80713 Strengthening Early Childhood Development Policies and Programs in Latin America and the Caribbean Strengthening Early Childhood Development Policies and Programs in Latin America and the Caribbean* CREDITS: COVER: STOCKXPERT / BACKCOVER: TIOM/DREAMSTIME. DESIGN: ALEJANDRO ESPINOSA / SONIDEAS.COM ©ALEJANDRO LIPSZYC/WORLD BANK * This Policy Note was prepared by Emiliana Vegas, Sr. Education Economist in The World Bank’s Human Development Department’s Education Team, and Veronica Silva, Extended-Term Consultant in The World Bank’s Latin America and the Caribbean Region’s Social Protection Team. Clark Mat- thews (Consultant) provided excellent research assistance. Amanda Epstein (Consultant) provided useful comments to early drafts. Contents Contents 1. Introduction and Objectives······················································································································· 3 2. Defining Early Childhood Development, Programs and Policies···················································· 4 3. A Typology of ECD Programs····················································································································· 5 4. A Framework for Classifying ECD Policies··························································································· 7 5. Identifying Options for Strengthening ECD Services at the Country Level: Case Studies of Colombia, Panama, and Chile········································ 11 i. Colombia···························································································································································12 (a) ECD Programs in Colombia··········································································································································12 (a) Classification of ECD Policies in Colombia·················································································································17 (b) Policy Options to Strengthen ECD Policies and Programs in Colombia··································································17 ii. Panama····························································································································································· 19 (a) ECD Programs in Panama············································································································································· 19 (c) Classification of ECD Policies in Panama····················································································································24 (d) Policy Options to Strengthen ECD Policies and Programs in Panama····································································25 iii. Chile ·································································································································································27 (a) ECD Programs in Chile ·················································································································································27 (e) Classification of ECD Policies in Chile ························································································································33 (f) Policy options to Strengthen ECD Policies and Programs in Chile ·········································································33 6. Conclusions···················································································································································36 References······························································································································································································ 37 Strengthening Early Childhood Development Policies iv and Programs in Latin America and the Caribbean Figures Figure 1. Categories of ECD Programs: Focus Areas and Institutional Arrangements·········································6 Figure 2. Inventory of ECD Programs in Colombia, by Type ················································································12 Figure 3. ECD Programs in Panama, by Type ········································································································· 19 Figure 4. Inventory of ECD programs in Chile, by type ······················································································27 Tables Table 1. ECD Policy Dimensions and Levels of Development·················································································8 Table 2. ECD Policy Dimensions, Variables and Levels of Development·······························································9 Table 3. Benchmarking ECD Policy Dimensions and Levels of Development in Colombia, Panama, and Chile························································································ 11 Table 4. Categorization of Selected ECD Programs in Colombia··········································································13 Table 5. Categorization of Selected ECD Programs in Colombia··········································································16 Table 6. Classification of ECD Policies in Colombia·······························································································18 Table 7. Categorization of Selected ECD Programs in Panama·············································································20 Table 8. Classification of Selected ECD Programs in Panama···············································································22 Table 9. Classification of ECD Policies in Panama··································································································24 Table 10. Categorization of Selected ECD Programs in Chile················································································28 Table 11. Categorization of Selected ECD Programs in Chile·················································································30 Table 12. Categorization of Selected ECD Programs in Chile················································································32 Table 13. Classification of ECD Policies in Chile····································································································35 Annex A1:Table 14. Selected Sectoral Programs in Latin America and the Caribbean··················································39 A2: Table 15. Selected Sectoral Programs in Latin America and the Caribbean··················································42 A3: Table 16. Selected Cross-Sectoral Programs in Latin America and the Caribbean·······································44 A4: Table 17. Selected Multi-Sectoral Programs in Latin America and the Caribbean········································45 A5: Table 18. Comprehensive Programs in Latin America and the Caribbean····················································48 v 1. Introduction and Objectives T he objective of this Policy Note is to provide a tool for countries in the Latin America and the Caribbean region to take stock of Early Childhood Development programs and policies in their territory. By benchmarking against other programs and policies across the region, countries can identify options to strengthen Early Childhood Development. In The Promise of Early Childhood Development for Latin America and the Caribbean, Vegas and Santibáñez (2010) put forth key building blocks for countries to achieve comprehensive ECD policies. These building blocks are based on the premise that all countries’ share the goal of ensuring that children have adequate experiences during early childhood, which will enable them to reach their full potential during childhood, youth, and into adulthood. Vegas and Santibáñez (2010) also document the state of ECD indicators in the region, which show great disparities across countries and within countries. Signed in February of 2010, the Partnership between The World Bank, ALAS Foundation, and Columbia University’s Earth Institute intends to advance on previous efforts and develop a possible roadmap to achieve comprehensive coverage of quality ECD services for all children in Latin American and Caribbean countries. This roadmap recognizes that each country in the region is at different levels of development in terms not only of coverage of ECD services but, equally important, in the definition of its policy goals and vision for ensuring that all young children, from conception to age six, have access to comprehensive services to develop to their full potential. In Latin America and the Caribbean, too few countries have made ECD a national priority. Access to ECD services varies widely by country, regions within countries, types of services, and the background of individual children and their families. In order to help countries interested in improving access, quality, and equity of ECD services, in the rest of this Policy Note, we: 1. Define Early Childhood Development and distinguish between ECD programs and ECD policies. 2. Introduce a typology of ECD programs and use it to categorize several interventions in Latin America and the Caribbean. 3. Develop a framework for classifying ECD policies at the national level, designed to help countries identify (i) their current level of development in this area, and (ii) some policy options to further develop ECD policies. ©ALEJANDRO LIPSZYC/WORLD BANK 4. Discuss 3 case studies of countries in the region, Colombia, Panama, and Chile, to provide examples of how the frameworks can be utilized to identify policy options to strengthen national ECD policies and specific programs. 3 2. Defining Early Childhood Development, Programs and Policies T hroughout this Policy Note, we refer to Early Childhood Development as the period from when a child is conceived to six years of age (0-6). Experiences during the first six years of life affect the development of a child’s brain and provide the foundation for all future learning, behavior, and health (Shonkoff and Phillips, eds. 2000). Recent work by Nobel Laureate James Heckman and his colleagues convincingly shows that factors operating during the early childhood years play an important role in the development of skills that determine outcomes later in life (Cunha and Heckman 2007; Heckman 2006; Cunha et al 2005; Carneiro and Heckman 2003). Research has also convincingly shown that early childhood interventions can act as an important policy lever to equalize opportunities for children and reduce the intergenerational grip of poverty and inequality (Heckman 2006). Developing healthfully during the early years and acquiring adequate physical growth, as well as cognitive (such as lan- guage and mathematics skills) and non-cognitive skills (such as social, emotional skills and self-discipline) are important determinants of success in school, at work, and in life more generally. Importantly, a child’s family environment is central to her development of skills and ability; hence, early interventions targeted to make up for some early family differences contribute to reducing early inequalities. Further, parental environments and family income available to children during early childhood are far more decisive in promoting human capital and school success than in the later years. In sum, three types of outcomes in early childhood are critical for life outcomes. These include: �� physical growth and well-being, �� cognitive development, and �� socio-emotional development. ECD policies and programs can directly affect these outcomes, and therefore benefit both individuals and societies. Before continuing, it is also important to distinguish ECD programs from ECD policies. By “programs,� we refer to specific interventions that may vary according to primary objective (e.g. improving physical growth and well-being, fostering cognitive or socio-emotional development), coverage (small scale, universal), and other program characteristics. In contrast, by “policy,� we refer to the regulatory framework and institutional arrangements for service delivery at the national and/or state level to ensure that a nation’s children have access to quality ECD services. Strengthening Early Childhood Development Policies 4 and Programs in Latin America and the Caribbean 3. A Typology of ECD Programs I n order to compare the wide variety of ECD programs that exist in the region, it is useful to characterize them according to a set of main attributes. These key characteristics of ECD interventions include: (i) Primary policy objective; (ii) Brief description; (iii) Focus area/intervention mechanism; (iv) Coverage/access; (v) Institutional ar- rangements; (vi) Financing; (vii) Service providers; (viii) Quality assurance mechanisms; (ix) Challenges for going to scale and improving service delivery. (i) Primary policy objective. Each ECD program should have a clear policy objective. Some examples include: getting young children school ready; providing nutritional supplementation to a specific population; ensur- ing parents receive parenting education to facilitate cognitive stimulation of infants. (ii) Brief description. For each program, it is useful to present a brief description of its main characteristics. (iii) Focus area/intervention mechanism. There are several important areas of focus of ECD interventions, including: health, nutrition, education, parenting practices, and poverty alleviation. Within these areas, there are also intervention mechanisms, such as milk or micronutrient supplements, early childhood care in centers and/or at home, preschool education, parenting education. An important dimension for classifying ECD programs is therefore the area of focus of the intervention. (iv) Coverage/access. Programs vary in the extent to which various populations can access them, ranging from very low coverage to universal access. (v) Institutional arrangements. Understanding the underlying institutional arrangements for the provision of ECD services is important. This includes policy setting, oversight (including monitoring and evaluation), and provision. (vi) Financing. The funding available for ECD as well as the specific financing mechanisms employed to chan- nel funds to programs and providers are important determinants to access, quality, equity and efficiency. Documenting the financing of ECD programs is also important for evaluating cost-effectiveness of alterna- tive interventions. (vii) Service providers often include various government agencies at several levels of government (national, state, local), private sector providers, and community organizations. For each program, it is important to understand who is responsible for its provision. (viii) Quality assurance mechanisms. Research evidence indicates the important role that quality of ECD services plays in the effects of ECD programs on an individual’s life outcomes. Understanding how dif- ferent programs ensure quality is therefore critical. Quality assurance mechanisms range from establishing standards for service delivery, to supporting providers in meeting the standards and enforcing compliance. (ix) Challenges for going to scale and improving service delivery. An important goal is for effective programs to be scaled up to reach all those young children who are eligible. This dimension refers to the challenges for going to scale and improving the quality of service delivery. Identifying these challenges is a necessary step toward then devising strategies to address them. 5 These characteristics are used to develop a categorization of ECD programs into four groups based on their primary policy objective, as follows: �� Sectoral: Provide a specific service to some or all children; �� Cross-sectoral: Provide some ECD services to some groups of children (can be specifically targeted to spe- cific populations); �� Multi-Sectoral: Give children equal opportunities to reach their full potential in life; and �� Comprehensive: Ensure that all children reach their full potential in life. Sectoral programs are typically independent interventions in specific sectors such as health or education, often led by government agencies or NGOs with low inter-institutional coordination. Examples of these include preschool education and nutritional supplements. Cross-sectoral programs also are usually independent interventions in specific sectors but with some component from another sector, often led by government agencies or NGOs. Some Cross-sectoral programs involve large-scale interven- tions with strong political leadership, they are often targeted to vulnerable populations but require relatively low inter- agency coordination or integration across sectoral policies. Examples of these include school feeding programs. Multi-sectoral programs involve the implementation of multiple interventions in a coordinated way, where the focus is reaching children with systematic interventions during early childhood. They can vary in the degree of coverage, some being targeted to vulnerable populations while others universal in coverage. They require a high degree of inter-agency coordination. Comprehensive programs are those with a compre- Figure 1. Categories of ECD Programs: Focus hensive approach to ECD involving multi-sectoral Areas and Institutional Arrangements interventions but tailored to each child, following indi- vidual ECD growth trajectories to ensure that all chil- Coordinated dren receive adequate multi-sectoral support as needed. interventions across They require a high degree of inter-agency coordination multiple sectors Comprehensive and integration across sectoral policies. Complexity of Institutional Arrangements Figure 1 graphically describes how these four catego- Multi-Sectoral ries of ECD programs differ in terms of focus areas and institutional arrangements. Cross In the Annex, we present a description of a diverse -Sectoral group of ECD programs in Latin America and the Caribbean and their classification into the four program Sectoral categories. However, it is important to note that these Focus Areas/Mechanisms categories represent a continuum of possible ECD inter- Single Sector Specific Sector Multiple sectors, Comprehensive regular ventions and that, therefore, some programs may not fall w/ inputs from specific programs monitoring, some other sector for targeted or universal services, exactly within the description of one category. In these universal with tailored cases, we use our best judgment to classify them into populations interventions one of the four categories, but recognize that improved Source: Authors. information may affect this classification.1 1 For instance, an evaluation of program implementation and impact may imply that a specific sectoral program moves up from one category to another. As a result, some programs . may be transitioning from, for example, “sectoral� to “cross-sectoral� Strengthening Early Childhood Development Policies 6 and Programs in Latin America and the Caribbean 4. A Framework for Classifying ECD Policies A s mentioned in the Introduction, ECD programs differ from policies. Most of the empirical research has focused on evaluating the impact of specific ECD programs. Based on the convincing findings of the large impacts of investing in ECD, policy makers around the world, together with the international community, now face the challenge of how to devise effective ECD policies to ensure that all children reach their full potential. In this section, we propose an approach to contribute to this process. The approach relies on (i) taking stock of the ECD programs and interventions that already exist in a specific country; (ii) analyzing their main characteristics and classifying them into Sectoral, Cross-Sectoral, Multi-Sectoral, and Comprehensive; (iii) evaluating the level of development of ECD policies at the national and/or subna- tional level; and (iv) identifying country-specific policy options to strengthen ECD policies and programs. In Section 3, we described the key characteristics and classification criteria for ECD programs. In this section, we turn to how to evaluate the level of development of ECD policies at the national and/or subnational level. In the next section, we present case studies from three selected countries, where we carry out all four steps in the approach delineated herein. The four critical dimensions of ECD policies at the national and or subnational level identified for the analysis include: 1. Enabling environment. This refers to: the existence of an adequate legal and regulatory framework to support early childhood development; the availability of adequate fiscal resources; and the degree of coordination within sectors and across institutions to ensure that services can be effectively delivered. 2. Degree of implementation. This refers to the extent of coverage (as a share of the eligible population) and gaps in coverage. 3. Monitoring and quality assurance. This refers to the development of standards for ECD services, the existence of systems to monitor compliance with those standards, as well as the implementation of systems to monitor ECD outcomes across children. 4. Policy focus. By definition, a focus on ECD involves (at a minimum) interventions in health, nutrition, education, and social protection. An ECD approach involving multiple sectors is a critical policy dimension. For each of these four dimensions, we evaluate the level of development of each country or system. These levels of development range from less developed (or “latent�) to fully developed (or “mature�). Table 1 describes the characteristics of the different levels of development for each of the three ECD policy dimensions. As Table 1 suggests, in an ideal situation, ECD policies in a country would be in the “mature� column for all three dimensions. In such an ideal situation, the country would have: (i) a solid legal framework for ECD, sustained financing for attaining ECD goals, and a high degree of inter-institutional coordination; (ii) universal coverage in key ECD ser- vices, such as maternal and child health and preschool education, information on ECD outcomes at individual, national, regional, and local levels; (iii) quality standards are well defined for all sectors, and all young children’s individual needs are monitored and met; and (iv) integrated services for all young children, some universally provided, others tailored to young children’s unique needs. Table 2 delineates, for each ECD policy dimension, the key variables and how they would be observed at each level of development. While the “mature� column represents the ideal, a country with an “established� level of development in the key ECD dimensions indicates a developed policy framework in a majority of sectors, adequate implementation, and multi-sectoral approaches to ECD. A “mature� level of ECD policy development is attainable in the medium- and long-term. In the meantime, one can identify the key dimensions where each country is falling behind this ideal and develop strategies to address those. This exercise is, by definition, country-specific and should be country-led. In the near future, we plan to develop instruments to facilitate the diagnosis of each country’s level of development regarding ECD Policies and Programs. To illustrate how this exercise may be relevant to policy makers in Latin America and the Caribbean, in the next sec- tion we illustrate its application to three country cases – Colombia, Panama and Chile –, which are at different levels of development with respect to their ECD policies. 7 Table 1. ECD Policy Dimensions and Levels of Development ECD Policy Level of Development Dimensions Latent Emerging Established Mature Legal framework Minimal legal frame- ECD regulations Developed legal non-existent, ad- work, a few programs in some sectors, framework for ECD, hoc financing, few with sustained many programs with Enabling sustained financing for institutions, low within financing, low inter- sustained financing, Environment attaining ECD goals, sector coordination, institutional coordina- functioning intra- and inter-institutional low inter-institutional tion, higher within- inter-institutional coordination. coordination. sector coordination. coordination. Coverage expand- Near-universal cover- ing but important age or universal Universal coverage Degree of Low coverage, gaps remain; some in some sectors; in ECD, with compre- Implementation pilot programs. established programs established programs hensive strategies in few sectors; high in several sectors, low across sectors. inequality in access. inequality in access. Standards for ECD ser- vices exist for most or Standards for ECD Standards for ECD all sectors; a system services exist for services exist for Limited standards is in place to regularly at least some sec- most or all sectors; exist for the provision monitor and enforce tors, but there is no a system is in place Monitoring and of ECD services; only compliance; informa- system to regularly to regularly monitor Quality Assurance minimal measures of tion on ECD outcomes monitor compliance; compliance; informa- infant & child mortal- at individual, national, increased information tion on ECD outcomes ity are reported. regional, and local lev- on ECD outcomes at at national, regional, els, all young children’s the national level. and local levels. individual needs are monitored and met. Integrated services Some health, nutrition, Some health, nutri- Health, nutrition, edu- for all children, some education, and infant/ tion, education, and cation, and infant/child universally provided, Policy Focus child protection ser- infant/child protec- protection services others tailored to vices, but minimal and tion services. well established. young children’s without coordination. unique needs. Source: Authors. Strengthening Early Childhood Development Policies 8 and Programs in Latin America and the Caribbean Table 2. ECD Policy Dimensions, Variables and Levels of Development ECD Level of Development Policy Dimen- Variables sions Latent Emerging Established Mature regulations in Legal framework non existent minimal developed some sectors Enabling high inter- Coordination low within sector high within sector low inter-institutional Environment institutional some programs many programs sustained for Financing ad hoc with sustained with sustained attaining goals universal in Coverage low expanding universal in ECD some sectors Degree of Implementation established in established in Programs pilot established in ECD few sectors several sectors outcomes outcomes at outcomes at at national, ECD Information minimal measures national, regional, national level regional, local & local level individual level Monitoring and Quality Standards in Assurance Standards in most all sectors, Quality Standards Limited or no Standards in sectors, compli- compliance is & Compliance standards some sectors ance is monitored regularly monitored regularly and enforced ECD Interventions (health, nutrition, well established integrated services Policy Focus some and minimal some established education & child services universally provided protection) Source: Authors. 9 5. Identifying Options for Strengthening ECD Services at the Country Level: Case Studies of Colombia, Panama, and Chile In this section, we apply the conceptual frameworks described above to three Latin American countries: Colombia, Panama, and Chile. These countries were selected because of their interest in expanding ECD and also because they are at different stages of development in terms of ECD policy. Specifically, we: 1. Take stock of the main ECD interventions in each country and use the typology of ECD programs intro- duced in Section 3 to categorize them into sectoral, cross-sectoral, multi-sectoral or comprehensive; and 2. Use the framework for classifying ECD policies discussed in Section 4 to identify, for each country, its current level of development in this area and some policy options to strengthen its ECD policies. Table 3 summarizes the levels of development for each ECD policy dimension in Colombia, Panama, and Chile. In the next three sections, we describe in detail the ECD programs and policies in these countries, from which this benchmarking is derived. Table 3. Benchmarking ECD Policy Dimensions and Levels of Development in Colombia, Panama, and Chile ECD Level of Development Variables Policy Dimensions Colombia Panama Chile Legal framework Established Emerging Established Enabling Environment Coordination Established Emerging Established Financing Established Latent Established Coverage Emerging Latent Established Degree of Implementation Programs Established Emerging Established ECD information Emerging Emerging Emerging Monitoring and Qual- ity Assurance Quality standards Established Latent Emerging and compliance ECD interventions (health, Policy Focus nutrition, education Established Emerging Mature & child protection) ©JULIO PANTOJA/WORLD BANK Source: Authors. 11 i. Colombia C olombia is a country with approximately 46 million people, of which some 4.38 million are aged five or young- er.2 Over the last number of decades the country has made a concerted effort to improve the lives of young children through the establishment of legal rights, increased investment and the provision of ECD services for health, nutrition, education, and child protection. These efforts have shown positive impacts on ECD objectives and have contributed to the decrease in the child mortality rate for children less than five years of age from 35 per thousand births in 1990 to 20 per thousand births in 2007. Despite the numerous improvements, it is important to note that the situation remains dire for many children in Colombia. Approximately 15% of children in Colombia are living under the international poverty line of US $1.25 per day. In 2008 (the latest year for which data are available), the gross enrollment rate in pre-primary education in Colombia was 49 percent (World Bank EdStats). (a) ECD Programs in Colombia At present, there are numerous ECD programs at the national, state, and municipal levels in Colombia. According to the typology introduced in Section 3, these programs include sectoral, cross-sectoral, multi-sectoral and comprehensive interventions. Table 4 categorizes selected ECD interventions in Colombia. It is important to note that this is simply a snapshot of the numerous interventions that are operational in the country. These interventions were selected due to their relevance and information availability. Figure 2. Inventory of ECD Programs in Colombia, by Type Coordinated Unidades de atención interventios across integral y recuperación multiple sectors nutricional para la Primera Infancia Programa Programas de atención desayunos infantiles diferencial con amor - DIA Comprehensivo Complexity of institutional arrangements Familias en acción Atención de la gestación y los Atención a la primera riesgos perinatalaes infancia en situación de discapacidad Instituciones Amigas Programa Buen de la Mujer y de la Prevención detección Comienzo - Medellín Infancia - IAMI y atención del Multi-sectoral maltrato infantil Estrategia de Atención Integral a Jardines Las enfermedades comunitarios prevalentes en la Hogares Comunitarios infancia - AIEPI de Bienestar - HCB Cross- Programa Ampliado sectoral Fondo de Fomento de Inmunizaciones para la Atención PAI Integral de la Primera Infancia Hogares infantiles, Modelo de atención lactantes y prescolares integral - Bogota Sectoral Focus Areas - Mechanism Single sector Specific sector w/inputs Multiple sectors, specific Comprehensive regular from other sector programs for targeted or monitoring. Some universal universal populations services, with tailored interventions Source: Authors. 2 While our definition of ECD includes ages 0 to 6, data for Colombia were available only up to age 5. Strengthening Early Childhood Development Policies 12 and Programs in Latin America and the Caribbean Table 4. Categorization of Selected ECD Programs in Colombia ECD Inter- Programa Ampliado de In- Hogares Comunitarios Desayunos infantiles con amor (DIA) vention munizaciones (PAI) de Bienestar (HCB) Classification Sectoral Sectoral Multi-Sectoral The primary objective of Desayunos in- The Programa Ampliado de Inmu- fantiles con amor (Breakfasts with Love The Hogares Comunitarios de nizaciones (Expanded Program on for Children) is to help improve the nu- Bienestar (Community Homes for Well- Inmunization) is in charge of the trition of children between six months being) program aims to attend to the Primary policy elimination, eradication and control and five years of age who belong to basic needs of the most marginalized objective of preventable diseases in Colombia, level one and two of SISBEN (Potential children below the age of six with re- in order to reduce mortality and Beneficiaries of Social Programs Identi- spect to affection, nutrition, health, pro- morbidity caused by these diseases in fication System) by providing breakfast tection, and psychosocial development. the population under the age of six. to supplement their daily diet. This program is a measure taken by the ICBF (Colombia Family Welfare Insti- The PAI was originally created by In 1986 the ICBF established, and tute) to provide nutritional supplements the WHO in 1974 and adopted in the CONPES (National Council for to the most marginalized children the Region of the Americas in 1977 . Economic and Social Policy) approved, during their crucial years of develop- During the following year the program the HCB program as a “human Brief ment. Auxiliary benefits of the program was established in Colombia to development strategy and a new description include the promotion of children’s provide access to all children from conception of holistic assistance affiliation to the general social security birth to the age of five and other in order to provide coverage to the system in health and the improved target populations with immuniza- poorest childhood population in participation and synergy within com- tions against prevalent diseases. urban zones and rural centers� . munities due to the program activities. The initial HCB model consisted of The nutritional component of the In 1978 the program provided vaccina- community family homes led by program is implemented using two tions for tuberculosis, poliomyelitis, community mothers who cared for types of breakfast: Breakfast One and diphtheria, pertussis, neonatal tetanus, 13-15 children. The program has Focus areas/ Breakfast Two. Breakfast One only and measles. The program has since expanded to include community group provides the program’s nutritional intervention expanded to include vaccinations for homes; community multiple homes; protein powder (called Bienestarina), mechanisms hepatitis B, rubella, mumps, influenza homes sponsored by companies; while Breakfast Two, which the vast and yellow fever. The vaccinations and family, women, and children’s majority of beneficiaries receive, are provided for free and are com- homes. As of 2005 the community includes whole milk, a solid base pulsory for the target population. family homes accounted for more cereal and traditional Bienestarina. than 75% of HCB assistance. The program provides coverage to children under the age of six and The program targets families classified The program is designed to reach to women in reproductive age and in levels 1 and 2 of SISBEN. The HCB the population in both rural and others in vulnerable locations. The Coverage/ program has the greatest coverage urban areas. In total, DIA provides objective is to have at least 95% of access among programs for young children breakfast to 1,228,641 children the target population vaccinated. in Colombia, and served approxi- annually, across 1,045 municipalities. In 2006 coverage was provided for mately 1,200,000 children in 2008. approximately 90% of the 929,630 children under the age of one. The programs operations are governed by the Social Security Reform Act (Law 100 of 1993) and involve political The HCB program is operated by the and administrative authorities at ICBF . In 1988, the program’s legal basis DIA is operated by the ICBF . An the national and sub-national levels, was strengthened when the govern- operational manual is used to as well as both public and private ment enacted Law 89 which increased explain the program, goals and target Institutional insurers and providers. The Ministry of ICBF revenues to assure expansion population. The manual also defines arrangements Social Protection defines the national of the program’s coverage. The ICBF the responsibilities of institutional and immunization policy and standards. is responsible for intervention design sectoral actors as well as community Districts, decentralized municipalities, and execution, excluding devising the volunteer and support groups. and departments are in charge of requirements for location, space and ensuring the availability of vaccina- infrastructure for the various homes. tion services, and supervising and promoting the delivery of services. The program is funded by the IDB and In 2009 the ICBF reported that the The program is funded by the ICBF and the Government of Colombia. In 2006 HCB program received income Financing/ had annual expenditures of $144 mil- the program had a budget of $99.321 from the 3% payroll tax in the cost- lion pesos in 2009. This marks a sub- million pesos. The Ministry of Social amount of US $760.789 million effectiveness stantial increase from the programs’ Protection is responsible for managing pesos, and the annual per child cost 2002 budget of $1.744 million pesos. and appropriating program resources. was approximately US $350. 13 ECD Inter- Programa Ampliado de In- Hogares Comunitarios Desayunos infantiles con amor (DIA) vention munizaciones (PAI) de Bienestar (HCB) Community mothers are the executors of the HCB program. They are trained in development, child health and nutri- tion, organization, and scheduling of activities, and are financially com- The breakfasts are delivered each The Ministry of Social Protection pensated for their efforts. In general, month to one of over 9,000 centers operates the program and distributes Service community mothers work for 8 hours in the country. Deliveries are made the vaccines. Under the terms of Law providers per day and provide meals for children each month and are regulated by 100, sub-national units are responsible during this time. Approximately 70% the program’s “Delivery Act� . for direct health service delivery. of community mothers are located in urban zones, and the remaining 30% in rural zones. The HCB program provides educational and household materials for community mothers. The National Health System (INS) The ICBF uses monitoring informa- is responsible for epidemiological tion for program supervision and to The ICBF and an externally con- surveillance and the public health ensure follow-up processes occur. tracted agency are responsibly laboratory. The PAI and the Office of Evaluation activities focus on areas conducting extensive program the Superintendent for Health Services such as program impacts, quality monitoring and evaluations. are responsible for overseeing the standards, contents and materials, program’s output. Official vaccination Quality Furthermore, the beneficiary and the implementation process. rates are computed at the municipal assurance families are crucial components of level and submitted to the National Since inception, the Government of mechanisms the quality assurance mechanism. Health Institute, which aggregates Colombia has undertaken two exhaus- Authorities must be contacted in the information and calculates the tive studies of the program. In addition, the instance that the program is national coverage rate. In addition, numerous other organizations, re- being used in any type of commercial the IDB undertakes monitoring and search institutes and universities have manner or for electoral purposes. evaluation of implementation of the conducted studies on the program. Strengthening the Expanded Program on Immunization 2005 - 2008 initiative. One of the larger challenges A major challenge in attaining increased An area for improvement are the Challenges for encountered by this program is coverage are sharp geographical and requirements for community mothers. going to scale the timely and consistent delivery demographic inequities in vaccination Community mothers in rural areas are and improving of supplements. Going forward, levels. Vaccination coverage in the less likely to have completed elementa- service expanded financial resources will poorer, remote municipalities is far be- ry and high school, and very few have delivery be required to increase coverage. low national or departmental averages. attended post-secondary education. The programs operations are governed by the Social Security Reform Act (Law 100 of 1993) and involve political The HCB program is operated by the and administrative authorities at ICBF . In 1988, the program’s legal basis DIA is operated by the ICBF . An the national and sub-national levels, was strengthened when the govern- operational manual is used to as well as both public and private ment enacted Law 89 which increased explain the program, goals and target Institutional insurers and providers. The Ministry of ICBF revenues to assure expansion population. The manual also defines arrangements Social Protection defines the national of the program’s coverage. The ICBF the responsibilities of institutional and immunization policy and standards. is responsible for intervention design sectoral actors as well as community Districts, decentralized municipalities, and execution, excluding devising the volunteer and support groups. and departments are in charge of requirements for location, space and ensuring the availability of vaccina- infrastructure for the various homes. tion services, and supervising and promoting the delivery of services. The program is funded by the IDB and In 2009 the ICBF reported that the The program is funded by the ICBF and the Government of Colombia. In 2006 HCB program received income Financing/ had annual expenditures of $144 mil- the program had a budget of $99.321 from the 3% payroll tax in the cost- lion pesos in 2009. This marks a sub- million pesos. The Ministry of Social amount of US $760.789 million effectiveness stantial increase from the programs’ Protection is responsible for managing pesos, and the annual per child cost 2002 budget of $1.744 million pesos. and appropriating program resources. was approximately US $350. Strengthening Early Childhood Development Policies 14 and Programs in Latin America and the Caribbean ECD Inter- Programa Ampliado de In- Hogares Comunitarios Desayunos infantiles con amor (DIA) vention munizaciones (PAI) de Bienestar (HCB) Community mothers are the executors of the HCB program. They are trained in development, child health and nutri- tion, organization, and scheduling of activities, and are financially com- The breakfasts are delivered each The Ministry of Social Protection pensated for their efforts. In general, month to one of over 9,000 centers operates the program and distributes Service community mothers work for 8 hours in the country. Deliveries are made the vaccines. Under the terms of Law providers per day and provide meals for children each month and are regulated by 100, sub-national units are responsible during this time. Approximately 70% the program’s “Delivery Act� . for direct health service delivery. of community mothers are located in urban zones, and the remaining 30% in rural zones. The HCB program provides educational and household materials for community mothers. The National Health System (INS) is responsible for epidemiological The ICBF uses monitoring informa- The ICBF and an externally con- surveillance and the public health tion for program supervision and to tracted agency are responsibly laboratory. The PAI and the Office of ensure follow-up processes occur. conducting extensive program the Superintendent for Health Services Evaluation activities focus on areas monitoring and evaluations. are responsible for overseeing the such as program impacts, quality program’s output. Official vaccination standards, contents and materials, Quality Furthermore, the beneficiary rates are computed at the municipal and the implementation process. assurance families are crucial components of level and submitted to the National mechanisms the quality assurance mechanism. Since inception, the Government of Health Institute, which aggregates Authorities must be contacted in the information and calculates the Colombia has undertaken two exhaus- the instance that the program is national coverage rate. In addition, tive studies of the program. In addition, being used in any type of commercial the IDB undertakes monitoring and numerous other organizations, re- manner or for electoral purposes. evaluation of implementation of the search institutes and universities have Strengthening the Expanded Program conducted studies on the program. on Immunization 2005 - 2008 initiative. One of the larger challenges A major challenge in attaining increased An area for improvement are the Challenges for encountered by this program is coverage are sharp geographical and requirements for community mothers. going to scale the timely and consistent delivery demographic inequities in vaccination Community mothers in rural areas are and improving of supplements. Going forward, levels. Vaccination coverage in the less likely to have completed elementa- service expanded financial resources will poorer, remote municipalities is far be- ry and high school, and very few have delivery be required to increase coverage. low national or departmental averages. attended post-secondary education. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability 15 Table 5. Categorization of Selected ECD Programs in Colombia ECD Familias en Acción Instituto Colombiano de Bienestar Familiar (ICBF) Intervention Classification Cross-Sectoral Multi-Sectoral Familias en Acción (Families in Action) aims to comple- The ICBF (Colombia Family Welfare Institute) is a ment family income to increase spending on food; national entity for coordinating Colombian policies for Primary policy improve children’s health outcomes by ensuring access family welfare. A large component is guaranteeing objective to regular healthcare; and improve childcare practices the rights, protection and well being of children and in terms of health, nutrition, and early stimulation. their families through extensive ECD interventions. The ICBF is a semi-autonomous institute under the Ministry of Social Protection. The ICBF was established in 1968 in response to problems such as nutritional deficiency, disintegration and instability of families, loss Founded in 1999, Familias en Acción is a conditional of values, and abandoned children. Since 1974, the ICBF cash transfer (CCT) program that targets pregnant has implemented and supported various modalities women and mothers with children less than 7 years of assistance for young children through integrated Brief description of age who are living in poverty, with a particular programs of care, nutritional support, preventive focus on displaced and indigenous families. The health, and socio-affective development. In 1986, the program uses a combined parent and child strategy ICBF established a very important program called to deliver ECD services to the targeted population. Hogares Communitarios to serve pregnant women and children from birth to five years of age, contribute to the eradication of poverty, and expand service coverage for working parents and vulnerable children. The intervention utilizes “community mother lead- � who guide assemblies of participating mothers. ers, The ICBF has a number of programs and ser- Childcare and family workshops cover topics of literacy, vices tailored to family, ECD, adolescents between health, nutrition, hygiene, contraception, child develop- Focus areas/ 7 and 17 years of age; older adults; and children ment and play. The program is tailored to the various with violated rights. Some of these include fam- intervention cultural identities of the regions and communities by in- ily education, children homes, help to pregnant mechanisms corporating ritual elements and promoting learning play. women and nursing mothers, pre-youth and youth Receipt of cash transfers and nutritional supplements clubs, various nutritional assistance programs, and by families are conditioned with respect to children’s specific programs for children with special needs. use of health services, such as immunizations and controls regarding physical growth and development. Familias en Acción has become national on scale cover- The ICBF is present in each of the departmental capitals ing all of the 32 departments and 1,093 of the 1,098 Co- and has 203 centers dispersed throughout the country. lombian municipalities. The goal for annual coverage is: These centers are effective in providing closer and par- Coverage/access 1,500,000 families (600,000 urban and 900,000 rural) liv- ticipative attention to children, adults and families of the ing in severe poverty. This includes 500,000 and 745,000 urban, rural, native and Afro-Colombians. Approximately children living in urban and rural locations, respectively. 10 million Colombians benefit from the ICBF services. Familias en Acción has not developed a strong legal basis. The program is located in the Director- ate of Presidential Programs within the Presidential Agency for Social Action and International Coopera- The ICBF was transferred from its former placement tion. Sectoral support is received from both the MoE Institutional under the MoH to the Ministry of Social Protection and the MoH. municipalities play a crucial role in the arrangements (which now also includes the MoH). The ICBF has an in- implementation of the program. In order to participate, dependent board of directors and head of the institution. each municipality must sign a legal document that outlines the various responsibilities of the mayoral offices. Failure to comply can result in temporary or permanent suspension of Familias en Acción. The ICBF has obtained partial autonomy through extensive funding support from a national 3% payroll tax Beneficiary families receive US $50 per month. that is mandated by a series of national laws, accords Program funding uses a two-pronged approach: and decrees. Communities, NGOs, and workers’ Financing/cost- the Government of Colombia (Presidency and cooperatives also contribute to the program, but the effectiveness the National Treasury) and international donors, amounts are not publicly reported. In addition, the namely the World Bank and IDB. Administrative ICBF receives grants and contracts from national and costs are an estimated 3% of the annual budget. international sources in the amount of approximately US $25 million annually for special projects. The ICBF allocates funds to each respective intervention. Strengthening Early Childhood Development Policies 16 and Programs in Latin America and the Caribbean ECD Familias en Acción Instituto Colombiano de Bienestar Familiar (ICBF) Intervention The provision of services uses a joint public and The ICBF services are provided through its various private approach. The CCT component is provided by interventions (listed above). The direct service provider the Government of Colombia. The expansion of the depends on the type of intervention and targeted program has necessitated additional technical sup- population. For instance, the ICBF implements the port people at regional levels called Enlace Municipal Service providers Hogares Comunitarios program directly, through (Municipal Liaison). Participating municipalities are contractors, and with the help of other programs responsible to pay the salaries of these individu- of the national system for family welfare; com- als. As at the end of 2007 , 1,090 were expected to munities throughout Colombia, and Parents’ be trained and in place. In addition, “community Associations support each community home. mother leaders� are private service providers. The intervention is monitored on a quarterly, semester and annual basis. Monitoring is conducted by profes- The ICBF conducts monitoring and evaluation activi- sional evaluators, other program professionals, and ties for its interventions. For example, with Hogares the program director. They look at various intervention Comunitarios, the ICBF uses monitoring information Quality assurance elements including the program structure, participants, for program supervision and to ensure follow-up mechanisms implementation process, contents, and materials and processes occur. Evaluation activities focus on areas methods. An extensive evaluation process is undertaken such as program impacts, quality standards, contents each quarter and semester by participants, profes- and materials, and the implementation process. sional evaluators, external evaluators, and the program director, to ensure program quality and effectiveness. Funding is reported to be fungible and lacking stability. In terms of effects, intervention has been found to Challenges for The ICBF reports that a major limitation is the availability be helpful in achieving improved nutrition and health going to scale of resources for the expansion of program coverage. outcomes, however unable to make major impacts and improving The ICBF continues to work to develop new and on child cognitive development and school readi- service delivery innovative approaches to serve vulnerable populations. ness. This could be due to differential quality in the components devoted to early child stimulation. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability (a) Classification of ECD Policies in Colombia Taking stock of ECD interventions is useful to map the landscape. However, the policy framework is critical for ensuring access, quality and equity of ECD services. As Table 6 shows, based on an analysis of Colombia’s ECD policies and programs, we observe that its Enabling Environment and Policy Focus are in the Established stage, while the Degree of Implementation is in the Emerging stage, according to the Framework presented in Section 4. (b) Policy Options to Strengthen ECD Policies and Programs in Colombia Colombia has made important strides toward strengthening its ECD policy framework, and numerous programs offering ECD services exist. However, important challenges remain, including expanding coverage of ECD services and achieving full implementation of Act 1295. As a first natural step, Colombia should focus on identifying gaps in coverage and reaching the excluded populations. Simultaneously, it will be important to further develop the level of coordination and synergy amongst service providers and government agencies. In the near future, Colombia should develop instruments to monitor individual children’s developmental pathways to ensure a comprehensive approach to ECD for all children. 17 Table 6. Classification of ECD Policies in Colombia ECD Policy Description Dimensions The perspective of the rights of children is based legally in the International Convention on the Rights of the Child (1989), ratified by Colombia in 1991. The Constitution provides the legal foundation for the comprehensive rights of children with Article 44, which establishes the basic rights of children; and Article 50, which entitles free health care to all children under the age of one that are not covered by any type of protection or social security. The Code of Children and Adolescents (Law 1098 of 2006) specifies the importance of the life cycle within human development and determines the right to personal development in early childhood, including health care and nutrition, vaccinations for disease, early education and protection against physical hazards. Established In 2007 , the National Policy for Early Childhood (Política Pública Nacional de Primera Infancia) was ad- Enabling opted with the aim to: promote the integral development of children from gestation up to six years Environment of age, respond to their specific needs and characteristics, and contribute to the achievement of equity and social inclusion in Colombia. The Ministry of Social Protection, ICBF and MoE are integral members. Both individually and in conjunction, these institutions operate numerous ECD interven- tions. In general, financing requirements for these programs can be considered adequate for develop- ing and maintaining services. The ICBF is financed with receipt of 3% of the national payroll tax. The latest development of ECD in Colombia is Act 1295 (2009). The act indicates that the purpose of the state is to contribute to improving the quality of life of expectant moth- ers and children under the age of six, and directs attention to the need to develop a com- prehensive system of care for infants that goes beyond the programs in place. The institutional framework for the National Policy for Early Education consists of three bodies, one national and two regional. The national body is tasked with centrally designing and managing the pro- gram, and one regional body promotes inter-sectoral and interagency coordination while the other man- Emerging ages resources and guides the formulation of the Comprehensive Care Plan and its implementation at Degree of the local level. This approach enables gathering and distribution of ECD information at all levels. Implementation High levels of coverage have been achieved through the numerous ECD interventions in health, nutrition, education, and child protection. Many of these programs are entrenched throughout the country, including difficult to reach municipalities and the most marginal- ized regions. High levels of inequality persist amongst ECD aged children. Colombia has quality assurance mechanisms that span sectors and institutes, in addition to those that are specific to interventions. Together, these mechanisms provide a framework to enforce compliance with ECD quality standards and to provide the necessary support so that it is possible to meet these standards. A key component in monitoring the efficacy of ECD interventions is the Quality of Life Survey (Encuesta de Calidad de Vida). In 2003 the survey was expanded to include variables that re- late, and therefore help monitor, the HCB (Hogares Comunitarios de Bienestar) program. The ICBF has various mechanisms to ensure quality across its range of services. For one, the ICBF has Emerging Monitoring established a system for supervising contracts with contributors and the units providing services to and Quality ensure fair, responsible transactions. For the institution’s largest ECD program, HCB, two full-scale evalua- Assurance tions (1996 and 2006) have been undertaken. The first provided a strategy for improving the HCB program and the second was an exhaustive review of the program’s primary aims and organization structure. In 2008 the Government of Colombia and the World Bank commenced a $15.8 million partnership aimed at strengthening the country’s monitoring and evaluation system. The investment encompasses the various levels of government and institutions, and through these has a direct impact on ECD quality as- surance. Collectively, the objective is to ensure the availability and production of quality information for program and policy design, to provide more information in order to make better-informed investment decisions, and to establish effective monitoring and evaluation capabilities at local and regional levels. Tables 4 and 5 above provide examples of interventions in health, nutrition, education, and child protection. A number of these programs have a single focus while others are more expansive and provide services Established in multiple areas such as health, nutrition and child protection. The level of inter-sectoral and interagency Policy Focus coordination has improved in recent years, providing a more collaborative approach to ECD. This achievement is in large part due to the creation of the National Policy for Early Childhood and, more recently, Act 1295. It appears that the country is prepared to develop a comprehensive system of care. To accomplish this it will be important to further develop the level of coordination and synergy amongst institutions and government. Strengthening Early Childhood Development Policies 18 and Programs in Latin America and the Caribbean ii. Panama P anama is a small nation with 3,504,483 people, of which 420,324 are under the age of five. Despite the country’s high income per capita compared with other countries in the region, high inequalities exist among the rich and poor. In 2008, nearly 33% of the population was living below the poverty line, which is valued at $3.13 per day. Furthermore, 14.4% of the population was living in extreme poverty, or on less than $1.77 per day. A large portion of these individuals are indigenous. During the last six years this age group has experienced an increase in chronic malnutrition. (a) ECD Programs in Panama Panama has numerous ECD programs in nutrition, health, education and development. The following section presents six. It is important to note that this is not a comprehensive list of all ECD programs, but rather an exercise to highlight some of the most important. This will provide the reader with a good understanding of ECD in Panama, what achievements have been reached, and where improvements can be made. In addition to interventions operated by ministries, private organizations and foundations are prominent. One such example is presented in the following tables. Two programs not depicted below are the Programa de Alimentación Complementaria Escolar (PACE, School Complementary Food Program), which is operated by the MoE, and Bono Familiar para la Compra de Alimentos (Family Bond for Food Pur- chase), which is a program initiated in 2005 by SENAPAN (Plan for Food and Nutritional Security) with contributions from the MoH, MoE, Ministry of Social Development, and Ministry of Agriculture, among others. Figure 3 presents the ECD interventions in Panama according to the typology discussed in Section 3. These interventions’ characteristics are described in Tables 7 and 8. Figure 3. ECD Programs in Panama, by Type Coordinated interventios across multiple sectors Programa preescolar de la Fundación Pro Comprehensivo Niños de Darién Complexity of institutional arrangements Programa de Alimentación Complementaria (PAC) del Ministerio de Salud Multi-sectoral Programa de Suplementación de Red de Hierro Oportunidades Programa Nacional de Suplementación con Vitamina A Cross- sectoral Programa Nacional Preescolar Sectoral Focus Areas - Mechanism Single sector Specific sector w/inputs Multiple sectors, specific Comprehensive regular from other sector programs for targeted or monitoring. Some universal universal populations services, with tailored interventions Source: Authors. 19 Table 7. Categorization of Selected ECD Programs in Panama Programa de Alimentación ECD Programa de Suplemen- Programa Nacional de Suple- Complementaria (PAC) del Intervention tación con Hierro mentación con Vitamina A Ministerio de Salud Classification Sectoral Sectoral Sectoral The Programa de Alimentación The primary objective of the The Programa de Suplementación Complementaria (Complementary Programa de Suplementación de Hierro (Iron Supplementation Food Program) distributes fortified con Vitamina A (Vitamin A Primary policy Program) aims to correct and foods to improve the nutritional Supplementation Program) is to objective prevent iron deficiency in children, status of children under five, improve maternal and child survival women of childbearing age, and pregnant women, nursing mothers, in areas of extreme poverty by pregnant and lactating women. and tuberculosis patients. providing Vitamin A supplements. The national survey of Vitamin Since 1995 the program has been A deficiency among preschool implemented throughout Panama Iron deficiency is the most preva- children indicates that 1.8% of and ensures the adequate intake lent nutritional deficiency and the children aged 12 to 59 months of calories for children. Compared main cause of anemia worldwide. are considered deficient. This Brief description with international standards, its Since 1998 the Programa de figure is low enough not to energy content is lower than Suplementación de Hierro has be considered a public health recommended due to the high been operating to lower the high problem; however, the prevalence prevalence of obesity in the prevalence of anemia in Panama. among indigenous populations country in both adults and children. of the same age group is 23%. The iron supplement is distributed in drops, syrups or tablets. Infants of low birth weight receive 10 The administration of doses of The program distributes Nutrice- mg per day; children aged 4-11 Vitamin A is as follows: children real, which is a corn-based supple- months one mg per day; children aged 6-11 months receive one Focus areas/ ment high in calories (180) and aged 12-23 months receive 30 100,000 IU dosage; children aged intervention protein (6 grams), and is fortified mg per week; children 6-11 years 1 to 5 receive two 200,000 IU mechanisms with vitamins and minerals. The and women of reproductive age dosages per year (one every six size of each portion is 45 grams. receive 60 mg and 400 mcg folic months); and lactating women acid once a week; and pregnant receive one 200,000 IU dosage. and lactating women receive 60 mg and 400 mcg folic acid per day. The program is intended for Beneficiaries of this program are children under the age of five, and children and pregnant women who In 2004 the program reported pregnant and lactating women, are classified as poor and usually coverage for approximately with a particular focus on priority do not have access to social secu- 90,000 children and women, of districts and children with low birth Coverage/access rity. The MoH reported coverage which 16.4% of the population weight. According to estimates of 43,000 children aged 12 to 23 aged 6 to 59 months received from the MoH, the program served months, 150,000 between 24 and coverage. Particular focus is 123,185 children under five years 59 months, and 25,000 pregnant on indigenous peoples. of age, and 26,072 pregnant and lactating women in 2006. and lactating women in 2009. The MoH is responsible for program operations, and the The MoH is responsible for Institutional The MoH is in charge of program Department of Nutrition is administering, operating and arrangements design, operations, and delivery. responsible for the develop- delivering the program. ment of the supplements. The program is funded by The PAC is funded by the the National Government and National Government and implemented by the MoH. The Financing/cost- The MoH reported a budget implemented by the MoH. In MoH reports that the annual effectiveness of US $813,336 in 2007. 2007-2008 the program had cost for each child aged 4 to 11 a budget of US $5 million. months is US $.02 and US $.04 for each child aged one to four. Administration of Vitamin A takes The delivery of the food is places at premises determined The MoH is responsible for determined by the MoH by the MoH. These include urban Service providers the distribution of iron and folic and made to health centers and remote facilities in rural areas. acid through its facilities. throughout the country. UNICEF assists with the acquisi- tion of megadoses of Vitamin A. Strengthening Early Childhood Development Policies 20 and Programs in Latin America and the Caribbean Programa de Alimentación ECD Programa de Suplemen- Programa Nacional de Suple- Complementaria (PAC) del Intervention tación con Hierro mentación con Vitamina A Ministerio de Salud Classification Sectoral Sectoral Sectoral Evaluations in 2001 with support from UNICEF , and in 2005 under The MoH is tasked with monitor- The MoH is tasked with ensuring the leadership of SENAPAN, ing and evaluating the program. program quality. Program monitor- have found that the program In conjunction with UNICEF , ing includes logging registrants and is well targeted and that better studies have been undertaken the distribution of Vitamin A supple- Quality assurance nutritional outcomes are observed to monitor and assess the state ments. Evaluations are ongoing mechanisms in smaller families and for children of iron deficiency and anemia in to ensure accuracy in targeting. with mothers who have higher Panama (with the most recent The national survey of Vitamin A education. The Department of occurring in 2006). Evaluations deficiency tracks prevalence. No Nutrition and MoH are responsible have found that the program is exhaustive impact assessment of for quality control and program effective in reaching its recipients. the program has been undertaken. operations, respectively. Since inception in 1992 the pro- Incidence of dilution within Reports indicate that at times gram has successfully expanded Challenges for families limits the effectiveness of during the year the program its coverage. The focus should going to scale programs. It is imperative that the experienced shortages, espe- be on the continued sustain- and improving designated beneficiary receives cially in drops and syrups for able provision of services to service delivery the nutritional supplement. children under the age of five. high priority populations, and in particular indigenous populations. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability 21 Table 8. Classification of Selected ECD Programs in Panama ECD Programa Preescolar de la National Preschool Program Red de Oportunidades Intervention Fundación Pro Niños de Darién Classification Sectoral Sectoral Sectoral The Red de Oportunidades (Oportunity Programa Preescolar (Preschool The objective of Panama’s Network) aims to reduce critical poverty Program) is a complementary feeding Primary National Preschool Program is to and enhance human capital through a program that contributes to improving policy provide compulsory education cross-sectoral approach that links improved the health and nutritional status of objective to children aged four and five. services with conditional cash transfers children aged 6-59 months in communi- (CCT) to families in critical poverty. ties across the province of Darién. A collection of free public schools and private institutions that In 1993 the Fundación Pro Niños de charge fees supply education Darién (Foundation for Darién’s Children) Red de Oportunidades was started in 2005 to students. During the 1990’s was founded with the objective of and is a national project as part of the Brief there was a boom in preschool reducing malnutrition in children by development strategy to combat extreme description education in public schools implementing interventions in the areas poverty. It has the highest coverage (kindergartens, COIF), and the of nutrition, health, education, and among all social programs in the country. creation of non-formal educa- community development. The Programa tion programs (CEFACEI and Preescolar was started in 1993. Educación Inicial en el Hogar). The CCT component disburses cash to the Kitchens are built in select communi- heads of households to spend on basic ties. These units are used to provide needs. In order to qualify, families are re- two snacks throughout the day (9am , quired to fulfill specific “co-responsibilities� Educational services are offered and 3pm). The morning snack consists requiring them to ensure their children Monday through Friday for of Nutricereal with a corn tortilla, and maintain regular school attendance and us- a period of 10 months. The the afternoon snack is Nutricereal. The Focus areas/ ing health services appropriate for pregnant services are offered in urban, corn-based Nutricereal is high in calories women and children under the age of intervention peri-urban, and rural areas, and and protein, and is fortified with vitamins five. Other components of the program mechanisms indigenous communities. In and minerals. In addition to the nutrition focus on basic services linked to the co- 2005 there was an average of component, the program also has an responsibilities (education, health and legal 20 students per teacher, and important health element: each child identification of beneficiaries), providing di- 95% of teachers were female. receives monitoring and evaluation of rect support to beneficiary families through their development, including height, a package of social work-related services, weight and hemoglobin, oral hygiene and improving rural infrastructure (public and receipt of de-worming medication. works, housing, agricultural development). The program provides for the inclusion of poor families in urban and rural areas, with a particular focus on indigenous In 2008 approximately 61% peoples. Figures from 2008 indicate that In 2005 the program served 1,276 Coverage/ of children aged four and five indigenous children under the age of five children aged 6-59 months in 31 com- access attended preschool. In 2009 account for 4.5% of the total beneficiary munity eateries. Each of these is located this figure dropped to 57%. population. The program provided coverage in the indigenous territory of Emberá. in 591 of the country’s 621 jurisdictions in 2008. Some 70,600 households and 398,800 people benefit from the program. Red de Oportunidades is comprised of various government institutions focused on providing its services to communi- The MoE is responsible for The Fundación Pro Niños de Darién, ties of extreme poverty in the country. preschool education. This includes which is authorized by the Government The Ministry of Social Development Institutional supervision, guidance, training and Justice Minister of Finance, founded is responsible for administering the arrangements teachers and managing operating and operates the program. In addition, the program and receives contributions strategies for the other provid- program receives contributions from the from the MoE, MoH, and Ministry of ers of preschool services. Ministry of Social Development and MoH. Finance. In 2007 the World Bank sup- ported the “social protection in support of the Red de Oportunidades project� . When the program began in 2006, US The Ministry of Social Development $35 per month transfers were provided provides an annual subsidy of US to recipients. In 2008 the figure was $100,000, and the foundation receives The MoE reports that spend- Financing/ adjusted to US $50 per month. As an undisclosed amount of private ing on preschool education is cost- of December 2008 the program had donations. A detailed description of the US $17 .66 per student. Private effectiveness dispersed US $43,530,341, of which program costs per child is not available. In schools set their own rates. nearly US $27 ,000,000 were distributed addition, the program receives assistance that year. The 2007 agreement with the from the MoH, including supple- World Bank is for US $24,000,000. ments and de-worming medication. Strengthening Early Childhood Development Policies 22 and Programs in Latin America and the Caribbean ECD Programa Preescolar de la National Preschool Program Red de Oportunidades Intervention Fundación Pro Niños de Darién Classification Sectoral Sectoral Sectoral The public institutions include: kin- dergarten in public schools, which serve children aged four and five; and child guidance centers (COIF), which operate in state and municipal institutions and serve children aged two to five. Community mothers are the main The MoE also has three non- source of service providers. In con- The distribution of funds is made through formal education programs: family junction with the MoH and Ministry an agreement with the Post Office. This re- and community centers for initial of Social Development, the program Service lationship is to be re-evaluated by the pro- education (CEFACEI); early child- provides counseling to mothers in areas providers gram. As part of the “co-responsibilities�, hood education at home (EIH); such as nutrition and instructions for the provision of education and health ben- and community centers for early administering products. Mothers are efits is from teachers and health personnel. education (CEIC). responsible for preparing the nutritional supplements in the community kitchen. Private institutions include private kindergartens, which are taught in secular schools and religious and children centers; and the Pro- grama Madres Maestras (Moth- ers Teachers Program), which is operated by the catholic church. Evaluation of similar programs (Oportuni- The MoE is responsible for dades in Mexico and Red de Protección quality assurance in preschool. In Social in Nicaragua) has found that a CCT the past number of years three intervention can improve food consump- As part of the monitoring aspect of evaluations have taken place tion, improve diets and enhance recipients’ the program, the weight and height Quality with support from the World wellbeing. As part of the World Bank of each child is recorded three times assurance Bank. In addition, UNICEF funded project, a comprehensive monitoring per year, and hemoglobin measured mechanisms a study entitled “Qualitative and evaluation system is being designed once a year. The program has a com- study of views on the expected and set up. The program has been puterized registration system that performance of students in recognized for its use of technology, and records each nutrition assessment. Kindergarten and First Grade� . in particular its ability to ensure quality of service by scanning and digitalization of paper based forms in a central office. Legislating compulsory educa- tion is an important first step to universal preschool education. Without the necessary financial A logical next step would be to support and implementation strengthen the monitoring and evalua- Challenges resources coverage remains One of the most pressing issues the tion component by developing a more for going to very low. This is particularly true program is facing is the misuse of rigorous impact assessment, as scale and amongst poor and extremely CCT funds. The project has expanded opposed to the current state where improving poor children, where coverage is rapidly and as a result concern has information is only recorded. service 18.1% and 9.2%, respectively. arisen as to the efficacy of targeting The program is effective in reach- delivery Geographical issues, which in- and use of funds by beneficiaries. ing the target population, but this clude major rivers and mountains population is very small. In the future areas, as well as scattered popula- the program may consider expansion. tions and a lack of infrastructure, make it difficult to reach certain facets of the population. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability 23 (c) Classification of ECD Policies in Panama Taking stock of ECD programs in Panama and categorizing them helps to understand the overall policy framework for ECD. As shown in the following table, an analysis of Panama’s existing Enabling Environment, Degree of Implementa- tion, and Policy Focus, leads us to classify the country as Emerging in terms of level of development of ECD policies. Table 9. Classification of ECD Policies in Panama ECD Policy Description Dimensions The rights of children are protected in the Constitution and by the sanitary code – a legal instru- ment adopted in 1947 that entrenches the mother and child as vital components of society. In December 1990 Panama ratified the Convention on the Rights of the Child, ensuring that all children under 18 years are entitled to full physical, mental and social development and free speech. The MoH is the main body responsible for ECD in Panama. In recent years a number of legislative advancements have been made to construct a sturdy foundation for the future development of a comprehensive ECD policy. In October 2004 the National Nutrition Food Plan was established through Executive Decree No. 171 as a body capable of developing nutrition policy. In November 2005 the Govern- ment of Panama mandated universal and free medical care to all children under the age of five though all MoH establishments. Complementary health policies directed to impact ECD have been devised (such as rules related to food fortification to combat malnutrition). Law No. 4 of 2007 created a national neonatal screening program to reduce the rate of infant mortality. Law No. 28 of 2008 established and regulates Early Learning and Family Development, an intervention through the MoH that focuses on infant development. In 2007 , the MoH launched the National Health Plan for Children and Adolescents. The aim is to ensure the rights of children and adolescents, to reduce gaps in health and integral development, and to support the proper development of the capacities of children and adolescents. One integral component of this includes strengthening community participation in managing health Emerging programs. In addition, the MoH has also designed the National Plan to Combat Infant Malnutrition Enabling 2008-2015. The plan focuses on the most vulnerable pregnant mothers, infants and children under 36 Environment months of age in priority districts across the country to reduce the prevalence of severe malnutrition. Chapter V of the Constitution provides free and compulsory education for four and five year olds through public and private institutions. The MoE is responsible for overseeing the sector. In 2009, through the current government, Executive Order 201 created the Advisory Council on Early Childhood, and laid the groundwork for the construction of the Comprehensive Care Plan for Early Child- hood. The council will aim to generate specific actions for ECD, including better coordination across public and private institutions to promote the maximum development of capacities of children. The Comprehensive Care Plan for Early Childhood will be submitted for its first review in Oc- tober 2010. The Advisory Council on Early Childhood is also working to improve the structure, strengthen programs, and increase public-private partnerships aimed at ECD. A critical next step is to ensure that the Comprehensive Care Plan for Early Childhood and other work to improve ECD are not disjointed efforts, but rather work in close collaboration with other sectors and policy developments (most notably, the Comprehensive Health Plan for Early Childhood). All of these actions and achievements listed above amount to a substantial step in the right direc- tion to improving the lives of children with investment in ECD. Panama is definitely making strides in the right direction and for this reason is listed as Emerging with optimism. It will be imperative to ensure access to the requisite financial resources and enforcement mechanisms moving forward. Since 2003 Panama has made substantial progress in reducing both child and infant mor- tality rates from 20.8 per 1000 and 15.2 per 1000 to 16.9 per 1000 and 12.8 per 1000, respectively. Another noteworthy improvement is the reduction in the prevalence of mal- nourished children under the age of five from 16.6% in 2003 to 12.4% in 2008. Coverage in education remains a large area of concern. Despite implementing manda- tory preschool education, coverage remains very unequal, especially for poor and ex- Latent Degree of tremely poor children where coverage is 18.1% and 9.2%, respectively. Implementation The improvements noted above and elsewhere in this section are a direct result of the interven- tions, policies, and actions taken in the last number of years. To this point the efforts of the MoH cannot be underestimated. Despite these gains, chronic malnutrition and income inequal- ity continues to impact development, and the legislated free healthcare has yet to achieve universal coverage. Bearing this in mind, the degree of implementation is classified as Latent. With continued efforts classification of Emerging should be attainable in the near future. Strengthening Early Childhood Development Policies 24 and Programs in Latin America and the Caribbean ECD Policy Description Dimensions The necessary inter-sectoral coordination and resources to develop and implement comprehensive ECD quality assurance mechanisms that encompass all services is yet to exist in the Panama arena. Some sectors have developed institutional bodies to evaluate, monitor and document information on ECD outcomes. For the most part these are independent and confined to a single service. Some of these have been developed with the financial and technical support of international bodies. For Monitoring Latent instance, the MoH has received assistance from UNICEF to undertake studies that monitor the and Quality state of iron deficiency and anemia for the Programa de Alimentación Complementaria (PAC) as Assurance well as support for an evaluation of the impact of the Programa de Suplementación de Hierro. A moderate stock of ECD information is available and will continue to be ad- vanced with the establishment of the Advisory Council on Early Education. Emerging As depicted in the previous section, several services exist in health, nutrition, education, and child protec- Policy Focus tion, with some overlap and coordination across service area. In recent years these services have become better established. No comprehensive sector approach exists to achieve national ECD objectives. Emergente Como se describe en la sección previa, existen diversos servicios de salud, nutrición, edu- Foco de la cación y protección infantil, con algún grado de superposición y coordinación a través de política las áreas de servicios. En años recientes, estos servicios han logrado afianzarse. No ex- iste un enfoque sectorial integral para el logro de objetivos de DIT a nivel nacional. (d) Policy Options to Strengthen ECD Policies and Programs in Panama Panama has quite a few programs to build from in order to strengthen ECD. However, it will be important for the country to develop a national policy for ECD and strengthen inter-sectoral coordination. The main challenge for Panama is developing a comprehensive approach to ECD that builds from the existing sectoral programs. In addition, reducing inequality in access to ECD services remains an important goal for Panama to reach the next stage of ECD development. Finally, ensuring that the quality of services is adequate is a key priority for this country. 25 iii. Chile C hile is a country with about 17 million people, of which some 1.24 million are under five years old3. In recent decades, the country has implemented important policies, both in health and preschool education, and also in social protection to the poorest families, which have had a significant impact on the situation of children in early childhood. Despite significant progress in these areas, geographical and socioeconomic inequalities persist, highlighting the need to provide the highest priority to policies and programs aimed at early childhood. Infant mortality rates among children under one year old decreased to 8.3 per thousand births in 2007, rising to 10.8 however in some areas of the country. While poverty in 2009 affected 15.1% of the population, it affected 24.6% of children under four years old, show- ing that early childhood is the group with the highest incidence of poverty in the country, a figure that rises to 39.1% in rural indigenous areas. Moreover, the first population study on child development conducted in 2006 showed that about 30% of children under five years old have not reached all developmental milestones expected for their age group (35.9% in the poorest quintile versus 23.1% in the highest income quintile). Nursery care coverage for children under two advanced from 2.7% in 2000 to 7.8% in 2009. Similarly, the coverage of kindergarten for children two and three years old increased from 19.3% in 2000 to 30.6% in 2009. However, while 27.2% of children in the poorest quintile attend kindergarten, 50.8% of children in the richest quintile do. In 2008, 66.4% of children aged four and five attended preschool. (a) ECD Programs in Chile The policy aimed at early childhood – Chile Crece Contigo (Chile Grows with You) – is composed of a diverse set of programs. Some of them have been deployed for several years, and others were created in the framework of Chile Crece Contigo in 2007. According to the typology described in Section 3, among these programs are sectoral, cross-sectoral, multi-sectoral and comprehensive interventions. Figure 4 presents an inventory of ECD programs in Chile by type of intervention. Figure 4. Inventory of ECD programs in Chile, by type Coordinated interventios across multiple sectors Atención temprana para niños con Programa Educativo Comprehensivo discapacidad Masivo Alimentación Nadie es Perfecto Programa Nacional escolar (preescolar) Complexity of institutional arrangements de Alimentación Complementaria Programa de Apoyo Modalidades no al Desarrollo PNAC convencionales de Multi-sectoral Biopsicosocial educación inicial Programa de Apoyo al Recién Nacido Protección Especial a la Infancia Subsidio Familiar Fondo de Intervenciones de Apoyo al Desarrollo Salas Cuna y Infantil Cross- Jardines Infantiles sectoral Fondo Concursable de iniciativas para Educación preescolar la Infancia Fondo de fortalecimiento Municipal Sectoral ©Curt Carnemark/WORLD BANK Focus Areas - Mechanism Single sector Specific sector w/inputs Multiple sectors, specific programs for Comprehensive regular monitoring. Some from other sector targeted or universal populations universal services, with tailored interventions Source: Authors. 3 While the definition of ECD used in this document applies to children aged 0 to 6, in Chile, census data are available in a quinquennial format; in this case 0 - 4 years old. 27 Table 10. Categorization of Selected ECD Programs in Chile Programa Nacional de Aliment- Programa de Apoyo al ECD Intervention Subsidio Familiar (SUF) ación Complementaria (PNAC) Recién Nacido (PARN) Classification Sectoral Sectoral Sectoral The goal of Programa Nacional de Alimentación Complemen- taria (National Complementary Food Program) is to contribute to growth and development, fostering The Programa de Apoyo al Recién the maximum genetic potential of Nacido (Newborn Support Pro- The primary objective of Subsidio Fa- children throughout the country. It gram) aims at providing support Primary policy miliar (Family Subsidy) is to support the intends to support the nutritional to families in order to ensure that objective needs of the most marginalized children status of pregnant women, as well all children have access to the through a monthly cash transfer. as to ensure harmonious fetal devel- best care conditions during the opment, successful breastfeeding, first stage of their development. and normal growth development. In addition, it expects to contribute to the reduction of prevalence of chronic diseases in adulthood. The program began implementation in 2009 as one of the new features of Chile Crece Contigo (CHCC), and was carried out in all maternity wards The program was created in 1952 of the public health system, serving when regular monitoring of prenatal The program was created in 1982 and about 70% of the annual births in the health for pregnant women and is aimed at families living in extreme country. It consists of the delivery of health checks for children less than poverty, whose children do not have a set of basic articles for newborns, six years of age were instituted. The access to social security. Currently, Brief description and guidance for families. The set program consists of the delivery of beneficiaries are pregnant women, includes items to encourage the milk and food supplements that are newborns and children under 18 whose attachment bond, and articles for appropriate to the nutritional needs families are part of the 40% most the newborns’ basic care (hygiene), of different populations, which are vulnerable households in the country. an equipped crib, and clothes for provided during health checks. the first months of the newborn’s life. Parental guidance is carried out at the ward, where educational materials are also distributed. The program delivers different nutritional products specifically designed for the different population groups: milk with Omega 3 (for The sets are distributed at the ma- SUF is a welfare benefit that focuses pregnant and lactating women); iron, ternity wards. Delivery is in charge on the most vulnerable families. It zinc, copper and Vitamin C fortified of the professionals attending birth provides a US $ 13 transfer per month. milk (for children under six years of and postpartum. It’s a social and Focus areas/ Recipients must apply through the age); fortified, low fat and calorie educational benefit, with universal intervention municipalities, and their socioeconomic cereal milk with added calcium (for coverage for the population served mechanisms vulnerability is established through the overweight children under six), and by the public health care system, Ficha de Protección Social (Social Pro- cream soup with micro and macro regardless of socioeconomic status. tection Form), the national instrument nutrients (to diversify the children’s The set is provided when the mother for assigning the major social benefits. diet). Since 2000, the program and newborn leave the hospital. added special food for premature babies, and children with PKU or special metabolic diseases. The transfer is aimed at families with children with no access to social This program has universal security, which form part of the 40% coverage, and in 2009 provided most vulnerable households in the coverage to 83.2% of the pregnant Coverage is 100% of births country. Since 2007 , the program’s women and children who are under attended in public health care coverage has changed, fixing 100% Coverage/access regular supervision of health. The facilities. In 2009, it served ap- coverage of applicants meeting require- public health care system provides proximately 160,000 newborns. ments. As of August 2010, the program services to approximately one shows a monthly average coverage million beneficiaries per month. of 2,060,039 beneficiaries (including pregnant women, newborns, mothers, and children less than 18 years of age). Strengthening Early Childhood Development Policies 28 and Programs in Latin America and the Caribbean Programa Nacional de Aliment- Programa de Apoyo al ECD Intervention Subsidio Familiar (SUF) ación Complementaria (PNAC) Recién Nacido (PARN) The transfer is allocated by the mu- The program is operated by the nicipalities on the basis of compliance The program is operated by the MoH, and funded by the Ministry with requirements which are verified MoH through the nationwide of Planning, as part of CHCC. The by the Superintendencia de Seguridad public health care system. Nutritional purchase of set items is done by Social (Social Security Superinten- Institutional products are distributed through bidding through the CENABAST dent’s Office), and monitored by the arrangements the primary health care system, (National Health Care System Supply Ministry of Planning. Subsidies are which in most parts of the country is Central Office) which distributes paid through the Instituto de Seguridad run by the municipalities and other sets to the 180 public maternity Social (Social Security Institute) and decentralized health services. wards throughout the country. its payment facilities throughout the country (including private banks). The program is completely funded The program is 100% funded by the Government, and is free for by the Government and is free The program is 100% Govern- Financing/cost- users, regardless of their socioeco- for users, regardless of their ment funded. Its annual budget effectiveness nomic status. In 2009, the program’s socioeconomic status. Its annual is US $ 329 million. budget was US $70.4 million. budget is US $ 25 million. Nutritional supplements are Sets of items are purchased Municipalities run the applica- purchased from the private sector from the private sector through tion process and the allocation Service providers through competitive bidding, competitive bidding, and are of benefits. The Social Security and distributed through the distributed through facilities of Institute’s payment facilities deliver public health care system. the public health care system. cash transfers to beneficiaries. The MoH is responsible for The program established quality quality control of the dietary The Ministry of Planning monitors standards to set suppliers. CEN- supplements. It monitors, oversees the application process and alloca- ABAST and the MoH conduct the Quality assurance and controls all processes involved tion of benefits monthly, through the quality control procedures, from mechanisms in production, distribution, and municipalities. The Social Security receipt of the products to their delivery to beneficiaries, and Superintendent’s Office oversees al- delivery to recipients, through evaluates acceptance and health location and continuance of subsidies. all stages of the supply chain. effects on the different groups. The greatest challenge is to This benefit is a well established The main challenge this well strengthen the program and the service of the Chilean Social Protec- Challenges for established program faces is to assigned budget. Developing stable tion Network, and has expanded going to scale continue researching in order to evaluation mechanisms to assess its coverage. One challenge is to and improving adjust products to the emerging the program’s results and impact in ensure stable mechanisms to as- service delivery nutritional needs of its beneficiaries. terms of children’s attention, care sess the program’s impact on the and development is imperative. lives of children and their families. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability Table 10 above shows some details of the most important interventions in Chile aimed at early childhood. It is impor- tant to point out that all of these interventions are organized in an integrated policy called Chile Crece Contigo, whose axis is the Biopsychosocial Development Support Program that tracks the trajectory of development of each child from the first prenatal check to the entry of them into the school system around five years of age. 29 Table 11. Categorization of Selected ECD Programs in Chile Atención Temprana para ECD Intervention Salas Cuna y Jardines Infantiles Programa Educativo Masivo Niños con Discapacidad Classification Sectoral Inter-Sectoral Multi-Sectoral The goal of Programa Educativo Ma- sivo (Massive Educational Program) is to help create a social environ- The aim of Salas Cuna y Jardines Atención Temprana para Niños ment that fosters early childhood Infantiles (Nurseries and Kindergar- con Discapacidad (Early Care for development, by raising awareness, Primary policy tens) is to promote equitable access Children with Disabilities) seeks to promoting and educating on proper objective to child care and early education in support the needs of young children care, timely stimulation and the de- its various forms, depending on the with disabilities or special needs. velopmental needs of children during children’s stage of development. early childhood. It is thus aimed at adults who are around children, es- pecially their parents and caregivers. The program operates through different means and guidance and educational tools. The website www. crececontigo.cl provides information The JUNJI (Kindergarten National on child development, counsel- Board) and the Integra Foundation ing by specialists, downloadable provide quality early childhood edu- The program involves the delivery of materials, and online interactive cation to poor or socioeconomically technical support for children with forums, among other services. vulnerable children under four years special needs, both for themselves Fono Infancia (Childhood Line) is a Brief description of age through the creation, promo- and their environment. This program telephone counseling service run tion, supervision, and certification was created as part of CHCC, to spe- by ECD specialists. The program of nurseries and kindergartens man- cifically support the special needs also broadcasts a weekly national aged directly or by other institutions. of young children with disabilities. radio show devoted to ECD related The institutions have different mo- issues. Educational TV shows, dalities, including non-conventional. called Crece Contigo TV, are played at all health centers. Additionally, the program has produced educa- tional materials for adults (booklets), which are distributed nationally. The program offers child care and early education, as well as nutri- Through various means, the program tion and training in parental skills The Fondo Nacional de la Discapa- addresses all relevant issues to and child development . There cidad (National Fund for Disabil- help parents and caregivers acquire are different educational levels ity) delivers technical aids (tools, adequate information, providing the Focus areas/ according to the children’s ages. prosthetics, orthotics, etc.) that allow necessary support mechanisms to intervention Arrangements vary according to children with special needs to realize meet their questions. The topics mechanisms the needs of families (extended their full potential for development are broad and are prepared by hours, or intercultural education, for since birth. Children are referred specialists in the field. Materials example) and to difficulties in access from specialized health care. are available in formats appropriate to facilities (seasonal kindergartens, to the needs of the recipients. early education in prison facilities, and radio shows, among others). Child care and early education ser- vices are aimed at children less than four years whose families are part of The program has universal coverage the 60% most vulnerable house- and serves the entire population, holds in the country. In the case of mainly adults who have a direct nurseries (for children under two), These services are aimed at children relation with children. The website priority is given to children whose with special needs who come from is visited by approximately 125,000 mothers or primary caregivers work families of the 60% most vulner- different users every month (it Coverage/ access outside the home, seek employment able households in the country. is the service website with the or study. Kindergarten or equivalent The services are protected by 2009 highest coverage in the country). services (for two and three year legislation, thus ensuring coverage Fono Infancia receives around 4,000 olds) are aimed at all children. of all children meeting requirements. calls per month. The radio show In 2010, coverage is: 85,000 is broadcast by the network with children under two years at- the highest coverage in Chile. tend nurseries, and 127 ,472 children attend kindergartens.. Strengthening Early Childhood Development Policies 30 and Programs in Latin America and the Caribbean Atención Temprana para ECD Intervention Salas Cuna y Jardines Infantiles Programa Educativo Masivo Niños con Discapacidad The JUNJI and Integra Foundation The Ministry of Planning, through have a wide network of nurseries The application process is run the Executive Secretariat of and kindergartens throughout the through municipalities and/or Social Protection, is responsible country, some directly managed public health care services by for national coordination of CHCC by them, other managed externally Institutional referral. Socioeconomic vulner- and runs this program in close (mainly, municipalities. In the case arrangements ability is evaluated through the cooperation with the Ministries of of external management, both Social Protection Form. The benefits Health, Education and Culture, and institutions transfer resources are allocated by the FONADIS with municipalities that distribute through subsidies per child served, (National Disability Fund). the educational material through the value of which varies depend- the CHCC community networks. ing on the service delivered. Early education services are The program is 100% funded 100% funded by the Government The program is 100% funded by Financing/ cost- by the Government. The annual and are free for all qualifying the Government. The 2010 annual effectiveness budget for 2009 amounted to families. The 2010 annual bud- budget was US $ 900.000. about US $ 750,000. get was US $ 542 million. Child care and early education ser- vices are provided directly by JUNJI The different educational tools are and Integra Foundation, or through Technical aids are delivered directly managed by the national municipalities that receive a monthly by FONADIS, and acquired coordination of CHCC or through Service providers subsidy per child served. The food is through competitive bidding other institutions (Fono Infancia, for provided by JUNAEB (National Board from private providers, both instance, is run by the Integra Foun- of Student Aid and Scholarships), domestic and international. dation, and the radio show is bid which is responsible for all school annually to private radio networks). feeding programs across the country. Both institutions, together with the Preschool Department at the MoE, have established a set of The educational contents are quality standards for each of the FONADIS sets quality standards for prepared by national experts services provided. Quality assurance Quality assurance the technical aids to be purchased, and are distributed after being mechanisms are designed, but are at mechanisms and evaluates standards’ compli- tested on potential users. The same an early stage. Legislation to create ance at the time of receipt. quality control mechanism ap- an Education Superintendent’s plies to audiovisual contents. Office Is under consideration. This entity could regulate and monitor the quality of ECD educational services. The CHCC Act that ensures access Knowledge of the specific A program as the one described to child care and early education ser- needs of potential beneficiaries requires constant content update, vices requires institutions to serve should be more accurate. This use of new technologies, and evalu- Challenges for vulnerable populations, and demands could be achieved by increasing ation mechanisms to assess impact going to scale expanding non-conventional modali- coordination with health care on recipients. The implementation and improving ties to serve the families in need of services. Administrative arrange- of such mechanisms is one of the service delivery such services. A major challenge is ments should be made to ensure major challenges this program faces, the institutionalization and consolida- flexibility in the processes, focusing along with future consolidation and tion of quality assurance mecha- on supporting emerging needs. securing the necessary resources. nisms for early childhood services. 31 Table 12. Categorization of Selected ECD Programs in Chile Fondo de Intervenciones de Apoyo Programa de Apoyo al Desar- ECD Intervention al Desarrollo Infantil rollo Biopsicosocial (PADB) Classification Multi-sectoral Comprehensive Programa de Apoyo al Desarrollo Biopsicosocial The objective of the Fondo de Intervenciones de (Biopsychosocial Development Support Program) Apoyo al Desarrollo Infantil (Child Development seeks to strengthen and promote the comprehensive Primary policy Interventions Support Fund) is to provide funding development of children from birth to age four, through objective at the local level ─specifically, the CHCC Com- a series of quality psychosocial interventions designed munity Networks run by municipalities ─ for the to complement prenatal care, childbirth support, child creation and continuance of ECD interventions. screenings and care for hospitalized young patients. This program tracks the developmental trajectory of Every year, the CHCC Community Networks can each child from the first prenatal screening until he or submit projects devised to develop one or more of the she is four years old, thus strengthening the regular following kinds of interventions: stimulation rooms at health checks which have been established in the health care centers or community centers, toy libraries, country for decades. The program is organized into mobile stimulation services, stimulation services at the Brief description 5 areas, according to the children’s developmental home, or improvement and/or extension of pre-existing stage: strengthening of prenatal development, stimulation services. These projects are aimed at personal attention of the birth process, attention to the children who are at risk of showing, or already showing development of hospitalized children, strengthening developmental delays. The submitted projects must be of the children’s comprehensive development, and designed in accordance with a pre-assigned budget. special attention to children at risk and/or vulnerable. Through this program, children enter CHCC automati- cally during the first prenatal health check. From then on, a sequence of actions takes place and continues The projects deal with different needs of children at until children are 4 years old, when they enter risk of showing or already showing developmental preschool. A range of services that complement delays. Children needing support are identified regular health checks are deployed, also considering Focus areas/ through developmental tests applied during regular possible critical situations that may occur during the intervention universal health checks. They are referred by the course of a child’s development, such as hospitaliza- mechanisms public health care system to the different ECD tion, vulnerability or risk, or developmental delay services available in the area. The CHCC Com- or deficit. Since the approach is psychological, the munity Networks run by the municipalities oversee health care system refers children and their families referral follow-up and effective care of children. to other educational or social services available in the area. The process is backed by the CHCC Com- munity Network, and run by the local Municipality. The Fund has national coverage and functions at Coverage is nationwide and the program serves the 345 municipalities in the country. Between 100% of children in the public health care system. Coverage/access 2007 and 2009, about 1,000 services of different This represents about 75% of Chilean children, types were created, thus serving approximately regardless of socioeconomic status. About 1 mil- 150,000 children throughout the country. lion children are covered by this program. The public health care system is in charge The Ministry of Planning coordinates the Fund of the program, especially at the primary through the Executive Secretariat of Social Protec- care level. Public maternity wards and pedi- tion System, the body tasked with operating CHCC atric hospitals also participate actively. Institutional at the national level. The allocated resources are The CHCC Community Network, coordinated by the arrangements transferred to the municipalities that develop Municipality, is responsible of responding and provid- projects, and which are supervised by the CHCC ing attention to the referrals made by the health care regional intersectoral coordination agencies. system in the most diverse areas that affect or may affect the development of children served by CHCC. The program is 100% funded by fiscal resources. The Fund’s annual investment is US$ 2.5 million. Its budget is assigned exclusively to the ser- Financing/cost- It is funded by fiscal resources, which are nearly vices that complement those provided during effectiveness doubled with local contributions by municipalities. regular prenatal and child health checks. The 2010 budget amounts to US $ 32 million. Services are provided by the public health care Municipalities and local education and health system (primary care, maternity and pediatric organizations generally run the projects, in alli- Service providers hospitals), with the intervention of the CHCC ance with other public or private institutions that Community Network in areas of care, early form part of the CHCC Community Network. education and social protection, mainly. Strengthening Early Childhood Development Policies 32 and Programs in Latin America and the Caribbean Fondo de Intervenciones de Apoyo Programa de Apoyo al Desar- ECD Intervention al Desarrollo Infantil rollo Biopsicosocial (PADB) Every year, the program provides a protocol for the Tecnical guidance and quality standards are pro- interventions considered, including quality standards for Quality assurance vided for each of the projects funded. The program services. The MoH is in charge of supervision, both at mechanisms also has control mechanisms and tools, especially the national and regional levels. The transferred resourc- in the case of services provided to children. es are conditioned on compliance with basic standards. The challenges this program faces are related to The program is established as the axis of CHCC Challenges for the expansion of projects in order to serve all areas, and has national coverage. Its main challenges are going to scale and to ensuring services and securing funding of those related to periodic evaluation and update of and improving existing and established interventions. It must also yearly benefits and services, as well as assess- service delivery carry out a systematic assessment of results and ments of the interventions’ results and impact. impact of services on children’s development. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability (e) Classification of ECD Policies in Chile Given that Chile has a specific public policy for early childhood development –Chile Crece Contigo–, it is the policy, rather than the country, that must be classified. According to the framework presented in Section 4, the Enabling Envi- ronment and Degree of implementation are in the Established level of development. The Policy Focus is in the Mature stage, while the Monitoring and Quality Assurance dimension is classified as Emerging. In terms of improving the policy, this last dimension offers the greatest challenge. (f ) Policy options to Strengthen ECD Policies and Programs in Chile The creation, in 2006, of Chile Crece Contigo as a comprehensive early childhood development policy has been a sig- nificant step towards investing decisively and with quality in the early years , in order to ensure equal opportunities from birth and addressing persistent inequalities in the country. The law that created CHCC, which was passed in 2009, helps to bring stability and to secure funding for the policy’s implementation over time. However, though having taken major steps, Chile seems to face chief challenges in this area, one of the most significant being to ensure the quality of benefits, services and programs that are accessible to young children and their families. Not only is it important to set standards for each of the services provided, but also to generate support mechanisms for their compliance and to develop effective tools for quality control. Another relevant challenge is to strengthen the CHCC inter-sectoral coordination bodies, to make sure that the follow-up and monitoring processes of the developmental trajectory of children are adequate and provided in a timely manner to support the needs of each child during his or her early life. 33 Table 13. Classification of ECD Policies in Chile ECD Policy Description Dimensions The legal framework for protection and special attention to children, in a rights-oriented child development approach, has been developed in Chile during the last two decades, es- pecially after the country ratified the Convention on the Rights of the Child in 1990. The legislation has been adapted to the emerging problems of children in the country and to support families’ needs, particularly those in the most vulnerable situation. Established Enabling The law that established Chile Crece Contigo, passed in 2009, recognizes the importance of early childhood Environment development as a priority public investment policy; establishes legal guarantees for a package of benefits, services and programs; and regulates bodies for articulation and intersectoral coordination, essential to the operation of a comprehensive policy that tracks individual development of each child covered by CHCC. The enactment of the recent legislation involves relevant challenges for the public institu- tions responsible for its implementation. Chile has the means and most of the resources needed to strengthen the policy. The effectiveness of such means is still to be evaluated. The policy includes a variety of programs, coordinated by means of a personalized follow-up mecha- nism of children’s development. Most programs have universal coverage, regardless of socioeconomic Established Degree of status, and those programs focused on a determined segment of the population have universal cover- Implementation age which is protected by law. The programs focus specifically on early childhood development. The greatest challenges the program faces are implementing of new programs, created specifically in the context of CHCC, and ensuring universal coverage and quality for pre-existing programs. While some programs have standards and quality assurance mechanisms, especially those in the area of health care, most programs require substantial progress regarding this issue. Emerging Monitoring and Quality Assurance Early education and preschool are the areas facing the major challenge.. While prog- ress has been made in the establishment of quality standards, there are no mecha- nisms for ensuring them, and no specific institutions have been created. The main strength of early childhood policy in Chile is precisely the holistic approach that guides the efforts of CHCC. The policy is specifically directed at young children, rather than children in general. Policy Focus The need to offer comprehensive services has led to very significant challenges for in- stitutions providing them. However, a new, more comprehensive intervention approach, Mature has gradually been established, offering advantages to all participating sectors. ©ACurt Carnemark,1992/WORLD BANK 35 6. Conclusions C ountries in Latin America and the Caribbean face many development challenges, but perhaps the most critical is that of human development. The foundations for human development are laid in the early years. When young children receive adequate nutrition, stimulation, and healthcare, they grow strong, able to learn and become productive citizens. When young children do not have healthy early childhood experiences, the impact on life outcomes is severely detrimental. As countries in the region strive to ensure that all children can reach their full potential, they can learn from each other as well as from countries outside the region in terms of how to design and implement effective ECD policies. In this Policy Note, we have developed a framework to categorize programs and to classify policies to benchmark ECD systems in order to help policy makers identify the current stage of development of their ECD system and, importantly, strategies to develop further. There is not one identical path for all countries to reach the ECD goals, but there can be a set of directions, or “Roadmap� to help countries identify their own unique path. This Policy Note has identified such a “Roadmap� along four critical dimensions – Enabling Environment, Degree of Implementation, Monitoring and Quality Assurance, and Policy Focus. In order for countries to strengthen their ECD systems, a first step is for each country to take stock of all its interven- tions in this area, understanding how they have evolved along a group of key characteristics described in Section 3 that include: (i) Focus area; (ii) Coverage/access; (iii) Institutional arrangements; (iv) Financing; (v) Service providers; (vi) Quality assurance mechanisms; (vii) Challenges for going to scale and improving service delivery. Building on this inven- tory of ECD programs, countries can use the ECD Policy Classification Framework introduced in Section 4 to identify their level of development (Latent, Emerging, Established, Mature) along the four dimensions (Enabling Environment, Degree of Implementation, Monitoring and Quality Assurance, and Policy Focus). A final step is to identify policy options to strengthen ECD policies and programs to achieve the goal of ensuring that all children can reach their full potential. Strengthening Early Childhood Development Policies 36 and Programs in Latin America and the Caribbean References Almeirda, L., V.R. Ramires, R.G.G. Paiva, and A. Schneider. 2009. “The Better Early Childhood Development Program: An Innovati- � Current Issues in Comparative Education, Columbia University, 11: 24-33. ve Brazilian Public Policy, Barnett, W.S. and M. Nores. 2009. “Benefits of early childhood interventions across the world: (Under) Investing in the very young, � Economics of Education Review, 29: 271-282. � Berlinski, S., S. Galiani and M. Manacorda. 2007. “Giving Children a Better Start: Preschool Attendance and School-Age Profiles. (Processed.) University College, London, UK. Berlinski, S., S. Galiani and P � London, Buenos . 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López, J.G., “Situación de la Inmunoprevención en Colombia, . Gobierno de Ministerio de Desarrollo Social. 2008. “Informe de Avance de la Red de Oportunidades� Panamá. Downloaded from: http://www.mides.gob.pa/wordpress/wp-content/uploads/2009/07/avance_diciembre_2008.pdf. Ministerio de Educación de Chile, www.mineduc.cl. Estadísticas de matrícula por nivel. . Gobierno de Chile. Downloaded from www.mideplan.cl Ministerio de Planificación, “Presupuesto 2009� 37 Ministerio de Planificación de Chile, septiembre 2010. Resultados preliminares CASEN 2009 – Primera Infancia. . Gobierno de Panamá. Memoria 2007, 61-42. Ministerio de Salud. 2007. “Nutrición: Programa de Alimentación Complementaria� Paglayan, A. 2008. “Reading between the lines: A closer look at the effectiveness of early childhood education policy to reduce in- . Georgetown University, MPRA Paper No. 13875. 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Tinajero, A.R. 2010. “Scaling-Up Early Child Development – Cuba’s Educate Your Child Program: Strategies and Lessons from the Expansion Process, � Wolfensohn Center for Development at Brookings. Downloaded from www.brookings.edu/global . UNESCO Policy Brief UNESCO. 2004. “Enrolment Gaps in Pre-primary Education: The Impact of a Compulsory Attendance Policy� on Early Childhood, 24. Downloaded from http://unesdoc.unesco.org/images/0013/001374/137410e.pdf. . Downloaded from http://unesdoc. UNESCO. 2006. “Panamá: Programas de atención y educación de la primera infancia (AEPI)� unesco.org/images/0014/001481/148103s.pdf. UNICEF . UNICEF . 2008. “Education Statistics: Panama� , Division of Policy and Practice, Statistics and Monitoring. Downloaded from www.childinfo.org. � (Processed). Vargas-Barón, E. 2007. “Going to Scale and Achieving Sustainability: Early Childhood Development in Latin America. World Bank, Washington, DC. Vegas, E. and L. Santibáñez. 2010. The Promise of Early Childhood Development in Latin America and the Caribbean. Washington, DC: The World Bank. World Bank. 2002. “Project Appraisal Document on a proposed loan in the amount of US$42.0 million to the Republic Oriental � Report No: 23825-UR, Country Management Unit for del Uruguay for a Third Basic Education Quality Improvement Project, Argentina, Chile, Paraguay and Uruguay, the World Bank. Websites consulted: EdStats: http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTEDUCATION/EXTDATASTATISTICS/EXTEDSTATS/0,,menuPK: 3232818~pagePK:64168427~piPK:64168435~theSitePK:3232764,00.html http://www.liconsa.gob.mx/liconsa/ http://panama.nutrinet.org/ Strengthening Early Childhood Development Policies 38 and Programs in Latin America and the Caribbean 7. Annex: Classification of Selected Regional Programs by Category A1:Table 14. Selected Sectoral Programs in Latin America and the Caribbean Support for Seamless Education Program Programa de Abasto So- ECD Intervention Vaso de Leche (Peru) cial de Leche (Mexico) (Trinidad and Tobago) Classification Sectoral Sectoral Sectoral The first phase of Support for Seam- The Vaso de Leche (VL) feeding pro- The Programa de Abasto Social less Education Program endeavors to gram in Peru aims to reduce child mal- de Leche (PASL) provides high- Primary policy improve the equity, quality and rele- nutrition by providing milk and other quality milk to improve the nutrition objective vance of educational services provided nutritional commodities to children of low-income families, pregnant in ECCE and primary education levels; six years old or younger and pregnant and lactating women, older adults, and to improve sector management and lactating mothers in poor areas. and in particular, young children. including monitoring and evaluation. The Government of Trinidad and To- PASL was implemented in 1944 with bago developed a strategic plan, Vision the inauguration of the first public The VL program was initiated by 2020, which states that economic milk-producing company (now called the World Bank in 1984. The pro- diversification and the creation of a Liconsa). In 1994 the program was gram began in Lima and has since highly skilled labor force are the keys revised to become part of the Ministry expanded throughout the country. for ensuring future competitiveness. of Social Development (MoSD). Nowa- The program became increasingly To help achieve this goal, the MoE days, Liconsa is a state-owned entity Brief description devised a multi-phased initiative called popular during the economic stress devoted to the industrialization of and downturns of the 1990s. Recently, Support for a Seamless Education high-quality milk and its distribution at concern over the stability of the System Program. The program is subsidized prices, in order to contrib- program has sparked public protest. part of an overarching attempt to ute to the proper nutrition of millions harmonize the efforts of the MoE in of disadvantaged Mexicans. Liconsa’s addressing equity, quality, efficiency, milk is fortified with the following and increased participation of children nutritional elements: iron, zinc, folic in ECCE through secondary education. acid and vitamins A, C, D, B2 and B12. The first phase of Support for a Seamless Education System Program has four components, with the first In addition to boys below the age of being the most substantive. This 12 and girls younger than 15, pregnant component aims to increase equity and lactating women, chronically ill and quality of educational services to Despite its name, the VL program and disabled people, women 45 to 59, all early education aged children. This Focus areas/ is not confined to the distribution and adults older than 60 are served by includes the construction, upgrading of milk or milk substitutes. In some PASL. The sale of milk at preferential intervention and equipping of 50 ECCE centers instances, cereals or a combination rates is available to people living in mechanisms (for three to four year olds) and the of commodities are distributed in lieu poverty. The authorized weekly allot- implementation of an extensive of, or in addition to, milk products. ment of milk per person in a house- training program for all staff. The hold is four liters. If a household has component also supports students six or more beneficiaries the weekly with disabilities with the establish- allotment is capped at 24 liters. ment of 12 demonstration schools (six ECCE and six primary schools) to model inclusive education practices. Priority is given to households with children aged six and under, as well In 2008 more than 6,000,000 Approximately 87% of three to four as pregnant or lactating women. After people benefited from PASL. This years olds are enrolled in ECCE that, on a priority basis, the program includes 3,807,042 girls and boys programs. However, recent assess- caters to children aged 7 to 13 and under the age of 12, and 56,869 ments indicate that 65% of centers people with tuberculosis. In total, the pregnant or lactating women. are in poor or critical condition and program reaches 4.2 million beneficia- Coverage/access pose risks to the safety of children ries, of which 2.8 million are children and staff. Less than 5% meet under the age of six. Reports indicate Beneficiaries of the program are recent standards pertaining to that at times the age limit for children selected according to socioeco- space, layout, and teacher train- is arbitrarily extended beyond the age nomic and demographic studies ing. Investment in the 50 centers of six. Furthermore, studies indicate that focus on geographic zones prioritizes communities that rank that the VL program does not ef- with a high prevalence of malnutri- lowest with the Basic Needs Index. fectively target pro-poor. In 2003, 75% tion. Operations cover 1,864 of of beneficiaries lived in urban areas, 2,445 municipalities in Mexico. and the remaining 25% in rural areas. 39 Support for Seamless Education Program Programa de Abasto So- ECD Intervention Vaso de Leche (Peru) cial de Leche (Mexico) (Trinidad and Tobago) Classification Sectoral Sectoral Sectoral The MoSD is responsible for PASL The MoE is the largest ministry with through SEDESOL. In response about 17 ,000 staff, including 14,000 The Ministry of Economy and Finance to studies conducted in the 1990s teachers. Operational responsibilities is in charge of Vaso de Leche. All that indicated large segments of are being de-concentrated to eight other food-based programs are the re- beneficiaries remained malnourished, regional offices. A major area of sponsibility of the Ministry of Women Institutional the MoH teamed with the MoSD emphasis for the MoE is the manage- and Social Development. It has been arrangements to enhance the nutritional content ment of teachers and their profes- suggested that the VL program may of the milk. Early results indicated a sional development. All new teachers be best served as part of this ministry. decrease in the prevalence of anemia entering the system are required to and iron deficiency among children have, at a minimum, a B.Ed, which aged 12 to 24 months, from 27% to only 30% of current teachers have. 17%, and 20% to 4%, respectively. The first phase of Support for The price per liter of milk is $4.00 Funding for the VL program is Seamless Education Program pesos and is established by Liconsa. provided by the National Treasury and requires US $62,500,000. Of this, Compared with the average market is directly transferred from the central the IDB is financing US $48,750,000 price of commercially pasteur- Financing/cost- government to municipalities. The mu- and the Government the remaining ized milk, this represents savings effectiveness nicipalities are responsible for buying US $13,750,000. The first com- of approximately 60% per liter. and transferring food to the registered ponent, early child development, Liconsa reports that $2,027 ,096,000 local mothers’ committee. The budget accounts for US $44,845,728, pesos were allocated for sub- is reported to be US $136 million. or 71.7% of the investment. sidies and transfers in 2007 . The MoE is responsible for service Each municipality has an administra- Liconsa distributes 90,526,857 liters provision of ECCE. Included with tive committee and a VL Mothers’ of milk each month, of which 75% is these responsibilities is establishing Committee elected from within the liquid form and 25% is powdered milk. criteria for admission of children respective neighborhood. These The powdered milk is most effective Service providers to the centers (outlined in the organizations are responsible for for reaching remote communities. The implementation manual) and the determining program beneficiaries, milk is distributed through a network hiring and training of teachers. registering beneficiaries, and the of 9,691 Lecherías (dairy centers) Demonstration schools are equipped administration and allocation of located throughout the country. with special education teachers. goods within the municipality. The MoE will receive technical as- In order to ensure high quality milk, sistance to develop a comprehensive The National Food Center is responsi- Liconsa applies strict quality control evaluation and monitoring framework ble for determining the nutritional val- measures (ie: more than 13,000 to inform subsequent phases of ue for each food portion. The Mothers’ control tests) to the acquisition the program. Among the innovative Committee and municipalities receive of raw materials, the production features in this operation are: i) the continual monitoring on the imple- process, and to product distribution. Quality evaluation of various ECCE models mentation, financial management, and A combination of internal and external assurance with respect to their cost effective- delivery of the program. The Govern- evaluations track beneficiary targeting; mechanisms ness and quality of care; and ii) an ment of Peru conducts surveys to the assess health benefits; and measure external evaluation of the demonstra- well-being of citizens, which are used compliance with the projects’ goals tion schools. In addition, mid-term and to assess the efficacy of the program. and objectives. The National Institute final evaluations of the project will be In addition, research institutes and of Public Health conducts several conducted along with an annual audit. universities have undertaken a studies that track and evaluate the The educational planning division will number of external evaluations. health benefits to children. monitor the program implementation. Strengthening Early Childhood Development Policies 40 and Programs in Latin America and the Caribbean Support for Seamless Education Program Programa de Abasto So- ECD Intervention Vaso de Leche (Peru) cial de Leche (Mexico) (Trinidad and Tobago) Classification Sectoral Sectoral Sectoral -The program should concentrate on effective targeting and service The program needs to continue to delivery to malnourished children improve targeting mechanisms to from birth to the age of six. reach the most malnourished children and beneficiaries. Furthermore, Challenges for Efforts to modernize the education - Several concerns have arisen as continued education programs are going to scale sector continue to be hampered to the best method to provide for required to both ensure that the milk and improving by the relatively slow speed and malnourished children. Entitled the is being allocated to children and not service delivery bureaucratic nature of the MoE. RECURSO program, the Government consumed by others in the household, of Peru has teamed with the Interna- and to detail the health benefits of tional Bank for Reconstruction and De- regular, consistent intake (approxi- velopment to conduct in-depth analy- mately two glasses per day) of milk. sis of social programming in Peru. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability 41 A2: Table 15. Selected Sectoral Programs in Latin America and the Caribbean National Preschool Pro- National Preschool Pro- ECD Intervention Educación Inicial (Mexico) gram (Argentina) gram (Uruguay) Classification Sectoral Sectoral Sectoral Educación Inicial offers compensa- Argentina’s National Preschool Uruguay’s National Preschool Program tory education with priority given Program aims to provide quality aims to promote the integrated to rural zones, indigenous people, education and equal opportunities to Primary policy development of each child within their and groups who are marginalized to all children for the development of objective bio-psychosocial environment, provid- improve child development and school their cognitive, emotional, social and ing the stimuli that they need to attain readiness for children from birth to motor skills, with a particular empha- their fullest possible development. four years of age and their parents. sis on improving school readiness. Both free public schools and private Educación Inicial was founded in Responsibility for preschool (and institutions that charge fees to 1993 and is placed within the National primary) education was decentralized students supply education. In the early Council for Educational Development to the provincial level in 1978. Both 1990’s a major constraint to preschool (CONAFE). The program is one of free public schools and private institu- education was the lack of teaching the largest in the area and targets tions that charge fees to students infrastructure. In response, during pregnant women and children from supply education. In 2007 the Ministry the 1995 – 2004 period a priority of Brief description birth to age four living in rural, peri- of Education, Science and Technology education policies in Uruguay was urban and urban areas with high levels received financial and technical assis- to expand preschool coverage, with of marginalization and indigenous tance from the IDB. One component particular targeting of lower-income populations. Upon completion of Edu- of the investment is in new works families. By 2002 nearly 800 new cación Inicial, children are expected and the expansion of educational classrooms were made available and (and adequately prepared) to enroll in infrastructure at the preschool level. were accompanied by an increase in the national kindergarten program. the number of preschool teachers. The program uses a combined strategy of parent education and child services. The services delivered in- clude prenatal education; education to In general, public schools operate in be a mother; child assessments; early two shifts (morning and afternoon) Public preschools operate five days a stimulation; parent education and sup- from the beginning of March to week during a 180 day school term. Focus areas/ port; and community participation. To the end of November, and run for Most of the institutions operate cater to indigenous groups, services three and a half hours, five days a in two daily shifts (morning and intervention are provided in the native language week. Operations vary amongst afternoon). Private schools determine mechanisms and educational materials are culturally private schools. Preschool educa- their own operational schedule. tailored. Over an eight-month period, tion is separated into three levels: home visits of one hour are conducted level one (age three), level two (age twice a week, individual consulta- four) and level three (age five). tions of one hour are held once a week, and parent meetings lasting two hours are held once a week. In May 2007 , the program reached Approximately 95% (648,828) of all Preschool is for children aged three to 2,085 municipalities and 22,855 com- five year olds attend preschool. Of five. Since 1999, the gross enrolment munities, serving 367 ,986 parents and which, 79% (or 513,099) attended of preschool students has improved 409,871 children. Some 70% of pro- public schools in 2008. At the four from 60% to 81% in 2007 . Specifically, gram participants reside in rural areas, and three year old levels, 481,929 the enrolment of children aged four Coverage/access and 21% are indigenous. The program and 234,644 attended preschool, and five, whom are legally required targets the most underprivileged with 67% and 57% attending to attend preschool, has steadily participants, with 19% and 47% being public schools, respectively. In improved and attendance is near reported as very highly marginalized general, private schools have higher universal today. Private schools are and highly marginalized, respectively. attendance rates in urban areas. more prominent in Montevideo. The 1993 Federal Law of Education Since the passing of the 1985 confined preschool policy to the Education Law, the education system provision of education services has been the responsibility of the The Unit for Compensatory Programs for children aged three to five, and National Administration for Public of CONAFE manages the program and universal provision to five year olds. Education (ANEP), the Ministry of channels it through State Coordinating The 2006 National Law of Education Education and Culture, and the Institutional Units for Educación Inicial to com- extended universal provision to four University of the Republic. ANEP is arrangements munities in all states. The National year olds. The Ministry of Education, in charge of preschool, primary, and Constitution, a series of plans, laws, Science and Technology is responsible secondary education; pre-service, and decrees and regulations provide a for national policy at the federal level, in-service teacher training. In total, the strong legal basis for the program. and the various provincial ministries of ANEP administers and oversees the education are tasked with admin- education for about 720,000 children istering and executing education. and some 45,000 employees. Strengthening Early Childhood Development Policies 42 and Programs in Latin America and the Caribbean National Preschool Pro- National Preschool Pro- ECD Intervention Educación Inicial (Mexico) gram (Argentina) gram (Uruguay) Classification Sectoral Sectoral Sectoral Educación Inicial receives public financial support from the SEP (Public Provision of public preschool – and of Aside from exemption from national Education Secretariat) and private public education in general – is mainly and municipal taxes, the state does funding from the World Bank and funded and managed at the provincial not provide financial support to IDB. Annual budgets are determined level (with funds delivered by the private schools. Public schools Financing/cost- by central offices in accordance with Education Services Transfer Act). In receive funding from the National effectiveness the goals established for each state. 2006 consolidated spending on educa- Budget. In 2007 it was reported that The cost per beneficiary is reported tion amounted to 4.7% of GDP , and 11.6% of government spending to be US $120 per child per month, no breakdown per level of education was on education. Of this, 9% was and US $114 per parent per month. (ie: preschool, primary etc) is available. allocated to preschool education. Administrative costs amount to 8% Private schools set their own rates. of the annual program budget. The head of the compensa- tory programs of CONAFE manages A combination of public and private central personnel hiring and dismissal. schools provide education services. A Both public and private schools Decentralized coordinators manage noteworthy difference is that private provide educational services and must these processes in the field. Regional schools are capable of making have qualified teachers. Early educa- units of state coordinators manage all decisions that affect the quality of tion teachers study in teacher training work at the local level through their education (ie: hiring or firing teachers). colleges to earn a qualification at the Service operational chains. There are 26,000 Individual public schools, on the other non-university tertiary level. In both providers paid educational agents that work hand, do not have the power to deter- the public and private sectors there directly with parents. These agents mine a wide range of issues that affect are classroom assistants to assist in are adults who have completed the quality of education that they pro- the provision of preschool education primary education, have experience vide (ie: staffing decisions or contents and care. Classroom assistances can in community programs for education of the curriculum). These decisions be teachers and/or community mem- or social development, and are able are made by provincial authorities in bers and they may have qualifications. to be mobile. On average, an agent compliance with national regulations. works with 10 children at a time. Internal and external evaluators assess the: program structure, participants, implementation process, contents, materials and media, and the operational chains of the program. In the last decade a number of Preschool is subject to the quality Evaluations occur weekly or for each studies have been undertaken by assurance mechanisms of the ANEP . service provided. Reports are prepared private institutions, universities and In addition, private institutions and monthly, quarterly, each semester, international organizations. In recent universities have conducted studies Quality and annually. The World Bank and IDB years some of these studies have paid into the impact of expanding manda- assurance conduct their own evaluations and particular attention to public vs private tory schooling to the preschool level mechanisms review internal evaluations. Educación schooling and the resulting impact in areas such as student retention Inicial receives careful and frequent on student educational indicators. and failure rates. Other studies focus monitoring. Participants in this process Monitoring and evaluation is con- on the quality of education provided include professionals, program ducted at the state and federal level. in both private and public schools. coordinators, and the director. The main objective of the monitoring is to ensure timely follow-up for program improvement over time. Although Educación Inicial is Uruguay has made substantial Challenges for well established with a strong progress in mandating universal As Argentina expands preschool going to scale legal basis, improved financial preschool. Going forward the largest coverage there is a need to invest in and improving support is required to ensure the challenge will be improving quality of improving the quality of public schools. service delivery program’s long-term sustainability education, especially across public and the expansion of services. schools and for poor students. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability 43 A3: Table 16. Selected Cross-Sectoral Programs in Latin America and the Caribbean ECD Intervention Oportunidades (Mexico) Classification Cross-Sectoral Oportunidades uses a range of services including cash payments, nutritional supple- Primary policy ments and improved access to preventative and primary health services, to increase ca- objective pacities in health, nutrition and education of the most marginalized families. Founded in 1997 as PROGRESA (renamed Oportunidades in 2002), the intervention uses a combined parent and child strategy through cooperative agreements with health, nutrition and education services. Target ages Brief description for enrolment include pregnant and lactating women and their children from birth until secondary school (approximately 15 years old), with a particular focus on young children from birth to 24 months of age. Transfer of cash payments to families requires that all household members visit health centers (more Focus areas/ frequent visits for pregnant women and young children); all school-aged children attend school; an adult member of the family attends the monthly information session. In addition to cash transfers, other intervention services include: prenatal education, childbirth support, child screening and assessments, parent educa- mechanisms tion, and primary healthcare services. Food supplements are available to all children between 6 and 23 months; aged two to five who suffer from malnutrition; and to pregnant and lactating women. Oportunidades serves slightly more than five million families. The program is present in Coverage/access 93,000 districts around the county. About 99% of these districts are rural or semi-urban, and the program covers 100% of Mexico’s most marginalized municipalities. Oportunidades was established with extensive legal support and has four institutions that par- ticipate at the federal level (SEDESOL; SEP; Health; and the Mexican Social Security Institute). Institutional SEDESOL is responsible for general coordination of Oportunidades through the program’s Na- arrangements tional Coordination Agency. This agency has technical and operational autonomy and provides the 32 State-Level Coordination Agencies – whom are tasked with attending to the families and for operating and supervising the program – with the program guidelines, features, etc. Oportunidades has attracted support nationally and internationally (IDB and World Bank). In 2006, the Financing/cost- program listed expenditures as US $1,470,932, of which 59% was provided by the Government and 41% effectiveness by the IDB. The annual budget is reported to have risen to $2.7 billion in 2007. These figures exclude the provision of health and education services at the state level. Administrative costs vary between 2.4 to 3%. The National Coordination Agency contracts specialized financial institutions to transfer the pay- ments to participant families. State health and education services, teachers, and health person- Service providers nel provide the direct services. At the local level, participants elect vocales from among them- selves to form community promotion committees. Vocales’ goal is to improve the link between families and the personnel of the various services and the National Coordination Agency Oportunidades conducts internal monitoring and in addition is monitored by fiscal agencies of the fed- eral government. Monitoring reports are issued bimonthly, each semester and annually. With respect Quality assurance to evaluation, Oportunidades is the most heavily evaluated CCT program in the region. This includes mechanisms annual evaluations by the National Institute of Public Health in collaboration with Oportunidades. Nu- merous evaluations have been conducted by universities and independent research institutes. - Social indicators for the indigenous population still lag behind, which ne- Challenges for going cessitates continued attention and targeting. to scale and improving service delivery - Graduates of Oportunidades may still be disadvantaged compared to other students leaving secondary school. The program may wish to expand services to help in the transition from school to the work place. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability Strengthening Early Childhood Development Policies 44 and Programs in Latin America and the Caribbean A4: Table 17. Selected Multi-Sectoral Programs in Latin America and the Caribbean Programa de Atención Integral a la Programa Primeira Infância ECD Intervention Madres Guías (Honduras) Niñez Nicaragüense (Nicaragua) Melhor (Rio Grande do Sul, Brazil) Classification Multi-Sectoral Multi-Sectoral Multi-Sectoral Madres Guías program provides The Programa Primeira Infância an array of continuous services Programa de Atención Integral a Melhor (PIM) aims to provide to marginalized pregnant women la Niñez Nicaragüense (PAININ) guidance to families, based on Primary policy and children under six to improve aims to support the psychosocial, their own culture and experiences, objective ECD objectives and to provide cognitive, and physical development to allow them to promote their children with the opportunity to of poor children under the age of six. children’s holistic development from develop their abilities and skills. pregnancy to six years of age. Started in 2003 by the Rio Grande do Sol government, the PIM has received technical assistance from the Latin American Reference Centre for Preschool Education, Madres Guías was founded in 1992 PAININ was designed in the early UNICEF , and UNESCO. The program by the Christian Children’s Fund of 1990s in response to widespread plays an important role in supporting Honduras (CCF-H). The program poverty. At the time there was families, providing them guidance uses a combined strategy of parent considerable supply of services tar- and promoting the holistic develop- education and child development. geting high-risk children and families ment of their children. In doing so, This approach is designed to but they were poorly coordinated the program adopts and tailors to highlight the importance of ECD and Brief description and failed to reach isolated areas. the customs, traditions and cultural identify, select and train mothers to PAININ provides a comprehensive characteristics of the community. become community leaders who ECD model by consolidating delivery The program uses a multi-sectoral promote and develop programs of services and targeting the poor- approach with integration among of integrated ECD. In addition, est, most isolated municipalities. The governmental departments (health, the highly participatory approach program has continued to adapt and education, social services and of the program builds on local is now on its third phase (PAININ III). culture). An initial diagnosis of child culture and childrearing patterns. development along with further assessments are used to inform the planning and implementation of activities to best suit the characteris- tics and needs of each child/family. The PAININ approach integrates early stimulation, health, nutrition The program uses several mecha- and day-care services. PAININ I nisms directed to children, parents established a two modality ap- The PIM provides families with two and families including prenatal proach: center-based, which serve modalities: individual and group education; newborn screening; more densely populated areas; and care. Individual care is for families child development assessments; mobile services, for use in remote with children from birth to three individualized child and family areas. Center-based provide early years of age and pregnant women. development plans; early stimula- Focus areas/ stimulation and preschool services. Children are seen once a week and tion; parent education and support; Mobile services are structured pregnant women bi-weekly for one intervention nutrition services and school around “community base homes� hour sessions. Group care is for mechanisms feeding; primary health services; from which mother-volunteers children aged three to six. Schedules social protection services; childcare deliver in-home early stimulation vary and the modality includes and preschool education; community and parenting skills to four or five games and playful educational participation; and basic education. families. In PAININ III a mobile activities planned by home visitors Services include both home visits preschool model was adopted under the supervision of the PIM and group sessions. Home visits are where educators travel to outlying technical coordination team. provided once a week and preschool areas to deliver early stimulation classes are held daily for 3.5 hours. and preschool services bi-weekly to children from birth to age five. 45 Programa de Atención Integral a la Programa Primeira Infância ECD Intervention Madres Guías (Honduras) Niñez Nicaragüense (Nicaragua) Melhor (Rio Grande do Sul, Brazil) Classification Multi-Sectoral Multi-Sectoral Multi-Sectoral The program serves families with PAININ has evolved into an The PIM targets at-risk popula- the highest rates of child mortality, integrated ECD program reaching 66 tions, such as low-income families malnutrition, and developmentally municipalities, including six on the (less than US$65 per month) and delayed children. In 2006, home Atlantic Coast. At the point of imple- children who do not attend formal visits and sessions were provided mentation the mobile preschool institutions. As of August 2008, in 233 communities for parents and anticipated a doubling in attendance the program was implemented in children from birth to three years from 22,000 to 56,000 children, or 225 of the 494 municipalities in Coverage/access of age, including 3,802 boys and 25% to 55% of children in benefi- Rio Grande do Sul. In total, 45,750 3,719 girls. Preschool services were ciary communities. During PAININ II families were being assisted by the offered for 1,266 children from three a detailed and transparent protocol program, including 68,625 children to six years of age and services for to identify localities with high rates and 5,490 expectant mothers prenatal and post-natal education of childhood vulnerability (defined receiving care during pregnancy. and care were provided for 890 as households with undernourished The goal is to expand the project newborns. Approximately 70% of children or children not attending to serve 100,000 children. the families live in rural areas. preschool) was established. The Code for Children and Adoles- cents of Honduras provides the legal The Ministry of Family is the execut- basis for the program. At the national ing agency of PAININ through the The PIM is operated by the state level, the CCF-H works closely with General Program and Project Bureau secretariat of health, in coordination all levels of government, specific de- (DGPP). The DGPP is responsible for with the secretariats of education; partments and agencies, and NGOs. the full technical, administrative and of culture; and of justice and social Coordination is formalized through general management of the program development. The state legislature Institutional signing agreements of mutual coop- as well as ensuring inter-institutional has passed a number of Decrees (ie: arrangements eration, both technical and financial. coordination. A basic condition 42.199 and 42.200) that have had a The program employs: one central for municipalities to participate in positive impact on the program. In program coordinator; two regional the project is that the municipal 2006 the program became part of coordinators, five supervisors, 134 governments must sign a participa- state policy with the passing of law parent educators, 159 community tion agreement with the Ministry of 12.544 for the promotion of ECD. educators, and 1,926 Madres Guías. Family which outlines the services In each community a general as- the municipality will commit. sembly elects a Parents’ Committee. Since inception the program has received support from numerous Rio Grande do Sul is reported to Total funding is an estimated US international donors including: invest approximately US $1.14 $300,000 with approximately 80% Norwegian Agency for Development million per month in the initiative provided by CCF-International. In Cooperation, World Bank, Central via transfers to the municipalities. addition, occasional grants are American Bank for Economic Inte- Financing/cost- In addition, the program reports received from UNICEF , the World gration, USAID, and UNICEF . Most effectiveness contributions from the private sector, Bank, and the National Commission recently, the IDB supported the third international aid organizations, and for Alternative Non-formal Educa- phase of PAININ with a US $15 mil- municipal governments. A com- tion. Administrative costs account lion loan over a two year period. The plete breakdown of the programs for 15% of the annual budget. Ministry of Family has reported that financial structure is not available. operating expenses represent ap- proximately 8.4% of the investment. The CCF-H Directorate provides Depending on the location, services technical guidelines to maintain are provided via the center-based program quality and conduct model and mobile services. The The PIM program has modeled activities for planning, monitor- center-based services are staffed by itself off Educa a tu Hijo in Cuba. ing, supervising, and evaluating educators, each of whom is required There is a state technical group the program. Regional offices to have completed sixth grade and for overarching, program issues Service coordinate activities and projects. be 18 years of age or older. The and municipal technical groups for providers Local personnel train Madres Guías. mobiles services educators have selecting and training staff and over- Parents’ Committees administer and the same requirements and travel to seeing execution of local actions. implement the program and manage outlying areas to deliver services. In In total, there are approximately follow-up activities at the community coordination with the communities, 1,600 home visitors employed. level. They conduct activities for suitable locations are determined early stimulation, health, nutrition where the services can be provided. and environmental sanitation. Strengthening Early Childhood Development Policies 46 and Programs in Latin America and the Caribbean Programa de Atención Integral a la Programa Primeira Infância ECD Intervention Madres Guías (Honduras) Niñez Nicaragüense (Nicaragua) Melhor (Rio Grande do Sul, Brazil) Classification Multi-Sectoral Multi-Sectoral Multi-Sectoral A baseline study was conducted prior to the program being imple- Throughout the lifespan of PAININ Children are monitored every three mented. Local educators monitor rigorous monitoring and evaluation months during their first year of life. the program, and supervisors and has been conducted to improve There is also at least one annual specialists in the national CCF-H the project design and effective- evaluation between the ages of Quality office review their work. Monitoring ness. Most recently, stipulated in one and six. Internally, the PIM is assurance reports are prepared bi-monthly and the agreement with the IDB, the undergoing a thorough process of mechanisms each semester. Internal evalua- Ministry of Family is required to monitoring and evaluation regarding tions are prepared quarterly and conduct extensive monitoring of its performance and achievements. annually. In addition, external all elements of the program. In Externally, the program is engaged evaluations have been undertaken. addition, midterm and final project in a Canadian Study with the Early These mainly focus on the efficacy evaluations are to be undertaken. Development Instrument (EDI). of the program objectives. - The limited budget hinders the program’s ability to broaden its reach Decentralization policy gives An ongoing challenge is the ability and have a more profound impact. municipalities the autonomy to of PAININ to accurately target and Challenges for decide whether or not to follow - In some instances, initial levels of reach the most marginalized children. going to scale state plans. Of the 323 munici- parental commitment to the program Since the outset substantial ad- and improving palities trained by the PIM program, have been low. The program has vancements have been made to this service delivery only 225 decided to execute the emphasized communication strate- regard with innovative approaches, program. This provides an obstacle gies to make parents aware of the such as the mobile preschool model. to future program expansion. numerous benefits of participation. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability 47 A5: Table 18. Comprehensive Programs in Latin America and the Caribbean ECD Intervention Educa a Tu Hijo (Cuba) Chile Crece Contigo (Chile) Classification Comprehensive Comprehensive The program’s objective is to achieve the maximum Chile Crece Contigo (CHCC) is an integrated system Primary policy level of development possible for each child in of social protection for children up to four years of age objective areas of emotional communication, intelligence, with benefits, interventions, and social services to language, motor development, health and nutrition. ensure that all children reach their full potential in life. Discussion of social policy in Cuba cannot be When former President Bachelet was inaugurated in separated from the country’s politics, cultural March 2006, she made it clear that a priority of her diversity and deeply embedded ideologies. The administration was to install a system of early child- fall of the socialist bloc in Eastern Europe in 1989 hood protection, designed to equalize the opportunities followed by the tightening of the U.S. embargo in for development of Chilean children. She appointed Brief description 1992 contributed to a severe economic crisis. At this a Presidential Commission to reach this goal, which point food became sparse, and early child indicators carried out technical work and extensive consultations all deteriorated. The government responded with to lay the foundation for the design and implementa- heavy investment in health and education, including tion of CHCC. The design reflects many of the lessons the establishment of universal preschool education and recommendations from international research and with the non-institutional Educa a Tu Hijo program. experience from effective child development programs. The Educa a Tu Hijo program offers a range of ser- vices including training for pregnant women; disease prevention and health promotion; primary health care; and dental clinics. In addition, the program has specif- ic services for each age group. The group from birth CHCC provides coordination amongst sectoral initiatives to two age receives individualized care from facilita- and programs to benefit children and their biological, tors that visit homes once or twice a week. Children physical, psychological and social growth at each stage in the group from two to six age participate alongside from gestation to four years of age. The level of support Focus areas/ their parents or caretakers in group sessions held for all boys, girls and their families is determined by his/ intervention once or twice a week in community spaces. her specific needs. Amongst others, CHCC provides pre- mechanisms natal and birth services; day-care and preschool centers; During home visits systematic monitoring is carried differentiated support (ie: subsidies) for children from the out to evaluate children’s development, and families’ poorest 40% of families; and each child receives biopsy- ability to stimulate children. Diagnosis of children’s chosocial support to monitor the trajectory of their ECD. level of development is used to evaluate language and fine more skills, perception, and emotional relationships in order to establish a development profile which is used to assemble first grade classes. In conjunction with Educa a Tu Hijo, two other The primary target for CHCC is children under four national programs – círculos infantiles, and Sa- years of age. In 2007 , the program was deployed in lones de Preescolar – provide early education 161 of the 345 communes (smallest administrative programs to nearly 100% of children from birth subdivision in Chile). Starting in 2008 the program Coverage/access to age six. Of which, Educa a Tu Hijo services began being rolled out in the remaining communities. 71%. Access is free of charge, and all children As of the end of 2008, 473,000 children under the age must be accompanied by a family member. of two had been incorporated into the system. During 2009 children up to the age of four were incorporated. Educa a Tu Hijo is a non-institutionalized, community- Coordination of CHCC is the responsibility of the based program that is part of the National Action Ministry of Planning (MIDEPLAN), specifically the Plan, which was established in 1991 by Cuba and Executive Secretariat for Social Protection. Several Institutional involved all of the bodies of the Central Administra- others institutions are important strategic partners arrangements tion of the State. The program is run by the MoE, including: MoH; MoE; Ministry of Labour; National which places the family at the center of program Women’s Service (SERNAM); JUNJI; INTEGRA ; activities. Assemblies of peoples’ power participate JUNAEB and the National Disability Fund (FONADIS). at the national, provincial and municipal levels. Due to the fact that the program is executed by MIDEPLAN reports that the CHCC had a budget of different sectors and receives funding from the $25,388,224,000 pesos for 2009, which represents a Financing/cost- MoE amongst other bodies, it is difficult to provide 159% increase over 2008. At $14,231,107 ,000 pesos, the effectiveness a budgetary breakdown. Approximately 0.26% biopsychosocial development component is the largest. to 0.32% of GDP went to Educa a Tu Hijo. Administrative costs account for $392,510,000 pesos. Strengthening Early Childhood Development Policies 48 and Programs in Latin America and the Caribbean ECD Intervention Educa a Tu Hijo (Cuba) Chile Crece Contigo (Chile) Teams of promoters and facilitators carry out Educa a Tu Hijo. The role of promoters (primarily teachers, The numerous interventions are provided and educators, and health professionals) is to educate the implemented using a comprehensive and coordinated community, mobilize resources, train facilitators, and approach that requires several public service providers. provide pedagogical guidance. Facilitators (primar- For instance, the differentiated support and guarantees ily health staff and educators) are responsible for component for children from the homes with low demonstrating stimulation exercises and techniques income (bottom 40% in Chile) provides services that for parents and children, assessing children’s range from livelihood training for unemployed parents Service providers development, and ensuring that families put their to free healthcare for children with mothers who are new skills to practice. The sessions are broken working, studying, or who have special needs. down into three periods: initial phase, intermediate phase, and closing phase. Promoters and facilitators The health sector is one more of the more important include people from: MoE; MoH; Ministry of Culture; actors, with many provisions of services including the National Institute of Sports, Physical Education, and initial pregnancy consultation; prenatal and postnatal Recreation; family and community members; Federa- car; birth; and biopsychosocial development support. tion of Cuban Women; amongst other sources. MIDEPLAN and the World Bank are working together Continuous and frequent evaluation of the Educa to strengthen the capacity for evaluation and monitor- a Tu Hijo program is conducted to determine the ing of social programs and policies. This includes the Quality assurance quality of the program and its processes. Children, design of an integrated system of monitoring for mechanisms parents, and workers and organizations that CHCC; evaluation of the effectiveness of addressing provide services participate in the evaluations. the needs of the beneficiaries; and the completion of the evaluation of the implementation of CHCC. - One obstacle with Educa a Tu Hijo is that com- munities may have a lack of experience with Chile Crece Contigo is still very much in the infant programs that span sectors. To respond to this stage. For this reason, many of the challenges in the Challenges for going near future relate to the implementation and policy to scale and improving issue it is important to provide ongoing training to increase the level of quality of local participation. adoption of CHCC. In particular, this involves expand- service delivery ing awareness of the intrinsic features of CHCC and - Volunteers are not always available they apply to children in all areas of the country. which creates logistical concerns. Legend: low coverage / uncertain sustainability medium coverage / medium sustainability high coverage / high sustainability 49 ©Scott Wallace/WORLD BANK