Cover Image
close this bookHDD-(PHN)FLASH, newsletter on Population, Health and Nutrition of the Worldbank Human Development Department (WB)
close this folderPHNFLASH 1993
close this folderPHNFLASH 1 November 9, 1993
View the document(introduction...)
View the documentIntegrated childhood development


Electronic Newsletter on Population, Health and Nutrition Issues
Population, Health and Nutrition (PHN) Department, World Bank

Integrated childhood development

Dr. Mary Eming Young
Public Health Specialist

The following document was prepared for Bank's World by Dr. Mary Eming Young, Public Health Specialist in the Population, Health & Nutrition Department. It draws from staff appraisal reports on child health and education projects in Bolivia, Colombia and Mexico with additional information from The Twelve Who Survive, by R. Myers and M. Alva's Children's First.

"A child is born without barriers. Its needs are integrated and it is we who choose to compartmentalize them into health, nutrition, or education. Yet the child itself cannot isolate its hunger for food, from its hunger for affection or its hunger for knowledge" Alva, 1986

Three specific international events have given new visibility to the child which cast institutional and organizational challenges facing early childhood programs at the national levels: (a) the Convention on the Rights of the Child was adopted by the United Nations General Assembly in November 1989; (b) the World Conference on Education for All, held in March 1990 under the sponsorship of the World Bank, UNDP, UNESCO, and UNICEF, placed special emphasis on the expansion of early childhood care and development through family involvement and community interventions, especially for poor and disadvantaged children; and (c) the World Summit for Children, held at the UN in September 1990, brought together 158 presidents and prime ministers. These meetings have expressed a new awareness of the importance of early education on the part of international donors and given additional impetus and commitments on the part of governments in favor of early childhood development.

Today at least 12 of every 13 children born will live to see their first birthday, compared with the 1960 figure of five for every six children born. What happens to the "12 who survive"? Many of the same conditions of poverty and stress that previously put children at risk to die now put them at risk of impaired physical, mental, social and emotional development in their earliest months and years. Delayed or debilitated development in the early years can affect all of later life. It can also be prevented.

Not only are more children surviving but social changes create conditions that require new ways of thinking about child care and development. We need to look beyond mere survival to a program of early childhood care and development. More women are entering the labor force. Family structures are changing, urbanization requires some different skills than those in the past. The highest level of labor participation is in Southeast and East Asia where 50 to 60 percent of the women aged 15 and over are economically active. In sub-Saharan Africa, the percentage is slightly below 50 percent. In contrast, in Latin America and the Caribbean 32 percent of women are economically active. With changing family structures more women have sole responsibility for supporting their families. In Latin America and the Caribbean almost 30 percent of households are headed by women, over 20 percent in sub-Saharan Africa and 15 percent in East and South East Asia.

There is increasing evidence that early investments in development of the "whole child" can bring improvements in the life of the child and benefits to the larger society. Cumulative research evidence continues to indicate that most rapid mental growth occurs during infancy and early childhood and that, on the whole, the early years are critical in the formation and development of intelligence, personality and social behavior. Fifty percent of development of intelligence is established by age 4. Furthermore, inadequate intellectual stimulation and affective care, as well as early malnutrition, are likely to result in severe and possibly irreversible damages to physical and emotional capabilities, which are crucial to further learning. In this sense, elementary and even kindergarten can be too late an opportunity to develop these capacities in children.

Why should we invest in early childhood development?

·Efficiency·. Early childhood education increases the return on primary and secondary school investments, contributes to human capital formation, raises participants' productivity and income levels and reduces public expenditures (i.e. lower welfare, health and education costs). In the U.S. Perry Preschool Program, in operation since 1962, a $1 investment yielded $6 in eventual savings due to lower educational and welfare expenditures and higher productivity among participants. In the U.S. Head Start Program, $1 spent is worth $4 in costs saved later. Similarly, studies carried out in Asia, the Middle East and particularly Latin America suggest that early childhood education increases school readiness skills, promotes timely school enrollment, lowers primary repetition and dropout rates, and improves overall academic skills. The beneficial impact of early education is particularly pronounced among the traditionally disadvantaged groups (e.g., girls and children with rural, indigenous, and lower-level socio-economic backgrounds).

Furthermore, increased primary school attendance decreases the availability of older siblings to act as supplementary caretakers. Where sibs have been forced to drop out of school to provide such care, there is strong argument for child care.

Evidence suggests that health- and nutrition-related programs are positively associated with physical growth, basic cognitive abilities, school readiness and positive classroom behavior. A 10-year study in Mexico shows the negative effect on school readiness of severe malnutrition and lack of home stimulation, evident in delayed language development. Child care and development programs are potentially useful as vehicles for extending primary health care. Child physical growth can be influenced by not only the food intake but also by how well a child is developing socially and psychologically and by how free a child and the child's care-giver are from stress and illnesses.

·Social equity·. A large part of cognitive achievement differentials between lower socioeconomic and higher income groups can be attributed to low levels of psychological stimulation among poor children, malnutrition and lack of sanitation, all of which are directly associated with, or can be positively affected by, education. Early childhood education can help reduce societal inequalities rooted in poverty, by giving children from disadvantaged backgrounds a fair start, especially those living in rural and urban-marginal areas.

·Intersecting needs of women and children·. Increased numbers of women-headed households and of women who must work create a major need for complementary child care. If care is available, the earnings of these women are more likely than would be the earnings of men to go toward improving and helping distressed families with very young children. There is a kind of vicious circle particularly in the cities in which low paying jobs prevent mothers from purchasing adequate child care, and the absence of adequate child care prevents mothers from seeking more stable, higher paying employment. This circle is particularly acute in resource poor households where the effect on families of not working is highest. Provision of subsidized care that meets women's need could help to break this circle, raising earnings and productivity and benefiting both women and children.

What can we do?

Non-formal early childhood education has been a major area of innovation worldwide. The Bank has already invested in several such projects-for example, in India, the Integrated Child Development Services and the Tamil Nadu Nutrition Projects; in Colombia, the Community Child Care and Nutrition Project; in Mexico, the Initial Education Project; and in Bolivia, the Integrated Child Development Project. This fiscal year, Viet Nam is preparing a project on early childhood development project this fiscal year. Other multinational agencies, UNICEF and UNESCO, and non-governmental agencies, such as the Bernard van Leer Foundation and the Aga Khan Foundation, have had extensive experiences on implementation of early child care and development projects.

Early child care and development projects can be carried out through two modalities, formal and nonformal (center-based or home-based). The non-formal modality has received increasing attention in recent years because formal educational programs have failed to reach the population most in need, are costly and do not address specific community needs. However, there are also problems with the non-formal strategies. The ISSUEs are: insufficient institutional capacity, inadequate targeting mechanisms, poor educational inputs, loosely defined supervision, inadequate incentives for community educators, inconsistent community support, and sporadic linkages with complementary programs (health and nutrition). Moreover, we need proper and ongoing evaluation of the non-formal programs in developing countries to assess their cost-effectiveness and determine what are the minimum inputs of such programs.

Finally, we do have an emerging strategy for going to scale in programming for early childhood care and development. This involves a rather deliberate, focused, phased approach. It requires not only political commitment and resources but flexibility and continuous leadership and supervision capable of fitting programs to existing environmental, organizational and material resources. It would also be well to remember that the primary school graduates of the year 2000 have already been born and are being prepared for their lives. What seems so far away is being influenced now. Child development, growth, and the struggle to survive are simultaneous, inseparable and mutually reinforcing processes. We need to re-examine policies and approaches to enhancing early childhood care and development. We need not only sustain our effort to increase child survival but also enhance the development potential of the child with a smile.

[Reprinted with the author's permission from Bank's World, Volume 12/Number 10 October 1993]