Diagnostic Review of Early Childhood Development

1
Diagnostic Review of Early Childhood Development

• Presentation to Portfolio Committee on Basic
  Education
• 18 June 2013

2
Background

• Department Performance Monitoring Evaluation in
  the Presidency and the Inter-Departmental
  Steering Committee on ECD commissioned
• A Diagnostic Review (HSRC-led team)
• In addition
• Review of the National Integrated Plan (NIP) for
  Early Childhood Development in SA 2005-2010

3
Review Team

• Prof Linda Richter (lead) Human Sciences Research
  Council
• Linda Biersteker Early Learning Resource Unit
• Prof Justine Burns University of Cape Town
• Dr Chris Desmond Consultant to HSRC
• Dr David Harrison DG Murray Trust
• Dr Nosisi Feza Human Sciences Research Council
• Prof Haroon Saloojee University of the
  Witwatersrand
• Patricia Martin Advocacy Aid
• Wiedaad Slemming University of Witwatersrand

4
NIP 2005-2010 Definitions

• Early childhood development (ECD) a
  comprehensive approach to policies programmes
  for children 0-9 years
• Specific focus on 0-4 years

5
Methods of the Review

• Assembled a team of 9 people with specific
  expertise
• Reviewed 112 background policy documents on
  ECD in South Africa
• Contacted or consulted more than 166 stakeholders
• Held 4 provincial panels Gauteng, KZN, WC and
  FS
• Met 4 times with the Steering Committee
• Produced 12 detailed Background Papers

6
Presentation

• Key Findings
• Key recommendations
• Progress to date

7
Key findings

• New science of development
• Long term consequences of exposures
• Health? (MORE DETAILS ON SLIDE 22)
• Human Capital ?(MORE DETAILS ON SLIDE 23)
• Psychosocial adjustment ?(MORE DETAILS ON SLIDE
  24)

1000 days window of influence 270 (pregnancy)
365 (year 1) 365 (year 2) 1000 days
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Key findings (2)

• Poverty
• Direct causes
• Indirect causes
• Resilience
• Even in adversity children do OK, some excel
• Parenting critical
• Intervention
• Effective and cost effective

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Key Findings (3)

• Good progress
• 87 households with young children have access to
  safe drinking water
• 82 connected to mains electricity
• 97 of women attend at least 1 antenatal clinic
• 98 health facilities offer PMTCT
• 91 of babies are delivered by a professional
• 89 of children fully immunised by one year
• 83 of births are registered
• 73 of eligible young children receive the CSG
• 80 of children enrolled in Grade R

10
Key findings(4)

• We are doing very little to support parenting
• We are doing almost nothing for the care of
  0- 2-year-olds (28 of whose mothers work)
• The per-child registered centre subsidy may be
  taking us in the wrong direction

No access
11
Main Recommendations

• Build multi-sectoral support for an integrated
  approach
• Led by an authoritative body with
  multi- stakeholder support
• Increase funding, including to pay practitioners
• Aim to reach the poorest children and families
  first
• Through home and community based programmes
• And multi-media campaigns to reinforce and
  support parenting

12
Developmental Progression
First 1000 days
13
Special Window of Opportunity
First 1000 days
14
Integrated multi-sectoral approach
15
Developmental Approach

• Planned safe pregnancy, delivery aftercare
• Nutrition and health care for pregnant women and
  children
• Social protection for families
• Preparation and support for parenting
• Child care for working parents other families
  needing assistance
• Opportunities for learning at home and with
  other children in structured activities
• Preparation for formal schooling

16
Planned Pregnancy

• 50 of SA pregnancies are unplanned or unwanted
  (most teen pregnancies)
• As many as 50 of these are terminated (self or
  services)
• Unintended pregnancies are associated with
• Later and fewer antenatal clinic visits
• Low birth weight, greater prematurity, congenital
  abnormalities
• Shorter duration breastfeeding
• Incomplete vaccinations
• Higher likelihood of stunting
• Greater risk of maternal depression

17
Safe Pregnancy

• Morbidity
• Neonatal deaths 38 of under-5 mortality
• Maternal deaths 237 per 100 000
• Child deaths - a child in a poor country who has
  lost their mother has 4 less chance of
  surviving to age 10 years
•  Disability
• Pre- and perinatal factors are the major cause
  of child disability in South Africa

18
Good Nutrition, Health Promotion

• Poor maternal nutrition ? IUGR
• Low birth weight ( 16)
• Best overall general predictor of child survival
  growth, health and wellbeing
• Breastfeeding 10 exclusive at 4mo
• 13 deaths averted highest proportion
• Early growth stunting (18)
• lt2 SDs height less 1 yr of schooling (SA)
• Loss of adult earnings (up to 19)
• Affect birth weight length in next generation

19
Parenting

• 50 of women 1st child by 20 years, most single
• Partner support 60 men dont live with their
  young children (22 in HH expenditure R10 000
  71 below R1 200)
• Mental health - maternal depression (31 PND in
  LMICs)
• Alcohol/drug abuse 13 among SAs
• Intimate partner violence 25 of women
• Severe punishment of young children 3-4yr olds
  r receive most beatings (from women)
• Retain beneficial practices demand feeding,
  co-sleeping, carrying

20
Next steps

• Finalise the Improvement Plan
• Development of an Integrated Programme of Action
• Inter-sectoral collaboration
• Joint vision
• Joint targets
• Joint budgets
• Joint monitoring and evaluation

21
THANK YOU!
22
Health

• Early growth patterns during foetal development
  infancy
• Influence adult height, offspring size
• Increase risks for chronic disease obesity,
  diabetes, cardiovascular disease
• Increase risks for mental illness
• Early exposure to adverse experiences (neglect,
  domestic violence, parental mental illness or
  substance use)
• Increase risk of chronic disease, mental
  ill-health and social maladjustment?

23
Human Capital

• Stunting before age 3 years (lt2SD) is associated
  with
• Less education
• Lower cognitive test scores
• Fewer grades passed
• Less learning
• minus1 grade of schooling
• Earnings food supplemented lt3 years
• Up to 46 difference in income
• Fewer hours worked ?

24
Psycho-social Adjustment

• Poor growth ? mental illness (famine studies)
• Adverse childhood experiences (ACE) ?
• Tobacco, alcohol and drug use, suicide risk,
  depression
• Toxic stress stress responsivity - revving
  engine, hair trigger reaction
• Influences internal working models or
  expectations - of relationships ?