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close this bookThe Condition of Young Children in Sub-Saharan Africa: The Convergence of Health, Nutrition, and Early Education (WB, 1996, 64 p.)
View the document(introduction...)
View the documentForeword
View the documentAbstract
View the documentAcknowledgments
View the documentAbbreviations
View the documentExecutive summary
Open this folder and view contents1. Socioeconomic indicators and trends affecting child survival and development
Open this folder and view contents2. The status of children In sub-Saharan Africa
View the documentAnnex 1: A list of sub-saharan African countries
View the documentAnnex 2: Key social sector indicators for child welfare
View the documentBibliography
View the documentAfrica technical department papers
View the documentRecent world bank technical papers

Executive summary

For many children in Sub-Saharan Africa, primary school interventions are already too late to prevent irreversible disability or to allow for the development of full adult capacity. Infant mortality in the region is one-and-a-half times that of the world average of 60 per thousand and over three times that of the European and Central Asian rate of 30 per thousand. About 30 percent of children under 5 suffer from chronic malnutrition. Under 5 mortality is two times higher than the world average of 173 per thousand and four times that of the European and Central Asian rate of 75 per thousand. Only 63 percent of the region's children have been immunized against tuberculosis and less than 50 percent against DPT, polio and measles.

Beyond the age of 5 an African child's chances of entering a primary school are less than 50 percent, of completing primary school, less than 35 percent, of finishing secondary school, less than 12 percent and of entering university under 2 percent. Many of the same conditions of poverty that previously placed the under-5 at risk of death later leave them at risk of poor health, malnutrition and impaired mental, social and emotional development. In the age of globalization and increasing competition, these are alarming statistics.

Persistent poverty frames the plight of the African child. In the last decade while much of the world moved forward to improve the basic human condition, the degree of poverty in Africa actually worsened. The number of African families who were unable to meet their basic needs doubled in that period as average incomes fell by a third. In the same period, population grew by more than 40 percent, the fastest growing rate in the world (an average annual rate of 3 percent or nearly two-and-one-half times the world average rate of 1.7 percent). Africa today has the youngest population of any region in the world. This demographic explosion has disproportionately increased the numbers of children seeking access to basic services and food security. While the OECD countries, given their rapidly aging structure, shift their attention to social security and gerontology, in the Africa region, the focus on a viable social policy for young children is an urgent necessity.

As of 1992, Africa's GNP of $530 was among the lowest of all regions of the world. Income distribution paints an even bleaker picture. In 1994, the average African government's expenditure on defense (about 9 percent) was more than twice that on health. Utilizing UNDP's Human Development Index (a composite of literacy level, life expectancy, and consumptive power), 41 of the 54 lowest human development countries are in Sub-Saharan Africa.

This picture is compounded by rapid urbanization and the emerging breakdown of traditional family support structures. Labor migration, deterioration of rural infrastructure, unemployment, civil strife, and rapid social change have all begun to take their toll on the African family. Of the nearly 5 million orphans and 20 million refugees in Africa, 80 percent are female. It is estimated that nearly one-third of African households are now being headed by single women. These same women are being forced to carry the burden of earning an income, managing a household and caring for children with decreasing assistance. The vicious cycle of poverty is reproduced when young girls drop out of school (or never enter) in order to help in the household, lose their childhoods by becoming pregnant in their adolescent years, and end up trapped in poverty.

In sum, the uneven pace of economic change in Sub-Saharan Africa, its rapid population growth rate and increasing urbanization, the changing family structure, and growing numbers of orphaned refugees and displaced women and children from internal civil strife, among other things, has placed the African family in increased conditions of adversity and the child in a state of high risk and in need of urgent attention.

This study is the first product in the Africa Region's Initiative on Early Childhood Development. Its purpose is to describe the condition of young children in Africa, call attention to their plight, and begin the exploration of strategies to address their condition. While past global initiatives have focused on promoting Child Survival (through age one) and Universal Primary Education for All (beginning at age 5), this new initiative is concerned with the neglected, but critical developmental age group between birth and school enrollment. It sees child development not as an extension of traditional schooling downward often referred to as early childhood education or preschool, but rather as the 'holistic' development of the child. It envisages the integration of physical, cognitive, and socio-emotional development as a necessary foundation for full growth and maturation.

The first 5 years are a crucial period in the development of a child. Brain development is almost wholly completed by age 2 and malnutrition peaks at around 24 months of age. This implies the need for early interventions of health, nutrition, cognitive stimulation and socialization programs as a synergistic force, converging to promote the child's total development. It does not necessarily mean a single program or 'silver bullet,' but rather the mutual reinforcement of multiple program interventions in an efficient and cost-effective manner.

While we know much about efforts to achieve such child-centered impact in the industrial world, we know very little beyond the condition of the child on the African continent. The Africa Regional ECD Initiative entails a three-pronged strategy of knowledge building and dissemination, prototype program development, and capacity-institution building. This paper on the status of the Africa Child will be followed by an assessment of the policy, programmatic and financial efforts of African governments, NGOs, private citizens, and donors to address the needs of the young African child. In-depth country studies focusing on specific program models in select countries will be undertaken to learn from and leverage the existing experience in Africa across the continent. In parallel with these activities, the Bank will support innovative prototype ECD programs and projects such as the one recently appraised on Integrated ECD Services for the young Kenyan child. The third prong will entail a dissemination, training and capacity building program for African policymakers and practitioners, as well as Bank staff, in the design and implementation of cost-effective developmental interventions for young African children.

This initiative is undertaken in a context where gender is beginning to emerge on the policy horizon as a central developmental concern. The girl child has become a specific issue on the African change agenda. The initiative will explore ways of expanding the opportunity of the female child from her traditional and often limited role as care-giver in poor households.

Integrated or converging early childhood development programs should be seen as essential for a healthy, prosperous, creative and competitive environment. They can have a positive impact on child quality, school efficiency, economic productivity and social equity. Africa's future lies in ensuring that its children grow up in an environment where they can meet their full potential.