Iraq SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2014 Policy Goals Status 1. Establishing an Enabling Environment Early childhood development (ECD) has not yet been a priority of the Iraqi government. A multisectoral ECD strategy does not exist, nor do mechanisms for intersectoral coordination. Iraq does have some laws to promote health care for pregnant women and young children. Currently there is no way to determine the level of spending on young children in the country, but the sector may be underfunded. 2. Implementing Widely Iraq has established a variety of health and nutrition programs, but fewer in social protection and child protection. Access to these services could be expanded. Enrollment in preprimary education is very low. There is fairly equitable access to essential health and nutrition services, but large disparities in learning opportunities for children from different socioeconomic backgrounds. 3. Monitoring and Assuring Quality Iraq collects a variety of survey data. The types of administrative data collected for the health, nutrition, social protection, and child protection sectors could be expanded to better gauge access and outcomes. Some documents containing standards and regulations date from the Baathist era and do not reflect current ECD best practices. There are some service delivery standards for preprimary schools but no construction standards. IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 This report presents an analysis of the early childhood government is incapable of providing basic services in development (ECD) programs and policies that affect many places, and infrastructure is failing. young children in Iraq and recommendations to move forward. This report is part of a series of reports prepared Until now ECD has not been a priority of the by the World Bank using the Systems Approach for Better Government of Iraq (GOI). The country lacks an ECD Education Results–Early childhood development (SABER- strategy or a lead ECD coordinating body. It provides ECD) framework and includes analysis of early learning, some basic health and nutrition services, but is weak on health, nutrition, social protection, and child protection social protection and child protection. Very few children policies and interventions in Iraq, along with regional and attend preprimary education, even though Iraq’s international comparisons. 1 constitution stipulates that education at all levels is free. Many of the regulations concerning early childhood Iraq and Early Childhood Development education date back to the Baathist era and do not reflect the current knowledge in the field, nor the values Iraq is a country of approximately 35 million people and of a democratic country. has a young and growing population. Its gross national income (GNI) per capita, using the Atlas method, in 2013 Iraq has the opportunity to develop an early childhood was US$6,710, making it an upper middle income strategy incorporating the latest (and ever growing) country. In 2013, it ranked 120th out of 186 countries in body of evidence in the field. Implementation will be a the Human Development Index. In 2012, almost 19 challenge, given the government’s weak capacity to percent of the population lived at or below the national deliver services and the security situation in many parts poverty line. of the country. A key part of building the support necessary from government and citizens for investing in The country has experienced years of conflict, ECD may be to raise awareness on the importance of instability, and violence. This has had devastating children’s earliest years for the country’s economic and consequences for the country’s young children and their social development. Table 1 shows several ECD families, with internal displacement, large numbers of indicators in Iraq, alongside figures for several other widows and orphans, and psychological trauma. The countries in the region. Table 1. Snapshot of ECD Indicators in Iraq with Regional Comparison Iraq Egypt Jordan Turkey Yemen Infant mortality (deaths per 1,000 live births, 2012) 28 18 16 12 46 Below-five mortality (deaths per 1,000 live births, 2012) 34 21 19 14 60 Moderate and severe stunting (below-five, 2008–12) (%) 22.6 28.9 7.7 12.3 57.7 7% 23% 34% 31% 1% Preprimary net enrollment rate (3–5 years of age) (%) (2007) (2012) (2012) (2012) (2011) Birth registration 2005–12 (%) 99.2 99.0 99.1 93.7 17.0 Source: UNICEF MICS, UNESCO Institute for Statistics database. 1SABER-ECD is one domain within the World Bank initiative, Systems Approach for Better Education Results (SABER), which is designed to provide comparable and comprehensive assessments of country policies. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 2 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Systems Approach for Better Education What should be in place at the country level to promote coordinated and integrated ECD interventions for young Results–Early Childhood Development children and their families? (SABER-ECD) Health care SABER-ECD collects, analyzes, and disseminates x Standard health screenings for pregnant women comprehensive information on ECD policies around the x Skilled attendants at delivery world. In each participating country, extensive x Childhood immunizations multisectoral information is collected on ECD policies x Well-child visits and programs through a desk review of available Nutrition government documents, data and literature, and x Breastfeeding promotion interviews with a range of ECD stakeholders, including x Salt iodization x Iron fortification government officials, service providers, civil society, Early learning development partners, and scholars. The SABER-ECD x Parenting programs (during pregnancy, after delivery, framework presents a holistic and integrated assessment and throughout early childhood) of how the overall policy environment in a country x High-quality child care for working parents affects young children’s development. This assessment x Free preprimary school (preferably at least two years can be used to identify how countries address the same with developmentally appropriate curriculum and policy challenges related to ECD, with the ultimate goal classrooms, and quality assurance mechanisms) of designing effective policies for young children and Social protection their families. x Services for orphans and vulnerable children x Policies to protect rights of children with special needs and promote their participation/access to ECD services x Financial transfer mechanisms or income supports to reach the most vulnerable families (could include cash transfers, social welfare, and so on.) Child protection x Mandated birth registration x Job protection and breastfeeding breaks for new mothers x Specific provisions in judicial system for young children x Guaranteed paid parental leave of least six months x Domestic violence laws and enforcement x Tracking of child abuse (especially young children) x Training for law enforcement officers in regard to the particular needs of young children presents an abbreviated list of interventions and policies that the SABER-ECD approach looks for in countries when assessing the level of ECD policy development. This list is not exhaustive but is meant to provide an initial checklist for countries to consider the key policies and interventions needed across sectors. Three Key Policy Goals for Early Childhood Development SABER-ECD identifies three core policy goals that countries should address to ensure optimal ECD outcomes: establishing an enabling environment, implementing widely and Monitoring and Assuring Quality. Improving ECD requires an integrated approach SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 3 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 to address all three goals. As described in figure 1, for What should be in place at the country level to promote each policy goal, a series of policy levers are identified, coordinated and integrated ECD interventions for young children and their families? through which decision makers can strengthen ECD. Health care x Standard health screenings for pregnant women Strengthening ECD policies can be viewed as a x Skilled attendants at delivery continuum. As described in x Childhood immunizations x Well-child visits Nutrition x Breastfeeding promotion x Salt iodization x Iron fortification Early learning x Parenting programs (during pregnancy, after delivery, and throughout early childhood) x High-quality child care for working parents Table 2, countries can range from a latent to advanced x Free preprimary school (preferably at least two years level of development within the different policy levers with developmentally appropriate curriculum and and goals. classrooms, and quality assurance mechanisms) Box 1. A Checklist to Consider How Well ECD Is Promoted at Social protection the Country Level x Services for orphans and vulnerable children x Policies to protect rights of children with special needs and promote their participation/access to ECD services x Financial transfer mechanisms or income supports to reach the most vulnerable families (could include cash transfers, social welfare, and so on.) Child protection x Mandated birth registration x Job protection and breastfeeding breaks for new mothers x Specific provisions in judicial system for young children x Guaranteed paid parental leave of least six months x Domestic violence laws and enforcement x Tracking of child abuse (especially young children) x Training for law enforcement officers in regard to the particular needs of young children SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 4 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Figure 1. Three Core ECD Policy Goals Table 2. ECD Policy Goals and Levels of Development Level of development ECD policy goal Minimal legal Nonexistent legal Regulations in some Developed legal framework; some Establishing framework; ad hoc sectors; functioning framework; robust programs with sustained an enabling financing; low intersectoral interinstitutional financing; some environment intersectoral coordination; sustained coordination; sustained intersectoral coordination financing financing coordination Coverage expanding but Near-universal coverage Universal coverage; Low coverage; pilot gaps remain; programs in some sectors; comprehensive strategies Implementing programs in some established in a few established programs in across sectors; integrated widely sectors; high inequality sectors; inequality in most sectors; low services for all, some in access and outcomes access and outcomes inequality in access tailored and targeted Information on Information on outcomes at national, Information on outcomes Minimal survey data outcomes at national regional, and local levels; from national to individual Monitoring available; limited level; standards for standards for services levels; standards exist for and ansuring standards for provision services exist in some exist for most sectors; all sectors; system in place quality of ECD services; no sectors; no system to system in place to to regularly monitor and enforcement monitor compliance regularly monitor enforce compliance compliance institutions to deliver services effectively, and sufficient Policy Goal 1: Establishing an Enabling fiscal resources with transparent and efficient allocation Environment mechanisms. ¾ Policy Levers: Legal Framework • Policy Lever 1.1: Intersectoral Coordination • Finance Legal Framework An enabling environment is the foundation for the design The legal framework comprises all the laws and regulations and implementation of effective ECD policies (Britto, that can affect the development of young children in a Yoshikawa, and Boller 2011; Vargas-Baron 2005). An country. The laws and regulations that impact ECD are enabling environment consists of the following: the diverse due to the array of sectors that influence ECD and existence of an adequate legal and regulatory framework because of the different constituencies that ECD policy can to support ECD, coordination within sectors and across and should target, including pregnant women, young SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 5 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 children, parents, and caregivers. Box 3 lists key laws have lower incidence of mortality and morbidity than governing ECD in Iraq. those who are not. It also costs nothing. See box 2 for ideas on how Iraq could promote breastfeeding in ways Some national laws promote health care for pregnant that would be most appropriate and applicable for the women and young children, but aspects could be country. strengthened. The Iraqi constitution guarantees health care for all citizens; it also ensures protection of Laws to promote appropriate dietary consumption by motherhood and childhood. The National Strategy on pregnant women and children could be expanded. Reproductive Health and Maternal and Child Healthcare Public Health Law No. 89 (1981) and the National guarantees that pregnant women receive antenatal visits Nutrition Strategy 2012–2021 mandate salt iodization. In and a skilled delivery. According to interviews with the Kurdish Regional Government (KRG), the Ministry of health officials, pregnant women are routinely screened Health is in the process of mandating salt iodization. for HIV, and referrals to treatment services are provided if necessary. Data on HIV prevalence in Iraq are scarce, Iron fortification of staples, such as wheat or rice, is but the number seems to be very low. encouraged but not mandatory. The anemia rates for young children and pregnant women in Iraq are 56 Ministry of Health (MOH) regulations and the National percent and 38 percent, respectively (WHO 2008). Strategy on Reproductive Health and Maternal and According to the WHO, that level of prevalence in young Child Healthcare establish that young children should children constitutes a severe public health problem, and receive a full course of immunizations. Young children that level among pregnant women is a moderate public are not required to receive well-child visits, which are an health problem (WHO 2008). Anemia can have adverse important component of children’s health care. Regular health effects: mild anemia may impair work checks are necessary to identify and treat children who productivity, and severe cases can increase risk of are not developing in a healthy manner. maternal and child mortality, as well as birth defects. The GOI could do more to promote the practice of While those figures may be outdated, they nevertheless breastfeeding. According to a 2011 International Baby suggest that efforts to improve iron consumption may Food Action Network report, Iraq had drafted laws to be necessary. The GOI could mandate iron fortification comply with the International Code on Marketing of of staples. It could also target nutrition interventions to Breastmilk Substitutes. It is not clear that this legislation young children and pregnant women, including through has since been passed and implemented. The Code vitamin supplements and provision of iron-rich foods. provides countries with guidance on how to structure Parasites may reduce the body’s ability to absorb iron, so policies and regulatory frameworks to encourage clean drinking water and access to basic health care may breastfeeding and infant feeding according to World also reduce anemia rates. Health Organization (WHO) guidelines. Currently no policy mandates that employers provide new mothers National laws promote opportunities for mothers to with breastfeeding breaks or facilities for breastfeeding. provide care to newborns and infants in their first year of life but could be further strengthened. The Labor Law Between 2008 and 2012 the rate of exclusive No. 71 (1987) gives mothers working in both the public breastfeeding for babies below 6 months of age in Iraq and private sector 72 days of paid maternity leave. was approximately 20 percent (UNICEF MICS). The low Women working for the government can extend this by rate may be explained by a lack of understanding among another 6 months at full pay, and then another 6 months the public of the importance of the practice. for 50 percent pay. Women in private sector jobs can Breastfeeding could be particularly beneficial in Iraq, request an additional 12 months of unpaid leave. No where many families do not have consistent access to paternity leave (paid or unpaid) is offered. clean water to mix with formula powder. Dirty water can cause diarrhea, which can have serious health consequences for very young children. Families may need to be educated on the many health benefits of breastfeeding. Babies who are breastfed SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 6 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Box 2. Brazil’s Campaign to Promote Breastfeeding Summary: Brazil’s campaign to promote breastfeeding is an example of successful efforts to change public perceptions and health care practices, resulting in a significant increase in breastfeeding. The campaign was initiated in 1980 by the National Food and Nutrition Institute. UNICEF and the Pan-American Health Organization helped to develop public awareness materials that addressed the lack of informational materials on breastfeeding in Portuguese. Instructional brochures were widely distributed to mothers. A media campaign featured radio, television, and print media spots and endorsements by well-known personalities. The WHO and UNICEF held training courses on breastfeeding for health care workers and managers, and the Baby Friendly Hospital Initiative was widely implemented to initiate early feeding. A coalition of actors helped make the campaign a success. The Catholic Church, mothers groups, associations of medical professionals, community leaders, politicians, and the media were all engaged in the effort. The exclusive breastfeeding rate rose from approximately 4 percent in 1986 to 40 percent in 2006. Key recommendations for Iraq drawing on Brazil’s experience: 9 Develop and disseminate Arabic language materials on the benefits of breastfeeding for a variety of audiences. These could include training materials for health care workers, awareness pamphlets for community leaders and nongovernmental organizations (NGOs), and instructional brochures for mothers. 9 Encourage breastfeeding from an Islamic perspective and engage religious organizations and leaders to spread awareness. 9 Train health care workers to educate mothers on the benefits of breastfeeding and to support them to initiate and maintain the practice. 9 Engage the support of NGOs, women’s associations, health workers, community leaders, and others. (Source: Implementation of Breastfeeding Practices in Brazil, http://www1.paho.org/English/DD/PUB/NutritionActiveLife- ENG.pdf ) There is no right to return to a job after pregnancy and Box 3. Key Laws Governing ECD in Iraq maternity leave, no explicit prohibition on x The Iraqi constitution (2005) provides a right to discrimination based on pregnancy or parental status, health care. It obliges the state to protect and no guarantee of accommodations for motherhood and childhood, and guarantees free education at all levels. breastfeeding. Lack of employment protections for x Care for People with Disabilities and Special Needs pregnant women and new mothers can make it difficult Law No. 38 (2013) establishes inclusive and equal for them to maintain their jobs while also adequately education and free health care for citizens with caring for infants. disabilities. x Regulations for State Homes No. 5 (1986) The adult female labor force participation rate in Iraq in establishes residential care homes for orphans or 2013 was 15 percent (World Bank). The labor force children whose parents cannot care for them. participation rate for women with young children is not x Regulations for Nurseries No. 1 (1992) gives clear, but it is likely lower. Ensuring nondiscrimination at authority to license and supervise nurseries to the the workplace and implementation of longer maternity Ministry of Labor and Social Affairs and lays out leave policies for private sector employees could help licensing requirements. improve female labor participation. Many families x Birth and Death Registration Law No. 148 (1971) requires birth registration with the Ministry of struggle financially to provide the necessities of life. Health. Income earned by a mother can improve her family’s access to nutritious food, health care, education, and housing. Iraqi law mandates free education, but very few children receive preprimary education. Iraq’s constitution guarantees citizens free education at all levels. The constitution does not specify what these levels are, and preprimary education is not explicitly mentioned. Children must attend first grade, starting at approximately age six. Attendance in preprimary schools in Iraq is very low. UNESCO reported a preprimary net enrollment rate of approximately 7 percent of 2007. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 7 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 (More recent figures are not available.) The gross successful at achieving universal birth registration in the enrollment rate was also approximately seven percent. country. In 2012 the preprimary net enrollment rate for the Arab Seventy-nine percent of children undergo violent region was 25 percent; table 3 shows enrollment rates discipline (UNICEF MICS). This high figure suggests that in several Arab countries. While enrollment has there may be widespread social acceptance of the use of increased across the region in recent years (in 2003, the violence to discipline children. Children who experience regional rate was 16 percent), it remains lower on violent discipline are at risk of physical harm, average than in any other region in the world except Sub- psychological trauma, and even difficulty learning. Iraq’s Saharan Africa. Even within a region with relatively low constitution states that violence and abuse in the family preprimary enrollment rates, Iraq’s rate of are prohibited, but there are few policies to this effect. approximately 7 percent stands out as low. The MOLSA in KRG has established a child protection hotline. The KRG passed the Law against Domestic Table 3. Preprimary Enrollment Rates in Arab Countries (%) Violence No. 8 (2011), which covers violence against Iraq Egypt Jordan Syria Yemen children. Apart from this, there do not seem to be other Preprimary net enrollment rate 7 23 34 11 1 policies to target reduction of family violence. (2007) (2012) (2012) (2012) (2011) (%) Source: UNESCO Institute for Statistics. The federal government’s legal system does not provide any interventions to protect children in the system. The In 2011, the Ministry of Labor and Social Affairs KRG provides training for judges and specialized courts (MOLSA) and MOE records indicated the existence of for children. 109 public nurseries (for children below age 4), 661 kindergartens (for children age 4 and 5), and 21,228 The GOI has established some social protection services primary schools in the federal areas. There were 49 but has not articulated a social protection policy for private for-profit nurseries and five private not-for-profit young children. According to the Regulation for State nurseries. By 2013, the number of private for-profit Homes No. 5 (1986), the Bureau of Social Services is to kindergartens had increased to 454, with 6 private not- establish an office of state homes. These homes provide for-profit schools. That same year there were 400 private residential care to orphans and children whose families primary schools. cannot care for them. It is not clear that these facilities provide or coordinate a range of services for young In KRG in 2013, there were 389 public kindergartens and children besides housing. The GOI also provides financial 3592 public primary schools, in addition to 403 Kurdish support to orphans. primary schools in Kirkuk province. The Care for People with Disabilities and Special Needs The National Strategy for Higher Education 2011–2020 Law No. 38 (2013) establishes that the MOE is to lays out the goal of increasing enrollment in provide inclusive and equal education for children with kindergartens (riyadh) from 7 percent to 30 percent special needs, including providing appropriate (Iraq’s National Strategy for Higher Education 2011- equipment and materials and training personnel 2020). It also mentions a project to increase awareness “beginning at the early childhood level.” The law of the importance of preprimary education through mentions primary and secondary school, but preprimary media, and to provide incentives to poor families and school is not mentioned. Under the same act, the MOH those in remote areas to enroll their children in is to provide free health insurance to citizens with preprimary school. It is not clear that these activities disabilities and special needs, offer necessary have been implemented, or if there are any clear plans treatments, and coordinate to provide other necessities on how to increase preprimary enrollment. of life. Child protection laws could be strengthened. The Birth Further discussion of the situation of children with and Death Registration Law No. 148 (1971) requires all special needs is discussed in the Policy Lever 2.3: Equity births to be registered with the MOH, which provides section of this report. free birth certificates. Birth registration is a critical component of child protection, and this law has been SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 8 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Policy Lever 1.2: Policy Lever 1.3: Intersectoral Coordination Finance Development in early childhood is a multidimensional While legal frameworks and intersectoral coordination process (Naudeau and others 2011; UNESCO-OREALC are crucial to establishing an enabling environment for 2004; Neuman 2007). To meet children’s diverse needs ECD, adequate financial investment is key to ensuring during the early years, government coordination is that resources are available to implement policies and essential, both horizontally across different sectors as achieve service provision goals. Investments in ECD can well as vertically from the local to national levels. In many yield high public returns but are often undersupplied countries, nonstate actors (either domestic or without government support. Investments during the international) participate in ECD service delivery; for this early years can yield greater returns than equivalent reason, mechanisms to coordinate with nonstate actors investments made later in a child’s life and can lead to are also essential. long-lasting intergenerational benefits (Valerio and Garcia 2012; Hanushek and Kimko 2000; Hanushek and The GOI does not have a multisectoral ECD strategy. The Luque 2003). Not only do investments in ECD generate MOLSA is currently developing a five-year National Child high and persistent returns, they can also enhance the Protection Strategy. The strategy targets children below effectiveness of other social investments and help age 18 and is multisectoral, covering health, education, governments address multiple priorities with single social protection, and child protection. investments. No institutional anchor is in place to coordinate ECD The budget process related to ECD expenditure lacks across sectors. No government body is designated as transparency. The GOI cannot report ECD expenditures, leading coordination between the sectors of education, so it is impossible to gauge the level of spending devoted health, nutrition, social protection, and child protection to young children. No explicit criteria are used to set ECD relating to young children. For federal areas, the Child budgets at the national and subnational levels. Welfare Commission is responsible for policies affecting Determining ECD spending is not a coordinated effort children of all ages. In KRG, the High Committee on Child across ministries. Welfare is the focal agency for children’s issues. There does not seem to be any staff on this committee devoted It is difficult to assess if the level of ECD financing is solely to young children, nor are there staff within adequate to meet the needs of the population. Total ministries whose job it is to focus on ECD. spending on ECD is not known in Iraq, nor is the level of spending by sector available. It should be noted that Mechanisms to coordinate services at the point of financing for ECD services can also come from delivery are not in place. To ensure that children receive nongovernment sources, but that amount is not known appropriate services, services should be coordinated at for Iraq. the point of care and delivery, which also reduces inefficiency. Mechanisms could include regular The burden of finance for ECD may not be distributed coordination meetings between implementers at the equitably across Iraqi society. Cost may be a barrier to subnational level, as well as some kind of integrated accessing services. In the public health care system, the service delivery manual or common plan of action. policy is that all preventive services are free, and Iraqi Dinars (ID) 500 (approximately US$0.40) is charged for No mechanism exists for collaboration between state treatment services. However, nearly half of total health and nonstate stakeholders. It is likely that Iraqi expenditure in the country is out-of-pocket, suggesting nongovernmental organizations (NGOs) and religious that Iraqis use private health care or are paying large fees institutions provide many health and social welfare for their services in the public system. Table 4 shows services to young children and their families. In some health expenditure indicators for Iraq compared with countries, nonstate actors such as these play an other countries in the region. important role in delivering services and have close knowledge of the challenges facing families. For this Public primary schools charge fees for uniforms, meals, reason, their input can be valuable to policy makers in and transportation. Public nurseries (for children below setting policies. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 9 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 the age of four) in federal areas and KRG charge tuition anemia problem may also be related to poor-quality and fees for meals and transportation costs. drinking water in many parts of the country, which can cause parasites. Better infrastructure and better primary Table 4. Regional Comparison of Select Health Expenditure health care to treat patients with parasites would also Indicators2 likely help reduce the problem. Iraq Egypt Jordan Turkey Yemen Out-of-pocket ¾ The GOI could consider studying the reasons for the expenditure as a 100 98 77 64 99 low rate of iodized salt consumption despite its salt percentage of all private health expenditure (%) iodization policy. This may suggest that the law is not Out-of-pocket expenditure as a being fully implemented, that salt found in Iraqi markets 46 60 28 17 72 are imports not required to be iodized, that Iraqis do not percentage of total health expenditures (%) consume much salt, or other reasons. Government expenditure on health as a percentage of 4 5 10 6 6 GDP (%) ¾ The GOI could revisit its strategy to promote Routine EPI vaccines breastfeeding. With a breastfeeding promotion program financed by government, N/A 100 100 N/A 15 2012 (%) in place, it is likely more could be done to make the Sources: WHO Global Health Expenditure Database 2012; UNICEF Multiple practice more widespread. The plan could include Indicator Cluster Survey. measures to promote public awareness on the importance of the practice to promote young children’s The level of remuneration of ECCE teachers may be health and address malnutrition and stunting. Health inadequate to attract high quality personnel. At public workers should also be educated to share messages with early childhood care and education (ECCE) centers, mothers. wages are set by the central government. The starting annual pay for teachers of two-to-four-year-olds at ¾ The GOI could consider ways to increase the demand public nurseries is ID 380,000 (approximately US$330). for and supply of preprimary education. On the demand Starting pay for teachers at primary schools is ID 594,000 side, this could include advocacy work among policy (approximately US$540), meaning teachers at the makers to persuade them to support investment in ECE preprimary age group make 64 percent of primary as key to the country’s economic development. Public teachers make when they begin their careers. All awareness to parents explaining the lifelong benefits of employees of MOE receive an ID 150,000 (approximately early stimulation and quality preprimary education could US$130) monthly incentive. Even with the “incentive,” raise demand for services. On the supply side, the GOI teachers earn far lower than the GDP per capita income could consider various modalities of service delivery. This of roughly US$6,670 in 2013. On top of this, the disparity could include attaching preprimary classrooms to in pay between preprimary and primary teachers can primary schools, establishing informal programs at discourage talented individuals from pursuing jobs with religious and community organizations, and interactive very young children. There are no standards for wages in audio instruction. Radio or mobile phone technologies private schools and ECCE centers. could be used to deliver services. It would be low cost and scalable, and require little infrastructure. Interactive Policy Options to Strengthen the Enabling audio instruction has been used to improve learning outcomes in a variety of challenging contexts. Environment for ECD in Iraq Legal Framework ¾ The GOI could study the best ways to address the problem of violent discipline and child abuse. A central ¾ The GOI could mandate iron fortification of staples component of this may be raising public awareness that and take other steps to address anemia. This could child abuse is unacceptable. It could also include include public awareness on nutrition, more effective expanding child abuse tracking and reporting activities, distribution of iron supplements for pregnant women establishing a task force for domestic violence and young children, and provision of iron-rich food. The prevention, training health care workers and educators 2 Out-of-pocket expenditure is any direct outlay by households, including whose primary intent is to contribute to the restoration or enhancement of gratuities and in-kind payments, to health practitioners and suppliers of the health status of individuals or population groups. pharmaceuticals, therapeutic appliances, and other goods and services SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 10 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 to identify child abuse and neglect, and reviewing laws to minimum required to ensure provision of quality early ensure that they adequately protect children from childhood care and education services. Given the lack of abuse. attention paid to the sector, it is likely that is it underfunded. ¾ The legal system could provide training for judges, lawyers, and law enforcement on dealing with young Policy Goal 2: Implementing Widely children. It could also establish a child advocacy body and specialized courts for children. Intersectoral Coordination ¾ The GOI could consider developing an explicit ECD strategy. This could take the form of a multisectoral strategy, or specific ECD strategies within each sector, with a high level of intersectoral coordination. Progress in ECD is far less likely to be achieved without clear goals and a plan of action. Effective ECD frameworks usually have a high-level political endorsement to ensure the prominence of ECD on the national agenda, a defined institutional anchor, and the inclusion of stakeholders from a range of sectors, with clear responsibilities for policy development and implementation. ¾ The GOI could develop coordination mechanisms for ¾ Policy Levers: Scope of Programs • ECD-related agencies. ECD interventions and policies Coverage •Equity typically include multiple ministries and government bodies, requiring coordination across ministries. The Implementing widely refers to the scope of ECD programs particular structure of coordination can vary greatly available, the extent of coverage (as a share of the according to the country context, but some mechanisms eligible population), and the degree of equity within ECD to promote coordination are essential to ensure effective service provision. By definition, a focus on ECD involves and efficient services. Nongovernmental stakeholders (at a minimum) interventions in health, nutrition, and service providers should also have a means to education, social protection, and child protection and collaborate with the government. should target pregnant women, young children, and their parents and caregivers. A robust ECD policy should Finance include programs in all essential sectors and provide ¾ The GOI could establish mechanisms to track ECD comparable coverage and equitable access across spending. It could put in place budgeting and regions and socioeconomic status—especially reaching information systems to allow for ECD-specific spending the most disadvantaged young children and their within each ministry and agency budget. It is essential to families. know how much the government currently spends on ECD or where this money goes. Policy Lever 2.1: Scope of Programs ¾ The GOI could consider using explicit criteria and Effective ECD systems have programs established in all formulas to allocate ECD funding, which could promote essential sectors and ensure that every child and a more efficient and equitable use of resources. Criteria expecting mothers have guaranteed access to the could include children’s characteristics, such as essential services and interventions they need to live socioeconomic status and internally displaced status. healthy lives. The scope of programs assesses the extent to which ECD programs across key sectors reach all ¾ The GOI may need to allocate or mobilize more beneficiaries. Figure 2 presents a summary of the key resources for ECD. An Organisation for Economic Co- interventions needed to support young children and their operation and Development (OECD) study suggests that families via different sectors at different stages in a a public investment of one percent of GDP is the child’s life. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 11 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Essential health programs exist to target some beneficiary groups. More could be done to support parents. The GOI routinely offers antenatal care, skilled delivery, comprehensive immunizations for infants, and growth-monitoring programs. In Erbil, Dohuk, and Sulaimaniya, mosquito bed nets are distributed to pregnant women and children to help prevent malaria. Well-child exams are not standard and can be crucial to identifying and treating health issues before they become more serious; they are an important part of promoting young children’s development. Currently no screenings are offered for maternal depression, nor are support services available for women who may be suffering from this. Given the very challenging situation facing many families in Iraq, it is likely that maternal depression is quite common. Programs aimed at improving parents’ ability to care for and interact with their children can be very beneficial to children’s development. Teaching parents about child development and positive parenting skills can help promote children’s cognitive and social development. Many parents in Iraq face overwhelming stresses while trying to raise their children in very difficult circumstances. Any support that parents receive will likely benefit their children too. Several nutrition programs target pregnant women and young children. Folic acid and iron supplements are offered to pregnant women. Young children receive vitamin A supplements. Other nutrition programs include breastfeeding promotion and feeding programs in nurseries (albeit very few children attend nurseries). Food supplements are not provided to pregnant women and young children. Healthy eating and exercise programs do not exist. Several different types of early childhood care and education programs are in place. Service provision options include public nurseries and kindergartens, as well as private for-profit and not-for-profit kindergartens. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 12 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Figure 3. Scope of ECD Interventions in Iraq by Target Population and Sector Few child protection and social protection programs are Policy Lever 2.2: in place. Residential care facilities exist for orphans and Coverage children whose families cannot care for them, but there are few other child protection programs. No body within A robust ECD policy should establish programs in all MOLSA in federal areas of the KRG is responsible for ECD essential sectors, ensure high degrees of coverage, and child protection. No data are available on how many reach the entire population equitably—especially the children are in the child protection system. most disadvantaged young children—so that every child and expecting mother have guaranteed access to In the area of social protection, parents employed in the essential ECD services. public sector receive a financial benefit per child for up to four children. No antipoverty measures are focused Access to essential health interventions for pregnant on ECD, such as cash transfers conditional on usage or women could be improved. Approximately 91 percent of ECD services. Orphans receive some financial support women in Iraq have a skilled attendant when giving birth from the government. (UNICEF MICS). Forty-nine percent of women receive at least 4 antenatal care visits, and 78 percent of women receive at least 1 visit (UNICEF MICS). Maternal health and child outcomes would likely improve if more women received regular prenatal care. Table 6 shows indicators of access to health interventions for pregnant women and young children in Iraq with regional comparisons. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 13 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 income countries have achieved universal or near The level of access to health interventions for young universal vaccination rates. This requires reaching all children could be increased. The percentage of Iraqi children several times to administer a full course of children below age 5 with diarrhea who receive immunizations. The percentage of children with rehydration therapy is 23 percent (UNICEF MICS). The suspected pneumonia who receive antibiotics is 67 proportion of one-year-olds vaccinated for DPT3 is 69 percent (UNICEF MICS). percent (UNICEF MICS). A number of low- and middle- Table 5. ECD Programs and Coverage in Iraq Scale ECD intervention Service is provided Universal coverage Education State-sponsored preprimary/kindergarten education Yes No State-sponsored ECCE Yes No Community-based ECCE No No Health Antenatal and newborn care Yes No Integrated management of childhood illnesses and care for development No No Childhood wellness and growth monitoring Yes No National immunization program Yes No Nutrition Micronutrient support for pregnant women Yes No Food supplements for pregnant women No No Micronutrient support for young children Yes No Food supplements for young children No No Food fortification Yes No Breastfeeding promotion programs Yes Yes Anti-obesity programs encouraging healthy eating/exercise No No Feeding programs in preprimary/kindergarten schools Yes No Parenting Parenting integrated into health/community programs No No Home visiting programs to provide parenting messages No No Special Needs Programs for OVCs (boarding schools and children’s homes) Yes No Interventions for children with special (emotional and physical) needs Yes No Anti-poverty Cash transfers conditional on ECD services or enrollment No No Comprehensive A comprehensive system that tracks individual children’s needs No No SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 14 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 The instability in the country may pose a challenge to the poverty alleviation for families who cannot afford ability of the government to provide consistent services nutritious food. and the families’ ability to access these services. Despite mandatory salt iodization, the rate of iodized Table 6. Regional Comparison of Level of Access to Essential salt consumption is only 29 percent (UNICEF MICS). This Health Services for Young Children and Pregnant Women suggests that the policy is not being implemented. It may (%) be worth studying the extent of implementation among Iraq Egypt Jordan Turkey Yemen Iraqi producers and importers. Salt iodization is very One-year-old children immunized against inexpensive, at roughly 5 U.S. cents per year, and yields 69 93 98 97 82 DPT (corresponding significant returns on investments. vaccines: DPT3) (%) Children below five Table 7. Regional Comparison of Level of Access to Essential with diarrhea receive 23 28 20 N/A 33 Nutrition Services for Young Children and Pregnant Women oral rehydration/ continued feeding (%) (%) Children below five Iraq Egypt Jordan Turkey Yemen with suspected Children below five pneumonia taken to 74 73 77 N/A 44 with health care provider 23 29 8 12 58 moderate/severe (%) stunting (%) Pregnant women Infants exclusively receiving antenatal breastfed until six 20 53 23 42 12 50 66 94 74 14 care (at least four months of age (%) times) (%) Infants with low Source: UNICEF Multiple Indicator Cluster Survey 2012. 13 13 13 11 N/A birth weight (%) Prevalence of Better coverage of nutrition interventions is necessary anemia in pregnant 38 45 39 40 58 to address stunting and anemia. In Iraq 23 percent of women (2005) (%) Prevalence of children below age 5 are moderately or severely stunted. anemia in 56 30 28 33 68 Stunting is defined as having a height (or length) for age preschool-aged children (2005) (%) more than 2 standard deviations below the median Sources: UNICEF Multiple Indicators Cluster Survey 2012; WHO Global according to international norms. It is an indicator of Database on Anemia. chronic malnutrition. Stunting early in life can have long- term effects: it can damage health and reduce an The net enrollment ratio in preprimary education is individual’s cognitive development, educational very low. As shown in table 3, in 2007 only 7 percent of performance, and economic productivity. This has Iraqi 3-5-year olds attended some kind of preprimary negative consequences not only for the well-being of the education. It is the exception rather than the norm for an individual, but the future of the country. As discussed in Iraqi child to attend preprimary school. Policy Level 1.1: Legal Framework, increasing breastfeeding rates would likely be an effective and Birth registration is universal. Birth registration reaches inexpensive way to decrease stunting rates. Table 7 99 percent of Iraqi children. Table 8 shows birth displays indicators on access to nutrition interventions registration rates in Iraq and several regional countries. for young children and pregnant women in Iraq, plus regional comparisons. Table 8. Regional Comparison of Level of Access to Birth Registration (%) In 2005, 56 percent of children below age 5 were Iraq Egypt Jordan Turkey Yemen anemic, and 38 percent of pregnant women had anemia Birth registration 99 99 99 94 17 (%) (WHO Global Database on Anaemia 2008). This suggests Source: UNICEF Multiple Indicator Cluster Survey 2012. that effective nutrition interventions are not reaching vulnerable populations. As discussed previously in this report, this may require a combination of mandating iron fortification of staples, micronutrient and food supplements, better medical and health education, and SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 15 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Policy Lever 2.3: services. Centers may not have staff trained to deal with Equity children with special needs. Based on the robust evidence of the positive effects ECD The curriculum is available in the country’s official interventions can have for children from disadvantaged languages of Arabic and Kurdish. According to Iraq’s backgrounds, every government should pay special constitution, children have the right to an education in attention to equitable provision of ECD services (Engle their mother tongue, which may include Syriac, and others 2011; Naudeau and others 2011). One of the Armenian, and Turkmen. Despite the existence of this fundamental goals of any ECD policy should be to provide policy, it is not clear that implementation extends to the equitable opportunities to all young children and their preprimary level. families. There is fairly equitable access to ECD services between Because of limited availability of data, it is difficult to socioeconomic levels. As figure 5 shows, access to assess if access to ECD services is equitable across several key ECD services is fairly equal between the different areas of the country. Preprimary enrollment wealthiest and poorest quintiles. Children from the rates are not available for different provinces and wealthiest households have slightly higher birth districts, so it is not clear how regions compare in terms registration rates, are slightly less likely to be of enrollment rates. It may be that rates are lower in underweight, and are a bit more likely to receive oral rural areas. rehydration therapy for diarrhea. The rate of skilled delivery is 15 percentage points higher for wealthier There is equity in access to preprimary school by women than for poor women. These disparities are gender. Boys and girls attend preprimary school at the smaller than those that exist in many countries. same net enrollment rate of 7 percent. Figure 5. Access to ECD Services by Richest/Poorest Income Quality ECCE services may not be accessible to many Quintile children with special needs. According to law, the GOI is to provide inclusive and equal education to children with special needs. It is not clear that this happens in education at the preprimary level. (Indeed, the vast majority of children without special needs in Iraq receive no preprimary education.) A government report entitled “Assessment of the Situation of Children with Special Needs and the Services Offered to Them, 2009” describes the Center for Diagnosing Disability as the main service provider for young children with disabilities. The main center is Source: UNICEF Multiple Indicator Cluster Survey in Baghdad, with 61 other centers in the rest of the Access to ECD services is slightly lower in rural areas federal area provinces. Committees at the centers decide than urban areas, but it is relatively equitable. Iraqis if children should receive special education services living in rural areas are somewhat less likely to use starting at age three. Children identified as disabled are improved sanitation facilities. Sixty-nine percent of Iraq’s referred to specialists, and programs for children with rural population had access to an improved water source hearing and vision impairments begin at age three. The in 2012 (World Bank) . Infrastructure may be worse in report says that there are 6,409 beneficiaries at these rural areas too. Underweight prevalence is virtually the centers, but clearly many more children have special same between young children in urban and rural areas. needs than that. The report describes that many children The rate of skilled delivery is about nine percentage who need the services are not enrolled for a variety of points higher for women in urban areas than for women reasons: their disabilities may be severe, the centers may in rural areas. Figure 6 shows access rates to ECD services be too far from their homes, there is no appropriate for rural and urban areas in Iraq. transportation, or the family is not aware of these SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 16 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Figure 6. Rural vs. Urban Access to ECD Services Figure 8. Children’s Books in the Home by Poorest and Richest Quintiles Source: UNICEF Multiple Indicator Cluster Survey Source: UNICEF Multiple Indicator Cluster Survey Clear differences are seen in the home learning environments of poorer and wealthier children. While Policy Options to Implement ECD Widely in access to some ECD services is fairly equitable between Iraq socioeconomic levels in Iraq, stark disparities are found in young children’s home environments. As figure 7 Scope of Programs shows, children in wealthier homes are much likely to ¾ The GOI could establish programs to screen and treat have adult support for learning than children in poorer maternal depression. Maternal depression can interfere homes. This can include an adult reading books, singing with a mother’s ability to care for and bond with a child songs, going outside, telling stories, or naming or and may increase the likelihood of language, cognitive, counting objects with a child. While only 10 percent of and behavioral impairments in children as they grow children from the wealthiest quintile attend early older. Efforts to support mothers and programs to childhood education, this is still 9 times higher than the prevent and treat maternal depression can yield high rate of attendance by children in the poorest quintile, returns. In some places, home visiting programs by who stand to gain the most from preprimary education. community outreach workers and community support Figure 8 shows the disparities in access to children’s groups have been shown to be effective in reducing books in the home among wealthier and poorer children. maternal depression, while also being fairly inexpensive. Figure 7. Early Learning Indicators by Poorest and Richest ¾ The GOI could establish programs to teach parents Quintiles about positive parenting methods, child development, and early stimulation. Such programs could also yield high returns for relatively low investment. These programs could take place through home health visits, or at religious institutions, women’s organizations, and community centers. ¾ The GOI could expand child protection and social protection programs. This could include support services targeting young children whose families cannot care for them. The GOI could consider establishing financial incentives to poor families to access ECD services. Source: UNICEF Multiple Indicator Cluster Survey Coverage ¾ The GOI could consider developing a comprehensive strategy and plan to increase health access for pregnant women and young children. While many women and children receive basic health services, too many still do SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 17 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 not have access to these essential services. The lack of unless programs are of high quality, the impact on health care may stem from a combination of low children can be negligible, or even detrimental. government capacity to deliver services and a crumbling health care system. The strategy would need to address Policy Lever 3.1: these issues to be effective. Data Availability ¾ The GOI could consider developing a comprehensive Accurate, comprehensive, and timely data collection can strategy to increase access to nutrition services for promote more effective policy making. Well-developed pregnant women and young children. This is necessary information systems can improve decision making. In to address stunting and anemia and may include offering particular, data can inform policy choices regarding the iron supplements and feeding programs, promoting volume and allocation of public financing, staff breastfeeding, improving access to health care, and recruitment and training, program quality, adherence to instituting poverty alleviation measures. standards, and efforts to target children most in need. Equity Administrative data on access to ECD and outcomes are not widely available, but many types of survey data are ¾ The GOI could study ways to improve the quality of collected. A few types of administrative data for Iraq are ECD services available to children with special needs. available; these figures reflect total uptake of services These children should be able to attend school, and staff and are gathered through a census. Available data and facilities should be adequately equipped to care for include the number of children enrolled in public and them. Special needs may include obvious physical and private ECCE centers, training of education service mental disabilities, but could also encompass children providers, and child outcomes in education, health, and who have been victims of conflict, displacement, and nutrition. Data on usage by young children of health, poverty. These children likely require extra nutrition, social protection, and child protection services socioemotional support. With properly trained staff, are not available. Table 9 displays several types of preschool can play an important role in helping children administrative data that are important to track in an ECD cope with stress and trauma, which in turn promotes system, with an indication of whether these are tracked their development. in Iraq. ¾ The GOI could consider ways to support poor parents Survey data are available for many indicators, often to enrich their children’s learning environment in the home. Parenting practices and stimulating environments through the UNICEF’s Multiple Indicator Cluster Survey for children can be promoted even in the face of minimal (MICS). Survey data are based on sampling a specific resources. This could include parenting programs on the population and can yield useful information on levels of importance of early stimulation, mobile libraries, and access to key ECD services. Table 9 displays several types programs aimed specifically at increasing enrollment in of survey data that can be important for an ECD system ECCE among children from poor families. to track, and an indication if these are tracked in Iraq. Some data are available to differentiate access to ECCE Policy Goal 3: Monitoring and Assuring by background characteristics. The GOI collects data on Quality enrollment in preprimary education by gender, ¾ Policy Levers: Data Availability • Quality urban/rural location, and subnational region. It does not collect data in a manner that can identify enrollment by Standards • Compliance with Standards special needs status, mother tongue, ethnicity, or Monitoring and Assuring Quality refers to the existence socioeconomic status. of information systems to monitor access to ECD services and outcomes across children, standards for ECD services, and systems to monitor and enforce compliance with those standards. Ensuring the quality of ECD interventions is vital because evidence has shown that SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 18 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Table 9. Availability of Data to Monitor ECD in Iraq Policy Lever 3.2: Administrative Data Quality Standards Indicator Tracked Ensuring quality ECD service provision is essential. A focus ECCE enrollment rates by region X on access—without a commensurate focus on ensuring Special needs children enrolled in ECCE quality—jeopardizes the very benefits that policy makers X hope children will gain through ECD interventions. The (number of) quality of ECD programs is directly related to better Children attending well-child visits (number of) X cognitive and social development in children. Children benefiting from public nutrition Learning standards are established for ECCE. In 1978 X interventions (number of) MOE introduced learning standards for early childhood Women receiving prenatal nutrition X education. These include developing motor, linguistic, interventions (number of) Children enrolled in ECCE by subnational social, artistic, and scientific skills, as well as knowledge 9 of good health, nutrition, and exercise habits. region (number of) Average per student-to-teacher ratio in public 9 Two kindergarten curriculum guidelines are available ECCE Is ECCE spending in education sector from MOE: Educational Experiences (2012) and X Educational Activities (2012). Educational experts differentiated within education budget? Is ECD spending in health sector differentiated developed these curricula, and they are intended to be X coherent and continuous with the primary school within health budget? Survey Data curriculum. They cover all relevant subjects except Indicator Tracked physical education and art. Population consuming iodized salt (%) 9 Entry requirements to become a preprimary teacher are Vitamin A supplementation rate for children minimal. Preprimary teachers must have completed X upper-secondary school, and there is a preference for 6–59 months (%) Anemia prevalence among pregnant women teachers who have completed a postsecondary course in 9 (%) education. However, some teachers who were hired Children below the age of five registered at before this requirement came into effect have not 9 birth (%) completed this level. No additional certifications are Children immunized against DPT3 at age 12 required. There is no requirement for teachers to 9 months (%) complete a preservice practicum. Pregnant women who attend four antenatal 9 visits (%) In KRG, MOE has raised the minimum qualification for Children enrolled in ECCE by socioeconomic X primary school teachers to a Bachelor’s degree in status (%) education. It has also begun a program to help current teachers meet these new standards. Data are collected to measure child development in kindergartens but may not be applied in any useful way. In-service training opportunities are not regularly Kindergarten teachers record information on individual available for teachers. No requirements are in place for children’s cognitive, linguistic, physical, and preprimary teachers to participate in in-service training, socioemotional development on child assessment cards. nor are there are any standard training courses. Many in- It is not clear that these data are aggregated and service programs are conducted based on support from analyzed at any higher level, but just remain with each international organizations and are not conducted in any teacher. systematic fashion. Health workers are not required to receive training on delivering ECD messages. In many countries, frontline health care providers including doctors, midwives, nurses, and extension health service workers are trained on sharing messages on developmental milestones, SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 19 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 positive parenting, and early stimulation for young and appropriate construction materials. The MOH has children. Since most parents of young children have established construction standards for both public and contact with these workers, it can be a good opportunity private hospitals and health centers. to share this information. The MOLSA is responsible for licensing nurseries. In Basic service delivery standards are established. accordance with Regulations for Nurseries No. 1 (1992), Standards are established for teacher-to-child ratios in MOLSA issues licenses to nurseries that comply with the preprimary classes. For children below age one, it is 1:8; regulations laid out in the document. If a nursery violates for one-to-two-year-olds, it is 1:10; for two-to-three-year these conditions, MOLSA is to notify it to this effect. If olds, it is 1:15; for three-to-four-year-olds, it is 1:20; and the nursery does not remedy the violation within 15 for four-to-six-year-olds, it is 1:25. These are fairly high days, it has another 30-day period to address it, after given the ages of the children. Particularly at the younger which the ministry can withdraw its license. ages, ratios this high could mean lack of adequate caregiving and an unsafe environment. Policy Lever 3.3: Compliance with Standards Kindergartens are supposed to be open for a minimum of five hours a day, five days a week. Establishing standards is essential to providing quality ECD services and to promoting the healthy development Many of the service delivery requirements for of children. Once standards have been established, it is preprimary facilities are laid out in the Regulations for critical that mechanisms are put in place to ensure Nurseries No. 1 (1992). This law gives MOLSA the compliance with standards. authority to open, operate, license, and supervise It is difficult to gauge what proportion of ECCE nurseries. It also spells out facilities requirements, such professionals comply with qualification requirements. as space requirements, cooling and ventilation, Given the available data from the MOE Statistical refrigeration, separate kitchen facilities, sleeping space, Department, it seems that approximately 25 percent of age-appropriate furniture, and sanitary facilities. It also ECCE teachers in federal areas comply with the gives requirements for staff (all must be women, except requirement of completion of upper secondary school. the guard, who must be male). It states that nurseries are to establish conditions for children’s natural and health Public ECCE facilities comply with some service delivery growth and to “protect children from psychological and standards. Data on compliance with service delivery social deviations.” The document does not seem to have standards in private ECCE centers are not available. In been prepared by ECD experts. federal areas, the teacher-to-child ratio in public kindergartens for children aged four to six is 1:28.9 in The Regulations for Nurseries and several other urban areas and 1:25.9 in rural areas. These are slightly regulations concerning education in Iraq are from the above the established standard of 1:25. In KRG the Baathist era, and the language they employ reflects this. average teacher-to-child-ratio is 1:16.3 for the same age It may be appropriate for the GOI to revisit these group. It seems that most schools comply with the regulations and revise them according to the country’s standard of a minimum of 25 hours of operation a week. principles, informed by ECD specialists. As there are no standards for construction for either ECCE centers are not required to meet any construction public or private ECCE centers, there is no compliance standards. Standards requiring potable water and to gauge. hygienic facilities apply to public nurseries and private nurseries, kindergartens, and primary schools. These standards do not apply to all public kindergartens and primary schools. It is not clear why this is the case. No construction standards are in place for any public or private ECCE centers. A strong set of construction standards would typically include requirements for electricity, a roof, a floor, windows, structural soundness, SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 20 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Policy Options to Monitor and Ensure ECD Comparing Official Policies with Outcomes Quality in Iraq The existence of laws and policies alone does not Data Availability always guarantee a correlation with desired ECD outcomes. In many countries, policies on paper and the ¾ Data collection and monitoring are important reality of access and service delivery on the ground are features of a strong ECD system and are necessary for not aligned. Table 10 compares ECD policies in Iraq with identifying needs and assessing programs. The GOI ECD outcomes. could expand the administrative data it collects, particularly the number of young children and women The GOI has been successful at implementing reached by health, nutrition, social protection, and child mandatory birth registration, achieving universal protection programs. coverage. The policy to iodize salt is less effective, with less than one-third of households consuming iodized ¾ Preprimary schools could use data collected by salt. While public preprimary education is free (but not teachers using the child assessment cards in a much mandatory) under the Iraqi constitution’s stipulation to more effective manner. Ideally these data would be provide free education at all levels, relatively few used to identify children experiencing developmental children attend preprimary school. In reality, Iraq has delays and provide early interventions to address them. very few preprimary schools. It is not common for young Additionally, these data could be analyzed to gain an children to receive this level of education, especially understanding of the situation of children in preschools. among poorer families. Young children are required to They could be used to set a baseline, determine priorities complete a full course of vaccinations, but approximately for intervention, and evaluate program impact. 30 percent of one-year-olds have not received a full course of DPT3 immunizations (UNICEF MICS). Table 10 Quality Standards compares ECD policies in Iraq with their outcomes. ¾ MOE could consider ways to improve the quality of Table 10. Comparing ECD Policies with Outcomes in Iraq preprimary teachers. This could include some kind of ECD policies Outcomes preservice training, and regular, mandatory in-service Household iodized training. Teachers working with young children need to Iraq has national policy to salt consumption have some knowledge of child development and encourage the iodization of salt 29% pedagogy and a familiarity with the curriculum. Preprimary school Preprimary school is free but not enrollment: ¾ GOI could establish construction standards for all compulsory in Iraq 7% ECCE facilities. The current lack of construction standards puts children’s safety at risk. Current Young children are required to Children with DPT3 structures may not be structurally sound or sanitary. At receive a complete course of (12–23 months): the same time, compliance mechanisms could also be childhood immunizations 69% established to enforce these standards. Completeness of Policy mandates the registration birth registration: Compliance with Standards of children at birth in Iraq 99% Sources: UNICEF Multiple Indicator Cluster Survey, UNESCO UIS, World Bank ¾ The GOI could establish mechanisms to monitor SABER-ECD Policy Instrument for Iraq ECCE centers for service delivery requirements. It may need to establish incentives for facilities to meet standards and offer support so that they can improve their services if necessary. This will likely require training MOE and local education officials on ECD principles, and developing their commitment to supervision based on an understanding of the importance of these programs. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 21 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Preliminary Benchmarking and International is home to one of the world’s most comprehensive and developed ECD policies and achieves a benchmarking of Comparison of ECD in Iraq “Advanced” in all nine policy levers. Iraq’s GNI per capita, using the Atlas method, in 2013 was US$6,710, making it Table 11 presents the classification of Iraq’s ECD policy an upper middle income country. Jamaica is included within each of the 9 policy levers and 3 policy goals. The because it has a slightly lower GNI than Iraq (US$5,220), SABER-ECD classification system does not rank countries and Colombia’s is slightly higher (US$7,560). In according to any overall scoring; rather, it is intended to comparison with Jamaica and Colombia, Iraq performs share information on how different ECD systems address the same or worse on policy levers. Yemen is the one the same policy challenges. other Middle East and North Africa (MENA) country in Table 12 presents the status of ECD policy development which SABER-ECD has been conducted. (Tunisia and in Iraq alongside a selection of other countries. Sweden Lebanon are currently under study.) Table 11. Benchmarking Early Childhood Development Policy in Iraq Level of Level of ECD policy goal Policy lever development development Legal framework  Establishing an enabling environment  Intersectoral coordination  Finance Scope of programs  Implementing widely  Coverage Equity  Data availability  Monitoring and Assuring Quality  Quality standards  Compliance with standards  Latent Emerging Established Advanced Legend: Table 12. International Classification and Comparison of ECD Systems Level of development ECD policy goal Policy lever Iraq Colombia Jamaica Sweden Yemen Legal framework      Establishing an enabling Coordination      environment Finance     Scope of programs      Implementing Coverage widely     Equity     Data availability      Monitoring and Assuring Quality Quality standards      Compliance with standards      SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 22 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Latent Emerging Established Advanced Legend: SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 23 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Conclusion essential ECD services in Iraq. Iraq has undergone years of conflict and instability, at great cost to its children and The SABER-ECD initiative is designed to enable ECD families. Early childhood development has not yet been policy makers and development partners to identify a priority of the government. Given the compelling body opportunities for further development of effective ECD of evidence of the importance of investing in young systems. This Country Report presents a framework to children, Iraq should strongly consider focusing attention compare Iraq’s ECD system with other countries in the and resources on this area. While crisis seems to follow region and internationally. Each of the nine policy levers crisis, and other more immediate concerns may seem to is examined in detail, and some policy options are demand priority, another generation of children grows identified to strengthen ECD are offered. up without the support to develop their full potential. Investing in Iraqi children may be the best investment Table 13 summarizes the key policy options identified Iraq can make in its future. to inform policy dialogue and improve the provision of Table 13. Summary of Policy Options to Improve ECD in Iraq Policy Policy options and recommendations dimension x Mandate iron fortification of staples, expand salt iodization, promote breastfeeding, and increase coverage of other nutrition interventions to address anemia and stunting x Update existing legislation concerning ECD to reflect recent evidence in the field and Establishing an the country’s values enabling x Expand policies and programs to address violent discipline and child abuse environment x Develop a multisectoral ECD strategy and implementation framework x Establish coordination mechanisms across ministries and ECD service providers x Establish mechanisms to track the level of spending on ECD in the country x Establish programs to screen and treat maternal depression x Establish programs to support parents to provide positive parenting, early stimulation, and enrich their children’s home learning environment, especially those in poorer families x Consider different modalities to expand preprimary enrollment, while ensuring quality Implementing x Launch a public awareness campaign to educate the public and government officials widely on the importance of ECD x Examine barriers to access to existing health and nutrition programs x Examine the steps necessary to increase access of children with special needs to preprimary education and other support services. This includes displaced children and children who have experienced psychological trauma. x Expand administrative data collected on access and outcomes in health, nutrition, social protection, and child protection x Establish preservice and in-service teacher for preprimary teachers to upgrade their Monitoring and skills Assuring Quality x Establish construction standards for all ECCE centers to ensure children’s safety, and mechanisms to monitor for compliance SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 24 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Acknowledgments This Country Report was prepared by Lindsay Adams (Consultant, Education Global Practice, World Bank) with inputs from Amina Denboba (Consultant, Education Global Practice, World Bank), and under the direction of Amanda Devercelli (Senior Education Specialist, Education Global Practice, World Bank). The report presents country data collected using the SABER-ECD policy and program data collection instruments and data from external sources. The report was prepared in consultation with the Middle East and North Africa Education Global Practice team and the government of Iraq. We are especially grateful for the guidance and assistance of Samira Halabi and Tomomi Miyajima (Education Specialists, Education Global Practice, World Bank). Dr. Ali Anbori led data collection in Iraq. For technical questions or comments about this report, please contact the SABER-ECD team (helpdeskecd@worldbank.org). Acronyms ECCE early childhood care and education ECD early childhood development ECE early childhood education (used interchangeably with preprimary or preschool) GNI gross national income GOI Government of Iraq KRG Kurdish Regional Government MICS Multiple Indicator Cluster Survey MOE Ministry of Education MOH Ministry of Health MOLSA Ministry of Labor and Social Affairs NGO nongovernmental organization OECD Organisation for Economic Co-operation and Development SABER Systems Approach for Better Education Results WHO World Health Organization References SABER-ECD (Systems Approach for Better Education Results–Early childhood development). 2014. Policy Instrument., Iraq: SABER-ECD 2014. Britto, P., H. Yoshikawa, and K. Boller. 2011. “Quality of Early Childhood Development Programs: Rationale for Investment, Conceptual Framework and Implications for Equity.” Social Policy Report 25 (2): 1–31. Engle, P. L., L. C. Fernald, H. Alderman, J. Behrman, C. O’Gara, A. Yousafzai, M. C. de Mello, M. Hidrobo, N. Ulkuer, S. Iltus, and the Global Child Development Steering Group. 2011. “Strategies for Reducing Inequalities and Improving Developmental Outcomes for Young Children in Low-Income and Middle-Income Countries.” The Lancet 378 (9799): 1339–53. Doi:10.1016/S0140-6736(11) 60889-1. Hanushek, E. 2003. "The Failure of Input-Based Schooling Policies." Economic Journal 113: 64–98. Hanushek, E. A. and D. D. Kimko. 2000. “Schooling, Labor-Force Quality, and the Growth of Nations." American Economic Review 90 (5): 1184–1208. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 25 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 Naudeau, S, N. Kataoka, A. Valerio, M. J. Neuman, and L. K. Elder. 2011. Investing in Young Children: An Early Childhood Development Guide for Policy Dialogue and Project Preparation. Washington, DC: World Bank. Neuman, M., and A. Devercelli. 2013. "What Matters Most for Early Childhood Development: A Framework Paper." SABER, World Bank, Washington, DC. Neuman, M. J. 2007. “Good Governance of Early Childhood Care and Education: Lessons from the 2007 Education for All Global Monitoring Report.” UNESCO Policy Briefs on Early Childhood. United Nations Educational, Scientific and Cultural Organization, New York. OECD (Organisation for Economic Co-operation and Development). 2011. “Starting Strong III: A Quality Toolbox for Early Childhood Education and Care.” OECD Publications, Paris. UNESCO-OREALC. 2004. “Intersectoral Co-ordination in Early Childhood Policies and Programmes: A Synthesis of Experiences in Latin America.” Regional Bureau of Education for Latin America and the Caribbean, United National Educational, Scientific and Cultural Organization. UNICEF Multiple Indicator Cluster Surveys (MICS) Valerio, A. and M. Garica. 2012. “Effective Financing.” In P. Britto, P. Engle, C. Super (Eds.) Handbook of Early Childhood Development Research and its Impact on Global Policy. Oxford University Press, New York. Vargas-Barón, E. 2005. Planning Policies for Early Childhood Development: Guidelines for Action. Paris: UNESCO/ADEA/UNICEF (United Nations Educational, Scientific and Cultural Organization/Association for the Development of Education in Africa/United Nations Children’s Fund). WHO Global Database on Anaemia. 2008. “Worldwide Prevalence of Anaemia: 1993-2005.” World Health Organization, Geneva. WHO Global Health Expenditure Database. http://apps.who.int/nha/database SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 26 IRAQ ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014 www.worldbank.org/education/saber The Systems Approach for Better Education Results (SABER) initiative collects data on the policies and institutions of education systems around the world and benchmarks them against practices associated with student learning. SABER aims to give all parties with a stake in educational results—from students, administrators, teachers, and parents to policymakers and business people—an accessible, detailed, objective snapshot of how well the policies of their country's education system are oriented toward ensuring that all children and youth learn. This report focuses specifically on policies in the area of Early Childhood Development. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 27