An essential package of services and support for ECD - Children's ...

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quality of interventions for young children and to understandingthe relationship between early development and learning and itsimpact on academic performance in later childhood.Children living in poverty and rural areas, and those withdisabilities, generally struggle to access quality services. 31While remarkable progress has been made to improve access toa range of essential services among the most disadvantaged, gapsand inequitable provision persist. Priorities for intervention are: 32• Parenting support, especially for 0 – 2 years.• Maternal health and well-being, including nutrition duringpregnancy and breastfeeding.• Child health and nutrition.• Safe and affordable child care for families who need it.• Educational stimulation opportunities for those not in earlylearning facilities (the majority of the poorest children), includingchildren with disabilities.These and other challenges need urgent attention. If disadvantagedchildren do not receive appropriate interventions early enough andtheir environments remain unchanged, they are likely to endurelifelong consequences, 33 and the vision of the NDP for South Africain 2030 will simply not be realised.Delivery is a major challenge – where do we start?While universal provision of a full range of services to address allchildren’s developmental needs is optimal, it is too challenging atask given limited resources. A service delivery approach is requiredthat aligns with current policy, is evidence based, and capable ofreducing risks while promoting the capacities of young children. Ineffect, an approach which defines and ensures essential services.The NIP for ECD provides a useful starting point by identifyinga range of core services for children younger than five years,targeting the most vulnerable children and households, andbuilding on existing services in health, social development andeducation. 34 This view is supported in other policies, such as theIntegrated Programme of Action for ECD 2013 – 2018.However, there is a need to go further – to consolidate and expandthe intentions of the NIP and provide concrete recommendationsfor a well-defined package of services and support for childrenaged 0 – 9 years in poor households.Figure 1: Examples of a developmentally-appropriate continuum of early childhood servicesEarly antenatalbooking,nutritionalsupport inpregnancy,maternal mentalhealth screeningBirth registration,social grantaccess, breastfeeding,health &nutritionalsupport,immunisation,developmentalscreening,caregiver supportInfancy(birth – 2 years)Quality earlylearningprogrammes,parentingeducation, health& nutritionalsupportPre-school(3 – 4 years)Quality education,services forchildren withdisabilities,health &nutritionalsupportFoundation phase(5 – 9 years)PregnancySource: Adapted from: Richter L, Biersteker L, Burns J, Desmond C, Feza N, Harrison D, Martin P, Saloojee H & Slemming W (2012) Diagnostic Review of Early Childhood Development. Pretoria:Department of Performance, Monitoring and Evaluation & Inter-Departmental Steering Committee on ECD.PART 2Essential services for young children29
An essential package of services and supportThis section presents a proposed “essential package of ECDservices and support” (the essential package), drawing heavily onthe work of Ilifa Labantwana vi . 35Different inputs are required at various stages of a child’sdevelopment. It is therefore necessary to build a continuumof services appropriate to the stages of development, fromconception throughout pregnancy through to the first years ofschool (see figure 1 on p. 29).The examples of services illustrated in figure 1 can be clusteredin five basic components. These make up the notion of an essentialpackage:1. Nutritional support2. Social services3. Maternal and child health services4. Support for primary caregivers5. Stimulation for early learningSuch an essential package of services must be viewed within thecontext of a broader set of provisions such as poverty alleviation,food security, basic household services and violence preventionthat create an environment conducive to young children’sdevelopment. 36The proposed essential package includes services that arealready mandated in policy and law, only adding others wherethere are gaps that must be filled, as indicated by evidence.Each component of the proposed essential package is outlinedin figure 2.Nutritional support for mothers and childrenPoor nutrition in young children is a serious health concern in SouthAfrica. The first 1,000 days of life are most critical for nutritionalsupport to ensure optimal growth and development. The StrategicPlan for Maternal, Newborn, Child and Women’s Health andNutrition 2012 – 2016 37 and the new Infant and Young Child FeedingPolicy 38 are two key policies providing a framework for essentialnutrition services.Social servicesTimely birth registration enables access to other services suchas social grants, free health care and education. Access to socialgrants is associated with improved nutrition, 39 and therefore takeupneeds to be strengthened in the first year of life.Social services are a vital support to families and children,including prevention and protection from abuse and neglect. Manychildren in South Africa experience violence, abuse, neglect andthe loss of caregivers, and psycho-social support services may beneeded to help children cope with grief, loss and trauma.Maternal and child health servicesEarly development begins at conception, and maternal and childhealth services are crucial for laying the foundation for optimalmaternal health and child development. Primary level services forpregnant women and young children serve to prevent illnesses,and promote good care and nutrition. Early intervention is essentialto minimise risks and prevent develpoment delay and disability.Support for primary caregiversSupport for primary caregivers includes information sharing onparenting and psycho-social support. Many caregivers living inpoverty carry significant burdens of care. Depression is commonand may compromise their capacity to care for young children. 40Psycho-social support for caregivers is therefore essential topromote the well-being of caregivers and to reduce the risk of poorcaregiving. In addition, the Children’s Act 41 provides for parentingprogrammes that support parents to provide responsive care foryoung children.Safe and affordable child care (including after-care for schoolagechildren) provides much needed support for caregivers whowork, study or are unable to care for their children.Stimulation for early learningAccess to quality early learning stimulation prior to grade Rsignificantly enhances the ability of children from impoverishedbackgrounds to benefit from schooling. 42 Early development andlearning are inextricably tied to nurturing contexts and the home istherefore a key site for intervention. 43Readiness to learn is not solely an outcome of engagement inearly learning opportunities. Children should also be demonstratingtheir emerging ability to exercise self-control, concentrate, and planand reflect on their actions by the time they enter school. 44 A rangeof early learning opportunities are available before school and canbe delivered through home visiting, community playgroups, toylibraries and centre-based programmes.Stimulation for early learning prior to the foundation phaseof formal schooling is not enough. Quality education is crucialthroughout the foundation phase to improve outcomes andprepare learners for later schooling.viIlifa Labantwana is a multi-donor partnership which develops models for scaling up integrated ECD in South Africa.30South African Child Gauge 2013
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