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close this bookEarly Child Development: Investing in the Future (WB)
close this folderPart II. The practice
View the documentIntroduction
View the documentEducating parents
View the documentTraining caregivers
View the documentDelivering services to children
View the documentReforming formal education systems to include preschoolers
Open this folder and view contentsEducating through the mass media


There is now a need for reliable and valid information about what works, why it works, for whom it works, and under what conditions it works.

- Raymond Collins and others (1990, p 18)

The mounting body of evidence that early childhood intervention can result in substantial future gains has prompted many nations to incorporate preschool programs into their national and regional development agendas. There is rising interest in these countries in nonformal models of education and care. It is thus not surprising to find programs based on the nonformal community development model operating in India (Integrated Child Development Services), Colombia (the hogares commentaries, or home based day care centers), Kenya (the Harambees, or "Let's Pull Together" movement), Brazil (cres commentaries, or community nurseries), Jamaica (the Community Study program, or backyard nurseries), the United Kingdom (Playground Movement), and Venezuela (the hogares de cuidado diario, or home day care program).

Because differences in cultural and economic environments make it impossible to rely on just one approach in early child development, it is important to identify a range of effective models rather than emphasize a single program model.

This section describes different programs that countries have used to promote children's physical and mental development. The interventions are grouped in five major types.

Educating parents

Parents are children's earliest teachers, and studies have proved that strengthening mothers' ability to stimulate their children and encourage them to learn can set the stage for adult success. In an attempt to lessen the imbalances caused by poverty frorn the start of life, several countries have introduced national programs to train poor parents in the principles of early child development.

Training caregivers

It is erroneously assumed that anyone can take care of young children, despite the growing wealth of research confirming the importance of teacher training to the quality of the early childhood experience. Moreover, teachers are far too often regarded as custodians and dispensers of knowledge who must follow a centrally controlled curriculum regardless of local conditions or the efficacy of other forms of learning. Instead, teachers should be trained to distinguish aspects of the curriculum that can and should be changed to accommodate local customs from those that cannot be modified without seriously compromising the program's efficacy.

Delivering services to children

Industrial nations have explored ways to help their poorer citizens get a better start in life for the past thirty years. Much of what they have learned can be used by early child development programs everywhere. An important lesson is that social deficits must be simultaneously attacked on several fronts: nutrition, health care, and education. This lesson underlies the U.S. Head Start program and the Special Supplementation Nutrition Program for Women and Infant Children (WIC). Programs in developing countries that deliver integrated services on a massive scale to help poor cizldren flourish as tinny grow, such as India's Integrated Child Development Services and Colombia's Community Child Care and Nutrition Project, recognize this lesson as well.

Reforming formal education systems to include preschoolers

Preschool education has been shown to enhance children's later progress and performance in school. It is positively associated with reduced repetition and dropout rates, and therefore with lower education costs. Not surprisingly, improving access to preschools is becoming a common feature of education reform.


Because traditional early child interventions reach relatively few children and most innovative techniques have yet to be extended beyond the pilot stage, early education specialists are increasingly turning to the mass media to get their message out. Teaching videos in particular have great potential to convey active learning strategies-immediately, engagingly, and accurately-on a large scale. These videos can be broadcast over national television and used in training courses, health care centers, and parental discussion groups. Better-informed parents are far more likely to demand preschool enrichment services from their government and to use active learning techniques with their children at home.

1. Training children's first teachers in Israel

Israel's Home Instruction Program for Preschool Youngsters trains mothers from disadvantaged families to act as home teachers for their preschool-age children. Using specially designed teaching materials and workbooks, the program serves 6,000 at-risk families a year and has been found to improve cognitive development and achievement and to decrease participants' chances of dropping out of school.

Since 1969 the Hebrew University has been administering a unique home based preschool enrichment program for disadvantaged Israeli children. Dr. Avima D. Lombard of the university's Research Institute for Innovation in Education came up with the Home Instruction Program for Preschool Youngsters (HIPPY) in order to test whether mothers trained to provide specially designed lessons to their preschoolers could improve their children's learning patterns.

HIPPY provides participating mothers of children aged three to six with educational training and materials in language development, sensory and perceptual discrimination, and problem solving. Twice a month a paraprofessional aide visits each mother in her home to deliver new storybooks and activity packets. The aide uses role playing to instruct the mother in the use of the materials, with the mother and aide taking turns playing mother and child. If the mother is illiterate, an older sibling may assume the teaching role in the mother's presence.

Mothers are expected to work with their children for a specified amount of time each week to complete the packet of programmed home activities supplied by the aide. Each activity lasts five to ten minutes, and each week's program consists of ten activity units. The degree of difficulty and pacing are carefully graduated over the course of the program. Every two weeks, the ten to fifteen HIPPY mothers supervised by the aide come together to review new lessons, share information, and offer suggestions based on their own experiences. During the meetings the women discuss such topics as health, hygiene, child development, children's books and games, the school system, handicrafts, home economics, and preparations for holidays.

HIPPY participants strengthen their own and their children's language skills by reading simple storybooks and completing detailed worksheets about content, vocabulary, and concepts that are incorporated into games and exercises. The worksheets also guide the mothers in activities aimed at developing their children's sensory discrimination skills by doing visual, auditory, and tactile exercises with simple materials and game pieces. Problem-solving activities include listing, sorting, matching, and grouping by attribute and theme.

HIPPY, studied extensively since its inception, has been shown to have a positive effect on the social, emotional, and cognitive development of preschool children. After three years of participation, HIPPY children score significantly higher than control group children on all measures of cognitive development and achievement and are far less likely to drop out of school. The effects of educational day care combined with HIPPY participation, moreover, appear to be additive. In addition, mothers who participate are accorded a higher status within the family, and their general outlook appears to be much more optimistic than that of mothers not in the program.

In 1975 Israel's Ministry of Education and Culture incorporated HIPPY into the package of education welfare services offered to localities with a high proportion of educationally disadvantaged children. The government is now committed to covering the costs of this national program and also provides the administrative infrastructure at the community level. Although one-on-one educational enrichment sounds expensive, three full years of HIPPY actually cost 40 percent less than one year of remedial education at the primary school level. Each family participating in HIPPY is expected to pay 30 to 50 percent of the program's cost per family, although program coordinators can reduce a family's required contribution when necessary. The remaining cost is covered by the government's general fund and through local fund-raising.

Today the Hebrew University Research Institute for Innovation in Education, where HIPPY originated, retains responsibility for monitoring and ensuring program quality. It also coordinates HIPPY on the regional and national levels, trains local and regional staff, and ensures a systematic flow of inputs. Every year roughly 6,000 Israeli families from about eighty urban and rural communities participate in HIPPY. Children in many other countries can now also benefit from the program, whose training and curriculum materials have been translated into Arabic, Dutch, English, German, Spanish, and Turkish.

2. Helping Parents Care for the Very Young in Israel

Building on their earlier success with HIPPY, Israeli researchers designed the HATAF program to extend home training for mothers of infants aged one to three. The HATAF program' reaches children during the years of most rapid intellectual growth.

In 1973 Dr. Avima D. Lombard's Hebrew University team developed the Home Activities for Toddlers and Their Families (HATAF) program to complement the training offered by their earlier successful program, HIPPY. Based on the ideas that the home environment shapes the child and that most parents are ready and willing to improve their own skills, the HATAF program has five major goals:

· Enrich the language skills of both mother and child. HATAF mothers are instructed in uses of language that encourage children to talk and develop basic language concepts as they play.

· Develop mothers' sensitivity to their toddlers' needs. HATAF mothers are instructed about the different stages of children's development and the conditions deemed optimal at each stage. (Between the ages of one and three, for instance, children learn mainly through physical, verbal, and emotional exploration and experimentation.) The HATAF program gives mothers an idea of what to expect at each stage and a sense of the important role of adults in advancing toddlers' development.

· Improve mothers' skills in using natural learning settings in the home Studies have shown that when mothers use daily events and activities as they occur to teach their children-teaching "on the fly"—their children develop a greater awareness of their environment and perform at a higher level socially, emotionally, and intellectually. The HATAF program strives to develop this skill in mothers by showing them how to turn daily occurrences and familiar situations into exploratory and learning activities for their children.

· Refine mothers' use of reinforcement techniques. Too much or indiscriminate use of reinforcement dilutes this powerful teaching technique's value as a spur to learning. HATAF mothers are taught to use immediate positive reinforcement in ways that are both specific and appropriate.

· Teach parents educationally productive techniques for playing with children aged one to three. Recent studies have confirmed the importance of toys and play in promoting children's early development. The HATAF program shows parents how to promote learning by selecting play activities appropriate to their children's stage of development and skill level and presenting these activities in an attractive way. It also urges parents to allow adequate time and space for their children to explore and discover by themselves-now known to be the basis of learning.

To reach these goals, the HATAF program emphasizes the importance of mother-child interaction and the use of simple, inexpensive teaching materials. Typically, one professional coordinator serves sixty to eighty families in a HATAF program. The coordinators are university educated, have experience in early childhood education, and are trained intensively in HATAF methods. The HATAF program coordinators meet regularly with the HATAF national director. In addition, four to six paraprofessional home visitors, recommended by local health and social service workers, are chosen from among the mothers of older children in the target community. Home visitors are expected to be literate. Each year begins with a week of training for home visitors in early education, child growth and development, and the methods and content of the HATAF program. Additional weekly training is provided over the course of the program. Home visitors are paid according to the number of families they serve.

Each home visitor works with twelve to fourteen mothers, for about an hour a week in the first year and an hour every two weeks in the second year. Children must be no more than eleven to thirteen months old when they are enrolled in the program. Home instruction centers on new, repeated, and spontaneous play activities. The aide involves the mother in all activities to help her learn new play behaviors. Groups of fifteen to twenty area mothers meet with the professional coordinator every two or three weeks to discuss such common parenting problems as sibling rivalry, toilet training, and discipline. Periodic mother-child workshops allow mothers to see how their children interact in a group setting, and meetings are often held in health or community centers to reinforce the link between the HATAF program and other community services.

HATAF activities can be divided into eight broad areas: language enrichment, storybook reading, make-believe, eye-hand coordination, gross motor activity, sorting, memory, and transformation of materials (such as cooking). Each activity is described on written worksheets and explained by the aide. Teaching materials are either easily found in the home (shopping baskets, kitchen utensils, natural materials) or are given to the mother during the instruction period (books, balls, dolls).

Today the HATAF program serves roughly 2,000 families through twenty-five centers throughout Israel. These families pay a modest monthly fee to cover part of the cost of the materials distributed. Coordinators and aides are local employees, but the national program staff are part of the Hebrew University's Research Institute for Innovation in Education.

A 1980 study concluded that HATAF mothers are more knowledgeable than mothers not in the program about their children's development and the educational value of different activities. They are also more inclined to see themselves as active agents in their children's development. A 1989 study confirmed that HATAF mothers take a far more active role than other mothers in creating an enriching home environment for their children.

3. Searching for the Best Care Model in Turkey

In an effort to discover the best approach to caring for children, Turkey's Early Enrichment Project conducted a study of children in custodial care, educational day care, and home care settings where half the mothers participated in training and half did not. The project found that educational day care produced the best results on all measures of psychosocial development, and that training mothers through enrichment programs involving extensive group discussions on child-rearing and maternal support was beneficial.

From 1982 to 1986 Turkey's Early Enrichment Project, seeking the optimal combination of home-based and center-based custodial and educational day care services for very young children, studied the effects of different approaches on preschool-age children. It then trained half the caregivers in each setting in early child development learning techniques and compared the results. While educational day care got the best results in all measures of psychosocial development, the children whose mothers had received training and outside support also showed significant gains (Kagitcibasi, Sunar, and Bekman 1988).

The Early Enrichment Project study evaluated child care settings in several low-income areas of Istanbul, tracking the progress of 255 children aged three to five in a variety of custodial day care, educational day care, and home care situations. Two-thirds of the mothers in the sample were factory workers with minimal education.

In the first year the study collected baseline data on the children's cognitive, social, and emotional development. All mothers were interviewed at home, and children were tested and observed both at home and in day care. In the second and third years, half of the mothers, selected randomly from each group, were trained in early child development techniques and supplied with educational materials based on the HIPPY model and adapted for Turkish use. The Turkish Mother Enrichment Program also trained the mothers selected on how to be more sensitive to their preschoolers' needs and how to foster their social, personal, and cognitive development. Training was given by paraprofessionals during biweekly home visits, and group meetings were held on alternate weeks.

The project continually built up its database. From its second year, when the five-year-olds entered school, it collected school grades at the end of every semester. In its fourth and final year, it administered a wide range of tests covering different areas of development to measure the effectiveness of the training. Tests were administered several times to increase their validity, baseline assessments were repeated in the fourth year, and school data were considered in the final evaluation.

Educational day care, it was found, produced superior results for virtually all indicators of psychosocial development, especially for cognitive development and school achievement. But children whose mothers received training also surpassed those in the control group in every measure. It was also found that trained mothers were treated with greater respect by their families, talked more and showed greater responsiveness when dealing with their children, and had higher aspirations for the future. The study concluded that parental education— less costly than center-based care-is effective and is well suited for wide application in Turkey, particularly when integrated into existing health and nutrition education programs.

In 1992, six years after the completion of the four-year study, a followup study was carried out to assess the long-term effects of training mothers. Of the original 255 families, 217 participated. The follow-up entailed extensive interviews with the young participants (now adolescents), with mothers and some fathers, and assessments of adolescents' school performance and intellectual competence. It was found that more of the participants whose mothers had received training were still in school. The children also tested higher in language use, mathematics, and overall academic performance during the five years of primary school and had larger vocabularies (as measured by a standardized test). Both the adolescents whose mothers had had training and their parents were generally more positive about the children's level of social integration, personal autonomy, academic orientation, and school adjustment than were members of the control group. They also reported better family relations and a higher status for mothers.

These results indicate that enriching the preschool experience confers substantial long-term benefits. In an effort organized by the Mother-Child Foundation and the Adult Education Division of the Ministry of Education and supported by a World Bank loan, the education methods devised and tested by Turkey's Early Enrichment Project are now being disseminated on a national scale.

4. Community Educators Working with Parents in Mexico

In an effort to enhance the early experience of Mexico's poorest infants, the national Initial Education Project is sending community educators into the home to teach parents what they can do to help their children develop. Early response to the project has been enthusiastic, and under its influence many of the country's traditional child-rearing practices are giving way to change.

In 1992 Mexico's Ministry of Education-in cooperation with UNESCO, UNDP, UNICEF, and the World Bank-launched a five-year Initial Education Project to improve the child care techniques used by the parents of 1.2 million of the country's poorest children under the age of three. The community educators who deliver the message are the keystone of the project. Generally young parents themselves or health providers living in the community, educators receive a stipend of US$ 150 a month. Their training consists of a two-week preservice course plus monthly follow-up sessions. Educators are expected to instruct parents about child development, positive parenting practices, nutrition, basic health and hygiene, and family planning.

In addition to organizing periodic group sessions, community educators visit parents in their homes once a week or every other week to teach them how to care for and stimulate their children in ways that will encourage the children's cognitive, psychological, and social development. By June 1995, 174,800 parents had undergone training in parenting, and it is estimated that 900,000 parents will be reached over the five-year life of the project.

The project has created jobs for 12,000 community educators, each of whom works with twenty families at a time. Ten of these community "nuclei" make up a "module," which receives technical input from a module supervisor. Ten modules form a "zone," monitored by a zone coordinator. Because Mexico's health and education services are handled by different ministries, the project was not designed to include a health component. Nevertheless, the coordination of these services has been excellent, with community educators and local health committees frequently conducting joint meetings for the local community to discuss child care and development issues.

Parents report that the training has changed their attitudes about childbearing, and many say they now recognize that traditional punishments for children are often inappropriate and unnecessary. In some areas the program is also changing ideas about gender roles in child-rearing. In remote villages in Chiapas, for instance, it is fathers who attend the training sessions.

5. Expanding Teacher Training Programs in Trinidad and Tobago

Trinidad and Tobago, as part of its Basic Education Project, is working with the private organization Servol and the University of the West Indies to expand the educational opportunities open to preschool program managers. The project will also train 350 current and 300 new preschool teachers and supervise them on the job.

Trinidad and Tobago, with Bank support, has undertaken to improve the quality of basic education throughout the country, and upgrading preschool programs is part of that campaign.

Two major institutions certify preschool teachers in Trinidad and Tobago-Servol, a nongovernmental organization that runs 148 government funded child care centers in the country, and the University of the West Indies. Servol's two-year preschool training program includes one year of full-time study and one year of supervised apprenticeship in the classroom. The University of the West Indies offers a six-month course in methodology and another six-month course in the management of early childhood centers. The Basic Education Project is strengthening and expanding these programs to train the trainers and will also sponsor workshops for field supervisors run by Servol, other NGOs, and the Ministry of Education.

The Basic Education Project's preschool trainer and supervisor training program focuses on curriculum content and training strategies. To allow participants to gain new knowledge while continuing in their jobs, it will offer seven one-week training sessions over the course of a year. On the job, participants will form teams to observe and comment on one another's performance. During the training sessions, consultants will provide feedback on participants' performance and teach them how to run workshops, how to offer helpful comments to other teachers, and how to implement a preschool curriculum. They will assess participants both at work and during the workshops the participants prepare and show them how to make safe, effective teaching equipment from such common items as shells, bottle caps, plastic scraps, old newspapers, and discarded lumber.

The project will also fund up to 350 scholarships for preservice training for prospective preschool teachers and give additional stipends to trainees from low-income communities during their year of full-time training. Servol will conduct field workshops so that roughly 130 teachers presently employed in early childhood programs can receive preservice training certification. In addition, each regional division of the Ministry of Education will have experts in early childhood care and education work with NGOs in training, supervising, and supporting in-service teacher trainees.

6. Introducing New Teaching Approaches in the Former East Bloc

The dramatic change in the countries of Eastern Europe and the former Soviet Union extends even to the kindergarten classroom. In line with the move toward democracy and a market economy, the Soros Foundation is sponsoring a project to train kindergarten teachers in educational approaches that encourage individuality and choice making.

One of the better legacies of communism is the high-quality kindergarten system ranging across all countries of the former Eastern Bloc. These are clean, safe places where working parents can leave their preschool-age children with confidence-from 7 a.m. to 7 p.m. Many of these facilities remain in good condition, so heavy investment in new child care centers is unnecessary. Less heartening is the old communist preschool curriculum, which takes no account of the special developmental needs of young children. Teachers tend to use the lecture approach and to require all children to do the same thing at the same time.

Under the Soros Child Development Program, teachers in seventeen formerly communist countries (Albania, Belarus, Bulgaria, Croatia, the Czech Republic, Estonia, the former Yugoslav Republic of Macedonia, Hungary, the Kyrgyz Republic, Lithuania, Moldova, Russia, Romania, the Slovak Republic, Slovenia, Ukraine, and Yugoslavia) are learning the best early child education techniques used in the United States and Western Europe. The program's curriculum, designed by Children's Resources International (CRI), emphasizes child-initiated play balanced by opportunities for group learning. The project funds teacher training and the purchase of materials for classrooms (books, paints, paper, substances that can be manipulated, wooden blocks, sandboxes, and water tables).

At the end of 1993 each of the Soros Foundation's country offices hired two local people to staff the country's child development program. In January 1994 these staff members and selected teachers attended a six-week training course in child-centered learning techniques in the United States. Visiting many Head Start and other early child development programs, they observed the techniques in practice and reamed to distinguish between excellent programs and those of lower quality. To give continued support, CRI provides ongoing technical assistance, and its trainers make follow-up visits to each country.

After the first year of operation, CRI-trained teachers began to train new teachers.

Kindergartens participate only with the agreement of the ministry of education. Each is encouraged to adapt the basic curriculum as it sees fit and continues to be responsible for paying its teachers' salaries. Thus, even if a country stops participating in the program, the benefits and basic care-giving structure remain.

Participating preschools are required to use a child-centered curriculum that teaches children to make choices as they play and gives each child an individual learning experience. Parents, too, must participate, and each site is encouraged to establish a "parents' room"— stocked with coffee, snacks, and sometimes even a washing machine-where parents can gather. Parents and grandparents also participate as salaried or volunteer teachers' aides, a feature that required legal changes in some countries. The Soros program sees the energy and enthusiasm of the newly involved parents as one of the most positive aspects of its preschool program.

The cost per child has varied widely depending on a country's resources. In Moldova the cost in the first year was US$ 157 a child. In Croatia and Albania it was as high as US$ 600 a child. But in the second year, Moldova's costs fell to US$ 20 a child, with start-up costs and reusable materials already paid for. Parents' contributions, though uniformly modest, also vary from country to country.

The positive response to the preschool program throughout the region has prompted CRI to begin work on a curriculum for infants and toddlers. And to ensure that gains made in preschool are not lost once the children enter the formal education system, a first-grade curriculum based on active learning principles will be introduced in 1996 by the countries participating in the Soros Child Development Program.

7. Meeting the Increasing Need for Child Care in Kenya

As more women enter the workforce in Kenya, the demand for early child development services has skyrocketed. To find out how best to improve and expand services, the government is launching a pilot early child development project with support from the World Bank.

In Kenya today, roughly half the country's 6 million preschool-age children live in poverty, a third of households are headed by women, and more and more women are entering the workforce. Not surprisingly, the demand for quality child care is rising. As a first step toward meeting this demand, the government-with World Bank assistance-has initiated a pilot early child development project.

Kenya already has a substantial network of community-supported preschool facilities, with some 18,400 centers caring for roughly a million children aged three to six. The communities provide the facilities, pay caregivers, organize the children's food programs, and supply materials for learning and play. The national government funds the training of preschool teacher trainers and designs the preschool curriculum. District governments train teachers and inspect and evaluate programs. And NGOs and local governments give financial and supervisory support to some centers. But with no recognized standards, preschool programs vary significantly in quality and type.

A recent government evaluation of the preschool system identified several weaknesses:

· Access to services-particularly for the poor-was low.

· The quality of physical facilities, personnel, services, and activities varied widely.

· With increasing numbers of children under age three attending child care centers and no plan in place for dealing with them during these crucial years, the risk of impaired early development was high.

· The public was largely unaware of the importance of early child development services.

· Caregivers' wages varied widely, and payment was irregular.

· Monitoring and supervision were inadequate.

· Preschool programs were not linked to the primary school system.

· Funding levels were too low to support efficient and effective preschool programs.

Kenya's pilot project will test ways of improving the quality of early child development services, increasing access for poor children, and increasing communities' capacity to organize, manage, and finance programs. It will also develop and test broader packages of services. To measure the pilot's success, the program will monitor poor children's access to early child development programs, profiles of children on entering primary school (average age, height, weight, immunization status), and dropout and repetition rates in the early grades.

The project proposes to train 15,000 preschool teachers and 5,000 community representatives on how to run and monitor enriched child care programs. To improve preschoolers' hearth and nutrition, the project will offer immunizations and food and micronutrient supplements and monitor growth. Pilot preschools will employ staff capable of diagnosing and treating common ailments, deworming children, and referring more severe cases for higher levels of care. Centers will continue to be managed by parents committees trained in the organization, management, and monitoring of early child services. An operations manual will outline targeting, disbursement, accounting, and auditing methods, and grants will be given to some communities to improve services. NGOs will help oversee the communities' management of child care centers.

The project will introduce new ways for communities to finance lechers' salaries, subsidize fees for the poorest children (in some cases, it will give grants directly to poor children to enable them to attend preschool), purchase school supplies, provide health and education materials, and improve facilities. It will also test a primary school curriculum that continues the teaching methods begun in preschool.

8. Giving Children a Head Start in the United States

In the mid-1960s the United States, as part of its War on Poverty, launched Project Head Start to provide education, health, and social services to the country's neediest preschool-age children. One of the first examples of an integrated early child development program, Head Start has served some 14.6 million youngsters. But because of inconsistent quality, its impact has been difficult to assess.

Head Start is a comprehensive early child development program providing education, health, and social services to low-income children and their families. Begun in the summer of 1965 as an eight-week demonstration project, Head Start became an essential element of President Johnson's War on Poverty. From its inception Head Start recognized the need to address children's educational, physical, and social service needs holistically-and to extend help to their families and communities as well. Head Start programs have four goals, each overseen by a different local coordinator, who makes sure that services meet the project's performance standards:

· Education. To provide each child with age-appropriate learning experiences that foster intellectual, social, and emotional growth.

· Health. To provide a comprehensive program of immunizations and medical, dental, mental health, and nutrition services.

· Social services. To help families assess their needs, gain access to services, and build on family strengths.

· Parental involvement. To instruct parents in care giving and teaching techniques and to encourage them to volunteer in the classroom and to plan and manage preschool programs.

Over the past thirty years Head Start has served about 14.6 million children and their families. In 1994 alone it served 740,493 children, in more than 40,000 classrooms operated by 1,405 grantees. In 1993,12 percent of its local sponsors were school systems or local government agencies, 47 percent were community action agencies (federally supported service delivery entities), and 28 percent were private nonprofit agencies.

Yet because of inadequate federal funding, the program today serves only 30 percent of eligible children-those whose families have incomes at or below the federal poverty guideline (US$ 15,150 for a family of four) or are eligible for public assistance. (Only about 5 percent of

participants have incomes below the requirement, and about 13 percent of participants are disabled.) Moreover, because of inadequate funding, most children enter Head Start when they are four years old, despite growing evidence that earlier intervention is more effective. In 1994 Head Start initiated the Early Head Start Program to provide early, continuous, and comprehensive child development and family support services to lowincome families and their children up to age three.

In 1993 the federal cost per child for the program ranged from US$ 3,500 to US$ 6,000, averaging US$4,343. In 1992 federal funds for the local programs were allocated as follows: 41 percent for education, 13 percent for administration, 13 percent for site occupancy, 9 percent for health and nutrition, 8 percent for transportation, 5 percent for social services, 4 percent to stimulate parent involvement, 3 percent for disability services, and 4 percent for other costs. Communities are required to match 20 percent of federal funds, in cash or in kind. In fiscal 1995 the federal appropriation for Head Start was US$3.5 billion.

The vast majority of Head Start children attend center-based, part-day programs during the school year only. Two home visits are required over the course of the program. The cost per child for home-based programs, in which a Head Start worker comes to the child's home weekly to work intensively with the parents, is about 10 to 20 percent less than that for center-based programs. Families can choose to combine the center-based and home-based approaches.

Head Start requires that classrooms be staffed by two paid staff persons teacher and a teacher's aide or two teachers. The program also tries to have a third person, a volunteer, in the classroom at all times. The Head Start staff to-child ratio is capped at 1:10, and the average classroom has about seventeen children. In 1994 fewer than half of Head Start teachers had undergraduate or advanced degrees. More had child development associate degrees earned through a combination of classroom and in-service training, for which scholarships are federally funded. The 1994 Head Start reauthorization bill strengthened the program's staff requirements so that by 1996 each classroom will be required to have a teacher who meets specific early child education training requirements.

Evaluations of Head Start over the years (McCall 1993) have found that it produces:

· Improvements in IQ scores and in academic readiness and achievement, greater self-esteem, and better social behavior and health.

· Better high school attendance rates, reduced retention in grade, and less use of special education services.

· Better communication between parents and children, increased parental participation in school programs, improved disciplinary practices in the home, and fewer feelings of anxiety and depression.

· Greater parental involvement in the child's early education, which was significantly associated with the child's later academic success.

· Improvement in the community attitude toward the poor and toward services for the poor.

· Substantial employment opportunities for the poor (36 percent of the program's employees are Head Start parents or former students; Children's Defense Fund 1993).

Head Start's greatest problems have been inconsistent program quality and the tendency for preschoolers' gains to fade by the time they reach the third grade. There has been no national longitudinal study of Head Start comparable to the High/Scope Perry Preschool longitudinal study, which suggested a US$ 7.16 return on every US$ 1.00 invested in early child development (Schweinhart, Barnes, and Weikart 1993). Because of the broad flexibility afforded local programs and the diversity of participants, Head Start is difficult to assess in a large study. It cannot be regarded as a uniform "treatment" and must be assessed for multiple outcomes in terms of its multiple goals (Collins and others 1990). Future Head Start evaluations need to focus on discovering what elements have proved most effective and how to ensure better-quality programs nationwide.

9. WIC Preventing Low-Birth-Weight Babies in the United States

The U.S. WIC program provides supplemental food, nutrition education, health care, and breastfeeding counseling to low-income women deemed to be nutritionally at risk and to their children up to age five. Operating for more than thirty years, WIC has cut the incidence of very low-birth weight babies in the United States by 44 percent and the rate of late fetal death by a third. Even/ dollar invested in prenatal WIC saves US$1.92 to US$4.21 in averted Medicaid costs.

After the 1969 White House Conference on Food, Nutrition, and Health, the U.S. government established the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to provide supplemental food, nutrition education, health care, and breastfeeding counseling to low-income, nutritionally at-risk pregnant and post-partum women and their children up to age five. The program has proved to be one of the most efficient ways to improve America's health.

To qualify for WIC, a client must meet certain income criteria and be certified as nutritionally at risk by a WIC clinic or doctor. States may set their income criterion no higher than 185 percent of the federal poverty level and no lower than the federal poverty level (Jones and Richardson 1995). Nutritional risk is determined on the basis of weight, height, and a blood test. Women taking part in WIC typically suffer from anemia, weight problems, preeclampsia, chronic infections, alcohol or drug abuse, homelessness, or mental retardation. Many have a history of low-birthweight babies, premature births, or neonatal loss. Children in the program exhibit signs of anemia, low birth weight, failure to thrive, lead poisoning, stunting, chronic infections, and congenital malformations. The nutritional risk status of all participants is rectified at regular intervals.

WIC has four components: a food package, nutrition education, medical care, and breastfeeding counseling. The WIC nutritionist gives each new WIC client vouchers redeemable for food items needed to correct that client's particular nutritional deficits. There are seven different food packages, but each usually includes milk or cheese, dry beans and peas or peanut butter, iron-fortified cereal, fruit or vegetable juice containing vitamin C, infant cereal, and infant formula. The average value of the food package is US$30 a month. The frequency with which coupons are issued varies from state to state (New York, for instance, issues coupons every two months).

While issuing food vouchers, the WIC nutritionist discusses good nutrition with clients, each of whom is required to attend at least two nutrition education sessions during her six-month certification. Meetings with the WIC counselor also provide an opportunity for pregnant participants to receive prenatal medical care. The improved birth outcomes for WIC participants can be attributed largely to early and frequent care during their pregnancies (box 11). One-on-one interaction with a caring professional is viewed by many as the key to the program's success.

Whenever possible, WIC clinics are located in a public or private nonprofit health agency that can provide ongoing, routine pediatric and obstetric care. Some programs have also had great success with mobile clinics, which pay regular, scheduled visits to atrisk neighborhoods.

Box 11 What WIC does Prenatal Reduces infant mortality rates

Reduced late fetal death rate by 20 to 33 percent.

Improves pregnancy outcomes

Significantly increased infant head size.

Reduced number of premature births to white women by 23 percent and to black women by 15 percent.

Reduced number of low-birth-weight births by 25 percent and of very low-birth-weight births by 44 percent.

Improves children's development

Associated with higher vocabulary test scores for children.

Improves diets

WIC women consumed more iron, protein, calcium, and vitamin C than nonparticipants.

Infants and children Improves children's diets

WIC infants consumed more iron and vitamin C than nonparticipants.

WIC children consumed more iron, vitamin C, thiamin, and niacin than nonparticipants.

Improves children's health

Rates of childhood anemia fell 16 percent after six months of WIC.

Reduced children's anemia rate nationwide by two-thirds between 1975 and 1985.

Improves children's development

WIC children tested higher than nonparticipants for digit memory.

Source: Based on Rush and others 1988; Yip 1987; GAO 1992.

To encourage breastfeeding, WIC offers more generous food packages to nursing mothers. Programs also hire lactation specialists or paraprofessionals trained to work with mothers, produce instructional materials, and buy breast pumps to lend to working mothers.

Studies over the years have consistently found the U.S. Special Supplemental Nutrition Program for Women, Infants, and Children to be a cost-effective way to improve the nation's health and to target services to Americans most in need. It has been estimated that for every dollar spent on prenatal care, US$1.92 to US$4.21 in Medicaid costs for mothers and newborns is averted. (For major studies of the past decade, see Rush and others 1988; GAO 1992; and Mathematica Policy Research 1990,1991,1992, and 1993.)

10. Community Centers Saving Children in India

India's community centers, or anganwadis, serve about 16 million children a year in the largest child development program in the world. Yet the program will have to expand still further if the country is to meet its great need for health and education services for women, infants, and children.

In rural India in 1984, 124 of every thousand children born to illiterate mothers died before age one. In the same rural areas in 1991, about 64 percent of children under three exhibited some level of malnutrition. And of the 101 million Indian children enrolled in primary school in 1991-92, 47 percent dropped out.

To improve the lot of its poor children, the Indian government initiated Integrated Child Development Services (ICDS) in 1975. ICDS has been supported by the World Food Programme, CARE, UNICEF, the European Union, USAID, and the World Bank. The World Bank has approved two loans in support of ICDS; the first supports the program in the states of Andhra Pradesh and Orissa, the second in the states of Madhya Pradesh and Bihar. The first loan was approved in 1990 and is to close in 1997; the second was approved in 1993 and is to close in 2000.

The program, now in virtually all Indian states, offers supplementary nutrition (usually hot meals of lentils, rice, and vegetables, or a mixture of grains) for children up to six and for pregnant and nursing women. For three to six-year-olds, it offers preschool education, immunizations, health checkups, and medical referral services. For pregnant and lactating women, it offers health and nutrition education.

ICDS services are delivered through a network of anganwadi (courtyard) centers, each run by an anganwadi worker and a helper selected from the local village. The anganwadi workers provide nonformal preschool education, supplementary feeding, health and nutrition education, parenting education, and maternal and child health referrals. They are paid an honorarium of US$7.50 to US$10.80 a month, depending on their educational qualifications.

One of the program's greatest challenges has been to provide training to its many workers. Some anganwadis are established two years before the workers can receive training. And some workers are able to weigh children correctly, for instance, but unable to plot growth charts or interpret the charts to advise mothers about future care. Improving program consistency and worker training is essential.

The two Bank-supported projects are designed to improve the delivery of supplementary foods, the coordination of health and nutrition services, the training of anganwadi workers, and the supply of preschool educational toys and materials. They also promote the introduction of interactive learning techniques. Each of the projects has established targets, by state, for reductions in severe malnutrition, moderate malnutrition, and infant mortality. In an effort to take the needs of the whole child into account, the projects aim to improve services for all age groups, but particularly for women and adolescent girls.

A recent review of nearly thirty nutritional impact studies confirmed that the ICDS program has had a positive impact on children under six. A 1984-86 comparative study found higher infant mortality rates in non-ICDS areas, and a study on the effects on primary education found that ICDS participants had higher primary school enrollment rates and better attendance and performance records. ICDS children from low- and middle-caste groups also had significantly lower primary school dropout rates than non-ICDS children from those groups (Consultative Group on Early Childhood Care and Development 1993).

11. Rationalizing Kazakstan's Kindergarten System

With the restructuring and privatization of state-owned enterprises, responsibility for kindergartens in Kazakstan is being passed on to municipalities, which can ill afford to operate them. At the same time tough economic conditions mean that young families must have two salaries to survive, ma/ring the need for a rational kindergarten system ever more pressing.

In the newly independent Republic of Kazakstan neither revenue-strapped municipal governments nor enterprises in the process of privatizing aare able to provide the liberal maternity leave, subsidized child care, and free kindergarten that the population had come to regard as entitlements under the Soviet system. Under communism, about 60 percent of the appropriate age group attended kindergarten, but by the end of 1994 enrollment had fallen to less than 30 percent. This decline reflects the approximately one-third reduction in available places between 1984 and 1994, the increase in the real value of fees in the face of declining real wages, and increased unemployment among women (both by choice and for lack of jobs).

The Kazakstan Social Protection Project, financed by a World Bank loan, is attempting to find ways to deliver social services and social protection during the difficult period of economic transition. Pilot projects have been established to help municipalities in the oblasts of South Kazakstan and Pavlodar cope with the divestiture by enterprises of health clinics, hospitals, and kindergartens and to help ensure the continued provision of services. The Bank loan is also financing modest rehabilitation and upgrading and the purchase of critical supplies and equipment for selected medical and kindergarten facilities, and the cofinancing-on a declining basis-of divested facilities' recurrent costs.

The project will also help municipalities to rationalize their social service systems and make them sustainable. To cut costs, oblast and municipal governments are considering such options as amalgamating services, targeting them more precisely, privatizing nonessential services, closing excess facilities, and improving food procurement practices. And to recover costs, they are considering introducing or increasing user fees and rationalizing and enforcing fee schedules. In 1992 Kazakstan's president decreed that kindergartens could charge fees to cover up to 30 percent of food costs, but a generous fee exemption and reduction policy and a general failure to collect fees resulted in lower than-expected revenues.

Determining the actual need for services is an essential part of rationalization. In the city of Shymkent, for instance, where fifty-seven municipal kindergartens and fifty-six enterprise kindergartens had served a population of 450,000, the project will finance the rehabilitation costs of the seventy-seven kindergartens deemed necessary. Of the rest, about twenty of the enterprise kindergartens will not be transferred to the municipality, ten kindergartens had already closed, and six municipal kindergartens housed in nonstandard buildings will be closed or converted to other uses.

By June 1995 about 23 percent of enterprise kindergartens operating in Kazakstan at the end of 1994 had closed their doors, but the promise of funding under the Social Protection Project has moved teachers and mothers at several sites to start renovating so that they can reopen the kindergartens. In some kindergartens the women have replaced walls and fixed roofs and floors.

Kazakstan, in the midst of preparing a national strategy for the divestiture of social assets and provision of social services, has yet to define the social, economic, and educational role that kindergartens will play in the new republic. Will they be day care facilities whose major purpose is to care for the children of working parents, or early child development centers that provide education, immunizations, primary medical care, and nutrition services? While the government sets quality and coverage standards for the country's early child program, the Kazakstan Social Protection Project will maintain at least a critical minimum of kindergartens in each project city.

12. Expanding Services for Children in Guyana

Despite being the second-poorest country in the world, Guyana recognizes the need in provide comprehensive services for children. With support from the World Bank, the government is combining basic health and nutrition services with center-based early education in a system to reestablish the provision of social services to the poor.

Guyana's economic troubles since its independence in 1966 illustrate well how an economy with ample natural and human resources can be devastated by counterproductive government policies. During its first twenty years the country's economy suffered from centralized decision-making, heavy public sector involvement, and a general disregard for the need to encourage the private sector. The subsequent economic decline has severely weakened once-strong social service delivery systems.

In 1988 Guyana's government-with the assistance of the International Monetary Fund (IMF) and the International Development Association (IDA)—embarked on a series of measures aimed at restoring economic growth and normalizing relations with external donors. At the same time it initiated the complementary Social Impact Amelioration Program (SIMAP).

Under the World Bank-funded Health, Nutrition, Water, and Sanitation Project, SIMAP is trying to reestablish the country's health care services and to improve the quality of existing child care facilities. The program provides food supplements to children under five and to pregnant and lactating women (one or two meals a day), rehabilitates and equips health care and day care centers, and constructs water supply and sanitation facilities and residential drainage systems. It also funds the construction, expansion, or rehabilitation of maternal and child outpatient service departments in district hospitals and provides supplies and seed stocks of essential drugs for primary health care facilities.

The program provides food supplements to all children aged six months to two years, to all malnourished children aged two to five years, and to all pregnant and lactating women visiting health clinics. The milk and rice distributed are purchased weekly by the sponsoring agency from qualified local suppliers. Evaluations suggest that free food is drawing women and children back into the health care system and that participation in "well child" clinics has increased dramatically.

Although Guyana's present system of day care centers can accommodate no more than a thousand children, even this level of commitment is unique for a country of its economic status. The day care centers are run by the municipalities, and a private day care industry is starting to develop. The government of Guyana trains all day care workers, including those working in private centers. Guyana's day care system may be limited right now, but the country clearly knows that young children are a good investment for the future.

13. Planning to Meet the Needs of Children in the Philippines

The Philippines is laying the groundwork for a massive program to improve and expand public services for young children. To establish baseline indicators and to chart the direction of funding for early child development services, it has initiated a thorough study of the current system

At the request of the Philippines Department of Health, the World Bank and the Asian Development Bank (ADB) prepared a report in 1994 to serve as the basis for further investment in the country's integrated child development programs. The report reviewed all current programs and activities related to Philippine children's health, nutrition, and early education.

The Philippines Departments of Health, Education, Social Welfare and Development, and Culture and Sport are now using that report to prepare a national early child program. While the Philippines investment plan is still in its early stages, it will certainly cover health, nutrition, and education, pursuing these general goals:

· Health. Strengthening and expanding child survival programs (including immunization programs and measures to control diarrhea!

· Nutrition. Strengthening and expanding programs for malnourished children, promoting breastfeeding and correct infant feeding practices, and supplying micronutrient supplements to at-risk mothers and children.

· Early education. Strengthening and expanding public preschool programs and testing a variety of day care schemes to help working mothers.

Box 12 Integrated management of the sick child: the WHO-UNICEF approach

The most common health complaints for children worldwide redate to diarrhea, pneumonia, malaria, measles, and malnutrition-frequently in combination. Recognizing the complex overlap of symptoms and effects, WHO and UNICEF have developed a health care approach of looking at each child's condition as a whole rather than targeting single diseases as in the past. The World Bank's World Development Report 1993 cited this new, integrated approach as a cost-effective health intervention for low-income and middle-income countries and predicted that it would do much to reduce the global burden of disease.

Integrated management has several basic goals:

· Accurate diagnosis in outpatient settings.

· Combined treatment of all major illnesses.

· Speedy referral for severe cases.

· Widespread promotion of such preventive interventions as immunizations, breastfeeding, and improved nutrition.

To help achieve these goals, health workers are being trained in how to assess, classify, and treat common diseases and how to instruct parents in basic health principles and practices. During training at a first-level facility, health workers will be taught to use the WHOUNICEF case management guidelines, and some will be trained in the management of drug supplies. Integrated management treatment charts and training methods have been tested in Ethiopia and Tanzania, and monitoring and evaluation tools are being developed. The integrated management of childhood disease shows such promise that the World Bank is already collaborating with WHO to introduce it in Bank supported projects in Brazil, the Philippines, and Tanzania.

Source: Based on information provided by Mariam Claeson, World Bank, October 1995.

All investment would narrowly target the poor and be designed to maximize community participation. An initial round of community interviews about the content of early child programs has already been completed, and two more rounds of consultation-and a program to mobilize local support for such programs-are planned.

Besides serving as a guide for planning, the 1994 World Bank-ADB report should also prove useful in attracting donor support. Once published, the report will be discussed at a donors workshop and distributed to potential funding sources worldwide.

14. Experimenting with New Service Models in Chile

Chile is trying to learn more about which kinds of early child development approaches are most effective in urban and rural settings. Its Primary Education Improvement Project is assessing how improving teacher training and teaching materials and providing food supplements affect poor children's futures.

In 1989 less than a fifth of all two- to five-year-olds were enrolled in preschool, and only 57.5 percent of that student cohort finished the eighth grade. To improve this record, the Chilean government in 1992 launched the Bank-assisted Primary Education Improvement Project, to provide preschool education for about 16,000 urban and 30,000 rural five-year-olds from poor families.

The project is hiring supervisors, teachers, and paraprofessionals; training parents in how to stimulate the minds of their young children; constructing 100 classrooms to provide roughly 4,500 preschool places; refurbishing 75 rural facilities donated by the communities; providing daily food for the children; providing teaching materials; instituting a mass media campaign to encourage parental participation; and conducting studies to ascertain the cost-effectiveness of each preschool model tried. Preschool programs are judged by their medium-term impact on the children's academic performance, behavior, and skills.

The project is testing two models of rural preschool education. Under the first model, the project is providing 29,000 sets of teaching materials and continuous in-service training for supervisors, school principals, teachers, and paraprofessionals. It is also conducting 3,000 local workshops to train some 23,400 parents in early education techniques. No food supplements are provided.

The second model is being implemented by INTEGRA, a government assisted agency that was responsible for enrolling 12.4 percent of all preschoolers in 1989. INTEGRA is hiring 15 supervisors and 150 paraprofessionals, refurbishing 75 small rural centers donated by the communities, and providing 2,000 daily food rations. Each rural child care center is run by two paraprofessionals and serves about twenty-five children under the age of six.

Evaluation procedures are integrated into all preschool programs. Mechanisms are set up at the outset to assess each model's effect on children's future academic achievement, behavior, and skills, and a cost effectiveness study will compare the three urban and two rural preschool models. These evaluations of the programs' relevance, efficiency, and effectiveness will guide future government investment in preschool expansion.

15. Restoring Services for Children in El Salvador

After years of war, El Salvador is now restoring and improving its education and health services for young children. The unique. Community based preschool system if has developed requires the active participation of parents and other community members. Improved facilifies and new teaching methods and materials in the classroom are benefiting preschoolers.

During El Salvador's ten years of civil strife, an estimated 75,000 people died, 750,000 emigrated, and 500,000 became refugees within their own country. Defense spending and interest payments on external debt crowded out spending for social services, and the children suffered. In 1991 about 60 percent of infant deaths resulted from diarrhea caused by lack of adequate sanitary facilities and practices. About 36 percent of children under five suffered from vitamin A deficiency in 1988, and only 29 percent of children under two received any health care at all. On the education front, only 7 percent finished primary school in 1979, and a fifth of rural first-graders dropped out. By 1986 only 60 percent of children in rural areas were enrolled in primary school.

In June 1989 the government of El Salvador instituted a far-reaching macroeconomic reform program and, with World Bank, USAID, and UNICEF support, began to implement the Social Sector Rehabilitation Project to rebuild public sector health and education services. As part of that project, El Salvador has devised an innovative program that encourages parents and community groups to define and administer preschool and early primary education services for about 70,0()0 students. Each preschool will accommodate at least twenty-eight children. Using established criteria, the Ministry of Education selects a community group (formed by teachers and parents or by NGOs) to run the preschools and provides funds to cover teachers' salaries and administrative costs, textbooks and teaching materials, nutrition assistance, and staff training. The community groups are responsible for hiring and paying teachers, providing furniture and physical facilities, and administering services.

Under the program, in-service training in the theory and practice of early child development will be provided for about 2,500 preprimary teachers. The program emphasizes small-group interaction and activities that strengthen children's problem-solving skills and readiness for reading, writing, and numeracy. All preprimary teachers in El Salvador will eventually be trained through the Ministry of Education, which runs regional preschool teacher training centers.

The cost of providing preschool services under this project has been estimated at about US$120 a child per year, including US$20 for food supplements. Teachers are paid US$160 a month to teach preprimary classes; teachers with larger classes can receive a salary increase of up to 10 percent. The project includes annual evaluations of preprimary and primary programs for their effect on child development and their cost-effectiveness, which will provide a basis for refining the programs' design. It is hoped that the programs can be adapted for other high-poverty areas in El Salvador.

El Salvador's Social Sector Rehabilitation Project also supports the expansion of education and health outreach activities; seeks to increase the number of health specialists and medicines available in villages; and includes an emergency birth and first-aid service. It will strengthen the social sector by instituting a new supervision system, improving financial and personnel management practices, and developing a health care financing policy-all of which will have implications for the country's network of early child development programs.

16. Addressing Basic Health and Education Needs in Venezuela

The Venezuelan government has made a strong commitment to expanding the capacity of its community day care and preschool programs. New construction and renovation projects undertaken with World Bank support have surpassed their project goals, opening the door to preschool education for thousands of young children.

Venezuela's abundant petroleum resources have made the nation rich. Yet in June 1994 almost half of Venezuelans were considered poor and more than a fifth critically poor. In 1988 only a third of preschool-age children attended a preschool program, and access to primary school was not universal. Venezuela's skewed income distribution and heavy burden of poverty derive chiefly from poor management of the national budget, insufficient targeting of social spending on the poor, rapid urbanization, and a high rate of population growth.

In 1990, with World Bank support, the government launched a seven year Social Development Project to rehabilitate the primary health care network; provide health care and nutrition services for pregnant and lactating women and for children up to age six; expand and improve preschool services for poor children; mount a campaign promoting beneficial health, nutrition, and education practices; and improve the government's capacity to design, plan, and implement social programs and assess their impact.

By the end of 1994 preschool programs had reached an estimated 44 percent of eligible children. The government's aim is to enroll at least half of all four- to six-year-olds in preschool programs by 1995. It is therefore supporting the establishment of new preschools, both conventional and informal. In conventional preschools young children receive formal instruction from a professional teacher. Informal preschool education in Venezuela tends to be provided by a teacher and community promoter who share teaching duties and provide health, nutrition, and recreation services.

The project will have built 1,600 conventional preschool classrooms by the end of 1995, which should accommodate 96,000 children. It will also build 185 informal preschool centers, extending coverage to 116,000 children in all. Although the construction of preschools has been highly successful, funds for building were recently cut 40 percent, and project funds must also cover the preschool feeding program, the purchase of furniture and materials, staff training and supervision, and administrative costs.

Community day care programs, expanded under the project, now serve 351,000 children and should easily reach the target of 500,000. Caregivers are selected from the community, trained, and paid a small monthly sum by the government and a small fee by the parents of each child. Each caregiver takes care of six to eight children in her own home. The government provides loans for home improvement and donates toys and other necessities. Although financed by the government, the program is run by Fundacil Nind other NGOs.

To complement the education interventions, Venezuela's Social Development Project will expand immunizations, preventive health care for infants, and treatment of acute diarrhea! illness and respiratory infections among infants and children. It will also provide nutritional supplements to pregnant and lactating women and to children up to the age of six. Malnourished children will receive three kilograms of powdered whole milk a month, and all other children two kilograms. By the end of 1995 the project expects to have provided access to these basic services to 420,000 pregnant women (up from 200,000 in 1989), 360,000 lactating women (up from 80,000), 640,000 infants under age two (up from 245,000), and 916,000 children aged two to six (up from 370,000).

Informal and formal early child programs are now considered essential for improving conditions among the poor, and Venezuela will include them in the new structural adjustment program it is preparing in collaboration with the World Bank.

17. Tuning in to Learn about Child Care in the Philippines

The Philippines' village-based Parents Effectiveness Service was scoring real gains among parents-but it reached few. When people started tuning in to ECD School of the Air and The Filipino Family on the Air, however, the audience for information on parenting and child care almost instantly grew by the thousands.

The Philippines' village-based Parents Effectiveness Service (PER) has been teaching parents about early child development in group discussions and home visits since 1989. Its efforts seem to be paying off: parents participating in the program show a better grasp of what infants and young children need, both physically and for their mental development, and are consequently more encouraging and less violent toward them. But only a few parents were getting the message.

Then, in 1992, PER introduced ECD School of the Air, an educational radio program, in the southern and largely Muslim province of Mindanao. A series of 180 lessons were delivered over the air in three and a half months. Participating parents answered questions about the program in test booklets so that their progress could be monitored. By 1994, 10,500 parents had taken part in the ECD School of the Air, and even more were listening to The Filipino Family on the Air, a thirty-minute radio magazine show initiated in 1993 to run for thirteen weeks each season. Already reaching an estimated 80 percent of Filipino households, even in far-flung areas, radio can be a cost-effective, powerful medium for teaching parents how to give their children a better start in life-and PER is tapping that potential.

Box 13 UNICEF's video-based approach to parental education

Recognizing the mass media's great potential as an educational tool, UNICEF is sponsoring a program to produce videos and other mass media materials for use in its ongoing programs in early child development. In an effort supported by the UNICEF Global Education Fund, these teaching videos will first be tested in parental education projects in Iraq, Jordan, Morocco, Turkey, Tunisia, and Gaza and the West Bank and then adapted for use throughout the Middle East and North Africa.

For parents, UNICEF has produced a four-part videocassette series of TVbroadcast quality-with accompanying print materials-to convey the best strategies now known for encouraging young children's growth and development. The goal is to instruct 80 percent of parents in the Middle East and North Africa by the year 2000 in the basics of child care and development. If successful in that region, the videos will be distributed in other regions.

Under the direction of Dr. Cassie Landers, UNICEF's New York office has developed a core set of materials to convey the universal principles of early child development, incorporating existing materials whenever possible. These materials will be used as the basis for country-specific initiatives. Four ten-minute animated videos and accompanying guidebooks ("Off to a Good Start: The First Year of Life"; "A Time of Adventure: One and Two-Year-Olds"; "Pathways to Learning: Three- and Four-Year-Olds"; "Ready for School: Five- and Six-Year-Olds") portray the normal sequence of a child's development, describing the major developmental tasks for each age group and showing how to create an effective learning environment in the home. To make the videos universally useful, realistic figures appear against neutral backgrounds. The animated series can be used with live-action sequences suited to the country setting or as standalone educational tools.

To produce videos in the countries where they are to be used, country teams are being formed of representatives from community NGOs; specialists in early education, nutrition, pediatrics, psychology, curriculum development, and training; video production and television specialists; and representatives from ministries of health, education, and social welfare. These groups are then divided into five working groups: concept design and development, video production, guidebooks and support materials, television broadcast, and community activities. Each working group consists of two to three people, and team members can serve on more than one to ensure continuity. The country teams work closely with UNICEF's New York office, which provides a timeline of tasks to be accomplished by each working group. UNICEF regional offices are responsible for coordinating and managing activity in the countries and communications with New York.

Source: From materials provided by Judith L. Evans, Consultative Group on Early Childhood Care and Development.

18. Using Radio to Teach Caregivers and Kids in Bolivia

In Bolivia an interactive radio program designed for use with young children in day care centers teaches children while also teaching the teachers-on how to interact with children and how to facilitate their development.

Bolivia is using an interactive radio program, Jugando en el PIDI, to teach children under six who attend Programa Integrado por Desarrollo Infantil (PIDI) centers, and at the same time to foster productive interaction between children and caregivers. Developed in 1993, the PIDI program seeks to use radio programs and cassettes as a cost-effective way to train teachers in developmentally appropriate techniques. The government agency Organismo Nacional del Menor, Mujer, y Familia is presently developing PIDI centers in the cities of El Alto, Santa Cruz, and Tarija.

For the pilot phase of the PIDI program, forty twenty-minute radio programs were designed around developmentally appropriate objectives for children aged three and four, to improve teachers' understanding of child development and of the activities best suited to each developmental stage. The programs were tested and extensively evaluated in 1993-94. The evaluations of the pilot series of Jugando en el PIDI found that it reflects the child development perspective, curriculum, and activities of the PIDI project by using active learning techniques, emphasizing the importance of learning environments, parents, and community, and providing interactive teacher training. The evaluations also provided continual feedback on the technical quality and pedagogical effectiveness of the programs, used in revising later programs.

Jugando en el PIDI includes stories on the adventures of Don Pancho and Katy, what TClara has in her surprise bag, and the antics of the parrot Ito. Along with new material to be learned, it broadcasts catchy songs (which the children learn quickly), jokes, and activities.

Evaluators concluded that radio programs such as Jugando en el PIDI are a cheap and effective way to train both caregivers, many of whom are uneducated and illiterate, and early child program supervisors, who are frequently too ill-trained themselves to offer helpful advice. By reinforcing each new technique with hands-on experience, interactive radio helped teachers in the pilot program to learn new practices thoroughly and provided a framework around which teachers could organize PIDI program activities. The program also made children more active and alert. Evaluators found that children arriving at the PIDI centers are generally reticent, shy, passive, and nonverbal. Once educated with Jugando en el PIDI techniques, they become more active learners-and therefore far more disruptive in class. To help teachers learn how to channel the children's activity into productive avenues, set limits, and instill expectations for appropriate behavior, it was suggested that the teachers' guide, supervisors, and group meetings address the problem of classroom management more fully. Finally, evaluators remarked that Jugando en el PlDI was fun, and that teachers and children alike looked forward to the radio show with enthusiasm. For that reason, the program is very likely to continue to be useful.

19. Producing TV for Tots in Nigeria

With too little money to provide traditional preschool classrooms for all of its young children, Nigeria, assisted by the World Bank, is turning to educational television as a way to reach millions at relatively little cost.

Although Nigeria's national education policy seeks to improve educational opportunities for very young children, the country cannot afford to fund a traditional program for all of its 13 million preschoolers. The Nigeria Development Communications Project therefore proposes using the mass media-and the Sesame Street model-to teach children aged three to six and instruct their caregivers in active learning techniques.

The five-year pilot project will design, produce, disseminate, and evaluate mass media instructional materials for preschoolers and their mothers. To accomplish this, it will support the development of institutions to produce educational television materials and train television managers and evaluators. Its goal is to reach 4 million preschoolers, 36 percent of whom already have access to television. To broaden access, fifteen local government authorities in ten states have agreed to supply additional televisions for child care centers, and televisions will also be bought with the project and grant funding.

The instructional videos will not only be transmitted over the national network; they can also be shown from "video on wheels" vehicles and at local viewing centers. The newly established educational television unit of the Nigerian Television Authority plans to produce 130 episodes for preschool children, designed to develop their language expression and comprehension skills, their ability to observe and to solve problems, and their prenumeracy, preliteracy, and social skills. The shows will also convey basic health and hygiene information to parents.

In addition to the videos for children and parents, the project will prepare four to six videos for preschool organizers, facilitators, and trainers to show them how to identify children's basic needs, how best to organize available space, how to monitor children's health, how to create an environment for learning and for stimulating children's play, thinking, and expression, and how to make sure children are getting affection and good nutrition. Other videos will show parents how to observe the effects of children's interaction with adults and what children learn from such interaction.

The five-year pilot project, whose total cost is estimated at US$10.23 million, will be supported by an IDA credit of US$8.03 million, a Nigerian Television Authority grant of US$1.71 million, and a combined UNICEF and Bernard van Leer Foundation grant of US$490,000.

The Nigeria Development Communications Project will establish a new, collaborative way to produce educational videos in developing countries. Training sessions for this enterprise will include not only TV producers and scriptwriters, but also sociologists and early child development specialists. To evaluate the project's impact, baseline data on educational and social indicators are already being collected on children and adults in the targeted areas, and changes in these indicators will be monitored throughout the project.

If the Nigerian venture works, it could introduce an inexpensive and highly effective method for improving conditions for young children. As Sesame Street has shown in the United States, nothing is more powerful than TV for getting out the education message.