100078  Albania   SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2015     Policy Goals Status 1. Establishing an Enabling Environment Albania has a well-developed set of laws governing sectoral policy and service  delivery for all children (0-18 years old). However, an enabling environment specifically for early childhood development (ECD) is not streamlined. Limited mechanisms are in place to align multi-sector policymaking to promote holistic development of children younger than 6 years old. An institutional anchor to coordinate ECD across sectors does not exist. The education sector reports expenditures on pre-primary education, but the government cannot accurately report public ECD expenditures in the health, nutrition, or child and social protection sectors.  2. Implementing Widely A wide scope of ECD services exists in Albania, including maternal and child  health care, pre-primary education, and programs for vulnerable children. However, levels of coverage vary. For example, prenatal care and childhood immunizations are close to universal, yet roughly one in three pregnant women have anemia and nearly one in five children suffer from moderate/severe stunting, suggesting limited access to nutrition interventions. Only one-third of children have access to pre-primary education. While some ECD services are provided equitably, such as birth registration and prenatal care, inequities exist for some essential ECD services, particularly in the education sector. The net pre-primary enrollment rate for the richest quintile of children is twice as high (48 percent) than the poorest quintile (23 percent). 3. Monitoring and Assuring Quality The government collects administrative data related to access to most ECD  services, but individual children’s development outcomes are not tracked. Standards for early learning have been developed, and a new early childhood education curriculum framework is under development. The inspection process for ECD facilities is in the process of reform. It would be useful for the government to institute a streamlined inspection process to ensure compliance with quality standards.        ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015   This report presents an analysis of the early childhood A series of disparate ECDͲrelevant laws covering health, development (ECD) programs and policies that affect education, nutrition, and child and social protection exist young children in Albania and recommendations in Albania. There is no overarching ECD law or policy; to move forward. This report is part of a series of reports rather, an Action Plan for Children (2012Ͳ2015)—drafted preparedbytheWorldBankinJuly2014usingtheSABERͲ andapproved by the Ministryof Labor,SocialAffairs,and ECD framework1and includes analysis of early learning, Equal Opportunities (MoLSAEO)—guides the overall health, nutrition, and social and child protection policies policies for children in Albania. The Ministry created the and interventions in Albania, along with regional and StateAgencyonProtectionofChildren’sRights(SAPCR)to internationalcomparisons. promote children’s protection and social inclusion, rights to health care and education, but the agency does not focus solely on ECDͲaged children (i.e., children under 6 AlbaniaandEarlyChildhoodDevelopment years old), and instead is charged with overseeing the rights of all children, ages 0Ͳ18. Other relevant ministries, Albania has a population of over 3 million people, of mainly the Ministry of Education and Sports (MoES) and which about 20 percent, or approximately 600,000, are the Ministry of Health (MoH), implement services for under the age of 14. Just over half (52 percent) of the young children. The National Council for Children’s Rights populationlivesinurbancenters.2Albaniaranked70thout aids the SAPCR in protecting and promoting children’s of 187 countries in the United Nations Development rights. Program’s Human Development Index.  The per capita Table 1 provides a snapshot of ECD indicators in Albania income was estimated in 2012 to be $8,200, ranking with regional comparisons. Stunting rates in Albania are Albania 131st in the world for this indicator. The country the highest compared to other countries in the region deriveslessthanoneͲfifth(17.5percent)ofitsGDPfrom listed in Table 1. Albania has the second highest stunting agriculture. In 2008, 12.5 percent of the population was rate in the region next to Ukraine and much higher than estimatedtobelivingbelowthepovertyline.3 neighboring countries of similar income levels such as  BosniaͲHerzegovenia 4 . Only 33% of children age 3Ͳ6 benefitfrompreprimaryeducation.  Table1:SnapshotofECDindicatorsinAlbaniawithregionalcomparison Bosniaand  Albania Croatia Macedonia Serbia Herzegovina InfantMortality(deathsper1,000livebirths,2010) 8.8 6 4 7 24 Below5Mortality(deathsper1,000livebirths,2010) 17 7 5 7 7 Moderate&SevereStunting(Below5,2006Ͳ2010) 19% 8.9% Nodata 4.9% 6.6% NetPreͲprimaryEnrollmentRate(3Ͳ6years,2011Ͳ 33% 11.6% 63.8% 23.5% 55.6% 2012) Birthregistration2005Ͳ2012 98.6% 99.5% Nodata 99.7% 98.9% Source: UNICEF Country Statistics (2012); UNESCO, Institute of Statistics (2012); Albania Ministry of Health (infant and child mortality); Albania Living Standards MeasurementStudy(preͲprimaryenrollment).  1 SABERͲECDisonedomainwithintheWorldBankinitiative,SystemsApproachforBetterEducationResults(SABER),whichisdesignedtoprovidecomparableand comprehensiveassessmentsofcountrypolicies. 2 CIAFactbook,2014. 3 CIAFactbook,2014. 4 NutritionataGlance,2011.  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  2 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  SystemsApproachforBetterEducation Box1:AchecklisttoconsiderhowwellECDispromotedat thecountrylevel Results–EarlyChildhoodDevelopment Whatshouldbeinplaceatthecountryleveltopromote (SABERǦECD) coordinatedandintegratedECDinterventionsforyoung SABER–ECD collects, analyzes, and disseminates childrenandtheirfamilies? comprehensive information on ECD policies around the Healthcare world. In each participating country, extensive multiͲ x Standardhealthscreeningsforpregnantwomen sectoral information is collected on ECD policies and x Skilledattendantsatdelivery programsthroughadeskreviewofavailablegovernment x Childhoodimmunizations documents, data, and literature, and interviews with a x WellͲchildvisits range of ECD stakeholders, including government Nutrition officials, service providers, civil society, development x Breastfeedingpromotion partners, and scholars. The SABERͲECD framework x Saltiodization x Ironfortification presentsaholisticandintegratedassessmentofhowthe x Micronutrientsupplementation overall policy environment in a country affects young EarlyLearning children’sdevelopment.Thisassessmentcanbeusedto x Parenting programs (during pregnancy, after delivery, identify how countries address the same policy andthroughoutearlychildhood) challenges related to ECD, with the ultimate goal of x HighͲqualitychildcareforworkingparents designing effective policies for young children and their x Free preͲprimary school (preferably at least two years families. with developmentally appropriate curriculum and  classrooms,andqualityassurancemechanisms) Box 1 presents an abbreviated list of interventions and SocialProtection policies that the SABERͲECD approach looks for in x Servicesfororphansandvulnerablechildren countries when assessing the level of ECD policy x Policies to protect rights of children with special needs development.Thislist isnotexhaustive,but is meant to andpromotetheirparticipation/accesstoECDservices provide an initial checklist for countries to consider the x Financial transfer mechanisms or income supports to keypoliciesandinterventionsneededacrosssectors. reach the most vulnerable families (could include cash transfers,socialwelfare,etc.) Š”‡‡‡›‘Ž‹…› ‘ƒŽ•ˆ‘”ƒ”Ž›Š‹Ž†Š‘‘†‡˜‡Ž‘’‡– ChildProtection x Mandatedbirthregistration SABERͲECD identifies three core policy goals that x Job protection and breastfeeding breaks for new countries should address to ensure optimal ECD mothers outcomes: Establishing an Enabling Environment, x Specificprovisionsinjudicialsystemforyoungchildren Implementing Widely, and Monitoring and Assuring x Guaranteedpaidparentalleaveofleastsixmonths Quality.ImprovingECDrequiresanintegratedapproach x Domesticviolencelawsandenforcement to address all three goals. As described in Figure 1, for x Trackingofchildabuse(especiallyforyoungchildren) each policy goal, a series of policy levers are identified, x Training for law enforcement officers in regards to the throughwhichdecisionͲmakerscanstrengthenECD. particularneedsofyoungchildren   Strengthening ECD policies can be viewed as a Figure1:ThreecoreECDpolicygoals continuum; as described in Table 2 on the following  page,countriescanrangefromalatenttoadvancedlevel of development within the different policy levers and goals.     SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  3 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  Table2:ECDpolicygoalsandlevelsofdevelopment LevelofDevelopment ECDPolicyGoal  Minimallegal Regulationsinsome NonͲexistentlegal Developedlegal Establishingan framework;some sectors;functioning framework;adͲhoc framework;robustinterͲ Enabling programswithsustained interͲsectoral financing;lowinterͲ institutionalcoordination; Environment financing;someinterͲ coordination;sustained sectoralcoordination. sustainedfinancing. sectoralcoordination. financing. Coverageexpandingbut NearͲuniversalcoverage Universalcoverage; Lowcoverage;pilot gapsremain;programs insomesectors; comprehensivestrategies Implementing programsinsome establishedinafew establishedprogramsin acrosssectors;integrated Widely sectors;highinequality sectors;inequalityin mostsectors;low servicesforall,some inaccessandoutcomes. accessandoutcomes. inequalityinaccess. tailoredandtargeted. Informationon Informationon outcomesatnational, Informationonoutcomes Minimalsurveydata outcomesatnational regionalandlocallevels; fromnationaltoindividual Monitoringand available;limited level;standardsfor standardsforservices levels;standardsexistfor Assuring standardsforprovision servicesexistinsome existformostsectors; allsectors;systeminplace Quality ofECDservices;no sectors;nosystemto systeminplaceto toregularlymonitorand enforcement. monitorcompliance. regularlymonitor enforcecompliance. compliance. Policy Goal 1: Establishing an Enabling Lawsandregulationspromoteadequatehealthcarefor pregnantwomenandchildren.Allpregnantwomenare Environment entitled to antenatal visits; uninsured women are ¾ PolicyLevers:LegalFramework• entitledtofourvisits,includingthreeultrasoundsduring IntersectoralCoordination•Finance pregnancy. The Government of Albania (GoA) provides skilled care to pregnant women during pregnancy, Anenablingenvironmentisthefoundationforthedesign delivery,andafterthebirthofthechildaspartofabasic and implementation of effective ECD policies. 5  An package of services for primary health care. Pregnant enabling environment consists of the following: the womenreceiveprenatalcareaccordingtotheGuideline existenceofanadequatelegalandregulatoryframework and Protocol of Antenatal Care. HIV screening of to support ECD; coordination within sectors and across pregnant women is not mandatory, but is encouraged institutions to deliver services effectively; and sufficient and HIVͲpositive women are referred for services. fiscal resources with transparent and efficient allocation Children are required to receive immunizations mechanisms. according to a national immunization program calendar administeredbytheInstituteofPublicHealth(IPH)atthe Policy Lever 1.1: Ministry of Health (MoH). Children are also required to LegalFramework have regular wellͲchild visits according to a schedule definedbytheGuidelineandProtocolof‘PostnatalCare’ The legal framework comprises all of the laws and and ‘Child WellͲbeing and Development.’ These include regulations that can affect the development of young one home visit by a doctor between the 1st and 3rd day children in a country. The laws and regulations which after the child leaves the maternity hospital, one home impact ECD are diverse due to the array of sectors that visit by a nurse between the 3rd and 5th day followed by influence ECD and because of the different constituencies another visit at the third week, monthly visits until the that ECD policy can and should target, including pregnant child is 12 months old, quarterly visits from ages 1 to 3, women,youngchildren,parents,andcaregivers. andacomprehensiveexamatage6priortoenteringfirst  grade.  5 Brinkerhoff,2009;Britto,Yoshikawa&Boller,2011;VargasͲBaron,2005. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  4 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  National laws promote dietary consumption by Albanian law does not mandate preͲprimary school pregnant women and young children. Albanian laws education.ThegovernmentpassedLawNo.62in2012that encourage breastfeeding and require the iodization of callsforfreeandmandatoryeducation,butthelawapplies salt. However, according to the MoH, there is no policy only to children ages 6Ͳ16. PreͲprimary school is not requiring cereals or other food staples to be fortified mentioned in the law. The government’s vision is to withiron.Yet,onethirdofbothAlbanianchildrenunder mandatethelastyearofkindergartenby2017.Otherlaws 5 years of age and pregnant women are anemic (WHO, establish goals for the functioning of nurseries serving 2005). Recognizing that iodine deficiency in young childrenages0Ͳ3andpreschoolsforchildrenages3Ͳ6,but children or pregnant women can lead to cognitive do not mandate free services. In Albania, the government impairments, the government should consider callsforallpreͲuniversityeducationtobefreeofcharge.At mandating iron fortification of food staples to address thekindergartenandnurserylevel,feesareonlyappliedfor thisissueatscale.Fortifyingflourandotherstaplefoods meals. This expense is subsidized by local government withvitamin A,folicacid,ironandzinc hasbeenproven units. asacostͲeffectivemeansofreducinganaemiaandbirth Child and social protections are established in Albania. defects6. Albanianlawmandatestheregistrationofchildrenatbirth. Laws protect new mothers’ ability to provide care to Lawsalsosafeguardagainstdomesticviolenceandprovide theirnewbornsduringthefirstyearoflife.In2010,the protectiontovictimsofviolenceinthehome.TheMinistry government ratified the Maternity Protection ofWelfareandYouth(MoWY)istheleadauthorityinissues Convention. Albanian law requires the government to related to domestic violence, but several other ministries provide one year of paid maternity leave to new are also involved, including the Ministry of Interior (MoI), mothers. Article 105 of the Labor Code prevents a MoH, the Ministry of Justice (MoJ), and the Ministry of pregnant woman from losing her job due to her Education and Sports (MoES). Amendments to the law pregnancy.AndadecisionbytheCouncilofMinistersin address parental obligations and issues such as abuse and 1996 required employers to guarantee women nursing neglect. breaks. Box 2 provides an overview of key laws, Law enforcement officers are trained in the prevention of regulations,andpoliciesgoverningECDinAlbania. domesticviolenceandtheprosecutionofperpetratorsand Box 2: Key laws, regulations, and policies governing ECD in family courts address issues regarding children ages 0Ͳ18. Albania The Action Plan for Children, which is in the process of x LawNo.8876forReproductiveHealth(2002) implementation, calls for training for judges and lawyers x ActionPlanforChildren(2012Ͳ2015) x LawfortheProtectionofChildren’sRights(2010) involvedinchildprotectionissues. x LawNo.9952forthePreventionandControlofHIV/AIDS(2008) Severallawshavebeenpassedtoprovideprotectionand x MinistryofHealth,GuidelinesforAntenatalCare(2013) x Law No. 8528 for the Encouragement and Protection of ECD services to orphans and vulnerable children and Breastfeeding(1999) children with special needs. Albania has established x StrategicDocumentforReproductiveHealth(2009Ͳ2015) ResidentialSocialCareInstitutionsfororphansandchildren x LawNo.9942forthePreventionofDisordersCausedbyIodine facing vulnerable conditions, including those exposed to Deficiency(2008) x LawNo.7703onSocialInsurance domestic violence, a risk of trafficking, or homelessness. x Decision of the Council of Ministers, No. 397 to allow nursing However,thelawdoesnotdifferentiatebyage,butinstead breaksfornewmothersduringworkinghours(1996) coverschildrenages0Ͳ18. x LawNo.69onethePreͲUniversityEducationSystem(2012) x LawNo.10129forCivilStatus(2009) Children with special needs are given access to public x LawNo.9669forthePreventionofFamilyViolence preschools and are covered by social protection policies x LawNo.8153fortheStatusofOrphans(1996) x LawNo.9355forSocialAssistanceandSocialServices(2005) that provide social insurance according to disability type. x Guideline No. 7, Procedures and Documents (for birth One of the strategic goals of the Action Plan for Children registrations)(2010) (2012Ͳ2015) is inclusive and quality education for all Source:GovernmentofAlbania. children. It calls for the inclusion of Roma children in preͲ   primary education and their smooth transition to first  grade. The Plan also calls for inclusion and individualized work with children with special needs. The government  6 MicronutrientInitiative.2009.InvestingintheFuture:AUnitedCallto ActiononVitaminandMineralDeficiencies SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  5 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  tracks children with disabilities, including mental, physical, Council of Ministers (CoM) decided in 2012 to establish visual,andhearing. regulations for collaboration between state and nonͲ state actors involved in child protection policies and PolicyLever1.2: servicedeliveryaimedatatͲriskchildren. IntersectoralCoordination Development in early childhood is a multidimensional PolicyLever1.3: process.7Inordertomeetchildren’sdiverseneedsduring Finance the early years, government coordination is essential, While legal frameworks and intersectoral coordination both horizontally across different sectors as well as are crucial to establishing an enabling environment for vertically from the local to national levels. In many ECD,adequatefinancialinvestmentiskeytoensurethat countries, nonͲstate actors (either domestic or resourcesareavailabletoimplementpoliciesandachieve international)participateinECDservicedelivery;forthis serviceprovisiongoals.InvestmentsinECDcanyieldhigh reason,mechanismstocoordinatewithnonͲstateactors public returns, but are often undersupplied without arealsoessential. government support. Investments during the early years Albania does not have a multiͲsectoral ECD policy and can yield greater returns than equivalent investments noministryorgovernmentbodyhasbeenappointedas made later in a child’s life cycle and can lead to longͲ an institutional anchor specifically to coordinate ECD lasting intergenerational benefits. 8 Not only do services. The government has not endorsed a investmentsinECDgeneratehighandpersistentreturns, comprehensive ECD policy or initiated a method of they can also enhance the effectiveness of other social implementing ECD services across sectors that is investments and help governments address multiple coordinated by one government body. In 2011, the prioritieswithasingleinvestment. government approved a regulatory framework for the Criteria are used for budget planning in some sectors, organizationandfunctioningoftheStateAgencyforthe but not others; budgets are not coordinated across Protection of Children’s Rights (SAPCR). The Action Plan sectors. There is a transparent budget process involving forChildren(2012Ͳ2015)outlinesstrategiesforensuring specific criteria to provide ECD services in health, that children receive services in various sectors and education, and social protection, but not in nutrition or authorizes the SAPCR to oversee implementation of the child protection. There is no coordination of an ECD plan and to work across sectors to ensure that the plan budget across sectors. No specific budget exists for ECD is followed. However, the Agency is charged with services. Expenditures are reported for kindergartens overseeingstrategiesforallchildren,ages0Ͳ18,andhas only. The parliament has passed a resolution calling on not created a department specifically to address the thegovernmenttofundECDservicesacrosssectors. needsofECDͲagedchildren. The level of financing for ECD services is either not Limited mechanisms exist for multiͲsectoral known or is inadequate to meet the needs of the coordination specifically for the 0Ͳ6 age group. While population.Withtheexceptionoftheeducationsector, the SAPCR does coordinate across sectors, there is total expenditures specifically for services across ECD currently no institutional structure for crossͲsector sectors are not reported. The SAPCR, MoWY, and MoH collaboration to address the specific needs of children cannot accurately report total expenditures for ECD ages 0Ͳ6. Additionally, no specific manual or integrated services within their respective sectors. The MoWY service delivery guidelines exist for this age group. reportstotalexpendituresforsocialprotectionservices, Mechanisms to promote coordination across relevant butnotspecificallyfortheECDͲagedpopulation. ministriesareneededinAlbaniatofacilitatealignedECD policy development and implementation with clearly In 2013, MoES allocated 3 billion lek to kindergarten, delineatedresponsibilities. representing 7.2 percent of the total Education budget. Fees are levied for ECD services in education for tuition The National Council for the Protection of Children’s and meals. There are no fees levied for health services Rights (NCPCR) has interͲministerial and civil society for pregnant women or young children. However, the representation,butdoesnotmeetonaregularbasis.The level of outͲofͲpocket expenditures as a percentage of  7 Naudeauetal.,2011;UNESCOͲOREALC,2004;Neuman,2007. 8 Valerio&Garcia,2012;WHO,2005;Hanushek&Kimko,2000;Hanushek& Luque,2003. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  6 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  total health expenditures is quite high, at 52 percent.9 and young children. Albanian law guarantees free Table5providesasnapshotoftotalpublicexpenditures access to a menu of health and nutrition on education and ECCE in Albania. Table 6 provides a interventions, but does not require screening of HIV comparison of regional health care expenditures in or STDs for pregnant women or the fortification with AlbaniaandfourotherEasternEuropeancountries. ironofcerealsandotherstaples.Bymandatingthese  two additional interventions and creating Table5:TotalpublicexpendituresoneducationandECCEin mechanisms for outreach to the community to Albania encourage uptake of services, the government could Totalpublic Totalpublic improvewomenandchildren’shealth. Totalpublic expenditureon Totalpublic expenditureon  expenditureon educationas%expenditureon ECCEas%of ¾ The government should consider working towards education ofgovernment ECCE education mandatory free preͲprimary school in the future. expenditure expenditures The government has established comprehensive 2013 42,499,732,000 10.7% 3,077,387,000 7.2% education laws mandating free and mandatory 2012 42,479,116,000 10.1% 2,749,860,000 6.5% schooling for children ages 6Ͳ16, but has not 2011 40,293,501,000 10.7% 2,774,901,000 6.9% Source:MinistryofEducationandSports,SABERͲECDPolicyInstrument,2014. extended the law to preͲprimary schoolͲaged  children.Thegovernmentvisiontomandatethelast Table6:Regionalcomparisonofselecthealthexpenditure year of kindergarten by 2017 is commendable. The indicators1 government could also encourage enrollment in  Albania Bosnia Croatia Macedonia Serbia lower levels of preͲprimary school. Although this OutͲofͲpocket maybedifficultintheshorttermgiventhetightfiscal expenditureasa 52% 28% 14% 36% 37% space, some efficiency gains could be achieved percentageoftotal healthexpenditures throughthedecliningstudentpopulationinprimary Totalexpenditureon andsecondarylevels,allowingthegovernmenttoat health/capitaat 541 928 1,410 835 1,250 least enhance access for poor and vulnerable purchasingpower parity(NCU/US$) children. Privateexpenditureon health(PvtHE)asa%of 52% 29% 18% 36% 39% –‡”•‡…–‘”ƒŽ‘‘”†‹ƒ–‹‘ǣ totalhealth expenditure ¾ The government may consider developing a multiͲ Totalhealthexpenditure 6% 10% 7% 7% 10% sectoral ECD strategy. The government has not asapercentageofGDP Percentageofroutine established coordination between sectors involved EPIvaccinesfinancedby 100% Nodata 100% Nodata Nodata inECDservicedelivery.Indoingso,thegovernment government would be able to improve synergies in integrated Source: WHO Global Health Expenditure Database, 2012; UNICEF Country Statistics,2010;InstituteofPublicHealth(EPIvaccinefinancinginAlbania). service delivery, define how to effectively reach the poorest households, and to track services and The level of pay for employees in some ECD services is fundingacrosssectorsandbetterallocateresources high, but not for others. The MoES pays preͲprimary to the sectors and services most in need. A good schoolteachers a minimum of 96 percent of what example of this strategy occurred in 2005 in Chile primary schoolteachers make. However, employees of when the government introduced the Chile Crece communityͲbased child care centers are not paid by the Contigo (CCC) intersectoral ECD policy, a multiͲ government,butinsteadarepaidbydifferentnonͲstate disciplinary approach to ECD service delivery. The organizations, such as Save the Children. The government may benefit from studying the CCC governmentdoesnotpayextensionhealthcareworkers. program and considering the adoption of a similar multiͲsectoral system in Albania. Box 3 describes PolicyOptionstoStrengthentheEnabling Chile’sECDintersectoralsystemindetail. EnvironmentforECDinAlbania ‡‰ƒŽˆ”ƒ‡™‘”ǣ ¾ The government may wish to consider expanding laws to promote health care for pregnant women  9 WorldHealthOrganization. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  7 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  ¾ Box3:LessonsfromChile:Multisectoralpolicydesignand ECD policy matters. Details of the commission are implementation describedinBox4onthenextpage.  Summary: A multisectoral ECD policy articulates the services ‹ƒ…‡ǣ provided to children and key stakeholders involved, including  responsibilities of service providers and policymakers. The policy ¾ The government may wish to establish criteria to should also present the legal and regulatory framework and determine ECD funding earmarked for services in  address any possible gaps. A policy can include a set of goals or nutrition and child and social protection. The objectivesandanimplementationplanthatoutlineshowtheywill  government currently determines funding based on be achieved. The benefits of doing so are manifold. The preparationprocessrequiresallstakeholderstocontribute,which specific criteria in the education and health sectors  inturnpromotesamoreholistic,synergeticapproachtoECDand only. The relevant ministries involved in nutrition  identifies possible duplication of objectives by individual and child and social development may also benefit stakeholders.Anotherbenefitisthatthepolicyframeworkclarifies from developing mechanisms to track specific  the boundaries within which all stakeholders are to operate and criteriatodetermineabudgetforECDͲagedchildren.  cancreateaccountabilitymechanisms. ¾ Thegovernmentmaywishtocreateamechanismto OnesuchexampleisChileCreceContigo(“ChileGrowsWithYou,”  report ECD expenditures across health, nutrition, or CCC), an intersectoral policy introduced in 2005. The multiͲ  disciplinary approach is designed to achieve high quality ECD by and protection sectors. With the overall budget for protecting children from conception with relevant and timely ECD services drawn from disparate sectors, it is  services that provide opportunities for early stimulation and critical that mechanisms exist to coordinate development. A core element of the system is that it provides budgeting and allocations amongst key agencies.  differentiated support and guarantees children from the poorest Currently, only the MoES reports expenditures, and  40 percent of households’ key services, including free access to does so for preͲprimary schools only. The MoH preͲprimary school. Furthermore, the CCC mandates provision of  services for orphans and vulnerable children and children with cannotaccuratelyreportexpendituresforhealthand special needs. The creation and implementation of the CCC has nutrition services specifically allocated towards the  ECDͲaged population. Similarly, the SAPCR does not been accomplished through a multisectoral, highly synergistic  approach at all levels of government. At the central level, the report total expenditures on child protection PresidentialCouncilisresponsibleforthedevelopment,planning, services. The MoWY reports total expenditures on  and budgeting of the program. At each of the national, regional, socialprotectionservices,butnotspecificallyforthe provincial, and local levels there are institutional bodies tasked  with supervision and support, operative action, as well as ECD age group. By creating mechanisms to report  development, planning, and budgeting for each respective level. expenditures in other ECD sectors, the government TheChileCreceContigoLaw(No.20.379)wascreatedin2009. may be able to determine where money would be  KeyconsiderationsforAlbania: betterallocatedtopromotedesiredECDoutcomes.  9 Multisectoralpolicythatarticulatesresponsibilitiesfor ¾ Thegovernmentmaywishtoconsiderestablishinga eachgovernmententity mechanism to coordinate the budget across ECD  9 Highlysynergeticapproachtoservicedelivery 9 Guaranteedsupportforpooresthouseholds sectors. By coordinating an ECD budget across  sectors,the governmentmaybebetter equipped to  determine where there are shortages of funds and wherefundswouldbestbeallocatedtoreapdesired ¾ The government may wish to consider appointing ECDoutcomes. one government entity to coordinate ECD services across sectors. While the SAPCR has been  establishedtopromotetherightsofchildrenaged0Ͳ 18,ithasnotbeenspecificallymandatedtooversee the delivery of ECD services, or to coordinate  servicesacrosssectors.Byappointinganinstitutional anchor,thegovernmentwouldbebetterpositioned  to ensure that ECD policies and service delivery mechanisms reached all ECDͲaged children in all  sectors.Thegovernmentmaybenefitfromlookingat the example of Jamaica. The government there  established an Early Childhood Commission responsibleforadvisingtheMinistryofEducationon SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  8 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  Box 4: Relevant lessons from Jamaica: multisectoral regions and socioeconomic groups – especially for the institutionalarrangementsforECD mostdisadvantagedyoungchildrenandtheirfamilies. Summary:In2003,theGovernmentofJamaicaestablishedtheEarly  Childhood Commission (ECC) as an official agency to govern the PolicyLever2.1: administration of ECD in Jamaica (Early Childhood Commission Act). Operating under the Ministry of Education (MoE), the ECC is ScopeofPrograms responsible for advising the MoE on ECD policy matters. It assists in thepreparationaswellasmonitoringandevaluationofECDplansand Effective ECD systems have programs established in all programs,actsasacoordinatingagencytostreamlineECDactivities, essential sectors and ensure that every child and managesthenationalECDbudget,andsupervisesandregulatesearly expectant mother have guaranteed access to the childhood institutions (ECIs). The ECC includes a governance arm essential services and interventions they need to live comprised of the officially appointed Executive Director, a Board of Commissioners, and seven subͲcommittees representing healthfully.Thescopeofprogramsassessestheextentto governmental and nonͲgovernmental organizations. It also has an which ECD programs across key sectors reach all operational arm that provides support to the board and beneficiaries. Figure 2 presents a summary of the key subcommittees. The ECC is designed with representation from all interventionsneededtosupportyoungchildrenandtheir relevant sectors, including education, health, local government and families via different sectors at different stages in a community development, labor, finance, protection, and planning. Each ministry or government agency nominates a representative to child’slife. serveontheBoardofCommissioners.ThesevensubͲcommitteesthat Albaniahasimplementedessentialhealthandnutrition provide technical support to the ECC board are comprised of 50 governmentalandnonͲgovernmentalagencies. programs that target all beneficiary groups. The MoH Furthermore, the newly established National Parenting Support providesapackageofessentialhealthcareinterventions Commission creates links between Jamaican parents and the that target all pregnant women and children, including Government of Jamaica. In 2012, the MoE introduced the National antenatal care, immunizations, child wellness visits, Parenting Support Policy. The government recognized that parents should serve an important role to promote and coordinate screening for maternal depression, and home visits for organizational efforts and resources for positive parenting practices. parents with young children. Nutrition programs have The National Parenting Support Commission Act further established alsobeenestablishedtotargetallbeneficiaries,including an official coordinating body to ensure effective streamlining of micronutrientsupportforpregnantwomenandchildren governmentactivitiesrelatedtoparenting. younger than 7 years old, the promotion of KeyconsiderationsforAlbania: breastfeeding,andfeedingatpreͲprimaryschools. 9 Established crossͲsectoral institutional anchor with representation from all relevant sectors, including Essential education programs exist in the country to education, health, local government and community target preͲprimary schoolͲage children. Albania has development,labor,finance,protection,andplanning public preschools and kindergartens as well as private, 9 Highlysynergeticapproachtopolicydesign 9 Improved coordination amongst relevant sectors to forͲprofit ECCE centers for children aged 3Ͳ5. There are effectively respond to the comprehensive developmental also partialͲday public and private ECE centers for needsofyoungchildren. children ages 0Ͳ36 months. There are parents committees at all preͲprimary schools and daycare  centers. PolicyGoal2:ImplementingWidely Essentialchildandsocialprotectionprogramstargetall ¾ PolicyLevers:ScopeofPrograms• beneficiaries. Albania has residential and social care Coverage•Equity institutions for orphans and vulnerable children, as well Implementing Widely refers to the scope of ECD as children with special needs. Free antiͲretroviral programsavailable,theextentofcoverage(asashareof medicationisprovidedforchildrenwithHIV/AIDS.Some the eligible population), and the degree of equity within social assistance programs are available that  focus ECD service provision. By definition, a focus on ECD partially on ECD. A pilot program to offer cash transfers involves (at a minimum) interventions in health, for enrollment in preͲprimary school operates in three nutrition,education,andsocialandchildprotection,and districts. shouldtargetpregnantwomen,youngchildren,andtheir  parents and caregivers. A robust ECD policy should On thefollowing page, Figure3providesanoverviewof includeprogramsinallessentialsectors,whileproviding the scope of ECD interventions in Albania by target comparable coverage and equitable access across population and sector. Table 7 provides an overview of thescaleofECDservicesinAlbania.  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  9 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015   Figure2:Essentialinterventionsduringdifferentperiodsofyoungchildren'sdevelopment    Figure3:ScopeofECDinterventionsinAlbaniabytargetpopulationandsector    SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  10 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  PolicyLever2.2:Coverage Table9providesaregionalcomparisonoflevelsofaccess to essential nutrition interventions for ECDͲaged children in Albania and four other Eastern European countries, A robust ECD policy should establish programs in all suggesting much room for improvement for overall essential sectors, ensure high degrees of coverage and nutritionofyoungchildren.NineteenpercentofAlbanian reach the entire population equitably–especially the childrenbelow5yearsaremoderatelyorseverelystunted. most disadvantaged young children–so that every child Additionally,Albaniahasthehighestprevalenceofanemia and expectant mother have guaranteed access to in children below 5 amongst the comparator countries essentialECDservices. listedinTable9. Access to essential ECD health and nutrition Table 9: Regional comparison of levels of access to essential interventions varies for pregnant women and young nutritioninterventionsforECDͲagedchildren children.Morethan99percentofpregnantwomengive Albania Bosnia Croatia Macedonia Serbia birth in the presence of a skilled attendant and 97 1ͲyearͲoldchildren percent attend at least one antenatal visit. Far fewer, immunizedagainstDPT 99% 92% 96% 96% 91% however, roughly 67 percent, benefit from at least four (corresponding antenatal visits during their pregnancies. According to vaccinesDPT3) Childrenbelow5with theInstituteofPublicHealth,in2013,therewasonlyone moderate/severe 19% 8.9% Nodata 4.9% 6.6% case of an HIV+ woman who received antiͲretroviral stunting medicines for the prevention of motherͲtoͲchild Infantsexclusively transmissionofHIV.While99percentof1ͲyearͲoldsare breastfeduntil6 38.6% 18.5% Nodata 23% 13.7% months immunized against DPT, other indicators of the breadth Infantswithlowbirth of coverage of health interventions are lower. Only 54 weight 3.6% 3.1% 5% 5.5% 6.1% percent of children with diarrhea receive oral Prevalenceofanemia rehydrationandcontinuedfeeding,andslightlylessthan inchildrenbelow5 31% 27% 23% 26% 29% 60percentreceiveantibioticsforsuspectedpneumonia. (2005) There is no information on the number of children who Source:UNICEFCountryStatistics,2007Ͳ2012;WHOGlobalDatabaseon Anemia,2005. receive Vitamin A supplementation. Table 8 provides a regional comparison of levels of access to essential ThevastmajorityofnewbornsareregisteredinAlbania. health and nutrition interventions for pregnant women Albania has a very high birth registration rate, at 98.6 inAlbaniaandfourotherEasternEuropeancountries. percent. Albanian laws provides for all children to be registered. The state police and municipality are Table 8: Regional comparison of levels of access to essential healthandnutritioninterventionsforpregnantwomen responsible for identifying children who have been  Albania Bosnia Croatia Macedonia Serbia abandoned or have not been registered and registering Skilledattendant 99.9 them with local authorities. Table 10 provides a 99.3% 100% 98% 99.8% comparisonofbirthregistrationratesinAlbaniaandfour atbirth % Pregnantwomen otherEasternEuropeancountries. receiving antenatal 66.8% 84.2% Nodata 93.9% 94.2% Table 10:Regionalcomparisonofbirthregistrationrate care(atleastfour Albania Bosnia Croatia Macedonia Serbia visits) Birthregistration 98.6% 99.5% Nodata 99.7% 99.7% Pregnantwomen 2000Ͳ2010 receiving Source:UNICEFMICS4,2011;UNICEFCountryStatistics,2007Ͳ 2011. antenatal 97.3% 87% Nodata 98.6% 99%  care(atleastone Albanian children have limited access to early learning visit) Prevalenceof opportunities.Earlychildhoodeducation(ECE)coverage anemiain No in Albania is gradually expanding. Yet the country is still 31% Nodata Nodata Nodata pregnantwomen data lagging behind other countries in the subͲregion. (2005) Comparedwithregionalandinternationalcountries,the Source: UNICEF Country Statistics, 2007Ͳ2012; UNAIDS, 2012; WHO Global DatabaseonAnemia,2006. levelofenrollmentinpreschoolislowinAlbania.Figure 4 displays the most recently reported gross preͲprimary enrollment ratios for selected European countries SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  11 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  (UNESCO). In 2012, the gross preͲprimary enrollment learn from countries in the subͲregion and highͲ ratio in Albania for children ages 3Ͳ6 years old was 69 performing EU member countries that have reached percent,whichreflectthenumberofchildrenenrolledin universal access and should consider developing preͲprimary (regardless of age) as a percent of the total strategies to ensure universal coverage of quality preͲ ECCE age population. During the period 2002Ͳ2012, the primary education. Box 5 reviews the provision of ECCE percentage of all children ages 3Ͳ6 enrolled in inFrance. kindergartens increased from 41 to 69 percent. Box 5: Relevant lessons from France: Adequate provision of Notwithstanding the continued increase in preprimary earlychildhoodcareandeducation enrollment rate (as shown in Figure 4), Albania still falls behindinprovidingearlychildhoodeducationcompared šƒ’Ž‡ ˆ”‘ ”ƒ…‡ǣ ƒ”Ž› Š‹Ž†Š‘‘† ƒ”‡ ƒ† to some East European countries. Belarus and Ukraine †—…ƒ–‹‘ are amongst the top performers in the subͲregion, with Publicly funded early childhood education (ECE) is well enrollmentof103percentand101percent,respectively. established and has a long history in France. Since the Internationally, countries such as Denmark, France, and eighties, ECE is the embedded under the auspices of the MinistryofEducation(MoE).Childrenhavealegalrightto Swedenhavealsoachieveduniversalcoverage. a place in a preschool from the age of three. France has Figure4:Grossenrollmentrate(ages3Ͳ6)inselectedEast one of the highest levels of publicly funded universal ECE Europeancountries provisionamongsttheEUcountriesforchildrenaged3Ͳ5. 120 France invests considerably in childcare and education EnrollmentRatio(%) services in the years preceding formal school entry and PreprimaryGross 100 Albania has achieved remarkable success in terms of providing 80 equal opportunities for children. The ecole maternelle is Belarus 60 the dominant institutional form of ECE provision for 40 Bulgaria childrenaged3yearstoschoolentryage,providingafullͲ 20 Hungary day service throughout the school year. Alongside the 0 ecoles maternelles, there are a number of other forms of Slovenia services outside the education system, particularly for 2002 2004 2006 2008 2010 2012 Ukraine children under 3 years of age, administered under the Year joint responsibility of the Ministry of Employment, Social Cohesion and Housing and the Ministry of Health and  Solidarity. Publicly subsidized centreͲbased services Source:UNESCOInstituteofStatistics include: childcare centers (etablissements d’accueil In addition, reported net enrollment rates range regulier), parent coͲoperatives (etablissements a gestion depending on the source, from 33 percent (Living parentale), multiͲcare (multiͲacceuil) and ‘kindergartens’ Standards Measurement Study, or LSMS, 2012) to 69 (jardins d’enfants) providing flexible childcare services. percent (Institute for Statistics, 2012). According to the Familydaycare(Assistancematernelle)andfamilycrèche 2012 LSMS data, the main reasons parents report as to (service d’accueil familial) are other forms of childcare whytheydonotsendtheirchildrentopreschoolarethat provision forchildrenunder3. Furthermore, a number of they believe their children are too young or they prefer other innovative services have been established with the aim to provide equitable access in rural and urban areas, tokeepthemathome.MorethantwoͲthirdsofparents including: mobile services (services itinerants) and open of children ages 3Ͳ4 years old who were not attending doorservices(lieuxd’accueilenfantsparents). preschool thought their children were too young,  suggesting that perhaps early learning experiences are BuildingontheexperiencesofthemajorityofEuropean not appropriately catered to the younger age group. countries that have well established ECCE systems and Nearly oneͲquarter of parents of all ECDͲaged children services such as France for example, the GoA is highly (3Ͳ6 years) reported that they preferred to keep their encouraged to improve its ECCE provision both in terms childrenathome. ofaccessandquality.Attheregionallevel,theEuropean Furthermore, while Albania’s Action Plan for Children Union (Eurydice) as well as the OECD lead the analysis (2012Ͳ2015) calls for the inclusion of Roma children in and policy dialogue in the subͲsector in order to shape preͲprimary education and their smooth transition to orientations for further improvement. Box 6 presents first grade, young children that are not enrolled in someofthehighlightsoftheEurydiceKeyDataonEarly kindergartens are predominantly young Roma children whoactuallyneedECCEmost.TheGoAisencouragedto SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  12 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  Childhood Education and Care in Europe report10(2014) PolicyLever2.3:Equity which provides a system analysis of the structure, organization, and funding of early childhood care and education in Europe, including insights into what Based on the robust evidence of the positive effects ECD constitutes high quality early childhood care and interventions can have for children from disadvantaged education through policyͲdriven and internationally backgrounds, every government should pay special comparableindicators. attentiontoequitableprovisionofECDservices.11Oneof Box 6: Early childhood care and education: key highlights the fundamental goals of any ECD policy should be to fromEurope provideequitableopportunitiestoallyoungchildrenand theirfamilies. EarlyChildhoodEducationandCareinEurope There is equity in service delivery across many ECD Thereporthighlightsanumberofissuesofparticularinterest to policyͲmakers including: access to ECEC; participation; sectors,butindicatorssuggestthatdeliveryisnotequal governance; funding and affordability; professionalization of across geographic areas. Disparity between urban and staff;leadership;parentalinvolvement;and,theprovisionof rural is evident in the birth weights of newborns, with targetedsupportfordisadvantagedchildren. twiceasmanypoorchildrenbornwithlowbirthweights Keyfindingsofthereportarethefollowing: as wealthier children. Other health and nutrition (i) EightEuropeancountriesguaranteeeverychildanearly indicators suggest parity in service delivery between placeinECEC–oftendirectlyfollowingchildcareleave; (ii) In most European countries, ECEC is split into two urbanandrural.Figure5providesasnapshotofequityin separatephasesaccordingtoage; three selected health, nutrition, and social protection (iii) Participation in ECEC is low for the underͲ3s, but high ECDindicatorsinruralandurbanareasinAlbania. during the year or two before starting primary Figure 5: Selected health, nutrition, and protection ECD education; indicatorsinruralandurbanareasinAlbania (iv) International student achievement surveys (PISA and PIRLS)clearlyshowthebenefitsofECECattendance; (v) Fees for ECEC vary considerably between European countries but around half provide education free of chargefromage3; (vi) LocalauthoritiesoftenfinanceECECforyoungerchildren while they share costs with the central level for older children; (vii) Educationalstaffworkingwitholderchildrenareusually required to have a Bachelor's degree as a minimum qualification; (viii) HeadsofECECsettingsneedrelevantexperienceinmost countries,buttheyreceivespecificmanagementtraining infewercountries; (ix) Allcountriessetlearningobjectivesrelatedtochildren's progressanddevelopment; (x) Most countries regularly assess children's progress and payspecialattentiontothetransitionbetweenECECand  primaryeducation; (xi) Many countries recommend that settings provide Thereisparitybetweenrichandpoorinaccesstosome support for parents and involve them in ECEC essential ECD services, but disparities exist in newborn governance; (xii) Disadvantaged children have lower ECEC participation birth weight. Birth registration among the richest and rates, even though most countries offer meansͲtested poorestAlbaniansisalmostequal,asisaccesstoaskilled financialsupporttoparents;and attendant during labor. However, the number of poor (xiii) Supportmeasuresfordisadvantagedchildrenexistin children born with low birth weights is greater than the mostEuropeancountries;inmostcasestheyfocuson number of rich children born with low birth rates— languagedevelopment. suggesting that poor pregnant women are not receiving  equal access to essential health and nutrition services.  10 11 EuropeanCommission/EACEA/Eurydice/Eurostat,2014.KeyDataonEarly Engleetal,2011;Naudeauetal.,2011. ChildhoodEducationandCareinEurope.2014Edition.EurydiceandEurostat Report.Luxembourg:PublicationsOfficeoftheEuropeanUnion. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  13 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  Figure 6 provides a snapshot of these selected health, Figure7:Earlylearningindicatorsfortherichestandpoorest nutrition,andsocialprotectionindicatorsfortherichest quintilesinAlbania andpoorestinAlbania. Figure6:Selectedhealth,nutrition,andprotectionECD indicatorsforrichestandpoorestquintileinAlbania   PolicyOptionstoImplementECDWidelyin Albania Wide disparities between rich and poor exist in the …‘’‡‘ˆ”‘‰”ƒ• ECCE sector. Only roughly a quarter of the poorest quintileofAlbanianchildrenattendspreͲprimaryschool, ¾ The government may consider implementing an while60percentofchildrenfromtherichestquintiledo. integrated program to provide ECD services across The gap in prevalence of learning materials for children all four sectors. Such a move would help to provide at home is even wider, with just 15.5 percent of comprehensive interventions to ECDͲaged children Albanians from the poorest quintile providing learning based on individual need. The government may materials at home, compared to 52.3 percent of the benefit from studying the Colombian example, children in the wealthiest quintile. The gap in adult where an ECD strategy called De Cero a Siempre, or support for learning is also substantial: 68.1 percent of “From Zero to Forever,” was recently implemented. Albanians in the poorest quintile supported learning, Box7describesthestrategyindetail. while96.2percentinthewealthiestquintiledid.Figure7 ¾ In the more immediate term, the government may provides a snapshot of the disparity in early learning considerestablishingparentingprogramstoensure indicators between the richest and poorest quintiles in that young children benefit from appropriate early Albania. learning opportunities. Such programs would provide appropriate training to parents to enable them provide enriching learning opportunities at home before their children go to school. Through effective coordination between existing programs across the different sectors, parenting programs couldbeaneffectivewaytoaddressyoungchildren’s earlylearningneedsintheshortterm. ‘˜‡”ƒ‰‡ ¾ The government may consider increasing outreach to pregnant women and women with young children to ensure essential health and nutrition servicesareutilized.Byincreasingawarenessamong womenoftheimportanceofantenatalcheckupsand goodnutritionduringpregnancy,thegovernment SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  14 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  may be able to increase the number of times “—‹–› pregnantwomenseeadoctor.Similarly,byreaching ¾ The government should consider improving access outtowomenwithnutritionandhealthinformation, to early learning opportunities for young Albanian the government may be able to increase the children from a disadvantaged background. percentageofchildrenwhoreceiveoralrehydration Evidence suggests that lack of appropriate early for diarrhea and antibiotics for suspected learningplacepoorchildrenatadisadvantagebefore pneumonia. they start school. The GoA should ensure access to ¾ The government may consider increasing outreach education for all children regardless of ethnicity, effortstotargetmotherstoincreasebreastfeeding. economic status, or place of residence, primarily While the government has infantͲfriendly programs targetingthemostdisadvantagedchildren. in hospitals, raising awareness of the benefits of ¾ The government may consider implementing breastfeeding through enhanced outreach may nutrition programs for young children and poor increase the number of women who choose to pregnant women to reduce stunting and ensure exclusivelybreastfeedtheirnewbornsforthefirstsix normalbirthweightofnewborns.ManyofAlbania’s months. ECDservicesappeartobeequitablydeliveredacross ¾ The government could benefit by focusing coverage socioeconomic levels and across demographics, but of health care services on children aged 0Ͳ3. The nutrition outcomes suggest a significant disparity in governmentcurrentlyfocusesitshealthcareservices theuptakeofessentialhealthandnutritionservices. forchildrenonallchildrenaged0Ͳ18.Byfocusingon Nearly one in five Albanian children suffer from health care services by age, including a focus moderate or severe stunting. Poorer women give specifically on ECDͲaged children, the government birthtolowbirthweightbabiesatagreaterratethan could improve essential health outcomes for young rich women. Increasing coverage of micronutrient children. programs and supplemental feeding programs in ¾ The government should consider existing entry poorerareasmayreducethedisparity betweenrich pointsandcommunityoutreachtoensurethatECDͲ andpoorinthebirthweightofnewborns. aged children are provided with appropriate early Box 7: Lessons from Colombia: From Zero to Forever learning opportunities before entry to primary strategyandschemeforcomprehensiveservices school.  While Albania has implemented free preͲ  Summary:TheGovernmentofColombiahasrecentlydeveloped primary schools for ECDͲaged children, less than 40  the De Cero a Siempre, or “From Zero to Forever,” strategy to percent of ECDͲaged children are enrolled in preͲ promote comprehensive ECD system across relevant sectors. A  major component of the new strategy is the Ruta Integral de primaryschool.Expandingapilotprogramdesigned Atenciones,orthe“SchemeforComprehensiveServices,”which to provide cash transfers to parents to enroll their  is an established list of specific ECD services that should be childreninpreͲprimaryschoolmaybeagoodoption delivered to all young children. This Ruta Integral provides an for the government to consider for increasing  operationalframeworkthatspansfromtheprenatalperiodto6 enrollment. Another idea is to offer communityͲ years of age and includes interventions related to the health,  nutrition, socioͲemotional development, cultural based grants for the establishment of new preͲ understanding,andprotectionofthechild.Colombia’snewECD  primary education programs through a communityͲ strategy emphasizes implementation at the local level; each driven development approach, targeting areas with  municipality is expected to establish a municipal ECD poor or vulnerable children. To ensure young committee. These municipal committees are responsible for  coordinating interventions at the level of service delivery to children receive adequate stimulation at home, ensurethatchildrenreceiveallessentialservicesoutlinedinthe healthworkerscouldbetrainedtotalktocaretakers  RutaIntegral. about the importance of early exposure to reading.  KeyconsiderationsforAlbania: At the same time, health service delivery points for 9 BecausepolicydecisionsandinterventionsinECDspan young children could be used as opportunities to  acrossmultipleministriesinAlbania,itisimportantto providefreebooksforfamiliestotakehome.Finally,  haveacommonplanofaction,notonlyatthepolicylevel, the government may consider a comprehensive butattheservicedeliveryandlocallevel. media and information campaign targeting parents  of young children, with key messages developed by  a government entity appointed to coordinate ECD  servicesacrosssectors. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  15 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  PolicyGoal3:MonitoringandAssuring Table11:AvailabilityofdatatomonitorECDinAlbania IndicatorsͲͲGeneral Source Quality INSTAT(Inst.Of NumberofChildrenaccordingtoagegroups Statistics) ¾ PolicyLevers:DataAvailability• IndicatorsforChildandSocialProtection Source QualityStandards•Compliancewith Numberofchildreninresidentialsocialinstitutions StateSocialServices (ages0Ͳ6) (SSS) Standards SSS Numberofpeoplewithdisabilities,byage Monitoring and Assuring Quality refers to the existence Numberofchildreninfostercare,byage SSS Adoption ofinformationsystemstomonitoraccesstoECDservices Numberofchildreninadoptionprocess,byage Committee and outcomes across children, standards for ECD Adoption services,andsystemstomonitorandenforcecompliance Numberofchildrenadopted,byage Committee with those standards. Ensuring the quality of ECD Numberofchildrentrafficked,byage MinistryofInterior interventions is vital because evidence has shown that Numberofcasesopenedforchildrenatriskatlocal Children’s level,byage ProtectionUnit unless programs are of high quality, the impact on Numberofchildrenreportingviolence,byage StatePolice childrencanbenegligible,orevendetrimental. IndicatorsforHealth Source Maternal,infant,andchildmortality0Ͳ5yearsold MoH PolicyLever3.1: Numberofchildrenbornunderweight MoH DataAvailability %ofchildrenbreastfed(agegroups) Surveillancestudies Accurate,comprehensive,andtimelydatacollectioncan %ofchildrenunder5whoareunderweight Surveillancestudies %ofchildrenunder5whoareoverweight Surveillancestudies promote more effective policyͲmaking. WellͲdeveloped Prevalenceofiodineandsaltdeficiencyamong information systems can improve decisionͲmaking. In Surveillancestudies childrenandpregnantwomen particular, data can inform policy choices regarding the InstituteofPublic Immunization(%ofchildrengettingimmunized) volume and allocation of public financing, staff Health,MoH recruitmentandtraining,programquality,adherenceto Antenatalcare MoH standards,andeffortstotargetchildrenmostinneed. Numberofchildrenattendingwellchildvisits MoH Numberofchildrenbenefitingfrompublicnutrition MoH Data are collected in all ECD sectors. The government interventions collects data on enrollment and usage of services in all Numberofwomenreceivingprenatalnutrition MoH interventions fourECDsectors,butdoesnotcollectdataontrainingof ECDspendinginhealthsectordifferentiatedwithin service providers and tracks child outcomes only in MoH healthbudget healthandnutrition.Dataarecollectedonenrollmentin IndicatorsforEducation Source preͲprimaryschoolatthesubͲnationallevelandinclude %ofchildren6Ͳ7yearsoldregisteredatschool(NET  metrics on urban/rural, gender, ethnic minority status, enrollmentrate) INSTAT Commune/ and special needs. Data on health indicators are also Numberofchildreninnursery/creche municipality collected at the subnational level and according to %ofchildren3Ͳ6yearsoldregisteredin  whetherthechildisurbanorrural.Dataarenotcollected kindergarten,comparedtoallchildren0Ͳ3 INSTAT forECDͲagedchildreninthesecategoriesinthenutrition ECCEenrollmentratesbyregion INSTAT sectororinthechildandsocialprotectionsector. SpecialneedschildrenenrolledinECCE(numberof) MoES ChildrenenrolledinECCEbysubͲnationalregion MoES Dataarenotcollectedtomeasurechilddevelopmentin (numberof) several categories. There are no data collected on AverageperstudentͲtoͲteacherratioinpublicECCE MoES cognitive,linguistic,physical,orsocioͲemotionallevelsof ECCEspendingineducationsectordifferentiated MoES withineducationbudget development among ECDͲaged children. Similarly, Source:CounselofMinisters,DecisionNo.267,2012.12 individual children’s development outcomes are not  tracked. Table 11 provides a comprehensive list of the availability of data to monitor ECD in Albania and the  institutionresponsibleforgatheringthedata.   12 IndicatorsdescribedinTable11arethoserelatedtoECD;additional info/dataonchildren(0Ͳ18)areincludedinthedecisiontableoftheCounsel ofMinisters. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  16 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  PolicyLever3.2: Health workers are required to receive training in QualityStandards delivering ECD messaging. Doctors, midwives, and psychologists receive training in ECD messaging, EnsuringqualityECDserviceprovisionisessential.Afocus including developmental milestones, child care, on access – without a commensurate focus on ensuring parenting,andmethodsofearlystimulationmethodsto quality–jeopardizestheverybenefitsthatpolicymakers enhance early child development. In addition to basic hope children will gain through ECD interventions. The ECD messaging, health workers could be trained to also quality of ECD programs is directly related to better talkaboutpreͲprimaryeducationenrollment.Thismight cognitiveandsocialdevelopmentinchildren.13 be a multiͲsectoral strategy to take advantage of an existing entry point, particularly in delivering basic MechanismsforensuringqualitypreͲprimaryeducation messagestopoorandruralfamilies. inAlbaniaarecritical.AccordingtotheOECD(2011),15Ͳ yearͲold students in Albania who had attended some The childͲtoͲteacher ratio is high and there is no preͲprimary school scored only 18 points higher on the standard for the minimum number of hours a preͲ PISA reading assessment than those who did not. The primary school must remain open. ChildͲtoͲteacher effectofpreͲprimaryschoolonreadingscoresatage15 ratios in Albania are high for small children, at 7:1 for isquitelowcompared to other countries.InKyrgyzstan, nurseries.ThereisnoofficialratioforECDͲagedchildren, forexample, studentswhoattendedpreͲprimaryschool but a MoES directive allows for a ratio of between 10:1 scoredanaverageof47pointshigherthanthosewhodid and 25:1, depending on whether the children are urban not;andinallOECDcountries,theaverageadvantageof or rural. Albanian law specifies the number of hours an preͲprimarywas33points. ECD learning center must remain open for 18Ͳ to 36Ͳ monthͲolds only (from 6 a.m. to 7 p.m.), but does not Standards for what children should learn exist, but specify the hours of operation for institutions serving there is no approved curriculum. In 2003, the Institute other ages other than to say that centers should offer for Education Department established learning fullͲorhalfͲdayservices. standards, called the Albanian Achievement Standards, for ECDͲaged children that include physical health, Infrastructure and construction standards for ECD approaches to learning, social and emotional facilities exist: Guidelines for nurseries and healthcare development,cognitiveandlinguisticdevelopment,and facilitiesareissuedbytheMoH,andguidelinesforpreͲ motorskillsdevelopment. TheInstitute isinthe process primary schools are set forth by the MoES. MoH of developing a new curriculum framework that will guidelines specify that nurseries, which provide for replaceanexistingone. children aged 0Ͳ36 months, should be 25 square meters ThereisahighleveloftrainingrequiredtobecomepreͲ at both public and private institutions. The MoES primary schoolteachers and there is regular inͲservice requirespreͲprimaryschoolsto provide20to25square training. PreͲprimary schoolteachers must obtain a metersofspaceperclassroomatbothpublicandprivate bachelor’s degree and pass an annual exam. Failing the preschools. Similarly, the MoH has established examorreceivinglowscoresforfiveyearsresultsinthe construction standards for hospitals and other health teacher losing his or her license. Credits and carefacilities. qualifications must be continually upgraded and preͲ Some mechanisms exist to enforce requirements, but primary schoolteachers must complete inͲservice quality monitoring could be improved. Responsibility training. Caretakers at nurseries and crèches that serve for identifying quality improvements to ECCE centers children aged 0Ͳ3 must be nurses. However, there is no now rests with local authorities and the state public authority in charge of preͲservice fieldwork and construction inspectorate. The inspection process is in fieldworkisnotrequired. process of reform. The State Inspectorate of Education will be responsible for monitoring compliance with quality standards for preͲprimary. An inspectorate of health and inspectorate of construction also exist. New  13 Taylor&Bennett,2008;Bryceetal,2003;Naudeauetal,2011;Victoriaet al,2003. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  17 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  quality standards for construction of schools are under for individual children, and then tracked over time. developmentandstillneedtobeapproved. ThegovernmentmaywishtoreviewtheChileCrece Contigo program for direction in this lever of ECD PolicyLever3.3: policy. The CCC program created a Biopsychosocial CompliancewithStandards Development Support Program that tracked individualchildren,makingitpossibleforECDservice Establishing standards is essential to providing quality providersinallECDsectorstoaccessachild’srecord. ECD services and to promoting the healthy development Box 8 provides details of the CCC data collection of children. Once standards have been established, it is strategy. critical that mechanisms are put in place to ensure Box8:LessonsfromChile:Thebiopsychosocialdevelopment compliancewithstandards. supportprogram Compliance with infrastructure standards is unknown. Summary:ChileCreceContigo,or“ChileGrowsWithYou”:One Nodataarereportedtotrackwhetherinstitutionsmeet oftheprogram’skeyaccomplishmentsistheabilitytoprovide construction standards. Local government units and timely, targeted service delivery. A core element that makes regionaleducationofficesareresponsibleformonitoring this possible is the Biopsychosocial Development Support compliancewithstandards.Anewregulatoryframework Program,whichtrackstheindividualdevelopmentofchildren. The program commences during the mother’s initial prenatal is being developed and should better delineate checkͲup, at which point an individual “score card” is created monitoringroles. forthechild.EachoftheprimaryactorswithintheChileCrece Contigo comprehensive service network – including family A majority of preͲprimary schoolteachers comply with support unit, public health system, public education system, teacherqualificationsrequirements.Almost60percent andothersocialservices–haveaccesstothechild’sfileandare of public preͲprimary schoolteachers and 78 percent of required to update it as the child progresses through the private preͲprimary schoolteachers hold a bachelor’s differentECDservices.Ifthereisanykindofvulnerability,such as inadequate nutrition, the system identifies the required degreeasrequiredbyMoESstandards. servicetoaddressthisissue.Throughtheintegratedapproach PreͲprimary schools comply with childͲtoͲteacher ratio toservicedeliveryandinformationsystemmanagement,these services are delivered at the right time and in a relevant guidelinessetbytheMoESandareopenforatleast15 manner,accordingtoeachchild’sneed. hours per week. Public and private preͲprimary schools appear to comply with childͲtoͲteacher ratios, though KeyconsiderationsforAlbania: 9 Streamlinedchildmonitoring private schools maintain a slightly better ratio than 9 Responsivesystemthattailorstotheindividual publicschools—18.4to1atpublicschoolsand15.8to1 child’sneed atprivateschools.PublicpreͲprimaryschoolsoperatean averageof30hoursperweek; dataarenotavailableon  hours of operation for private preͲprimary schools; —ƒŽ‹–›–ƒ†ƒ”†• similarly, there is no data available on compliance with constructionstandardsatpublicorprivateECDcenters. ¾ The government could consider streamlining the quality inspection process to ensure collaboration PolicyOptionstoMonitorandAssureECD betweennationalandlocalgovernmentsaswellas QualityinAlbania across the health and education sectors. The MoES maywishtoconsiderstrengtheningthedepartment ƒ–ƒ˜ƒ‹Žƒ„‹Ž‹–›ǣ responsible for overseeing construction of preͲ ¾ Streamlining the system to collect timely ECD data. primaryschoolstoensurethatqualitystandardsare The government may benefit from tracking the maintained. The Ministry may also wish to move cognitive, linguistic, physical, and socioͲemotional forward with approving a document outlining development of preͲprimary school children. By standards that is currently under development. By tracking the individual development of children, the outlining a clear registration and accreditation government would be able to ensure that a process,thegovernmentcanassureuniformquality comprehensive network of ECD services benefited standardsofECDcentersacrossgeographiclocations everychild.Aphasedapproachcouldbeconsidered inAlbania. starting with defining the data to be collected ¾ ThegovernmentmaywishtoconsiderrequiringpreͲ (including data on child development outcomes), servicefieldworkforpreͲprimaryschoolteachers followed by ensuring the defined data are collected SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  18 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  andappointingapublicauthoritytooverseepreͲservice ‘’Ž‹ƒ…‡™‹–Š–ƒ†ƒ”†• requirements. The MoES may wish to apply preͲservice ¾ The government may consider establishing legally practicums or fieldwork for preͲprimary schoolteachers binding requirements for ECCE service provision to similar to the requirements for teachers of first grade. guarantee that acceptable minimum standards are While most preͲprimary schoolteachers in Albania are met. highlyeducated,addingthiselementtotheircurriculum mayhelptoenhancethequalityofECDeducation. ¾ Implementing measures to ensure that preͲprimary  schools are inspected and in compliance with Box 9: Lessons from Jamaica: Ensuring quality in ECCE building codes. Regular inspection of preͲprimary provision schools for compliance with building codes is important. The Ministry may also wish to develop a Summary:TheEarlyChildhoodCommission(ECC)inJamaicahasthe responsibility to ensure the integrated and coordinated delivery of mechanism to oversee private preͲprimary schools, early childhood services. The Commission has a range of legislated for which compliance with infrastructure standards functions, one of which indicates direct responsibility to supervise andhoursofoperationarecurrentlyunknown. andregulateearlychildhoodinstitutions(ECI). Standards for the operation, management, and administration of ¾ ECD service delivery would benefit if the ECIs:TherearetwotypesofStandards;thosetransmittedbyanAct governmentconsideredstreamliningtheinspection or Regulations and which therefore carry legal consequences and process for nurseries serving children ages 0Ͳ3. those that serve to improve practice voluntarily and are not legally Studying the service delivery oversight mechanism binding. For practical purposes, quality standards for ECIs include bothsetsofstandards,withclearindicationsofthosestandardsthat established by the Government of Jamaica may be arelegallybinding. useful. Jamaica streamlined inspection and Standard statements for ECI: to improve the quality of services registration under the authority of one body to provided by ECIs, the ECC has developed a range of robust ensure compliance with ECD standards. Box 9 operational quality standards for ECIs. The Act and Regulations, which together comprise the legal requirements, specify the describes in detail the Jamaican oversight minimum levels of practice below which institutions will not be mechanisms employed to ensure compliance with registeredorallowedtooperate.Thestandardsthatarenotlegally qualitystandards. binding define best practices for early childhood institutions and servetoencourageinstitutionstoraisetheirlevelofpracticeabove minimum requirements. While ECIs are encouraged to achieve the ComparingOfficialPolicieswithOutcomes highestpossiblestandardstoensurethebestoutcomesforchildren, In many countries, policies on paper and the reality of thelegallybindingstandardsguaranteethatminimumstandardsare access and service delivery on the ground are not met. aligned. For instance, Albanian law encourages new Inspection and registration: Inspection of ECIs is the procedure designated under the Early Childhood Act for ensuring that mothers to breastfeed their infants for the first six operators comply with the minimum acceptable standards of months of life, but less than 40 percent of women practice.TheECCisrequiredtoinspecteachECItwiceannually.Itis exclusively breastfeed for 6 months. Similarly, Albania a requirement of registration that the registered operator coͲ hasapolicytoprovideiodizedsalt,butoneͲfourthofthe operates with the ECC’s inspection process. The “registered populationdoesnotconsumesaltthathasiodineadded. operator”isdefinedasthepersonrequiredtoapplyforregistration ofanECIandmaybeanindividualoragroup. PreͲprimary school is not mentioned in the country’s KeyLessonsforAlbania: education laws guaranteeing access to free education 9 Consider establishing legally binding requirements for (those apply only to children aged 6Ͳ16) and fewer than ECCE service provision to guarantee that acceptable 40 percent of ECDͲaged children in Albania are enrolled minimumstandardsaremet. 9 Consider assigning a special entity with a delineated role in a public or private preͲprimary school. Table 12 to monitor and regulate ECCE service providers. An comparesECDpolicieswithECDoutcomesinAlbania. improved quality monitoring system will ensure that best outcomesareachieved.              SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  19 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  Table12:ComparingECDpolicieswithoutcomesinAlbania PreliminaryBenchmarkingandInternational ECDPolicies  Outcomes ComparisonofECDinAlbania Lawcomplieswiththe Exclusivebreastfeeding On the following page, Table 13 presents the InternationalCodeofMarketing  rate(>6mo.): classification of ECD policy in Albania within each of the ofBreastMilkSubstitutes 38.6%  Householdiodizedsalt ninepolicyleversandthreepolicygoals.TheSABERͲECD Albaniahasnationalpolicyto consumption classification system does not rank countries according encouragetheiodizationofsalt 75.6% to any overall scoring; rather, it is intended to share PreͲprimaryschoolisnot  PreͲprimaryschool information on how different ECD systems address the coveredbyAlbania’seducation enrollment: samepolicychallenges. laws 39.8% Youngchildrenarerequiredto  ChildrenwithDPT(12Ͳ Table 14 presents the status of ECD policy development receiveacompletecourseof 23months): in Albania alongside a selection of OECD countries. childhoodimmunizations 99% Albania’s ECD system functions on par with these  Completenessofbirth countries, performing better than some in a few policy Policymandatestheregistration registration: levers.Forinstance,Albania’scoverageofECDprograms ofchildrenatbirthinAlbania 98.6% and equitable distribution of ECD services score higher Source:UNICEF,CountryStatistics;GovernmentofAlbania. than countries of comparison. While policy levers  covering data availability, quality standards, and compliance ranked as “emerging,” they are on par with other countries listed. And while Albania’s coordination of services across sectors was very low, at “latent,” severalothercountriesofcomparisonalsorankedlowin thatcategory. Table13:BenchmarkingEarlyChildhoodDevelopmentPolicyinAlbania Levelof Levelof ECDPolicyGoal PolicyLever Development Development LegalFramework  EstablishinganEnabling  Environment InterͲsectoralCoordination   Finance ScopeofPrograms   ImplementingWidely Coverage  Equity  DataAvailability  MonitoringandAssuring  Quality QualityStandards   CompliancewithStandards  Latent Emerging Established Advanced Legend:     SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  20 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015    Table14:InternationalClassificationandComparisonofECDSystems LevelofDevelopment ECDPolicyGoal PolicyLever Kyrgyz Russian Albania Armenia Bulgaria Republic Federation LegalFramework      Establishingan Enabling Coordination      Environment Finance      ScopeofPrograms      Implementing Coverage  Widely     Equity      DataAvailability      Monitoringand QualityStandards  AssuringQuality     Compliancewith Standards      Latent Emerging Established Advanced Legend:  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  21 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015   Conclusion establish a stronger enabling environment, it is The SABERͲECD initiative is designed to enable ECD recommended that Albania consider establishing free policymakers and development partners to identify preͲprimary school for children aged 3 to 5 and opportunities for further development of effective ECD appointing a body to oversee intersectoral coordination systems. This Country Report presents a framework to among ECD sectors, among other policy suggestions. To compare Albania’s ECD system with other countries in implement ECD services more widely, Albania may the region and internationally. Each of the nine policy consider integrating service delivery across sectors and levers is examined in detail and some policy options increasing outreach to pregnant women. To better identifiedtostrengthenECDareoffered. monitor quality of ECD services, the government may wish to streamline data collection as well as the Table15summarizesthekeypolicyoptionsidentifiedto inspection process in place to ensure compliance with inform policy dialogue and improve the provision of qualitystandards. essentialECDservicesinAlbania.Forinstance,to   Table15:SummaryofpolicyoptionstoimproveECDinAlbania Policy PolicyOptionsandRecommendations Dimension x EstablishfreepreͲprimaryschoolforchildrenaged3to5 x Expandlawstopromoteessentialhealthandnutritionservicestowomenandyoung children Establishingan x DevelopamultiͲsectoralstrategy Enabling x AppointaninstitutionalanchortocoordinateECDservicedelivery Environment x CreateamechanismtocoordinatethebudgetacrossECDsectors x EstablishandutilizespecificcriteriatodeterminethebudgetforallECDsectors x SetupamechanismtoreportECDexpendituresinallECDsectors x ImplementanintegratedprogramtodeliveryECDservicesacrosssectors x Establishparentingprogramstoensurethatyoungchildrenbenefitfromappropriateearly learningopportunities x Increaseoutreachtopregnantwomenandparentsofyoungchildrentoensurethat essentialhealthandnutritionservicesareutilized x Increaseoutreachtopregnantwomentoencouragebreastfeedingexclusivelyduringthe first6monthsoftheirnewborn’slife Implementing x FocuscoverageofECDservicesonchildrenaged0Ͳ3 Widely x Improvingaccesstoearlylearningopportunitiesforyoungchildren,targetingthosefroma disadvantagedbackground x Scaleupimplementationofcashtransferprogramsdesignedtoencourageparentsto enrolltheirchildreninpreͲprimaryschool x Implementprogramsorworkwithdevelopmentagenciestoimplementprograms designedtoprimarilyreducestuntingbutalsotoincreasenutritionalintakeamong poorpregnantwomentoclosethegapinbirthweightofnewbornsbetweenrichand poor x Implementasystemtotracklinguistic,cognitive,physical,andotherchilddevelopment indicators x Streamlinethecollectionofdatatoensuredataarecollectedinatimelymanner x EstablisharegistrationandaccreditationprocessforpublicandprivatepreͲprimary schools Monitoringand x RequirepreͲservicefieldworkandappointagovernmentbodytooverseepreͲservice AssuringQuality compliance x ImplementmeasurestoensurethatpublicandprivatepreͲprimaryschoolscomplywith buildingcodes x Streamlinetheinspectionprocessunderonebodymandatedtoensurecompliancewith qualitystandards SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  22 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  Acknowledgements This Country Report was prepared by Deborah Horan (Consultant, Education Global Practice, World Bank) with inputs from Rebecca Sayre (Consultant, Education Global Practice, World Bank) and Amina Denboba (Consultant, Education Global Practice, World Bank), and under the direction of Quentin Wodon (Adviser, Education Global Practice, World Bank). The report presents country data collected using the SABERͲECD policy and program data collection instruments anddatafromexternalsources.Thereportwaspreparedin consultationwith EuropeandCentralAsiaEducationGlobal PracticeteamandtheGovernmentofAlbania.WeareespeciallygratefulfortheguidanceandassistanceofKeikoInoue (Senior Education Specialist, Education Global Practice, World Bank). For technical questions or comments about this report,pleasecontacttheSABERͲECDteam(helpdeskecd@worldbank.org). Acronyms CCC  ChileCreceContigo(“ChilesGrowWithYou”) CoM  CouncilofMinisters ECC  EarlyChildhoodCommission(Jamaica) ECI  EarlyChildhoodInstitution(Jamaica) ECCE  EarlyChildhoodCareandEducation ECD  EarlyChildhoodDevelopment ECE EarlyChildhoodEducation(usedinterchangeablywithpreͲprimaryorpreschool) ECEC EarlyChildhoodEducationandCare GoA GovernmentofAlbania IPH InstituteofPublicHealth MoES MinistryofEducationandSports MoH MinistryofHealth MoJ MinistryofJustice MoLSAEO MinistryofLabor,SocialAffairsandEqualOpportunities MoWY MinistryofWelfareandYouth NCPCR NationalCouncilfortheProtectionofChildren’sRights SABER SystemsApproachforBetterEducationResults SAPCR StateAgencyfortheProtectionofChildren’sRights SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  23 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  References SABERͲECDPolicyInstrument,Albania2014 SABERͲECDProgramInstrument,Albania2014 Britto,P.,Yoshikawa,H.,Boller,K.2011.“QualityofEarlyChildhoodDevelopmentPrograms:RationaleforInvestment, ConceptualFrameworkandImplicationsforEquity.”SocialPolicyReport,25(2):1Ͳ31. Engle,P.L.,L.C.H.Fernald,H.Alderman,J.Behrman,C.O’Gara,A.Yousafzai,M.CabraldeMello,M.Hidrobo,N. Ulkuer,andtheGlobalChildDevelopmentSteerGroup.“Strategiesforreducinginequalitiesandimproving developmentaloutcomesforyoungchildreninlowͲincomeandmiddleͲincomecountries.”TheLancet,Early OnlinePublication,23September2011.Doi:10.1016/S0140Ͳ6736(11)60889Ͳ1. Hanushek,E.(2003)."TheFailureofInputͲBasedSchoolingPolicies."TheEconomicJournal113;64Ͳ98. Hanushek,E.A.andD.D.Kimko.(2000).“Schooling,LaborͲForceQuality,andtheGrowthofNations."TheAmerican EconomicReview,Vol.90,No.5,1184Ͳ1208. Naudeau,S,N.Kataoka,A.Valerio,M.J.Neuman,L.K.Elder.2011.InvestinginYoungChildren:AnEarlyChildhood DevelopmentGuideforPolicyDialogueandProjectPreparation.WorldBank,Washington,DC. Neuman,M.&Devercelli,A.2013."WhatMattersMostforEarlyChildhoodDevelopment:AFrameworkPaper." SABER,WorldBank,WashingtonDC Neuman,M.J.2007.“GoodGovernanceofEarlyChildhoodCareandEducation:Lessonsfromthe2007Educationfor AllGlobalMonitoringReport.”UNESCOPolicyBriefsonEarlyChildhood.UnitedNationsEducational,Scientificand CulturalOrganization,NewYork. OECD(OrganisationforEconomicCoͲoperationandDevelopment).2011.“StartingStrongIII:AQualityToolboxfor EarlyChildhoodEducationandCare.”OECDPublications,Paris. UNESCOͲOREALC.2004.“IntersectoralCoͲordinationinEarlyChildhoodPoliciesandProgrammes:ASynthesisof ExperiencesinLatinAmerica.”RegionalBureauofEducationforLatinAmericaandtheCaribbean,UnitedNational Educational,ScientificandCulturalOrganization. VargasͲBarón,E.2005.“PlanningPoliciesforEarlyChildhoodDevelopment:GuidelinesforAction.”Paris: UNESCO/ADEA/UNICEF(UnitedNationsEducational,ScientificandCulturalOrganization/Associationforthe DevelopmentofEducationinAfrica/UnitedNationsChildren’sFund). Victoria,B.H.,L.Adair,C.Fall,P.C.Hallal,R.Martorell,L.Richter,andH.S.Sachdev2008.“MaternalandChild Undernutrition:ConsequencesforAdultHealthandHumanCapital.“TheLancet371(9609):340Ͳ57.            SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  24 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  Appendix:SABERͲECDPolicyClassificationRubricFindings PolicyGoal/Lever/Indicator LevelofDevelopment/ IndicatorResult 1.EstablishinganEnablingEnvironment Emerging 1.1LegalFramework Established ai)Isthereapolicythatguaranteespregnantwomenfreeantenatalvisitsandskilled Bothfreeantenatalvisitsand delivery? skilleddelivery aii)ArestandardhealthscreeningsprovidedforHIVandSTDsforpregnantwomen? No bi)Areyoungchildrenrequiredtoreceiveacompletecourseofchildhood Yes immunizations? bii)Areyoungchildrenrequired tohavewellͲchildvisits? Yes,andonaregularbasis ci)DonationallawscomplywiththeInternationalCodeofMarketingofBreastMilk Manyprovisionslaworlaw Substitutes? cii)Doesanationalpolicytoencouragesaltiodizationexist(orhasiteverexisted)? Mandatory ciii)Doesanationalpolicytopromotethefortificationofcereals/stapleswithiron No exist(orhasiteverexisted)? di)Areparents/caregiversguaranteedpaidparentalleavefollowingchildbirth? 1yearwithatleast50%pay dii)ArewomenguaranteedjobprotectionandnonͲdiscrimination,breastfeeding Allguidelinesarefollowed breaksandbreastfeedingfacilitiesinaccordancewiththeILOMaternityProtection Convention? e.Doestheeducationlawmandatetheprovision offreepreprimaryeducationbefore No primaryschoolentry? fi)Isthereapolicymandatingtheregistrationofchildrenatbirth? Yes fii)Doesthegovernmentpromotethereductionoffamilyviolence? 2Ͳ3services fiii)Doesthenationaljudicialsystemprovidethefollowingspecificprotection 3to4selectservicesprovided interventionstoyoungchildren:provisionoftrainingforjudges,lawyers,law enforcementofficers,andestablishmentofspecializedcourtsandchildadvocacy body? gi)IsthereapolicytoprovideorphansandvulnerablechildrenwitharangeofECD Policyexistsandservices services? providedwithinonesector gii)Aretherelawsinplacetoprotecttherightsofchildrenwithdisabilitiesand Legalrighttoservicesin2to3 promotetheirparticipationandaccesstoECDservices,includinghealthcareand sectors ECCE? 1.2IntersectoralCoordination Latent a.DoesthegovernmenthaveanexplicitlyͲstatedmultiͲsectoralECDstrategy? NomultiͲsectoralECDstrategy b.HasaninstitutionalanchorbeenestablishedtocoordinateECDacrosssectors? No ci)Arethereanyregularcoordinationmeetingsbetweenthedifferentimplementing Regularcoordinationmeetings actorsatthesubͲnationallevel? attendedbyallactors cii)Isthereanyintegratedservicedeliverymanual/guideline(i.e.anysortofcommon No planofaction)? d.IsthereamechanismforcollaborationbetweenstateandnonͲstatestakeholders? Thereareconsultationmeetings involvingnonͲstatestakeholders 1.3Finance Emerging ai)TowhatextentdoesthebudgetuseexplicitcriteriaatthenationalorsubͲnational Criteriaareusedin2to3sectors leveltodecideECDspending? aii)Towhatextentisdeterminingthebudgetacoordinatedeffortacrossministries? Nocoordinationmechanisms aiii)CanthegovernmentaccuratelyreportpublicECDexpenditures? ExpenditureonECDarereported in1sector bi)Whatpercentageoftheannualeducationbudgetisallocatedtowardspreprimary 5%to9% education? bii)WhatpercentageofroutineEPIvaccinesisfinancedbygovernment? 100% ci)Accordingtopolicy,whattypesoffeesareleviedforECDservices? 4to7typesoffees cii)Whatisthelevelofoutofpocketexpendituresasapercentageoftotalhealth 40%ormore expenditures? SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  25 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  di)Istheremunerationforpreprimaryteachersenteringthefieldcompetitive? 75%butlessthan100%of primaryteachersalary dii)ArecommunityͲbasedchildcarecenterprofessionalspaidbythegovernment? No diii)Areextensionhealthserviceprofessionalspaidbythegovernment? No 2.ImplementingWidely Established 2.1ScopeofPrograms Established a.Doessentialhealthprogramsexistinthecountrytotargetallbeneficiarygroups? 4essentialhealthinterventions b.Doessentialnutritionprogramsexistinthecountrytotargetallbeneficiarygroups? 4essentialnutritioninterventions c.Doessentialeducationprogramsexistinthecountrytotargetallbeneficiary 2Ͳ3educationinterventions groups? d.Doessentialchildandsocialprotectionprogramsexistinthecountrytotargetall 4essentialprotection beneficiarygroups? interventions 2.2Coverage Established ai)Whatistherateofbirthsattendedbyskilledattendants? 90%andabove aii)Whatpercentageofpregnantwomenbenefitsfromatleastfourantenatalvisits? 51%to70% aiii)WhatpercentageofHIV+pregnantwomenandHIVͲexposedinfantsreceiveARVs #N/A forPMTCT? bi)Whatpercentageofchildrenunderfiveyearsofagewithdiarrhea receiveoral 41%to84% rehydrationandcontinuedfeeding? bii)Whatpercentageof1ͲyearͲoldchildrenisimmunizedagainstDPT? 91%andabove biii)Whatpercentageofchildrenbelowfiveyearsofagewithsuspectedpneumonia 51%to90% receivesantibiotics? biv)Whatpercentageofchildrenlessthanfiveyearsofage(inatͲriskareas)sleeps #N/A underanITN? ci)WhatistheVitaminAsupplementationcoveragerateforchildren6Ͳ59monthsof #N/A age? cii)Whatpercentageofchildrenisexclusivelybreastfedbelowtheageofsixmonths? 21%to40% ciii)Whatpercentageofthepopulationconsumesiodizedsalt? 51%to89% civ)Whatpercentageofpregnantwomenhaveanemia? 10%to39% d.Whatisthegrossenrollmentrateinpreprimaryeducation? 35%to59% e.Whatisbirthregistrationrate?(childrenbelow5years) 91%andabove 2.3Equity Established ai)WhatistheratioofpreprimaryenrollmentatthesubͲnationallevelfortheregions #N/A withthehighestandlowestenrollment? bi)Isthereequitableaccesstopreprimaryschoolforboysandgirls? Equaltoorlessthan1.1 ci)Isthereaninclusiveeducationpolicytocatertotheneedsofspecialneeds Yes childrenwithinregularECCEservices? cii)Iscurriculumorteachingmaterialstranslatedintomajorlanguagegroups? No di)Whatistheratioofbirthregistrationcomparingrichesttopoorest? 1 dii)Whatistheratioofskilledattendantsatbirthcomparingrichesttopoorest? 1 diii)Whatistheunderweightprevalenceinchildrencomparingrichesttopoorest? Greaterthan2lessthan0.7 ei)Whatistheratioofbirthregistrationforurbanregionstoruralregions? 1 eii)Whatistheratioofurbantoruralaccesstoimprovedsanitationfacilities? 1 3.MonitoringandAssuringQuality Emerging 3.1DataAvailability Emerging ai)TowhatextentareadministrativedatacollectedonaccesstoECD? 7ormoreindicatorsarecollected andavailable aii)TowhatextentaresurveydatacollectedonaccesstoECDandoutcomes? 7ormoreindicatorsarecollected andavailable b.AredataavailabletodifferentiateECCEaccessandoutcomesforspecialgroups Datadifferentiateaccessand (gender,mothertongue,rural/urban,socioͲeconomicstatus,specialneeds)? outcomesfor3to4special groups c.Aredatacollectedtomeasurechilddevelopment(cognitive,linguistic,physical,and No socioͲemotional)? d.Areindividualchildren’sdevelopmentoutcomestracked? No SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  26 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015  3.2QualityStandards Emerging ai)Dostandardsforwhatstudentsshouldknowandlearnexist? Yes aii)Isthereoneormorepreprimarycurriculathathavebeenapprovedorare No availableforteacherstouse? aiii)Isthepreprimarycurriculumcoherentandcontinuouswiththecurriculumfor No primaryeducation? bi)Whataretheentryrequirementstobecomeapreprimaryteacher? Formaltertiarytrainingwith specializationinECD bii)IsthereregularinͲservicetrainingforECCEprofessionalstodeveloppedagogical Yes andteachingskills? biii)IsthereapublicauthorityinchargeofregulatingpreͲservicetrainingforECCE No professionals? biv)IssomeformofpreͲservicepracticumorfieldworkrequired? No c.ArehealthworkersrequiredtoreceivetrainingindeliveringECDmessages 2Ͳ3typesofhealthworker (developmentalmilestones,childcare,parenting,earlystimulation,etc.)? di)WhatistherequiredchildͲtoͲteacherratio? Morethan15:1 dii)Whatistherequiredminimumnumberofhoursofpreprimaryeducationper Nostandard week? diii)Doinfrastructurestandardsexist? Yesandincludesallelementsof infrastructurestandards e.Arethereestablishedregistrationandaccreditationproceduresforbothstateand No nonͲstateECCEfacilities? fi)Doconstructionstandardsexistforallhealthfacilities? Forhospitals,healthcentersand healthposts 3.3CompliancewithStandards Emerging a.DoECCEprofessionalscomplywithestablishedpreͲservicetraining Between51%and85% standards/professionalqualifications? compliance bi)DoaveragechildͲtoͲteacherratioscomplywithestablishedstandard? Compliancewithestablished standardofmorethan15:1ratio bii)Dopreprimaryschoolscomplywiththeestablishedminimumnumberofopening Compliancewithestablished hoursofpreprimaryeducationperweek? standardof15hoursormore biii)Whatpercentageofpreprimaryfacilitiescomplywithinfrastructurestandards? Lessthan60% ci)DoaveragechildͲtoͲteacherratioscomplywithestablishedstandard? Compliancewithestablished standardof15:1 cii)Dopreprimaryschoolscomplywiththeestablishedminimumnumberofopening Nocomplianceorunknown hoursofpreprimaryeducationperweek? ciii)Whatpercentageofpreprimaryfacilitiescomplywithinfrastructurestandards? Nocomplianceorunknown  . SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  27 ALBANIAۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2015    www.worldbank.org/education/saber The Systems Approach for Better Education Results (SABER) initiative produces comparative data and knowledge on education policies and institutions,withtheaimofhelpingcountriessystematicallystrengthen their education systems. SABER evaluates the quality of education policies against evidenceͲbased global standards, using new diagnostic toolsanddetailedpolicydata.TheSABERcountryreportsgiveallparties with a stake in educational results—from administrators, teachers, and parents to policymakers and business people—an accessible, objective snapshot showing how well the policies of their country's education systemareorientedtowardensuringthatallchildrenandyouthlearn.  ThisreportfocusesspecificallyonpoliciesintheareaofEarlyChildhood Development. ThisworkisaproductofthestaffofTheWorldBankwithexternalcontributions.Thefindings,interpretations,andconclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governmentstheyrepresent.TheWorldBankdoesnotguaranteetheaccuracyofthedataincludedinthiswork.Theboundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The WorldBankconcerningthelegalstatusofanyterritoryortheendorsementoracceptanceofsuchboundaries. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  28