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There are at least three kinds of action that the Bank can undertake:

(a) do more projects on integrated early child development in Bank lending program;

(b) support sector work and policy dialogue to assess needs of integrated child services in relation to other public programs and enhance public awareness; and

(c) evaluate conduct research and evaluate programs.

In addition, the Bank should seek to develop and strengthen its partnerships with other international and nongovernmental agencies which have an accumulated experience in developing and implementing early childhood interventions. Among UN agencies, UNICEF has been a leader both in early child development operational experience and in promoting the rights of children. The Bank needs to collaborate with UNICEF to bring people together from various program sectors to formulate an integrated policy towards human resources development, to evaluate studies on cost and financing early child programs, and to provide technical guidance and to analyze, monitor and evaluate integrated early childhood programs. The Bank should also draw on the experiences of bilaterals and NGOs, such as the Bernard van Leer Foundation, Save the Children, the Christian Children's Fund. Within the Bank, awareness of and concern for pivotal role young children play in economic development need to be increased.

Do more projects on integrated early child development

As cost proves to be one of the most serious obstacles to the development and operation of early childhood programs in developing countries, mobilization of new resources together with efficient use of available resources is critical. To date, the Bank has made fourteen loans through the human resources sector to such programs, and several more are in various stages of preparation. More needs to be done. This kind of projects combines efficiency and equity; and cut across traditional human resource subsectors. One way to do so is through add-on programs. International experience indicate that add-on programs can be an effective approach to introduce an early child development component to sectoral projects in nutrition supplement, education, and maternal and child health care.

Introducing early child development interventions within the health care and nutrition supplement sectors can be implemented through, for example, incorporating psychosocial development information into training and maternal and child health care components. Health education programs, especially when delivered through mass media, should stress the young child's need for cognitive stimulation and affective care. Programs that bring parents and caregivers together to provide nutritional supplementation, growth monitoring, and nutrition education can usually provide an entry point for delivering early education interventions. Home visits, intended to monitor nutrition and health status, can also provide opportunities to talk with parents about the mental and social development of their children and expose parents to age-appropriate development activities.

In the education sector, primary projects can support child-to-child components in which children at school learn to care for their younger siblings. The Jamaican Child-to-Child Program, targeted at children 9 to 12 years old, has demonstrated that parents also benefit from the information about health, nutrition, and cognitive development brought home by their children. This intervention has a multigenerational impact as it influences the targeted children, their siblings, and their parents. It also is intended to influence the behavior of these children once they themselves become parents. In addition, the content of adult education and literacy programs should incorporate information about the needs of young children.

The Bank can also strengthen its support of communications strategies to deepen public awareness of early child development. There is wide recognition throughout the Bank of the critical role of communications in such social sector programs as child survival, family planning, safe motherhood, and improved water quality and sanitation. Now more resources are needed to disseminate information about child development.

Support sector work and policy dialogue

Sector work should focus on (a) a child's needs in terms of nutrition, health care, and schooling, using such indicators as anthropometric measures, infant and child mortality and morbidity data, immunization coverage, primary school enrolment, age of enrolment, dropout and repetition rates, completion rates, and male-female differentials; (b) work should also review existing and proposed childoriented policies, programs, and projects; assess their synergies and complementarities, and formulate policies that foster the integrated approach to child developments; (e) finally, sector work should identify gaps that can be addressed by additional or adapted policies (including changes in the legal framework, where needed) and by Bank-funded projects. In addition, the Bank should assist governments to develop national child and family policies. Along with informing the public, special attention should be directed toward informing policymakers at national and regional levels and disadvantaged communities where children are at risk. The mass media can also deliver developmental curriculum to children and their families. Mexico's Initial Education Project and Nigeria's Development Communications Project are two examples in the Bank's lending portfolio that channel information through mass media (see box 31).

Fund research and evaluation

The Bank's own capacity to fund this activity needs to be strengthened. Within the Bank, information from staff from different programs and sectors should be solicited in order to formulate policy and identify technical assistance to analyze, design, monitor, and evaluate integrated early childhood programs. In addition, the following topics need urgent attention:

- Assessment of the marginal social costs of different kinds of services for children. To do this, longitudinal studies are needed at various locations in developing countries.

Such studies could be based on existing Bank projects. However, the evaluation would need to extend beyond the project loan cycle of five or seven years. It would also be necessary for the evaluation to set up comparison groups to control for a range of non-project variables.

- Creation, validation, and establishment of instruments to measure children's integral development in contexts appropriate to developing countries, that is, beyond those currently available, which are mostly limited to children's health care and nutritional status.

In Latin America and the Caribbean, work has already started on developing instruments to measure children's integral development. A child development scale designed by Nelson Ortiz at UNICEF in Colombia has been applied in selected settings in
Colombia and has been tested and adapted to
Bolivia's Integrated Child Development
Project. A child school readiness scale needs to be developed to help assess the strength of early child development programs and readiness of young children to enter the formal school system.

- Evaluation of various financing schemes currently used in developed and developing countries and assess their sustainability.

- Conduct of social communications research to identify what motivates parents and communities into demanding, participating in, and paying for early child services.