comprehensive early childhood development policy
TRANSCRIPT
Comprehensive Early Childhood Development Policy
The case of Chile
“Chile grows with you”
2005/2006 – Two main facts
31
35.6 37 34
14.4
22.5 21.8
29.8
0
5
10
15
20
25
30
35
40
2 - 11 m 12 - 23 m 24 - 35 m 36 - 47 m
Age - in months
Q1
Q5
Developmental delays by age & income quintile
(% of population), Chile 2006
Q1 Q2 Q3 Q4 Q5 All
15 - 29 y 24.3 31.9 44.9 47.4 50.3 38.7
30 - 44 y 39.8 50.8 63.5 70.5 80.6 59
All 31.9 40.8 53.5 58 64.5 48.3
0
10
20
30
40
50
60
70
80
90
Female labor participation, by age &
income quintile - Chile 2006
Why Chile Crece Contigo (CHCC)?
O Despite good economic results, high level of inequality, starting before birth.
O Wide range of services, high coverage, low quality – specially for most vulnerable.
O High increase of teenage maternity/paternity
O High rates of developmental delays (children under 4), including high income households.
O Low rate of women labor participation.
O Poor performance in international tests – all social groups.
What did we have to start?
O Wide network of primary health services – high coverage and adherence.
O Very good health indicators.
O A network of public nurseries (children under 2y) and kindergardens (2 – 3y) – insufficient coverage and unequal quality.
O Universal access policy to preschool education (4 – 5 y) – low demand.
O Big number of little programs focused on early childhood.
O POLITICAL WILL
CHCC was designed based on …
Scientific evidence
Pre-investment
studies
Broad Consensus
Global approaches
Stages of development of Neural Circuits: the importance of the first 1000 days
FIRST YEAR
-8 -7 -6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Birth (Months) (Years)
Sensory Pathways (Vision, Hearing)
Language Higher Cognitive Function
Source: Nelson (2000)
Scientific evidence
RISK FACTORS
Poverty
Infections/
illnesses
Malnutrition
(stunting, micronutrient deficiencies) Toxic
stress (institutionalization,
maltreatment, neglect, trauma)
Maternal depression
Lack of opportunities
(stimulation, responsive
relationships, protection)
Disparities begin prenatally or early in life
Scientific evidence
Policies that can help lead to success…..
Maternal health and prenatal care
Child health and nutrition
Parenting and family support
Quality early childhood programs
Family economic supports and
ongoing education
Quality primary schools
Supporting Protective Factors Scientific evidence
Preventive Interventions are more efficient and produce more favorable outcomes
than later remediation
Source: Heckman, J. (2007)
B-3 4-5 6-18 19+
Rates of return to
human capital
investment
Preschool programs
K-12 schooling
College, job training
Programs targeting the earliest years
Age
Scientific evidence
Children rearing
patterns –
indigenous
communities,
ruarl, urban
families, etc.
Teenage
pregnancy –
family support
Conditions
for
humanized
birth
Systematization
of experiences
nationwide
Regulations
related to
children and
families
Children and the
use of physical
space (homes,
community
facilities, etc.)
Pre-investment
studies
Special Ministers
Committee
Cross-ministerial
technical group
Presidential
Advisory
Council
Proposals for
action
2006
Technical and
political design
and action plan
for
implementation
2006
Implementation
2007
1 2 3 4 5
Pre-
investment
studies
2005
CHCC
LAW
Approved
2009
Starting by cohort
2007: pregnancy
and 1st year.
Entitled
services
and
benefits
Policy trajectory 2005 - 2009
Broad Consensus
What is Chile Crece Contigo?
O Integrated suite of services (children under 4y and their
families)
O Universal and targeted interventions
O Multiple public providers – improving supply side
O Central and regional coordination – Ministry of Planning
O Local Coordination: Municipalities
O Continuos monitoring of each child development trajectory,
O System approach
Global approache
s
All Children(100%)
• Interactive educational tools –
parenting knowledge and skills
• Legislation improvements
• Biopshychosocial
Development Support
Program (PADB)
• Newborn Support
Program (PARN)
• Nobody is Perfect
(parenting skills)
Children with
some vulnerability
– risk factor (74%)
Children covered by
public health system
(81,6%)
• Good quality - free nursery and
kindergarten
• Home visits by health teams
• Family allowance
• Comprehensive care for children with
developmental delays
• Technical aids for children with
disabilities
• Preferential access to the social
protection system
Interventions and targets (children under 4y)
Supporting and tracking each child development trajectory –
Children covered by the public health system
1° prenatal
ckec up
Entry to
preschool
Support to Bio-Psycho-Social Development –
Entry program to CHCC
Universal services
FA – Nursery– Kindergarden –
Preferential access to social programs
– Modalities to support developmental
delays, Technical aids for disability
Differentiated services depending on the child
Entry
point to
CHCC
Exit
point
from
CHCC
Management Information system – including referrals
Strengthening PRENATAL care
Personalized support to DELIVERY process
Integral support to HOSPITALIZED
children
Strengthening regular children health CHECK
UPS
Interventions for children with
DEVELOPMENTAL DELAYS Support to Bio-
Psycho- Social Development
Program
PROVIDER: Public Health
Network (national,
regional, local)
Universal services
Targeted services
Legal Guarantees to CHILDREN from
60% most vulnerable households
PROVIDERS: Ministry of
Education – Disability
Fund - Municipalities
Differentiated services for FAMILIES from
40% most vulnerable households
PROVIDERS: Different
agencies – mainly through
municipalities
O Technical aids (disability)
O Nursery and KG modalities
– mothers working, studying
or seeking job.
O Part-time KG modalities –
mothers not working out of
home.
O Family allowance from
pregnancy.
O Remedial education.
O Training and job placement
services.
O Improving housing conditions
O Social and legal services
O Mental health services
Lessons learned
Chile and worldwide
Lessons Learned From the Chilean experience
1. Children specific developmental needs.
1. Learning needs of parents and caregivers.
2. Parents and caregivers coping styles and required support.
1. “Points of contact” of the public agencies with the youngest
children and their families.
2. Providers mapping – national and local level. Coverage and
quality.
3. Stakeholders assessment – political and social commitment
Design informed by strong diagnostics
O Build on what you have – improve all you can – don’t invent
the wheel. Always someone in the country has implemented
something helpful. You only need to search.
O A comprehensive approach is the right way to ensure
different supports (services) to the exactly same child.
O The management model is the main challenge, more the
implementation than the design (many actors, same
objective, common results, same children, different skills
and experience). Don’t forget to take into account each
institutional culture.
Main Lessons From Implementation
O Policy coordination under a non sectorial Ministry is an advantage.
High political priority always helps.
O Local management is crucial – they work with the families on daily
basis.
O A common management information system is the main tool for
cross-sectoral coordination and service delivery (registry,
monitoring, referral).
O Timely and coherent services to the children and their families.
O Having an evaluation agenda/plan (processes, results and impact)
allows continuous improvements.
Main Lessons From Implementation
Lessons Learned Worldwide
Characteristics of successful programs
O Integrated across sectors
O Parents as partners with teachers to support
children’s development
O Opportunities for children to initiate learning &
play
O Blend traditional child care, cultural beliefs &
evidence-based practices (curriculum, materials)
O Systematic in-service training, supervision,
monitoring, and evaluation
Source: Lancet series on child development, 2007, 2011
