Pa­tri­cia Martin Wiedaad Slem­ming

Weekend Argus (Saturday Edition) - - FRONT PAGE -

IT’S time for a ma­jor shift in how we plan for Early Child­hood De­vel­op­ment (ECD), as a gov­ern­ment and a coun­try, to en­sure the best out­comes for our chil­dren. ECD has been one of the gov­ern­ment’s de­vel­op­ment pri­or­i­ties since 2010. Since then, we have seen in­creased bud­gets and sys­tems al­lo­cated to a mas­si­fi­ca­tion pro­gramme. So, why have we not seen the promised re­turns, such as im­proved ed­u­ca­tion out­comes and lower lev­els of in­equal­ity?

ECD mas­si­fi­ca­tion is the gov­ern­ment’s main ap­proach (pri­mar­ily mak­ing more cen­tres and ECD sub­si­dies avail­able) – but it hasn’t worked.

South Africa adopted the Na­tional In­te­grated Early Child­hood De­vel­op­ment Pol­icy in 2016. It says that ECD is a pe­riod of de­vel­op­ment from birth un­til chil­dren en­ter for­mal school. Dur­ing that time, they and their par­ents must re­ceive ap­pro­pri­ate sup­port­ive ser­vices, es­pe­cially in the first 1 000 days of life.

Why is ECD so im­por­tant, and es­pe­cially in the first two years?

The brain de­vel­ops faster in early child­hood than at any other pe­riod, lay­ing the foun­da­tions for learn­ing and ed­u­ca­tion po­ten­tial later in life. Dur­ing this phase, ex­po­sure to risk and ad­ver­sity has the most po­ten­tial for harm, but it is also the pe­riod dur­ing which pre­ven­tive and pro­tec­tive in­ter­ven­tions have the great­est ben­e­fit.

The ma­jor­ity of chil­dren in South Africa are ex­posed to de­vel­op­ment risks and need ap­pro­pri­ate care from birth.

Young chil­dren re­quire the cor­rect nu­tri­tion, car­ing in­ter­ac­tions with par­ents and care­givers, and a safe and stim­u­lat­ing en­vi­ron­ment. Par­ents need sup­port to of­fer their ba­bies op­ti­mal health, growth and de­vel­op­ment.

ECD cen­tres are not best placed to pro­vide care in the first two years.

Care at home by a par­ent or care­giver is bet­ter, and where there are no other op­tions, it should be well-sup­ported to en­sure good qual­ity of care.

There­fore, the ECD mas­si­fi­ca­tion ap­proach is a poor fit with the sci­ence and the coun­try’s needs.

Where should we in­vest our time and money for qual­ity es­sen­tial ser­vices in the early years?

In­vest­ing in our health sys­tem’s scope for ECD ser­vices dur­ing preg­nancy and the first two years of life is eas­ier, less costly and more ef­fec­tive than try­ing to in­ter­vene later in pre-school and for­mal ed­u­ca­tion set­tings.

By the time chil­dren reach three years old, and en­ter ECD cen­tres, it is too late.

We in­vest so much time and money in these cen­tres, yet we have missed the win­dow of op­por­tu­nity.

We then face the risk that their brains will not have de­vel­oped op­ti­mally to sup­port fu­ture learn­ing and de­vel­op­ment – it is a case of too lit­tle too late.

The health sys­tem, be­cause it al­ready reaches nearly ev­ery mother and child, is the most fea­si­ble plat­form from which to launch ser­vices.

Its ex­ten­sive pri­mary health care plat­form in­cludes both home-based and clinic vis­its just at the right time in a child’s life. Can the health sys­tem do this? Yes, the pol­icy and ser­vice de­liv­ery foot­print is in place. The foun­da­tions just need to be strength­ened.

But, a ma­jor gap is par­ent­ing sup­port.

There is strong ev­i­dence that an ex­panded health pack­age which in­cludes sup­port to par­ents is fea­si­ble, cost-ef­fec­tive and im­proves out­comes for chil­dren.

These should be in­te­grated into the stan­dard pack­age of ma­ter­nal and child health ser­vices pro­vided. In ad­di­tion, health work­ers should en­sure early iden­ti­fi­ca­tion of de­vel­op­men­tal dif­fi­cul­ties and dis­abil­i­ties, as well as ac­cess to early in­ter­ven­tion for these chil­dren and their fam­i­lies.

It is for these rea­sons that the Na­tional In­te­grated ECD Pol­icy re­quires the De­part­ment of Health to de­velop and im­ple­ment an in­te­grated and ex­panded na­tional home, com­mu­nity and fa­cil­ity-based sup­port pro­gramme for preg­nant women, moth­ers and in­fants in the first two years of life.

These would strengthen the pos­i­tive de­vel­op­ments al­ready in place: For ex­am­ple, the Road to Health Book­let – given to all in­fants at birth – is be­ing re­vised to en­sure that all in­fants re­ceive de­vel­op­men­tally sup­port­ive ser­vices.

But, there are missed op­por­tu­ni­ties for in­creas­ing ac­cess to ECD ser­vices through the health sys­tem.

The Min­is­ter of Health re­cently spoke of two ini­tia­tives, the NHI fund­ing model and the Pri­mary Health Care (PHC) re-en­gi­neer­ing ini­tia­tives which are the de­part­ment’s re­sponses to en­sur­ing eq­uity in ac­cess to health care. In the case of chil­dren, there is a strong fo­cus on school health as the en­try point for preven­tion and pro­mo­tion.

In his Bud­get speech in May 2017, the min­is­ter noted that 3.2 mil­lion school­child­ren had been screened for lan­guage, vi­sion, hear­ing, and oral health. Of these, 119 340 were iden­ti­fied as hav­ing vi­sion prob­lems, 34 094 hear­ing prob­lems, and 8 891 have speech prob­lems.

For these chil­dren, this may be the first time these dif­fi­cul­ties have been iden­ti­fied – and for many it may be too late for ef­fec­tive re­me­di­a­tion to over­come the bar­ri­ers to learn­ing.

Let us take the case of vi­sion as


Early child­hood de­vel­op­ment plans are im­por­tant for our chil­dren’s fu­ture.

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