(By Dr Fred Nunes) The highly specialised structure of our government into separate technical ministries is not always well suited to serving needs that require collaboration from several disciplines. Early childhood development (ECD) is one of these areas.
More and more, data show that a child’s prospects in life are considerably limited if not substantially determined in what is loosely called The First 1,000 Days, or roughly the period of pregnancy and the first two years of a child’s life. Some stretch the period for a further six months to the first 30 months. Needless to say, it is the poor who are most affected. Insufficient pre-natal care, insufficient nutrition, inadequate or inappropriate emotional stimuli all result in permanent harm to the child’s physical, mental and emotional growth. And the net result is long term disadvantage of income earning. There are programmes that suggest that intervention costing less than US$1.50 per child can have a radical impact in reversing this intergenerational aspect of poverty.
The challenge is that to make these interventions work, we have to design programmes or work with NGOs who will function across typically separate domains – health, education, and social welfare even agriculture. Although the problem manifests itself as one of poverty, the real learning has been that mere cash transfers do not have the impact of more integrated programmes. But before trying to design a programme, let us first understand the science on which it is built. Child development starts very early, well before pre-school, indeed, even before birth. The sensory pathways in our brains that determine our capacities in adult life, form and begin to develop in the last trimester. While still low at birth, the pathways for vision and hearing develop exceedingly rapidly in the first month, peak in about the fifth month and then new pathways are added far more slowly and fall to being quite low by month 18.
Similarly, the pathways for language in a child’s brain are quickly laid out in the first six months, peak by the 10th month and then additional pathways are added far more slowly. The same is true for our higher cognitive function, same pattern: a steep rise to a peak at about month 14 and then a steep decline of additional pathways to a much lower rate of growth by the 26th month. [*See Chart 1]
There is no escaping the importance of optimising this incredible period of brain development in early childhood. There will never be another period like this in the child’s life. It is in this period that the economic and cultural differences within our society set our children on very different paths. If we truly want to create a level playing field, this is where public policy has an important role to play. If we take this logic seriously, we would realise our highest returns to human capital by investing most at the beginning and must less later on. [*See Chart 2]
My hunch is that if we were to plot our investment it would almost be the mirror opposite of this line, being very low in early years (birth to 3 years), still very low in pre-school and then much higher for high school and college. If this is correct, we are investing far too late, long after the opportunity for highest returns has passed. What would such a programme look like? Actually, given the network of health personnel, especially Community Health Workers (CHWs), Guyana is well placed to deliver an appropriate ECD programme.
Patrick Premand*, suggests that such a programme would have four components (a) Protection, (b) Nutrition (c) Health and (d) Psycho-social stimulation.
Protection would include family planning and pre-natal care, birth and child registration, guidance in child rearing, discipline, punishment and conflict management. Clearly, there would be a real role for Social Welfare and Child Protection officers.
Nutrition would involve exclusive breastfeeding, complimentary feeding, recognising malnutrition, Vitamin A supplementation, deworming and iron absorption. Obviously, there would be a real opportunity for Agricultural Extension Officers to advise on what foods are best suited for what nutrition – and how those foods should be prepared.
Health involves vaccination, educating parents to act promptly at the first sign of disease, providing guidance on hygiene, sanitation and hand-washing. This would be a central role for CHWs and their link to Health Centres.
Psycho-Social Stimulation is undoubtedly the most challenging set. Like the others, this arena involves change in behaviour; but this one is more challenging culturally. Getting parents to speak with their children long before they have language. These are not traditional services in the public sector, yet as we see in Chart 1, they are critical.
This involves language stimulation, stimulation through play, getting the child ready for school, psycho-social development of the child (attachment, separation, managing his/her moods – excitement frustration, etc.), helping the parents to understand child development and to manage the child’s sleep. I would imagine that Child Welfare would have all these skills. I am unaware of how instrumentally they are employed in positive service to families.
This is not mere theory. Programmes with some of these components have been implemented in Jamaica, Colombia, Nicaragua, Chile, Bangladesh and Niger. Visits of as little as 2.5 hours per week with a trained educator that cost $100 per month have led to claims of income increases of 42% in adulthood. In some instances the programmes are delivered through NGOs.
This is pretty persuasive stuff. But it requires a radical shift in how we make public investment decisions. And the primary beneficiaries will be the poor. So we know full well this won’t happen. We will continue to spend public funds so that they support those who already have power and privilege. In all likelihood, we will ignore the data and continue to use public funds to provide welfare for the middle and upper classes.
Patrick Premand, a World Bank staff member in the Global Practice for Social Protection and Labour. He made a presentation, “Linkages between SPL and ECD” to the SPL Learning Event in Istanbul, in April 2014. The two charts attached are from that presentation.
Dr. Fred Nunes is a life member of the Family Planning Association of Guyana. Dr. Nunes was integrally involved in the drafting of the Medical Termination of Pregnancy Act during his tenure at Pan American Health Organisation here in Guyana.