plenary 6 child development practices across countries

INNOVATIVE APPROACHES TO IMPROVE

EARLY CHILDHOOD DEVELOPMENT (0 - 3 YEARS)

Robert Scherpbier & Margo O'Sullivan

Chief of Health, Nutrition & WASH

Chief of Education & Child Development

UNICEF China Office

Presentation Outline

Early Childhood Development (ECD)

Global situation and evidence

UNICEF China’s innovative Integrated ECD 0-3 approach

Future: SDGs

200 million children under age 5 (>15 million in China)

do not reach their full development potential

Source: Grantham-McGregor, S., et al. (2007). Lancet. 369:60-70.

China ranks 3rd

Key brain functions develop before age 2

and synaps formation depends on experience

Hearing and sight ------- 3-4 months (peak at 3.5 mo)Language 6 months-2 yrs (peak at 9 mo)Resolving problems 7 months-10 yrs (peak at 1.5 yrs)

Early stimulation and nutrition supplementation

have similar and additive effects

Source: S Grantham-McGregor et al. Lancet 1991; 338 (8758):1-5

Child maltreatment, bad hygiene, illness and poverty

cause toxic stress and affect brain development

Impairment of brain functioning =

reduction in human capacity

• Excessive and repeated stress causes

the release of chemicals that impair cell

growth and interfere with the formation

of healthy neural circuits in the brain

• Toxic stress can damage the brain‘s

stress response system and contribute

to premature ageing of the body

Early childhood development

has five sets of determinants/risk factors

1. Maternal & child nutrition - brain’s building blocks



2. Early stimulation – enhances synaps formation

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3. Child protection – stress toxins if ignored

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RON/ZHOU YE PLEASE INSERT

RELEVANT PICTURE(S) IF NOT GOOD



4. Hygiene, sanitation and health – toxins if ignored

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5. Family socio-economic status - toxic stress if poor

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The more risk factors children face,

the more delays will occur in their development

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Future: SDGs

Focuses on whole child, i.e. her progression in

physical, social, emotional, cognitive and language

domains

Focuses on first 1000 days, i.e. from pregnancy

to age 2

Focuses on China’s most disadvantaged

children

Jointly engages parents and children

UNICEF China’s innovative approach to ECD 0-3

builds on globally identified success factors

UNICEF China’s innovative approach to ECD 0-3

builds on globally identified success factors

Engages all stakeholders, especially

government

Explores and combines different service

models to support family to reach children’s

full potential

Uses the same tools in all project sites

Where possible promotes a multi-sectoral

approach

Ensures rigorous monitoring and evaluation

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Community based complementary delivery models

to improve ECD in children 0-3 years of age

Provide integrated services supported by Mobile Resource

Units

Establish home based play groups through outreach

Establish ECD Centres

in rural and urban communities

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Integrated Early Childhood Development (IECD) for

children 0-3 years in China’s poverty “battle fields”

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Songtao

county in

Guizhou

province

Fenxi and Lin Counties

in Shanxi province

Liping

county in

Guizhou

province

Integrated Early Childhood Development (IECD):

a demonstration project in 4 poverty counties

Integrates services: health services, home visits,

home-based playgroups, ECD centres, child

protection and social services are combined to

support families to reach children’s full potential

Uses Mobile Resource Units to bring expertise to

villages

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Integrated Early Childhood Development (IECD):

a demonstration project in 4 poverty counties

Uses a multi-sectoral appr.

• National Health & Family

Planning Commission

• Ministry of Civil Affairs

• China National Children’s

Council (CNCC)

• All China Women’s

Federation

• State Council Leading

Group Office on Poverty

Alleviation and Dev.

• UNICEF China

IECD 0-3 baseline survey findings:

40% of rural children U3 have suspected development delays at least in one domain

Most children face multiple risk factors:

• 78% of children <6 mo are not exclusively breastfed

• 96% of children do not get minimal acceptable diet

• 71% of households do not have at least 3 picture books

• 45% of household do not have at least 2 toys

• 62% of caretakers performed violent discipline

• 93% of households do not have sanitary latrine

• 50% of children are left behind

• 60% of households are below the poverty lineSource: UNICEF IECD survey, PKU and HNWASH, 2013

Service providers and their roles

Specialist providersEarly detection, referral and

interventions for children with suspected developmental delay

Support of children at risk of violence, abuse or family issues

Social assistance for the economically poorest

Village health workers

Assessment of developmental milestones

Psychosocial support for depressed parents

Routine health services

All village providersAdequate nutritionEarly stimulation

Protective, safe and caring environments

Screening to assess dev’t risksReferral to specialist providers

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Role of Mobile Resource Unit (MRU)

Technical training

On-site technical support

Data collection

Verification and Referral

Link resources for special cases

MRU

Health Centre services:

ECD services complement routine health care

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• Counsel for appropriate

infant feeding

• Monitor growth

• Detect and treat anaemia

• Asses dev’t milestones

• Identify children at risk

• Psychosocial support

• Refer when needed

Social worker services:

Identify child protection risks, follow up, refer

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1 Social Worker at county level covering 20 villages

Home visits, family support and referral

- Home visits conducted by Social Worker to assess

family situation and develop plan depending on the

situation and/or refer children to other MRU service

providers

- Village-based providers (village health worker,

Women’s cadres) refer children with protection risks

and child welfare needs to Social Worker for follow up

visits and further action depending on the issue

- Social Worker works with county Civil Affairs Bureau to help families apply for

hukou registration and social assistance schemes to which they are entitled

- The village conference attended by service providers and village leaders

discusses the identified cases for further planning and support

- Social Worker provides support and advice to parents on child protection, child

welfare policies, positive discipline, etc.

Social worker services:

Identify child protection risks, follow up, refer

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Capacity development – three types:

• Training of social workers in MRU to

improve their professional skills

• Awareness raising of service

providers to identify and report

potential child protection/welfare

cases to the social worker

• Training of parents and other

caregivers on child protection, child

welfare policies, positive discipline,

etc.

ECD centres:

Early Stimulation for children 0-3 years

• Volunteer led parent-child

games, story book reading to

enable the parent to learn and

play at home with children

• Parent classes

• Focus group discussion

• Story book borrowing

• Parent-child free play

• Identify/refer child neglect/abuse to social worker

Home-based: Early Stimulation for children

0-3 years

In villages that cannot

provide ECD centre space,

home-based play groups are

set up:

• 5-6 families in a group

• Two times per week

Home-based activities in

Daidong village of Panshi Town,

Songtao County of Guizhou

province, May 2015

Liping county Dazhai Village

Specialised capacity building:

the example of Early Stimulation Workers

• Devise training

materials and

programme

• Training

programme for

volunteers

• Ongoing support by

ECD expert in MRU

• ECD centre manual

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Integrated capacity building:

bringing together different service providers

Around 350 ES volunteers and

community women’s cadre completed

the training module

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Modules in the Training Resource

Package for community volunteers and women’s cadre

Understanding the basic principles of

CRC and child protection

Understanding the importance of early

childhood development

Setting up and managing a community

ECD center

Home visits and working with parents

Organizing and managing parent-child

activities

Organizing and managing a parent-

child story reading

Basic knowledge on communication

for development

Using house materials to make toys and

play with children

On-site real time practice training

Conducting parent classes

Conducting community activities to

promote the utilization of ECD services

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ECD 0-3 tools for all service providers

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Parents Booklet


Child care for development


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ECD 0-3 tools for Health Workers

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Counselling cards

Monitoring child dev’t

ECD 0-3 tools for Early Stimulation

Puppets12 Story Books

Reading together

Puzzles

ECD training manuals

ECD 0-3 tools for Social Workers

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Insert pictures of tools, even if only checklists

Early impact of IECD project

Increased government commitment to IECD

IECD project welcomed and acknowledged by the

local government and communities

Project-developed IECD counseling cards and

Parents Booklet adopted by NHFPC for national

scale up

Improved IECD service coverage in project counties

Improved knowledge and capacity of service

providers on providing IECD services


Improved caregivers’ awareness,

understanding and practices for nutrition, early

stimulation and child protection

Increasing attention to children’s social,

emotional and psychological development, in

addition to physical development which

traditionally receives attention

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• An estimated 4,000 children under 3 years of age are in

the 80 project villages

• Village doctors provided micronutrient supplements (Ying

Yan Bao) to 1,709 children age 6-24 months, increasing

the coverage from 30% at baseline to 70% in 2015

• Village doctors conducted growth monitoring 5,564 times

• 29,459 early stimulation interactions were facilitated

between children with their parents

• Social workers and volunteers conducted 1,364 home

visits, and provided 256 training sessions to rural families

and caregivers

• MRU provided ECD services 4,852 times, and assisted in

follow up and referral services 2,648 times (55%)39

CONCLUSIONS

• Over 200 million children globally do not reach their

development potential: 16 million (8%) live in China

• Maternal & child nutrition; early stimulation; child

protection; hygiene, sanitation, child health; and

family wealth are key determinants for early

childhood development

• Building brains starts early. Returns on investment

are largest before age 3, thus a focus on ECD is

needed

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CONCLUSIONS

• Some risk factors cannot be corrected after

age 2. Accumulation of risk factors leads to

development delays, thus an integrated

approach is needed

• Parents are key to early childhood

development

• All stakeholders need to work together for

ECD, and a multi-sectoral approach is key to

addressing all risk factors

• Investing in ECD is good for children and the

economy41





Future: SDGs

Investing in ECD improves individuals’ and societies’

economic productivity, and reduces inequalities

Investing in Integrated ECD helps to achieve SDGs:

• SDG 1 (end poverty), target 1.3: % children receiving a

child or social grant

• SDG 2 (end malnutrition), target 2.1 and 2.2: % children

exclusively breastfed, stunting prevalence, anaemia

prevalence in WRA

• SDG 3 (healthy lives and wellbeing) target 3.8: coverage

of tracer interventions (immunization, pneumonia &

diarrhea care)

Towards SDGs: empower the future early

• SDG 4 (quality education) target 4.2: % children U5

who are developmentally on track in health, learning and

psychosocial wellbeing

• SDG 6 (water and sanitation) target 6.1 & 6.2: % health

care facilities with basic water, sanitation and hygiene;

population with handwashing facility in household, %

population using basic sanitation facilities

• SDG 16 (peaceful society) target 16.2: % children aged

1-14 years experiencing any physical punishment in the

last month

Investment in ECD is the child’s right to life, survival, and

development

Towards SDGs: empower the future early

Special thank you to Porsche

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Who wants to support

ECD 0-3 ?!?

plenary 6 child development practices across countries

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