purpose of formulating, conceptualizing and overseeing ECD programmes inthe various sectors (government, non-governmental and private). The Council is supported by astrong Secretariat with technical skills related to ECD. In the long term the Council will beinstitutionalized within a major Ministry. Thus in Malaysia a mechanism was put into place tomaintain the federation for the purpose of furthering the development of ECD policies andprogrammes.

! COOPERATION: WORKING TOGETHER TOWARD THE SAME END, MUTUAL REINFORCEMENT OF MESSAGES ANDPRACTICES

In this type of integration those offering early childhood services each pursue their ownindividual organizational goals, but they meet together to share information on the messages theyare conveying to be sure that families are getting consistent support from each of the variousservices. While this would seem like a minimum and obvious way of working together, in factthere are numerous instances where it does not happen. Nationally the sectors may cooperate toassure mutual reinforcement of messages, but those implementing the programme in thecommunity may not have the same level of understanding. An example comes from a country inSouth Asia where parallel programmes are being operated in the community, one by the Ministryof Health and the other by a Ministry associated with women’s affairs. The Ministry of Healthprogramme focuses on health and nutrition, while the second ministry promotes parenteducation activities focusing on children’s cognitive development. The programmes both targetthe 0-5 age group and rely on volunteers at the community level to implement the programme.Not infrequently the volunteer works in both programmes. However, the worker in the field seesher two tasks as completely separate. She sees herself as monitoring physical growth for theMinistry of Health and monitoring development for the second Ministry. The activities arecarried out on different days of the week. On one day children are brought to the health centrefor health monitoring. On another day they are brought to a different location for the parenteducation programme. (This puts double demands on the time of both the mother and thecommunity worker.) Rather than understanding the interaction between health, nutrition andstimulation, the volunteer sees them as separate. As a result, opportunities are lost; the parentdoes not understand (and therefore may not adequately support) the synergistic relationshipbetween nutrition, health and psychosocial well-being.

With cooperation there is the possibility for integrated programming. This is unlikely to be thecase if it is only national planners and policy makers who define the cooperation. Unless peoplefrom the community on up are involved in working together to achieve mutual goals, cooperationis more likely to result in parallel programming. This does not yield true integration and thesynergies possible when programme components are offered within one setting.

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! COORDINATION: BRING PARTS INTO PROPER RELATION, CAUSE TO FUNCTION TOGETHER

This strategy is useful in areas where there are already a number of operational services. Itinvolves sitting down with community members to identify the kinds of services offered andassess their effectiveness. The framework used for the assessment presents a conceptuallyintegrated picture of child development and requirements for family support. The communityassessment process allows everyone in the community to identify gaps in terms of types ofpopulations being served and/or in the kinds of services being offered. Decisions can then bemade as to how these gaps might be filled, and by whom.

An interesting example of this approach is being developed in the Philippines. In this instancethe community is being given responsibility for undertaking a review of early childhood coveragein the community and for creating an action plan from a Menu of Options that would bringadditional services to the community. A process for developing a community profile has beendeveloped that allows the community to map all the families in the area and to determine if theyare receiving the services they should for their young children. Services within the communityare also mapped in terms of their geographic coverage, their accessibility and what they offer. Asa result of the mapping, families where children have not been immunized can be identified;those children attending early childhood programmes can be noted; families requiring child carecan be identified, etc. In turn, the location, service hours, the scheduling of specific services, theavailability of appropriate staff, etc., can be noted in terms of the services offered. From thismapping the missing services can be identified and the community can create an action plan.

The resources required to develop these programmes come from the community itself, matchedwith government support in terms of financial resources, materials and/or training andsupervision. A formula has been developed for the receipt of matching funds that provides thegreatest degree of government support to the poorest communities. One of the supports offeredby government will be training of local personnel. The training curriculum is being created by amulti-disciplinary team and will be inclusive of health, nutrition, cognitive and psychosocialinputs. Those who receive the training will have a common core of knowledge and will beequipped to work in health centres, day care facilities, as home day care providers, and/or asparent educators. This particular approach to coordination is likely to yield an integrated earlychildhood programme at the community level.

In sum, one way to achieve integration is to bring together the services that exist. Another set ofstrategies has to do with building on existing programmes, either to strengthen what they arecurrently providing or to add additional components to current services.

! STRENGTHEN EXISTING SERVICES

In some places a framework for the development of integrated services exists. These services maybe under-utilized because people are not aware of what can be provided; they may not beproviding the full range of services because those involved in service delivery are not adequatelytrained; they may be under-resourced, thus narrowing the focus of the effort; and/or the effortmay be strongly influenced by outside donors, giving priority within the programme to those

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things which donors will fund. However, since an infrastructure exists, a sound strategy is tostrengthen what is being offered.

The ICDS programme in India is a good example of a programme with an integrated frameworkthat is not yet meeting its potential, for all the reasons provided above. The various evaluationsof the project have pointed to the weakness of the education/ stimulation programme and theneed to strengthen the training of the workers. As Swaminathan (1993) notes, "From thebeginning, the ICDS has placed heavy emphasis on the health and nutrition aspects of childdevelopment, to the neglect of cognitive development, language skills and indeed of holistic childdevelopment. ...Resource constraints no doubt play a major role in this outcome, but theperception of priorities is also important. A powerful influence has been ‘survival; beforedevelopment’ school of thought," (223) which Swaminathan sees as UNICEF’s influence on theprogramme. Thus work is needed to strengthen the stimulation component of the programme.

Having the conceptual framework in place, and having 20 years of experience in operating theprogramme, the Government of India is in a position to strengthen the system rather thanstarting a whole new set of early childhood initiatives. Several steps are being taken to do this:control of the programmes is being decentralized, giving states and districts greater authority indetermining how the programme is run and identifying for themselves gaps that need to be filled,focusing on priority needs within their area, etc. Another strategy has been for the government towork more closely with non-governmental agencies, turning the operation of ICDS programmesover to the NGOs who may be more closely attuned to needs, resources and the culture within agiven geographic area. A third strategy has been to secure the support of a broad range ofinternational donors to provide specific inputs for the programme (food, training, curriculumsupport, material development, etc.).

! ADD COMPONENTS TO COMPLEMENT CURRENT SERVICES

A legitimate and useful strategy would be to add a missing component into an on-going sectoralprogramme. An option is to incorporate early childhood development actions into on-goingprogrammes of adult education, community development, child care, health, nutrition, etc. Thisstrategy is quite common. Among programmers phrases that can be heard include: "We could useday care centers as a vehicle for offering integrated services to the family." "Programmes would bemore cost-effective if they could provide integrated health and education services." "Children arealready getting an education, why can't we add a health component?" "We should develop anearly childhood programme in conjunction with women's income generating activities." Thesestatements reflect the various ways people have begun to stimulate cross-sectoral programming,with the goal of creating integrated services.

This strategy avoids the need for expensive new infrastructure. Although not without cost,experience shows that such integration can be efficient and produce a synergism that benefits theoriginal programme. For instance, experiments might be carried out with ways of incorporatingforms of parental education into pre-school programmes. Or, social and mental developmentdimensions might be incorporated into on-going food supplementation or nutritional educationor growth monitoring programmes directed to families.

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In Latin America there are community-based programmes in operation where components havebeen added as the need became evident. An example comes from Peru where, in 1972, a nationalcommitment was made to provide pre-school (initial education) for all children in Peru.Recognizing the diversity of cultures represented in the various regions of the country,communities were encouraged to develop models of pre-school education that met theirparticular needs. Within Puno, Peru, a non-formal model evolved that was subsequentlydisseminated to other parts of the country.

The Puno programme began in 1967 as a community-based effort to provide nutrition educationto women. But when the initial education movement began, the programme shifted its focus to thedevelopment of a pre-school for Quechua and Aymara children 3-6 years of age. In 1973 itbecame known as the Proyecto Experimental de Educacion Initial No-Escolarizada de Puno(PRONOEI). The programme operates in simply constructed Children's Houses (Wawa Wasisand Wawa Utas), constructed by community members who donate the materials as well as theirtime and skill. Pre-school-aged children are provided with an educational programme, basichealth care, and nutritional supplementation. The centers have also been used for the delivery ofhealth components. For example, they are used as the base of operations during immunizationcampaigns. Thus a programme that began as a nutrition education effort for women evolved intoa centre-based programme for young children and their families.

In sum, the principles of integrated programming help policy-makers and programmers define theparameters of what they can do to work toward integrated programming. However, another levelof specificity is required. What follows in Section V are some very specific strategies that can beundertaken in creating a programme in a specific community that will ultimately yield servicesthat meet the overall needs of young children and their families.

Strategies in the Development of Integrated Services

Creating an integrated programme and introducing programme components into existinginstitutional and service structures is a complex and difficult process. The time and energyrequired to introduce new components is generally underestimated by those involved. It is notjust a technical process but involves important interpersonal, political, bureaucratic, socio-cultural and resource factors. Nonetheless it can be done. Experience to date suggests there are avariety of strategies that can be undertaken to introduce and provide the necessary on-goingsupport for the implementation of health, nutrition, care and education components (i.e.,integrated and holistic programming). These include the following:

! BEGIN WITH PARENT/COMMUNITY PARTICIPATION IN DEVELOPING THE PROGRAMME

Within current ECD programmes one of the strategies most frequently advocated is to havestrong community participation in programme development, from the definition of the need, todevelopment of a plan of action, to project implementation, to evaluation of outcomes. It isargued that since parents are the-policy makers in most areas of their children's lives, theirinvolvement in the design and operation of an early childhood care and development centreincreases the likelihood of continuity of experience for the child between the home and school.

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This same argument is being made for parental and community involvement in theimplementation and management of ECD programmes in Majority World countries. The generalconsensus is that the greater the level of community involvement, the more likely it is that theprogramme will meet community needs and become an integral part of community life. Whilecommunities have limited resources, the on-the-ground commitment of communities is whatsustains programmes over time. And, in fact, while other sponsors may provide resources to theinitial development of an early childhood programme, without community belief in andcommitment to the effort, the programme will not be successful.

It should be noted, however, that the extent to which parents can and will become involved inearly childhood care and development programmes is determined by a number of variables. Forexample, there is cultural variance in the degree to which it is deemed appropriate for parents tobe involved in the education of their children. In some societies women are responsible for careof the child, but do not play a role in educating the child. Thus, they would not feel they shouldbe a part of the child's on-going education. Yet another variable is the time that parents haveavailable to become involved. Where early childhood care and development programmes havebeen created in response to needs for day care, women are likely to have little, if any, time to beinvolved in the day-to-day activities of the programme. Another variable that affects the extentof parent and community involvement in ECD programmes is related to the political structure ofthe programme, and the extent to which control for the programme is centralized ordecentralized. Where the programme is designed and introduced from outside the community,there may be little room for parent and community involvement.

! DEVELOP THE CONCEPTUAL FRAMEWORK

All the stakeholders—families, the community, representatives from the various sectors, policy-makers and potential funders—should be a part of the process of developing the overallframework that will be used to guide programme implementation. Then, over time, as people atthe various levels are developing curriculum, training materials, support and managementsystems they will have a common vision in mind. Reference to the framework guides the settingof priorities and gives all involved a sense of what is ultimately to be accomplished. This is acritical step in the process of creating a truly integrated approach.

! ASSESS THE EXISTING SITUATION

Before creating new interventions or introducing new components to on-going programmes, it isnecessary to conduct a needs assessment to ascertain what is already known and practiced in aparticular setting, and to determine immediate needs and desires in relation to the frameworkthat has been developed. Then new elements can be introduced in response to needs. Theassessment should include an understanding of the situation of the child (age, degree of risk ofmalnourishment, etc.) and the child variables that are likely to affect nutrition, and the extent towhich these need to be taken into account in developing a programme. For example, what arethe characteristics of the children to be served? Is gender an issue in the culture? If so, howshould that be addressed? What is the developmental level of the children to be served? Whattype of supports are required?

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The assessment should also include an understanding of the caregiving environment. Where arechildren cared for? Who takes care of the children? What is the status of the primary caregiver’snutrition and health? What are the demands on her/his time? What supports do the primarycaregivers have and what do they need? Who supports the family? What institutions andprogrammes exist to provide support and empowerment? Are there untapped resources withinthe community that could be used in providing better support for children's development?

In designing the assessment, Zeitlin (1993) would suggest identifying successful or positivepractices of individuals within the community, to be used as the frame of reference in developingsupports for families. Calling this approach positive deviance, Zeitlin says that rather than focusingon what families lack, the focus should be on identifying, honoring and building on localstrength, and that this should be an underlying principle of all types of assessment, analysis andaction to improve care. When individuals are found who are doing something positive (positivedeviations), then it is possible to try to identify the factors that allowed them to be successful. Forexample, if only two families in a village send their girl children to school, you can try to identifywhat makes those families different. What supports, beliefs, and practices have led to this positiveoutcome?

Furthermore, in assessing the existing situation, emphasis should also be put on identifyingelements in the culture that are supportive of child growth and development. It is important tobe aware of local childrearing practices and beliefs that can be built upon in the introduction ofnew elements. These should also be the basis for developing new programmes.

! DETERMINE WHAT PROGRAMME ELEMENTS SHOULD BE INTRODUCED AND DETERMINE THEIR VIABILITY WITHINCURRENT CONSTRAINTS

Here the focus is on specifying the kinds of behaviours that are to be encouraged within theprogramme. These clearly include child and parental behaviours. However, they also includecommunity and national (policy-level) behaviours. Planners need to be realistic about thecomponents that can be introduced in early childhood programmes. For example, althoughhealth care technology makes it possible for people with low levels of education to deliver a widevariety of services, paraprofessional staff may not have the skills necessary to deliver sophisticatedhealth care services. (Even the weighing of children and accurately recording their weight ongrowth charts is a skill many community workers have not yet acquired.)

Every new programme that is implemented depends on the skills, knowledge, competence andtime of local workers, who may be volunteers. It needs to be recognized that with theintroduction of each new programme component there are new demands on the communityworker. As was described above, while conceptually these components may be related, thoseworking with families are likely to see each component as an entirely new activity. Each newprogramme asks them to do something more, and they are becoming overburdened.

There are two ways to address this issue. First, there is a need to re-think the role of communityworkers. It is time to shift from a reliance on volunteers to recognizing the dedication,knowledge, skills and competencies that these women have and to compensate them in someform. At a minimum they should have enhanced status in the community, and consideration

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should be given to providing them with at least some minimal amount of monetary support. Nohuman service programme can operate without them.

Second, there is a need to bring together all the ‘pieces’ that the volunteers are delivering in theirwork with children and families into a conceptual and programmatic whole. This would allowthem to deliver more information in a much more effective way. As noted, this approach is beingtried in the Philippines where a new training curriculum is being developed.

! SELECT LEADERS RESPONSIBLE FOR PROMOTING THE NEW COMPONENT FROM AMONG INDIVIDUALS WHOHAVE LOCAL CREDIBILITY, A GENUINE COMMITMENT TO THE EFFORT, AND A PERSONAL STYLE SUITED TO THETASK

It is critical that the individual who initiates contact with the agency that will be enhancing itsprogramme have credibility with the people in that agency. If the agency is a governmentministry, then the individual must have formal credentials that make that person credible tothose already involved in the ECD programme. If, on the other hand, the agency is aninternational organization that promotes community development, then the initial contactshould be made by someone with a similar philosophy and approach to working withcommunities.

! DETERMINE WHERE THE PROGRAMME IS TO BE OFFERED, AND UNDER WHAT CONDITIONS

Each type of early childhood programme requires a different strategy for the implementation ofmultiple components. Programmes that provide direct services to children can take place inpurpose-built centres (although this is an expensive alternative), in community buildings, inhomes, in conjunction with places of work, etc. Where they are offered will depend on the age ofthe children being served, the goals of the programme, who is offering the service, the needs ofthe family in relation to child care, etc. Two specific examples of decisions made in reference towhere programmes are offered, and under what conditions, follow. One is in relation to schoolreadiness programmes, the other is child care associated with women’s work.

School Readiness/Preparation. Within school readiness programmes the intent is usually to‘prepare’ the child for school. These programmes are designed to meet the needs of childrenliving in poor urban and rural areas who are seen as having a disadvantage when they enterprimary school. Because of the ethnic, social, regional, or family background of these childrenthey lack the experiences, skills, and knowledge that more affluent peers bring to the schoolexperience. As a result, they do poorly, drop out of school early, and are likely to continue thecycle of poverty. In the hopes of breaking that cycle, preschool programmes have been developedfor this group of children so that once they enter the school system they can compete on anequitable basis with their peers.

When located in the primary school, there is a tendency in these pre-school programmes to thinknarrowly about child development as if ‘cognitive’ or ‘mental’ development were its onlycomponents. They tend to represent an extension downward of the formal educational system interms of staffing, curriculum and methodology. Thus these programmes are unlikely to beintegrated and may be difficult to integrate because they are dominated by the formal school

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structure. When pre-school programmes are located in other settings, such as communitybuildings or homes, it may be possible to achieve multiple goals, in terms of health care, nutrition,parent education and community development, as well as education.

Women’s Work. Early childhood programmes are being developed in conjunction with women'swork. During the last 20 years there has been an increased recognition of women's role indevelopment, and efforts have been made to support women's greater involvement in the wageeconomy. Some of the programmes designed to promote women's development have beensuccessful; others have not met intended goals. By and large, those that have met with the mostsuccess are those that have provided women with the supports they have needed, whatever thatmight be. The primary support required is a recognition of the fact that even though women arebeing given new opportunities, their traditional responsibilities related to the household and childcare remain intact. In order for women to fully participate at the workplace, quality child caremust be available.

An example of an early childhood programme developed in relation to women’s work comes fromIndia, a country that has had legislation in support of employer-sponsored child care since 1964.For many years it was not enforced. However, there is continuing pressure for industries tocomply. Sometimes this pressure comes from non-governmental organizations. For example, aprivate voluntary organization, working with the construction industry, created the MobileCreches system, which began in 1969. This child care programme is established where women areinvolved in construction and moves with them from one building site to another. As buildingsare completed and new ones begun elsewhere, families are shifted. The Mobile Creche also shifts,providing a consistent, fully integrated, early childhood programme for children from infancythrough age 12. Mobile Creches have also been established to serve the children of street cleaners,rag pickers, and other families representing the lowest social status groups in India. The locationof the child care—at the women’s place of work—has been critical to the success of theprogramme.

! CREATE DEMAND FOR AND ESTABLISH THE LEGITIMACY OF THE ACTIVITIES IN RELATION TO WHAT ISCURRENTLY BEING PROVIDED

It is important for the community to understand the need for the programme element, whether itbe Vitamin A supplementation or child stimulation, in order for it to be introduced effectively.Those to be involved in the programme (sponsors, community members and parents) must cometo believe in the importance of the components to be introduced. Even though there may be anECD programme in place that is fully utilized by the community, if something is ‘tacked on’ tothe programme, it will not necessarily be accepted. People need to value the addition and seeways that it can enhance their lives.

Once the public is demanding the service or product, then those responsible for creating thedemand must be in a position to supply it, whether that be appropriate care for young childrenoutside the home, supports for women's involvement in income-generating activities,immunization dosages, sources of Vitamin A, or other services.

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! DEFINE CLEARLY AND OPENLY THE GOALS AND LIMITS OF THE PROGRAMME COMPONENT AND HOW THEY ARETO BE INTRODUCED

Related to the need to help people see the introduction of new components as useful to them, itis equally important to be clear about what that component will and will not contribute to thecommunity. In order to incorporate a new approach appropriately those operating the programmeneed to understand clearly what the components are and what their role will be in implementingthe new component. The staff and management of the on-going programme need to feel that thenew component has something to offer them and that the links are beneficial to them as well asto the population being served.

Staff need to understand that they will be required to undertake additional training, and theyneed to know if the introduction of the components is going to demand more of their time. (Forexample, recording periodic information on children's growth and development is time-consuming and may be an entirely new task for staff.) If staff are not willing to accept the newdemands on them, the programme will not be implemented effectively. Thus the clearer the goalsand expectations are from the beginning, the more likely it is that the new components will beimplemented fully.

! SHOW SENSITIVITY TO THE CULTURAL, SOCIAL AND INTERPERSONAL BONDS THAT HOLD PROGRAMMESTOGETHER

The introduction of a new programme component implies disruption of the equilibrium of thesocial system within an agency or organization, and therefore it should be based on mutualnegotiation, clarification of intent, adaptation of expectations and plans, and establishment ofconsensus on roles and obligations. The likelihood of short- and long-term programme success isenhanced by building links between the old environment and the new programme component.Any programme that has been in place for some time will have a history that has created aprogramme culture. That culture will include both formal and informal ways of operating andcommunicating that are an integral part of what the programme has to offer. Anyone attemptingto enter the programme must try to understand the culture of the organization and must notviolate the norms and values that hold the programme together. It is best to listen and observebefore stepping in with recommendations for changes.

! ADDRESS THE NEED TO ENHANCE ORGANIZATIONAL CAPABILITY

Adequate management systems need to be part of any new approach or technology. Theorganizational and management skills required to operate the expanded programme need to beidentified and should be available within the host agency. If these skills do not exist, then specificsteps have to be taken to develop staff capability. This may include a re-definition of staff rolesand new supports may be required to make these systems function effectively.

! ALLOW ADEQUATE TIME AND RESOURCES FOR PLANNING, START-UP, TESTING AND IMPLEMENTING THEPROGRAMME

Those sponsoring the introduction of the components are likely to want to get things movingquickly. They are aware of the urgency of getting needed services to populations not currently

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being served. They also have a good understanding of what the components involve and they cansee an obvious fit with current programming. However, those who will be implementing thecomponent may need more time to see the fit and to incorporate the activity into their daily life.

Adequate fiscal resources must be available. The costs of a programme may vary in kind andamount from one community to another. However, the on-going costs must be within thecommunity's present and future means.

! PLAN FROM THE BEGINNING FOR PROGRAMME GROWTH AND INSTITUTIONALIZATION OF THE PROGRAMME

A primary constraint to adding components to existing efforts is that many programmes aredeveloped on a pilot basis, but they neither continue beyond the project development phase, norare they disseminated to other communities. Even though a project shows promise, it may nothave staying power and thus it may not be appropriate to expend limited resources on additionalcomponents. Thus, before investing more in current programmes it is necessary to questionwhether or not they could successfully undergo the organizational changes required to take onnew services and become institutionalized.

One mistake commonly made in the development of programmes is to wait until the programmeis fully functioning and coming to the end of its funding before thought is given to how to sustainthe effort over time. Experience would suggest that as the programme is being planned it isimportant to address the issue of how it will be maintained over time, financially and in terms ofprogramme quality. From the beginning, plans must be made in relation to the pace of growthand the long-term viability of the effort.

In general, when seeking expanded coverage, it would be most efficient to link new input withlarge-scale efforts where an infrastructure already exists that includes facilities, basic services,staffing, training and on-going support. It should be noted, however, that while it is logical tocoordinate additional input with successful large-scale programmes, few of these exist, and theymay not reach those most in need.

! CREATE MONITORING AND FEEDBACK MECHANISMS IN THE EARLY STAGES AND ENSURE THAT USERS ARECOMMITTED TO THEM

An important aspect of any programme is knowing how well the programme is doing in meetingits goals and objectives. In order to make this assessment, an evaluation or monitoring systemneeds to be put into place. While quite obviously the system should assess the impact of theprogramme on those being served, monitoring systems also need to be developed to assess theeffectiveness and efficiency of the organization.

These systems should not be set up and operated by people outside the programme. Rather, theyshould be an integral part of the day-to-day activities of staff. If staff are involved in developingthe monitoring system, and if they see how it can help them in their work, then they are likely tofollow through and keep the system going. However, if the evaluation and monitoring activitiesbecome busywork they will be done without much thought and they will ultimately have littlevalue. When staff are able to use the information they are gathering for planning and makingtheir work more effective, the tools will be used.

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In terms of measuring the effects of child progress related to an early childhood programmewithin a holistic view of child development, it is necessary to pay attention to physical, mental,social and emotional dimensions of development. Whereas the physical dimensions are relativelyeasier to measure and there is relative agreement among experts as to which indicators are to beused, this is not the case when trying to measure cognitive or social or emotional development.Nevertheless, progress is being made on these fronts, and the lack of agreement has notprevented evaluators from developing and applying reasonable measurements in their desire toassess child progress.

The evaluation should include attention not only to assessing effects on child development butalso attention to effects on the characteristics and functioning of family environments.

! DEVELOP SUPPORTIVE NATIONAL POLICIES AND REGULATIONS

Political commitment at all levels is required and should include an appropriate supportive policy,adequate budget allocations, and a willingness to make structural reforms where necessary. Inestablishing a programme it is important to be able to answer questions such as:

! What political factors might have an impact on children's growth and development?

! What is required in terms of national policy and support in order for the programme to beeffective?

! Is there enough political will to address the problem in a significant and sustainable way?If not, what will it take to get policy-makers "on-board"?

! What legislation and laws are in place (in a variety of sectors) to support theimplementation of appropriate programming?

! What other mechanisms need to be put into place? What is the process for doing so?

In sum, there are a variety of strategies that can be used to create integrated programmes — fromcreating new inter-sectoral efforts to building on existing early childhood programmes that arecurrently supplying a part of what is required. While it would be useful if each of the strategiesdescribed above could be illustrated by multiple examples from all corners of the globe, this is notpossible because not enough experimentation has been done with creating services that meetchildren’s multiple needs. The prevailing approach continues to be sectoral. And the morespecialized the sectors become, the more people adhere to the importance of their particularvantage point and the knowledge they bring to the table. We need to be constantly remindedthat

A child is born without barriers. Its needs are integrated and it is we who choose tocompartmentalize them into health, nutrition or education. Yet the child itself cannot isolatehunger for food from its hunger for affection or its hunger for knowledge. The same unityextends to the child’s perception of the world. The child’s mind is free of class, religion,colour or nationality barriers, unless we wish it otherwise. It is this intrinsic strength in theunity of the child, that we need to exploit, for building a better world, and a more integrateddevelopment process. (Alva 1986)

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In creating more holistic programmes, the mechanisms for creating integrated programmes arenot nearly as critical as changing mind-sets. Our challenge is to step back from our own sectoralbias long enough to focus on the unity of the child and to create programmes that will breakdown the barriers and maximize the synergies that are created when the child is recognized as awhole person.

ReferencesAlva, M. Keynote Address to the South Asian Association for Regional Cooperation’s Conference on South Asian

Children in Children First. New Delhi, India, 1986.

Bredekamp, S. (Ed.) Developmentally Appropriate Practice in Early Childhood Programs Serving Children fromBirth through Age 8. Washington: National Association for the Education of Young Children, 1987.

Chaturvedi, E., B. C. Srivastava, J. V. Singh, & M. Prasad. Impact of Six Years Exposure to ICDS Scheme onPsychosocial Development. Indian Pediatrics 24:153-160, 1987.

Convention of the Rights of the Child, Adopted by the General Assembly of the United Nations on 20 November1989. New York, The United Nations, 1989.

Engle, P. Care and Child Nutrition: Theme paper for the International Nutrition Conference (ICN), March 1992.

Levinger, B. Promoting Child Quality: Issues, Trends and Strategies. Washington D.C.: Academy for EducationalDevelopment, 1992.

Evans, J. L. Toward Lifelong Education for All: Early Childhood and Family Education. Paper commissioned byUNESCO, 1997.

Evans, J. L. & P.M. Shah. Child Care Programmes as an Entry Point for Maternal and Child HealthComponents of Primary Health Care. Maternal and Child Health and Family Planning Division of FamilyHealth World Health Organization, Geneva, 1994.

Evans, J. L. Health Care: The Care Required to Survive and Thrive, Coordinators’ Notebook, No. 13, 1993.

Government of India (GOI), National Plan of Action: A Commitment to the Child. New Delhi, 1992.

Inter-Agency Commission, World Conference on Education for All, World Declaration of Education for All andFramework for Action to Meet Basic Learning Needs. New York, UNICEF House, April 1990.

Lal, S. & R. Wati, Non-formal Preschool Education — An Effort to Enhance School Enrolment. A paperpresented at the National Conference on Research on ICDS, February 25-29, 1986. New Delhi: NationalInstitute for Public Cooperation in Child Development (NIPCCD), 1986.

Myers, R. G. The Twelve Who Survive: Strengthening Programmes of Early Childhood Development in theThird World. Ypsilanti, MI: High Scope Press (Second Edition) 1995.

Myers, R. G. The Young Child and the Family Project: Looking Ahead. A Discussion Paper prepared forUNESCO, 1992.

24

Myers, R. G. Preparing Children for School and Schools for Children. A discussion document prepared for theConsultative Group on Early Childhood Care and Development Meeting, Washington, D.C., October 28-29, 1991.

Myers, R. G. Effects Of Early Childhood Intervention on Primary School Progress And Performance in theDeveloping Countries: An Update. Paper presented at a seminar on The Importance of Nutrition andEarly stimulation for the Education of Children in the Third World. Stockholm, 6-9 April, 1988

Pollitt, E., K.S. Gorman, P.L. Engle, R. Martorell, & J. Rivera. Early Supplementary Feeding and Cognition,Monographs of the Society for Research in Child Development, 58:7, 1993.

Pollitt, E. Nutrition and Educational Achievement. Nutrition Education Series: Issue 9, Paris: UNESCO, 1984.

Sharma, A. & N. Sood. Approach and Strategies of Child Development in India: A Review, New Delhi: NationalInstitute of Public Cooperation and Child Development, 1989.

Swaminathan, M. Current Issues in Early Childhood Care and Education. in T.S. Saraswathi and B. Kaur (Eds)Human Development and Family Studies in India: An Agenda for Research and Policy. New Delhi:Sage Publications, 1993.

UNICEF. Towards a Comprehensive Strategy for the Development of the Young Child. An Inter-AgencyPolicy Review. March 1993.

UNICEF. Report on Implementation Progress of the Bina Keluarga Balita (BKB) Project, 1985.

UNICEF. Food, Health and Care: UNICEF Vision and Strategy for a World Free from Hunger andMalnutrition. New York: UNICEF, 1992.

Zeitlin, M. Nutritional Resilience in a Hostile Environment: Positive Deviance in Child Nutrition. NutritionReview, 49:9, 259-268, 1991.

WHO/MCH, Physical Growth and Psychosocial Development of Children: Monitoring and Interventions,Protocols I and II. Geneva: World Health Organization, (MCH 91.11)1992

World Health Organization, WHO Child Care Facility Schedule: With User's Manual. Geneva: World HealthOrganization, (WHO/MNH/PSF/90.3) 1990.

World Bank. Best Practices in Addressing Micronutrient Malnutrition. Washington D.C.: World Bank,Population, Health and Nutrition Department, 1993.

Yusof, K. Sang Kancil—Care of Urban Squatter Settlements. World Health Forum 2(2):278-281, 1982.

Zeitlin, M. Child Care and Nutrition: The Findings from Positive Deviance Research. Final Report to UNICEF,the Italian Government and Tufts University. Positive Deviance in Nutrition research Project, 1987-1992,1993.

Copyright © 1997 The Consultative Group on Early Childhood Care and Development

Early Childhood Counts: Programming Resources for Early Childhood Care and Development.CD-ROM. The Consultative Group on ECCD. Washington D.C.: World Bank, 1999.