Diagnostic Review of Early Childhood Development

Presentation to Portfolio Committee on Basic Education

18 June 2013

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BackgroundDepartment 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

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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

Review Team

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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

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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

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Presentation

Key Findings

Key recommendations

Progress to date

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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

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1000 days – window of influence270 (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

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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

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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

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Developmental Progression

First 1000 days

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Special Window of Opportunity

First 1000 days

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Integrated multi-sectoral approach

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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

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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

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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

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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%) <2 SDs height = less 1 yr of schooling (SA) Loss of adult earnings (up to 19%) Affect birth weight & length in next generation

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Parenting … ± 50% of women 1st child by 20 years, most single Partner support – 60% men don’t 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

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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

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THANK YOU!

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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←

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Human Capital Stunting before age 3 years (<2SD) is associated with: Less education

Lower cognitive test scores Fewer grades passed Less learning= ± minus1 grade of schooling

Earnings – food supplemented <3 years Up to 46% difference in income Fewer hours worked ←

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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 ←

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