94322 Republic of Guinea SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2013 Policy Goals Status 1. Establishing an Enabling Environment Policies and regulations promote some level of access to ECD services in all sectors in Guinea. The National Policy for Preprimary Education and Child Protection supports access to education and social protection services, but does not mandate compulsory preprimary enrollment. Budget allocations for ECD are insufficient, and there is a lack of synergy between sectors in the implementation of interventions. 2. Implementing Widely Although the scope of ECD programs targets all beneficiaries, inequalities exist in the level of coverage between regions and socioeconomic groups. Children and families in marginalized communities generally have less access to ECD services. Specialized interventions are required to ensure equal access for all beneficiaries. 3. Monitoring and Assuring Quality Guinea collects administrative data on some important ECD indicators, but lacks a comprehensive system to monitor children’s development across sectors. Standards for ECD service delivery exist but are not always mandatory or adequately enforced. GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 This report presents an analysis of the Early Childhood Guinea is home to 10.2 million people, including Development (ECD) programs and policies that affect approximately 1.7 million children below the age of 5. young children in Guinea and recommendations Table 1 displays a snapshot of ECD indicators in Guinea to move forward. This report is part of a series of reports and other countries in West Africa. An estimated 40% of prepared by the World Bank using the SABER-ECD these children are stunted, while 21% are underweight. framework 1 and includes analysis of early learning, Malaria, malnutrition, and low levels of birth registration health, nutrition and social and child protection policies are significant problems, especially for children in rural and interventions in Guinea, along with regional and areas and young refugees from Sierra Leone and Liberia. international comparisons. Currently, only 9% of all children aged 3-6 attend preprimary school. In recent years, the Government of Guinea (GoG) has implemented policies and programs to Guinea and Early Childhood Development increase access to ECD services, and improve intersectoral coordination amongst key ministries. A The Republic of Guinea is a low-income country situated national Directorate for Preprimary Education and Child on the West coast of Africa. Despite its considerable Protection (DNEPPE) has been established, as well a Child mineral wealth, the country has a GDP per capita of Code and preschool education policy. ECD-related US$498, and 47% of the population lives below the policies have also been developed in the health and poverty line. It is ranked 178 out of 182 countries in the nutrition sectors. Despite this commitment, the UNDP Human Development Index. The country is Government faces the challenge of developing funding currently in a period of political transition following the mechanisms to support the expansion of ECD coverage takeover by a military junta in 2008 and the return to while ensuring the quality of service delivery. civilian rule in 2010. Table 1: Snapshot of ECD indicators in Guinea with regional comparison Snapshot of ECD Indicators in Guinea with Regional Guinea Liberia Mali Nigeria Sierra Leone Comparison Infant Mortality (deaths per 1,000 live births) 81 74 99 88 114 Under-5 Mortality (deaths per 1,000 live births) 130 103 178 143 174 Maternal Mortality Ratio (deaths per 100,000 births) 980 990 460 550 860 Gross Preprimary Enrollment Rate (36-59 months, 2010) 9% 47% 5% 9% 14% Birth registration 2000-2010 43% 4% 81% 30% 51% Source: UNICEF Country Statistics, 2010 1 SABER-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 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Systems Approach for Better Education Box 1: A checklist to consider how well ECD is promoted at the country level Results – Early Childhood Development What should be in place at the country level to promote (SABER-ECD) coordinated and integrated ECD interventions for young children and their families? SABER – ECD collects, analyzes and disseminates Health care comprehensive information on ECD policies around the x Standard health screenings for pregnant women world. In each participating country, extensive x Skilled attendants at delivery multisectoral information is collected on ECD policies x Childhood immunizations and programs through a desk review of available x Well-child visits government documents, data and literature, and Nutrition interviews with a range of ECD stakeholders, including x Breastfeeding promotion government officials, service providers, civil society, x Salt iodization development partners and scholars. The SABER-ECD x Iron fortification framework presents a holistic and integrated Early Learning assessment of how the overall policy environment in a x Parenting programs (during pregnancy, after delivery and country affects young children’s development. This throughout early childhood) assessment can be used to identify how countries x High quality childcare for working parents address the same policy challenges related to ECD, with x Free preprimary school (preferably at least two years with the ultimate goal of designing effective policies for developmentally appropriate curriculum and classrooms, young children and their families. and quality assurance mechanisms) Social Protection Box 1 presents an abbreviated list of interventions and x Services for orphans and vulnerable children x Policies to protect rights of children with special needs policies that the SABER-ECD approach looks for in and promote their participation/ access to ECD services countries when assessing the level of ECD policy x Financial transfer mechanisms or income supports to development. This list is not exhaustive, but is meant to reach the most vulnerable families (could include cash provide an initial checklist for countries to consider the transfers, social welfare, etc.) key policies and interventions needed across sectors. Child Protection x Mandated birth registration Three Key Policy Goals for Early Childhood x Job protection and breastfeeding breaks for new mothers Development x Specific provisions in judicial system for young children SABER-ECD identifies three core policy goals that x Guaranteed paid parental leave of least six months countries should address to ensure optimal ECD x Domestic violence laws and enforcement outcomes: Establishing an Enabling Environment, x Tracking of child abuse (especially for young children) Implementing Widely, and Monitoring and Assuring x Training for law enforcement officers in regards to the Quality. Improving ECD requires an integrated approach particular needs of young children to address all three goals. As described in Figure 1, for Figure 1: Three core ECD policy goals each policy goal, a series of policy levers are identified, through which decision-makers can strengthen ECD. Strengthening ECD policies can be viewed as a continuum; as described in Table 2 on the following page, countries can range from a latent to advanced level of development within the different policy levers and goals. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 3 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 2: ECD policy goals and levels of development Level of Development ECD Policy Goal Minimal legal framework; Developed legal Non-existent legal Regulations in some Establishing some programs with framework; robust inter- framework; ad-hoc sectors; functioning inter- an Enabling sustained financing; institutional financing; low inter- sectoral coordination; Environment some inter-sectoral coordination; sustained sectoral coordination. sustained financing. coordination. financing. 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 in sectors; inequality in most sectors; low services for all, some access and outcomes. access and outcomes. inequality in access. tailored and targeted. Information on outcomes Information on outcomes Information on outcomes Minimal survey data at national, regional and from national to at national level; Monitoring available; limited local levels; standards for individual levels; standards for services and Assuring standards for provision of services exist for most standards exist for all exist in some sectors; no Quality ECD services; no sectors; system in place sectors; system in place system to monitor enforcement. to regularly monitor to regularly monitor and compliance. compliance. enforce compliance. Policy Goal 1: Establishing an Enabling National laws and regulations could be improved to comprehensively promote appropriate dietary Environment consumption for women and young children. The 2001 ¾ Policy Levers: Legal Framework • National Health Policy (NHP) and the 2005 National Food Intersectoral Coordination • Finance and Nutrition Policy (NFNP) both seek to promote the An Enabling Environment is the foundation for the design widespread consumption of iodized salt, and the and implementation of effective ECD policies2. An enabling continued distribution of iron and Vitamin A to pregnant environment consists of the following: the existence of an women and young children. The Government of Guinea adequate legal and regulatory framework to support ECD; (GoG) has enacted legislation requiring the fortification of coordination within sectors and across institutions to wheat flour with iron, folic acid, zinc, and Vitamin B, and deliver services effectively; and, sufficient fiscal resources has initiated a policy to fortify refined vegetable oil with with transparent and efficient allocation mechanisms. Vitamin A. 3 Currently, approximately 97% of young children in Guinea receive Vitamin A supplements. The Policy Lever 1.1: iodization of salt is voluntary in Guinea, and only 41% of Legal Framework the population consumes iodized salt. In 1997, Guinea developed a draft policy in line with The International The legal framework comprises all of the laws and Code of Marketing of Breast Milk Substitutes, an regulations which can affect the development of young international directive that promotes the appropriate children in a country. The laws and regulations which nursing of infants and young children. The policy is still impact ECD are diverse due to the array of sectors which awaiting Government approval, and the GoG currently influence ECD and because of the different constituencies implements a few provisions of the Code. The Public that ECD policy can and should target, including pregnant Health Code (1997) and the Policy for the Promotion of women, young children, parents, and caregivers. Breastfeeding (2009) mandate the exclusive breastfeeding 2 3 Brinkerhoff, 2009; Britto, Yoshikawa & Boller, 2011; Vargas- Ordinance no. A/2006/4600/MSP/MCIRME/MEF/SGG of Baron, 2005 September 6, 2006 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 4 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 of infants from birth to six months of age. Currently, only policy applies to both private and public sector 48% of infants in Guinea are exclusively breastfeed until 6 employees. Women are permitted to take unpaid leave months of age. Table 3: Regional comparison of parental leave policies Policies and regulations promote some provision of Sierra healthcare for young children and women. The Public Guinea Liberia Mali Nigeria Leone Health Code and the Expanded Program on 98 days 90 days 98 days 84 days 84 days Immunization (EPI) require all children to receive a paid paid paid paid paid complete course of childhood immunizations. Though maternity maternity maternit maternit maternit policies do not require children to attend well-child visits, leave at leave at y leave at y leave at y leave at the Public Health Code mandates child monitoring for 100% 100% 100% 50% 100% malnourished children and children with certain diseases, salary for salary for salary for salary for salary for women; women; women; women; women; including HIV/AIDS and sickle cell anemia. In 2003, the no leave no leave 3 days at no leave no leave Ministry of Public Health (MoPH) developed a National for for 100% for for Health Development Plan (NHDP), which includes fathers. fathers. salary for fathers. fathers. maternal and child health as a major component. The fathers. NHDP commits to promote access to prenatal and Source: World Bank’s Women, Business and the Law database obstetric care and ensure the provision of quality care for young children. Pregnant women with HIV/AIDS are not to exceed nine months at the end of their maternity required by law to receive standard health screenings leave (Article 62). In reality, given the high levels of and appropriate medication to prevent mother-to-child employment within the informal sector, the vast majority transmission prior to, during, and post birth. According to of Guinean women do not benefit from paid maternity the Labor Code (1988), new mothers are entitled to free leave. There is no policy mandating paternity leave for medical care to be provided by their employers. new fathers. National laws and regulations do not adequately The Labor Code also provides pregnant women and new promote early learning. The National Education Sector mothers with protection, including requiring employers Policy (2005) and the Policy Statement on the Preprimary to provide an hour break for nursing mothers for a total Education Sub-Sector (PSPES) register preprimary of 15 months, and prohibiting the dismissal of pregnant education as the first level of education. The PSPES’ goal women (Articles 62 & 63). Table 3 compares parental is to increase preschool coverage from 9% to 30% by leave policies in Guinea with neighboring West African 2020 for children aged 3-5 years old. The policy supports countries. the expansion of Early Childhood Care and Education (ECCE) through the development of 303 Community National laws and regulations promote child Education Centers (CECs) and the training of ECCE protection and care for disadvantaged children. The educators and supervisors. The Ministry of Social Affairs Guinean Civil Code (Article 192) mandates the and the Advancement of Women and Children (MASPFE) registration of children at birth, and the government has developed guidelines for establishing CECs and a has established a National Committee to support Birth learning framework for public and private ECCE registration. The birth of a child must be registered providers. Government policies do not mandate within 15 days of the date of birth, and failure to do so compulsory preprimary or parenting education. is considered an offense. Exceptions are made contingent upon certain circumstances. National policies guarantee job protection for pregnant women, and opportunities for new parents to care for The Guinean Constitution, the Penal Code, and the their infants during the first year of life. Article 59 of the Code of Criminal Procedure contain measures that Labor Code (1988) mandates the provision of 98 days of afford protection to children. In 2009, Guinea adopted a maternity leave to working women, paid at 100% salary. comprehensive Child Code that includes several Maternity leave is partially financed by the GoG and enhanced protection measures, especially for victims of partially paid for by the employer. The parental leave domestic violence, trafficking, and child labor. In 1999, SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 5 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Guinea ratified the UN Convention on the Rights of the Policy Lever 1.2: Child (CRC), making it the 14th country to sign the Intersectoral Coordination international child protection treaty. Guinea has also ratified the African Charter on the Rights and Welfare of Development in early childhood is a multi-dimensional the Child. The GoG has set up a national commission to process. 4 In order to meet children’s diverse needs monitor the implementation of the CRC, and in 2001, during the early years, government coordination is established a Children’s Parliament to advocate for the essential, both horizontally across different sectors as rights of all children. well as vertically from the local to national levels. In many countries, non-state actors (either domestic or In 1996, the government established the Ministry of international) participate in ECD service delivery; for this Social Affairs and the Advancement of Women and reason, mechanisms to coordinate with non-state actors Children (MASFE) to promote and implement policies are also essential. for all children, including orphans and children with special needs. MASFE developed the National Policy on Guinea has an explicitly stated intersectoral ECD policy Preprimary Education and Child Protection, which offers and strategic plan. The National Policy on Preprimary access to ECD services for OVCs and children with Education and Child Protection (PPECP) details a special needs. The GoG has also established a Steering multisectoral strategy for the management of ECD that Committee to support the protection of orphans and includes education and child protection, and elements vulnerable children (OVCs). Policies to support the of health and nutrition. The policy provides guidelines rehabilitation and reintegration of children affected by for ECD activities at the national and subnational levels, conflict have been introduced. and the Government has established an integrated list of ECD services. Although the central Government is The Ministry of Security has created a special police unit responsible for the design of ECD policy in Guinea, to investigate child abuse and child trafficking. Training national and sub-national government bodies are programs have been developed and implemented for responsible for the provision of ECD services under the judges and lawyers to familiarize them with the CRC and supervision of MASFE. matters related to ECD aged children. Guinea has established an institutional anchor to lead Key Laws, Regulations, and Plans Governing ECD ECD policy but coordination amongst ministries is in Guinea limited. The Ministry of Social Affairs and the Advancement of Women and Children is the coordinating x The Public Health Code (1997) ministry for ECD. Within MASFE there is the National x The United Nations (UN) Convention on the Rights of Directorate for Preprimary Education and Child Protection the Child (Ratified, 1999) x The African Charter on the Rights and Welfare of the (DNPEPE), which is tasked with developing and African Child (Ratified, 1999) implementing ECD policies and programs. Focal points for x National Health Policy (2001) ECD include the Director and Deputy Director of DNPEPE, x National Health Development Plan (2003) the Manager of the Preprimary Division, and x National Food and Nutrition Policy (2005) representatives from the parental education and x National Policy on Preprimary Education and Child monitoring and evaluation teams. Protection (2007) x Child Code (2009) In 2002, the GoG established a steering committee to x Integrated Early Childhood Program Standard (2009) coordinate childhood development policies, which x Policy Statement on the Preprimary Education Sub-Sector (2012) includes a unit on ECD. As displayed in Figure 2, the x National Education Sector Policy (2012) Central Unit for Early Childhood (CUEC) comprises representatives from relevant ministries, including: 4 Naudeau et al., 2011; UNESCO-OREALC, 2004; Neuman, 2007 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 6 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Figure 2: Structure of the National ECD Taskforce Guinea’s ECD system currently operates with limited service delivery coordination. MASFE, the Ministry of Pre-University Education Mechanisms exist to promote coordination between (MEPUEC), the Ministry of Public Health, the Ministry of state and non-state stakeholders. The Guinean Justice, the Ministry of Youth and Youth Employment, Network for Early Childhood (REGUIPEN) facilitates the Ministry of Planning and International Cooperation, knowledge exchange between organizations working on the Ministry of Information, the Ministry of Territorial ECD. Local NGOs, development partners, and Administration and Decentralization, the Ministry of government agencies meet occasionally to develop ECD Culture, the Ministry of Sports, and the Governorate of strategies and coordinate program implementation. Conakry. The ECD group is tasked with setting policies and standards for ECD services, and monitoring the Policy Lever 1.3: quality of service provision. 5 Finance A letter of cooperation exists between the relevant While legal frameworks and intersectoral coordination ministries for the implementation of the PPECP. CUEC is are crucial to establishing an enabling environment for set to meet once a month to coordinate activities.6 ECD, adequate financial investment is key to ensure that Despite these formal mechanisms for collaboration, resources are available to implement policies and there is a lack of coordination between ministries in the achieve service provision goals. Investments in ECD can actual provision of ECD services. This is in part due to yield high public returns, but are often undersupplied budget constraints. There is no ECD-specific budget without government support. Investments during the allocation dedicated to the Ministries in charge of early years can yield greater returns than equivalent health, nutrition, or education. investments made later in a child’s life cycle and can lead to long-lasting intergenerational benefits7. Not 5 Ordinance no.6233/PASE/CAB/90 6 7 Ordinance no.6233/PASE/CAB/90.; Ordinance no.2002/MASPFE/ Valerio & Garcia, 2012; WHO, 2005; Hanushek & Kimko, 2000; CAB March 7, 2002. Hanushek & Luque, 2003 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 7 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 only do investments in ECD generate high and persistent There are no criteria or method for determining ECD returns, they can also enhance the effectiveness of other financial allocations or spending for health and social investments and help governments address nutrition. There is no national law or policy establishing multiple priorities with single investments. the minimum level of public funding for ECD. Each of the relevant ministries is responsible for financing ECD The Government makes some budgetary allocation for interventions and there is limited coordination in the preprimary education and child protection. ECD budget management of ECD investments across sectors. planning for education and child protection is Information on budgeting and spending for young coordinated between MASFE, the Ministry of Finance, children and pregnant women for health and nutrition and the Ministry of Pre-University Education. Following programs does not exist. As part of the World Health the annual adoption of the Budget Act, the three Organization’s Global Strategy for Women and ministries meet for a joint planning session to Children’s Health, the GoG expressed its commitment determine the childhood development budget for to establishing a budget line for reproductive health MASFE, which includes ECD. For FY2012, MASPFE commodities and ensuring access to free prenatal and budgeted GNF 500 million Guinean Francs (US$68,331) obstetric care as well as care for newborns. each for ECCE and child protection. The level of public ECD expenditure is inadequate and The Ministry of Pre-University Education’s (MEPUEC) high private costs are a barrier to access, especially for budget for FY2012 included GNF 13 trillion Guinean low-income families. There is only one publically Francs (US$1.77 billion) for education. Though the funded preprimary school in Guinea, located in the MEPUEC has the expansion of preprimary education as capital, Conakry. The private sector, NGOs, and one if its priorities, the specific allocation for ECD is not community groups provide the majority of ECCE available. services in the country. Families have to pay a number of fees to access these services, including tuition, The Policy Statement on the Preprimary Education Sub- matriculation, the costs of uniforms, and other school Sector (2012) seeks to significantly increase public fees. International development partners provide a lot funding for ECCE as part of its goal to expand of the funding for ECCE and social services, especially to preprimary enrollment to 30% by 2020. The National young children living outside of Conakry. Policy on Preprimary Education and Child Protection also has increased funding for ECCE and child protection By law, families are entitled to a number of as one of its priorities. MASFE plans to organize complimentary health services, including: labor and advocacy and lobbying sessions to increase the funding delivery, child growth monitoring, prenatal checkups, allocation for preprimary education from 8% to 30% in antiviral treatment for pregnant women, malaria the National Development Budget. In 2010, the GoG treatment, and Insecticide-treated bed nets (ITNs) for commissioned a study to develop strategies for pregnant woman and young children. In practice, financing ECD in Guinea. It is unclear whether the however, the level of out-of-pocket health expenditures findings and recommendations from this study have is considerably high. As presented in Table 4, data from been implemented. the World Health Organization Global Health Expenditure Database shows that out-of-pocket expenditure accounts for 88% of the total expenditure on health in Guinea. When compared to neighboring West African countries, Guinea has one of the highest levels of out-of-pocket health expenditure. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 8 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 4: Regional comparison of select health Intersectoral Coordination: expenditure indicators8 Guinea Liberia Mali Nigeria Sierra ¾ Although Guinea has established a multisectoral Leone strategy and an institutional anchor, financial Out-of-pocket expenditure as a percentage of all 99% 52% 99% 95% 90% constraints may affect its ability to successfully play private health expenditure its coordinating role. Developing effective Out-of-pocket health coordination mechanisms and synergies amongst expenditure as percentage 88% 35% 53% 59% 79% relevant government entities could help improve of total expenditure on health Guinea’s multisectoral strategy. The Government General government expenditure on health as a 5% 12% 5% 5% 13% could consider improving information sharing on percentage of GDP ECD-related budget allocations and spending, and Percentage of routine EPI No effectively leveraging ongoing projects in one sector vaccines financed by 24% 6% 20% 71% government data to support policies and strategies in other sectors. Source: WHO Global Health Expenditure Database, 2010; UNICEF Country Statistics, 2010 Finance: ¾ The Government provides limited ECD financing, and in The adequacy of official levels of remuneration for ECD order to access key services, families must bear a large service providers is difficult to assess. The Government share of the costs. This severely limits access to has no standard salary for ECCE professionals. The essential health, education, nutrition, and social compensation for preprimary teachers and caregivers protection services for many poor families, and in varies by communities, and in some cases, particular, families living outside of Conakry. Currently, remuneration takes the form of in-kind payment. many key ministries do not have ECD specific line According to policy, the Government compensates items. These Ministries could consider inserting specific extension health service professionals in line with public line items within their budgets for pregnant women service regulations; however, no data exist on the exact and young children, and coordinating their spending level of compensation. information and program implementation with other ministries. To support MASFE’s goal of increasing Policy Options to Strengthen the Enabling preprimary education to 30% by 2010, the Government Environment for ECD in Guinea could consider the following options, independently or jointly: Legal framework: ¾ The GoG has developed policies and regulations in all x Provide grants to rural development relevant sectors to support ECD. The Child Code and communities (RDCs) to further the expansion of the National Policy on Preprimary Education and Child ECCE Community Education Centers (CECs); Protection ensure the protection of young children and x Provide cash transfers or vouchers to families support the provision of ECCE services. The contingent upon enrolling a child in preprimary Government could focus on expanding policies that school or accessing other ECD services. Box 2 promote access to healthcare and appropriate dietary describes a successful example of a cash transfer consumption for all ECD beneficiaries, including program in Mauritius; officially passing a policy addressing the marketing of x Develop a public-private cost sharing breast milk substitutes and mandating salt iodization. arrangement to build more CECs and expand the development of public preprimary schools; and x Create an ECCE start-up credit loan in order to expand service delivery for underserved 8 Out of pocket expenditure is any direct outlay by households, communities. including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 9 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Box 2: Relevant lessons from Mauritius on financing Policy Lever 2.1: ECD: conditional cash transfers (CCTs) to promote ECCE Scope of Programs enrollment Summary: The Government of Mauritius has focused Effective ECD systems have programs established in all policy efforts on increasing preprimary school enrollment essential sectors and ensure that every child and in the last decade. In order to encourage parents to enroll expecting mothers have guaranteed access to the their children, the Government provides all families with essential services and interventions they need to live financial support contingent upon the child attending the healthfully. The scope of programs assesses the extent final year of preprimary school (age 4 in Mauritius). The to which ECD programs across key sectors reach all transfer amounts to USD 6 per month and has helped beneficiaries. Figure 3 presents a summary of the key achieve an 85% enrollment rate in preprimary school for interventions needed to support young children and children aged 3 to 5 in Mauritius. Provision is largely through non-State centers (17% of all preschools are their families via different sectors at different stages in a State-managed), but the design and enforcement of child’s life. quality control mechanisms has remained central to Government policy efforts. Figure 3: Essential interventions during different periods of Key considerations for Guinea: 9 Incentivizing on-time enrollment in preprimary school could help address the significant problem of early enrollment in primary school. 9 CCTs could be combined with grant programs to Community Education Centers (CECs) to increase student enrollment and improve integrated ECD services at the community level 9 It will be important to determine the appropriate funding level to maximize effectiveness of policy Policy Goal 2: Implementing Widely ¾ Policy Levers: Scope of Programs • Coverage • Equity Implementing Widely refers to the scope of ECD programs available, the extent of coverage (as a share of the eligible population) and the degree of equity within ECD service provision. By definition, a focus on ECD involves (at a minimum) interventions in health, nutrition, education, and social and child protection, and should target pregnant women, young children and their parents and caregivers. A robust ECD policy should ECD programs are established across all relevant include programs in all essential sectors; provide sectors and target a wide range of beneficiary groups. comparable coverage and equitable access across Guinea has a range of ECD interventions in the regions and socioeconomic status – especially reaching education, health, nutrition, and child protection the most disadvantaged young children and their sectors. Interventions exist that target children aged 0 families. to 83 months old, pregnant women, and caregivers. As presented in Figure 4, programs targeting parents, caregivers and preprimary aged children are limited. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 10 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Figure 4: Scope of ECD interventions in Guinea by Essential nutrition programs in Guinea are provided target population and sector with the assistance of international development partners. The Department of Food and Nutrition of the MoPH works with a number of development partners to provide food fortification and nutrition surveillance programs for the full range of ECD beneficiaries. Each year, MoPH organizes a breastfeeding campaign that targets nursing and pregnant women. Education programs are provided for children aged 3 to 6 by Community Education Centers, private institutions, and public institutions. Non-state actors provide the majority of ECCE services in Guinea, with coverage in a limited number of regions. International development partners support a variety of ECCE programs, including teacher training, parental education, and curriculum development. There is limited information on the provision of the ECCE services to children with special needs. In order to expand coverage and provide integrated ECCE services for children living in rural and marginalized communities, the Directorate for Preprimary Education and Child Protection has introduced a program to establish Community Education Centers (CECs). According to the A range of health interventions exists that target all 2012 Policy on the Preprimary Education Sub-Sector, the beneficiary groups. Since 1979, the Ministry of Public Government plans to build 303 CECs. Each CEC serves Health (MoPH) has implemented EPI to provide the full between 30 to 40 children aged 3 to 6 years old, and course of childhood immunizations for children aged 0 provides preprimary education as well as nutrition and to 83 months. The Government also implements an health interventions, including child growth monitoring, Integrated Management of Childhood Illnesses school feedings, and nutritional surveillance. Each programs that targets all children. Child monitoring community selects one or two early childhood educators programs are provided at local health centers and CECs who are trained and tasked with managing the CECs. Once in accordance with national health policy. A host of a year, community health workers are tasked with international development partners, often in providing vaccines, and nutritional and health monitoring coordination with MoPH, implement a range of health for children attending CECs. CEC’s also provide parental programs, including: prenatal and post-natal care, education, including courses on childhood health, child parental education on child health, immunization rights, and literacy programs for women. support, child growth monitoring, and malaria treatment and prevention. In 1997, the Government Local women’s associations, community groups, piloted a community health insurance scheme for safe parents, and CRDs supervise and support CECs in each motherhood (MURIGA) to support access to pre-natal community. Families contribute to the monthly salary of and neonatal care. The Government has since adopted CEC educators and caregivers. MASFE and the Ministry MURIGA as a national maternal health strategy; it is of Pre-University Education provide CECs with technical currently implemented in 17 of Guinea’s 33 prefectures. The community health insurance scheme helps cover the costs of child vaccinations, drug prescriptions, and referrals for women and children. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 11 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 and financial assistance as well guidelines for the Table 5: ECD programs and coverage in Guinea implementation of preprimary programs. In 2008, 293 Scale CECs had already been established with support from Number of ECD Intervention Regions Level of UNICEF, ActionAid, GiZ, KfW Banking Group, Agence Covered Coverage Française de Développement, and the World Bank. (out of 8) Education (stimulation at early learning) There are some child protection initiatives provided by Government-provided early childhood care and 1 Low the Government and NGOs. In 2005, the GoG education introduced a new drive to increase the level of birth Privately-provided for profit early childhood 8 Low registration, which was, at the time, 28% of Civil service care and education Privately-provided not-for-profit early officials, community health workers and midwives have 8 Low childhood care and education participated in training programs to help encourage Community-based early childhood care and families to obtain birth registration for their children 8 Low education and as of 2010, the rate of birth registration had Health increased to 43%. Prenatal healthcare No data Labor and delivery 8 Low Special programs exist for the housing and care of Comprehensive immunizations for infants 8 Low orphaned and vulnerable children. The Government has Childhood wellness and growth monitoring No data established a family tracing and reunification program Nutrition for children separated as a result of the wars in Micronutrient support for pregnant women 8 Universal neighboring Sierra Leone and Liberia, and health and social protection programs exist for refugee children. Food supplements for pregnant women No data Micronutrient support for young children 8 Universal Table 5 shows that in Guinea a range of ECD programs Food supplements for young children No data are established in education, health, nutrition, and child Food fortification 8 Universal and social protection. Many programs, especially in the Breastfeeding promotion programs 8 Low education sector, are provided with limited coverage in Anti-obesity programs encouraging healthy a number of regions in the country. Guinea does not eating/exercise No intervention have a comprehensive system in place to track Feeding programs in preprimary schools No data individual children’s needs and, where necessary, Parenting intervene. Development partners such as UNICEF, Plan Parenting integrated into health/community Guinea, Helen Keller International, SOS Children’s programs 8 Low Village International, and ChildFund provide many of Home visiting programs to provide parenting No intervention the ECD services outside of Conakry. messages Social and Child Protection Programs for OVCs 3 Low Interventions for children with special No data (emotional and physical) needs Cash transfers conditional on ECD services or No intervention enrollment Comprehensive A comprehensive system that tracks individual No intervention children’s needs Source: SABER-ECD Policy Data Collection Instrument and SABER-ECD Program Data Collection Instrument *Note: Nearly universal coverage signifies coverage rates above95% SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 12 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Policy Lever 2.2: Figure 6: Student enrollment in preprimary programs Coverage by type of provider Public, Communit A robust ECD policy should establish programs in all 0.09% y -Based , essential sectors, ensure high degrees of coverage and 8.37% reach the entire population equitably–especially the most disadvantaged young children–so that every child and expecting mother have guaranteed access to essential ECD services. Access to Early Childhood Care and Education (ECCE) in Private & Guinea is limited. The Guinean Government does not NGOs, mandate compulsory preprimary education for children 91.54% aged 3 to 6 years old. Currently, only 9% of preschool aged children attend preprimary programs in Guinea, Source: MASPFE, Statistics on Preprimary Education, 2010-2011 and access is disproportionate, with most schools located in the capital of Conakry. Figure 5 displays the The Education Sector Strategy and Policy Statement on number of students enrolled in preprimary programs by the Preprimary Education Sub-Sector seek to increase region. As displayed in Figure 6, roughly 92% of preprimary enrollment to 30% by 2020 and expand students attend ECCE programs provided by the private coverage in rural areas. By 2020, the Government plans sector and non-governmental organizations. to: Community-based preschools account for close to 8% of x Develop 38 public preprimary centers in urban areas preprimary enrollment, while public ECCE institutions and 303 Community Education Centers; are nearly non-existent, with only one public pre- x Provide pre-service training for 796 preprimary primary school operating in the whole country. teachers and continuous in-service training for 2,023; x Introduce a parental education program that targets 5,000 parents in 303 communities; Figure 5: Student enrollment in preprimary programs x Develop and distribute 341 pedagogical, information, by region and games kits to preprimary centers; and 60000 x Organize advocacy and lobbying sessions to increase # Students in ECCE Programs the funding allocation for preprimary education from 50000 8% to 30% in the National Development Budget. 40000 As presented in Table 6, nursery schools constitute the 30000 majority of ECCE centers in Guinea with a percentage 20000 share of 74.6% (929), followed by community-based 10000 centers with a share of 10.4% (129). There exist fewer childcare centers (0.7%, 52 centers). The majority of 0 ECCE facilities are located in urban and peri-urban areas putting children in rural areas at a disadvantage. Region Source: MASPFE, Statistics on Preprimary Education, 2010-2011 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 13 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Access to essential maternal health interventions is Table 6: Number of ECCE centers by type low. By international standards, the level of antenatal Childcare Nursery Kinder- Region Crèche CEC care and health services during childbirth is relatively Centers School garten Boké 4 46 6 low in Guinea. Currently, 46% of women have access to Conakry 24 6 1 569 0 skilled attendants at birth and only 50% of pregnant Faranah 24 28 women receive antenatal care at least four times. Kankan 5 46 20 Twenty-two percent of HIV+ pregnant women receive Kindia 1 1 2 133 24 antiretroviral drugs to prevent mother-to-child Labé 1 4 35 6 transmission. Compared to other countries in the Mamou 1 2 19 11 region, this rate is relatively low. The cost and physical N’zérékoré 3 1 33 57 34 accessibility of maternal health interventions is often Total 29 9 51 929 129 prohibitive, especially for poor families. Table 8 % Share 2.3% 0.7% 4.10% 74.6% 10.4% compares a number of essential maternal health Source: MASPFE, Statistics on Preprimary Education, 2010-2011 interventions in Guinea and neighboring West African Young children have low access to essential health countries. interventions in Guinea. Table 7 displays a regional Table 8: Maternal health services in West Africa comparison of coverage of health interventions. Guinea Sierra has a low rate of DPT immunization for 1-year old Guinea Liberia Mali Nigeria Leone children (57%) compared to neighboring countries. Births attended by 46% 46% 49% 39% 42% Although 74% of children receive anti-malarial skilled attendants medication, only 5% of Guinean children sleep under Pregnant women receiving antenatal insecticide-treated bed nets (ITNs). This rate is care (at least four 50% 66% 35% 45% 56% alarmingly low considering the high prevalence of times) HIV+ pregnant malaria in the country. Currently, 38% of young children women/exposed infants receiving ARVs 22% 38% 34% 22% 62% suspected to have pneumonia receive antibiotics and for PMTCT 39% of young children suffering from diarrhea receive Source: UNICEF Country Statistics, 2010 oral rehydration and continued feeding. The level of access to essential nutrition interventions Table 7: Level of access to health interventions for in Guinea is inadequate. The period between young children in West Africa conception and the age of two is a window of Sierra opportunity to address and prevent the damage caused Guinea Liberia Mali Nigeria Leone 1-year-old children by malnutrition. Malnutrition prevents the full physical immunized against DPT development of children, which hinders linguistic, 57% 64% 76% 69% 90% (corresponding cognitive, and socio-emotional development. The level vaccines: DPT3ß) Children below 5 with of moderate and severe stunting amongst children 5 diarrhea receive oral 38% 47% 38% 25% 57% years old and younger is high in Guinea (40%), much like rehydration/ continued other countries in West Africa. The rate of exclusive feeding Children below 5 with breastfeeding for infants below 6 months old is 48%, No suspected pneumonia data 62% 38% 23% 27% which suggest the need to bolster the Government’s receive antibiotics annual breastfeeding campaign. Like other countries in Children below 5 sleep 5% 26% 70% 29% 26% the region, Guinea has a high prevalence of anemia in under ITN Children below 5 with No pregnant women. Notably, Guinea has achieved 97% fever receive anti- 74% 67% 49% 30% coverage in the Vitamin A supplementation for young malarial data Source: UNICEF Country Statistics, 2010 children. Table 9 summarizes the nutritional status of young children and pregnant women in Guinea and other West African countries. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 14 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 9: Level of access to essential nutrition Policy Lever 2.3: interventions for young children and pregnant women Equity in West Africa Sierra Guinea Liberia Mali Nigeria Based on the robust evidence of the positive effects ECD Leone Children below 5 with interventions can have for children from disadvantaged moderate/severe 40% 42% 38% 41% 36% stunting (2006-10) backgrounds, every government should pay special Vitamin A attention to equitable provision of ECD services9. One of supplementation the fundamental goals of any ECD policy should be to coverage (6-59 97% 53% 59% 91% 100% months) provide equitable opportunities to all young children Infants exclusively and their families. breastfed until 6 48% 34% 38% 13% 11% months of age Large disparities exist in access to preprimary Infants with low birth weight 12% 14% 19% 12% 14% education between young children in urban and rural locations. The level of access to preprimary education Prevalence of anemia 69% 62% 73% 67% 60% for girls and boys in Guinea is nearly even, however, as in pregnant women Children below 5 with Figure 7 illustrates, the rate of preprimary enrollment 79% 88% 83% 76% 83% anemia varies significantly by region. Conakry has the highest Population that No number of students enrolled in preprimary programs 41% 79% 97% 58% consumes iodized salt data (43%) while Mamou (2%) has the lowest. Data on Source: UNICEF Country Statistics 2010, WHO Global Database on Anemia preprimary enrollment by socioeconomic status are not available. The level of coverage of child protection interventions in Guinea is improving. In 2005, the GoG launched a Wealthier families have better access to health, campaign to increase the rate of birth registration. nutrition, and social protection services than poorer Between 2005 and 2010, the rate of birth registration families. An analysis of data from the UNICEF Multiple increased from 28% to 43%. This achievement and the Cluster Survey (MICS) reveals significant disparities in low rate of birth registration in Guinea, suggest the access to ECD services by wealth and urban-rural need to scale up the Government’s efforts to promote location. Figure 8 illustrates the level of access to a birth registration. The legacy of war in the neighboring number of ECD services by socioeconomic status. While countries of Liberia and Sierra Leone brought in child 83% of children from the richest quintile are registered refugees to Guinea, many of whom remain unregistered at birth, only 20% of children from poorer families are and therefore, unable to access education and other registered. Pregnant women from the wealthiest social services. Table 10 displays birth registration families are twice as likely to have skilled attendants at coverage in the region. Improved attention to the birth as women from the poorest families. registration of child victims of conflict is important. Approximately 1% of wealthy children are underweight compared to 19% of the poorest children. Table 10: Level of access to birth registration in West Africa Sierra Guinea Liberia Mali Nigeria Leone Birth Registration 43% 5% 81% 30% 51% Source: UNICEF Country Statistics, 2010 Figure 7: Number of children enrolled in preprimary programs by region (ages 3 to 6) 9 Engle et al, 2011; Naudeau et al., 2011 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 15 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Boké Figure 9: Level of access to essential ECD interventions Conakry by urban-rural location Faranah 90% Kankan 80% Kindia 70% Labé 60% Mamou 50% N’zéré… 40% 0 20000 40000 60000 30% Urban Rural 20% Source: MASPFE, Statistics on Preprimary Education, 2010-2011 10% 0% Figure 8: Level of access to essential ECD interventions Birth Skilled attendant Use of Improved by socioeconomic status Registration at birth Sanitation Urban Rural facilities 90% 83% 80% Source: UNICEF Country Statistics, 2010 and UNAIDS Database 70% 57% 60% Policy Options to Implement ECD Widely in 50% Guinea 40% 30% 26% Scope of Programs 20% 19% 20% ¾ In Guinea, ECD services are provided largely by 10% 1.3% development partners and NGOs who often work with 0% government entities. Currently, the level of Birth Registration Skilled attendant Underweight Government provision of ECD services is low. This at birth Prevalance contributes to low access to essential ECD services in Poorest Wealthiest some areas and low provision of key services in some Source: UNICEF Country Statistics, 2010 and UNAIDS Database sectors. The Government could consider introducing more programs for children with special needs, OVCs, and child refugees. For health and nutrition programs, Access to ECD services is highly uneven by urban-rural the Government could involve the agriculture and location. Figure 9 presents access to a selection of ECD transportation sectors to ensure the provision of services by urban-rural location. Young children and accessible nutrition and health commodities to rural families from urban areas have better access to families. Box 3 describes an example from Senegal, sanitation facilities than those in rural areas. While 84% where the Government has expanded nutrition of women in urban areas have the assistance of skilled programs in the country. attendants at birth, only 33% of women in rural areas do. Furthermore, 78% of children in urban areas are Coverage registered at birth, compared to 33% of rural children. ¾ ECD coverage remains a major issue in Guinea, The data suggest the need for more interventions particularly for rural communities. The GoG should targeted at young women and pregnant women in rural target programs at pregnant women and young areas and locations outside of Conakry. children in hard-to-reach areas. Shortages in essential health commodities remain a barrier to access and consumers have to pay large sums of money health services. Increasing the level of SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 16 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Box 3: Relevant lessons Senegal: Improving access to nutrition interventions in hard-to-reach populations Summary: In 2002, the Nutrition Enhancement Program (NEP) was launched by the Government of Senegal to provide multisectoral support for nutrition and enhance nutritional conditions for children below age 5 and pregnant and lactating women. It includes a community-based growth monitoring and promotion and community IMCI (Integrated Management of Childhood Illness) with maternal counseling, home visits, and cooking demonstrations. The project integrated nutrition interventions (i.e. growth monitoring and promotion) with existing health sector interventions (i.e. IMCI). The Ministry of Health and local development agencies already provided a relatively good scope of coverage of health interventions in local communities. Thus, the nutrition sector leveraged existing resources for delivering the NEP interventions. Due to the synergistic effect of bringing together the nutrition and health sectors, the NEP became a mechanism for delivering other essential health and nutrition services provided by existing programs (including insecticide-treated bed nets and vitamin A supplements). As of 2012, the Government of Senegal has expanded the community nutrition program to reach more than 60% of the target population. Key considerations for Guinea: 9 Given Guinea’s focus on integrated ECD services through Community Education Centers, these nutritional components could be included in the parental education programs provided by CECs. 9 Promoting feeding practices combined with the delivery of essential health services can be an effective strategy to promote the holistic development of children. essential health commodities and bolstering the Policy Goal 3: Monitoring and Assuring community health insurance system could be effective. Also, improving the referral system for Quality community health workers and training local ¾ Policy Levers: Data Availability • Quality midwives and healers could be useful for providing health and nutrition services to beneficiaries in Standards • Compliance with Standards marginalized communities. The GoG could consider Monitoring and Assuring Quality refers to the existence working with communities to set an appropriate of information systems to monitor access to ECD pay scale for ECCE professionals. MASFE could scale services and outcomes across children, standards for its efforts to increase public provision of preprimary ECD services and systems to monitor and enforce education by further expanding the creation of compliance with those standards. Ensuring the quality Community Education Centers and possibly of ECD interventions is vital because evidence has shown attaching preprimary programs to primary schools. that unless programs are of high quality, the impact on Equity children can be negligible, or even detrimental. ¾ There are wide disparities in access for young children and pregnant women based on socioeconomic status and urban-rural location. The Policy Lever 3.1: poorest and most marginalized communities have Data Availability considerably less access to essential ECD services. Accurate, comprehensive and timely data collection can School grants to CECs and Conditional Cash Transfer promote more effective policy-making. Well-developed (CCT) programs could potentially be used to information systems can improve decision-making. In increase preprimary enrollment and support the particular, data can inform policy choices regarding the provision of health and nutrition services to these volume and allocation of public financing, staff communities. recruitment and training, program quality, adherence to standards and efforts to target children most in need. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 17 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 The Directorate for Preprimary Education and Child Guinea participated in the 1996 and 2003 UNICEF Protection and other ministries collect administrative Multiple Indicator Cluster Surveys (MICS). MICS collects data on young children’s access to education and and provides a range of household data on access and social protection services. The GoG has established a outcomes related to interventions in health, nutrition, Research and Statistics Unit within the National education, child protection, and water and sanitation. Directorate for Preprimary Education and Child Table 11 presents a series of key indicators that a Protection (DNEPPE). With the support of UNICEF and country can collect to track the provision of services to UNESCO, data are collected on child protection and promote young children’s development. These data education access for young children. DNEPPE tracks and include both administrative and survey data. disaggregates data by urban-rural location and gender but not by socioeconomic characteristics. According to Table 11: Availability of data to monitor ECD in Guinea MASFE, indicators have been developed in nine areas to Administrative Data: monitor child protection, including the protective Indicator Tracked environment, child sexual abuse and violence, economic Special needs children enrolled in ECCE (number of) X exploitation, children in institutions, children affected Children attending well-child visits (number of) 9 by conflict, children in conflict with the law, orphans and vulnerable children, child development, and youth Children benefitting from public nutrition 9 interventions (number of) participation. Women receiving prenatal nutrition interventions X (number of) In 2008, political turmoil disrupted the work of the Children enrolled in ECCE by sub-national region national birth registry service, and data on birth 9 (number of) registration is not up to date at the national level. The Ministry of Territorial Administration and Average per student-to-teacher ratio in public ECCE 9 Decentralization is working with development partners Is ECCE spending in education sector differentiated to build the capacity of the national birth registry X within education budget? service to improve and expand data collection on birth Is ECD spending in health sector differentiated X registration. The Government does not currently collect within health budget? data on access to ECD services for children with special Survey Data needs. Indicator Tracked Population consuming iodized salt (%) 9 Within the Ministry of Pre-University Education there is Vitamin A Supplementation rate for children 6 -59 a statistics and planning department that collects data 9 months (%) on education, including longitudinal data on a number Anemia prevalence amongst pregnant women (%) 9 of variables and data on academic performance. It is Children below the age of 5 registered at birth (%) 9 unclear whether the MEPUEC collects data on Children immunized against DPT3 at age 12 months preprimary education. At the community level, data are 9 (%) collected on child learning outcomes and growth Pregnant women who attend four antenatal visits monitoring through Community Education Centers 9 (%) (CEC). Children enrolled in ECCE by socioeconomic status 9 (%) Some administrative and survey data are collected on Source: UNICEF Country Statistics 2010, MASPFE, and MoPH. health and nutrition in Guinea. The Ministry of Public Note: X refers to indicators that are not tracked and я refers Health, as part of its larger monitoring and evaluation to indicators that are tracked. work, collects some administrative data on progress in child nutrition monitoring, immunization, and child and maternal health indicators. As in the education and social protection sectors, administrative data collection agencies for health and nutrition are limited by a lack of technical and financial support. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 18 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Policy Lever 3.2: Government has expressed its interests in introducing a Quality Standards curriculum on integrated prevention and care for newborns and childhood illness in health training Ensuring quality ECD service provision is essential. A focus institutes. on access – without a commensurate focus on ensuring quality – jeopardizes the very benefits that policymakers The DNEPPE has also established infrastructure standards hope children will gain through ECD interventions. The for preprimary schools. Standards require ECCE providers quality of ECD programs is directly related to better to have functional hygiene facilities, potable water, play cognitive and social development in children10. areas for children, and sound building structures. The Information Guide on the Creation and Management of The DNEPPE has developed early learning standards Community Education Centers includes a number of for preprimary education. In 2009, the DNEPPE infrastructure standards for CECs. introduced the Integrated Early Childhood Program Standard, which includes pedagogical tools and Registration and accreditation procedures are difficult guidance for the education of children ages 3-6. The to assess. There is limited information on the integrated standard outlines development areas, registration and accreditation procedures for including cognitive development, language, numeracy preprimary schools and CECs in Guinea. and literacy, hygiene, health, and nutrition, physical development, art, and science. The Standard recommends one educator and one assistant per 40 Policy Lever 3.3: children, and provides suggestions on how to organize Compliance with Standards the school day. Although French is the official language Establishing standards is essential to providing quality of instruction, the Standard includes guidance on ECD services and to promoting the healthy development instructing young children in their mother tongue. The of children. Once standards have been established, it is Standard also contains specific child assessment tools critical that mechanisms are put in place to ensure based on preprimary class level. The Education Sector compliance with standards. Policy seeks to harmonize preprimary and primary education programs to facilitate the transition from Some preprimary teachers meet established pre-service preschool to primary school. Limited information is training standards. Guinea has a total of 3,018 teachers available on the implementation of the integrated working in private, community, and public preprimary standard and the Education Sector Policy. schools. The Government requires ECCE teachers to have a high school diploma and vocational training in ECD. The There are established infrastructure and service delivery majority of ECD teachers do not have the required training standards in Guinea for ECCE. The National Directorate for and education. Currently, there are only 800 ECD teachers Training and Advanced Vocational Training of Staff with high school diplomas, 94 with 2-year undergraduate (DNFPPP) and the Directorate for Preprimary Education degrees, 134 with Bachelor’s degrees, and 200 with and Child Protection have developed training standards Master’s degrees. for preprimary educators and caregivers. According to the standards, preprimary educators for children aged 2 to 6 Preprimary schools do not adequately comply with are required to have a secondary school diploma and established infrastructure standards. Despite vocational training, an ECD certificate or specialized established standards, many preprimary schools do not course, participation in specialized ECD training, and a meet basic sanitation and infrastructure standards. As supervised practicum. ECD educators are also required Table 12 illustrates, only 63% percent of schools have biennially to take 480 hours of in-service training on child an enclosed space, 32% of schools have no access to a protection, health, nutrition, sanitation, and cognitive and water source, and 19% have no latrines. Only 72% of social development. For health service providers, the schools provide children with an area to play. 10 Taylor & Bennett, 2008; Bryce et al, 2003; Naudeau et al, 2011; Victoria et al, 2003 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 19 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 12: Compliance with infrastructure standards in Guinea Policy Options to Monitor and Assure ECD Number Water Functioning Quality in Guinea Region Enclosure Play Area Latrine of Schools Point Canteen Data Availability: Boké 85 56 17 43 53 63 Conakry 647 562 181 505 514 628 ¾ Guinea has put in place a number of relatively Faranah 55 26 2 18 37 44 reliable systems to monitor the provision of Kankan 78 10 55 56 78 75 education, health, nutrition, and social protection Kindia 170 111 22 98 105 159 services to young children. Systems also exist at the Labé 46 34 5 31 27 36 community level to monitor child learning Mamou 33 22 1 14 20 26 outcomes and growth monitoring. Although, N’zérékoré 150 51 10 33 76 60 MASFE, MEPUEC, and the MoPH collect data on Total 1264 872 730 798 910 1018 young children, there are no mechanisms for joint Number monitoring of child outcomes in interconnected Total % 69% 58% 63% 72% 81% domains. Local monitoring systems are not Source: MASFE, Statistics on Preprimary Education, 2010-2011 connected with central data collection structures. The GoG could consider leveraging the assistance of Although there is no mandatory student-teacher ratio in development partners to conduct periodic surveys Guinea, the actual ratio of students to teachers does of child development outcomes across the country, not meet international standards. The Integrated with special attention to marginalized communities. Standard suggests a student-teacher ratio of 40:1, Data collection systems can be improved by which is more than twice the recommended ensuring appropriate financial and technical international standard of 15:1. In practice, student- support. teacher ratios range from 46:1 to 58:1. Table 13 presents information on the number of teachers and Quality Standards students in preprimary programs. ¾ MASFE has developed standards for the provision of Table 13: Number of students and teachers in ECCE services but these are not always mandatory. preprimary schools in Guinea It is highly recommended that the Government Ratio of mandate essential quality standards for ECCE Region Students Teacher Student to Teachers service delivery, especially in terms of the ratio of Boké 10,082 215 47:1 students to teachers. MASFE and the Ministry of 89,155 Pre-University Education could develop a Conakry 1,831 49:1 professional career ladder for ECCE teachers with Faranah 7,742 116 67:1 standardized remuneration and incentives for Kankan 8,497 149 57:1 obtaining higher and specialized degrees. Kindia 15,528 329 47:1 Labé 3,692 76 49:1 Compliance with Standards Mamou 2,908 64 45:1 N’zérékoré 13,908 238 58:1 ¾ Although standards exist for quality assurance in Total 151,512 3,018 50:1 ECD provision, these are not always adequately Source: MASFE, Statistics on Preprimary Education, 2010-2011 enforced. The GoG should closely monitor programs and set review standards for community and private ECCE service providers. Attention to compliance with infrastructure standards is also important. The GoG could consider taking a phased approach to compliance and enforcement, preparing a series of minimum standards that all centers must meet and then additional standards that could be met in a SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 20 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 phased approach, with support from the Table 14 compares key policy provisions and associated Government. It is important that whatever outcomes in Guinea with countries in West Africa. Mali approach is adopted, promotes the inclusion and is the only country on the list that has a policy that participation of community and private service mandates salt iodization and the rate of coverage is providers, rather than taking a punitive approach relatively higher, (76%), than countries like Guinea that discourages registration and participation in (41%) where salt iodization is voluntary or Liberia (20%) the formal system. where no policy exists. Although Guinea has adopted only some provisions of the International Code of Comparing Official Policies with Outcomes Marketing of Breast Milk Substitutes, it has a relatively The existence of laws and policies alone does not higher rate of exclusive breastfeeding (48%) than Liberia always guarantee a correlation with desired ECD (34%), Sierra Leone (11%), and Mali (38%) where the outcomes. In many countries, the implementation of Code has been adopted. This seems to highlight the policies does not ensure service delivery and access. moderate effectiveness of Guinea’s annual This is the case in Guinea, where for example, the law breastfeeding promotion campaigns. mandates that all children receive a complete course of immunization but only 57% of 1-year old children are None of the countries below mandate compulsory immunized against DPT. Despite policies mandating preprimary education, and coverage varies from as low birth registration and support programs, only 47% of as 5% in Mali to approximately 47% in Liberia. 11 children are registered, suggesting that most children Conversely, all countries mandate Birth registration, have no legal identity and limited access to social and rates vary from country to country. Mali has services. By contrast, policies on food fortification with achieved the highest rate of birth registration (81%), Vitamin A have yielded a 97% coverage rate. Box 4 while Liberia has the lowest (5%). The mixed policy compares selected ECD policies in Guinea with ECD outcomes presented here underscore the importance of outcomes. addressing critical policy omissions and the importance of implementation and policy enforcement mechanisms. Box 4: Comparing ECD policies with outcomes in Guinea ECD Policies Outcomes Some policies comply with the Exclusive breastfeeding International Code of Marketing rate (> 6 mo): of Breast milk Substitutes 48% Expanded Immunization Program Children with DPT mandates a complete course of (1 year old): childhood immunizations 57% Birth Registration of children is Birth registration rate: mandatory 43% Preprimary education is Net preprimary school encouraged but not compulsory enrollment (3-5 years): for 3-5 year olds 9% Policy encourages consumption Household consumption of iodized salt but it is not of iodized salt: mandatory 41% 11 There is some concern over the validity of this statistic in Liberia. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 21 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 14: Comparing policy intent with ECD outcomes in Guinea and comparison countries Guinea Liberia Mali Sierra Leone Salt Iodization Salt Iodization Policy Voluntary No policy Mandatory Draft policy Population Consuming Iodized Salt 41% 20% 79% 58% Appropriate Infant Feeding and Breastfeeding Promotion Compliance, Code of Marketing of Breast Milk Some provisions in law & Voluntary Law Draft policy Substitutes policies Exclusive Breastfeeding until 6 Months 48% 34% 38% 11% Preprimary Education Not compulsory; largely Not compulsory; State Not compulsory; Largely Not compulsory; largely Preprimary School Policy non-state provision and non-state provision non-state provision non-state provision Preprimary School Enrollment Rate 9% 47% 5% 14% Birth Registration Mandatory; Within 15 Mandatory; Computerized Mandatory; Since 2006; Mandatory; Just a law; Birth Registration Policy days of birth or face a registration system; free free of charge; within 30 new decentralized policy penalty within 30 days of birth days of birth 2010 Birth Registration Rate 43% 5% 81% 51% Preliminary Benchmarking and International implementation, develop mechanisms to expand ECD Comparison of ECD in Guinea coverage and ensure quality, and find options to adequately finance ECD interventions. Table 15 presents the classification of ECD policy in Guinea within each of the nine policy levers and three Table 16 presents the status of ECD policy development policy goals. For the Enabling Environment policy goal in Guinea alongside a selection of countries in East and Guinea’s level of development is classified as emerging. West Africa. In terms of legal framework, the level of Guinea’s Child Code, National Policy on Preprimary development for Guinea is on par with Sierra Leone, Education and Child Protection, and its health, nutrition, Uganda, and Tanzania. Guinea has made more progress and education sector policies guarantee the provision of in intersectoral coordination than other countries in many essential ECD services. Implementing Widely is West Africa. deemed latent in Guinea. Although programs are established in all essential sectors, coverage levels Finance for ECD is a particular challenge for many remains low and universal coverage for the eligible countries in Africa. The level of coverage and equity of beneficiary population in all essential sectors is yet to ECD service provision in Guinea is relatively low be achieved. Finally, Monitoring and Assuring Quality is compared to Liberia, Uganda, and Tanzania. While classified as emerging, with key quality standards being Guinea has relatively developed program standards, the developed, but requiring further regulation and level of compliance with standards remains low and on compliance reinforcement mechanisms. Guinea’s par with other countries in West Africa. challenge is to improve intersectoral program SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 22 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 15: Benchmarking Early Childhood Development Policy in Guinea ECD Policy Goal Level of Development Policy Lever Level of Development Legal Framework Establishing an Enabling  Intersectoral Coordination Environment   Finance Scope of Programs  Implementing Widely  Coverage Equity  Data Availability Monitoring and Assuring  Quality Standards Quality  Compliance with Standards   Latent Emerging Established Advanced Legend: Table 16: Classification and Comparison of ECD Systems in East and West Africa Level of Development ECD Policy Goal Policy Lever Sierra Guinea Liberia Mali Uganda Tanzania Leone Legal Framework Establishing an Enabling Coordination Environment Finance Scope of Programs Implementing Widely Coverage Equity Data Availability Monitoring and Quality Assuring Quality Standards Compliance with Standards Latent Emerging Established Advanced Legend: Conclusion systems address the same policy challenges. This The SABER-ECD initiative is designed to enable ECD Country Report presents a framework to compare policy makers and development partners to identify Guinea’s ECD system with other countries in the region opportunities for further development of effective ECD and internationally. Each of the nine policy levers are systems. The SABER-ECD classification system does not examined in detail and some policy options are rank countries according to any overall scoring; rather, identified to strengthen ECD are offered. it is intended to share information on how different ECD SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 23 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 The establishment of a National Directorate for assistance as well as support for the development and Preprimary Education and Child Protection, and the implementation of costed implementation plans and implementation of a multisectoral ECD policy have been ECD-specific budget line items. Table 17 summarizes instrumental in the development of ECD in Guinea. Each possible policy options presented in this Country Report of the relevant sectors has demonstrated commitment to improve ECD in Guinea. to early childhood development but now need effective mechanisms for coordinating their interventions. Acknowledgements Guinea’s challenge is to expand ECD coverage, especially for beneficiaries outside of Conakry, while This Country Report was prepared by the SABER-ECD ensuring quality service provision. High quality team at World Bank headquarters in Washington, DC. standards and compliance must accompany expansion The report presents country data collected using the for service delivery to be successful. SABER-ECD policy and program data collection instruments and data from external sources. The report Currently, the Guinean system suffers from limited was prepared in consultation with the World Bank technical and financial capacity. Exploring and Human Development Africa team and the Government implementing innovative and workable financing of Guinea. For technical questions or comments about arrangements will be necessary to ensure the execution this report, please contact the SABER-ECD team of ECD policies. Development partners currently (helpdeskecd@worldbank.org). working in the country could provide valuable technical Table 17: Summary of policy options to improve ECD in Guinea Policy Policy Options and Recommendations Dimension x Make mandatory the iodization of salt and approve the draft policy on The International Code of Marketing of Breast Milk Substitutes x Increase MASFE’s financial allocation for preprimary education and child protection Establishing an x Build the capacity of the Central Unit for the Management of ECD Enabling Environment x Improve information sharing on ECD program implementation as well as budget allocations and spending amongst the key ministries x Consider School Grants and Conditional Cash Transfers for increasing preprimary enrollment and access to essential health and nutrition services, including through CECs x Increase access to essential ECD services for children with special needs and OVCs Implementing x Consider alternative means for expanding coverage of ECD services for young children and Widely pregnant women in marginalized communities x Strengthen quality assurance standards and promote compliance x Provide technical and financial support for improving data collection systems, including Monitoring and the collection of child development outcome indicators Assuring Quality x Standardize preschool educators’ remuneration system and introduce a professional career ladder SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 24 GUINEA ۣ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 www.worldbank.org/education/saber The Systems Approach for Better Education Results (SABER) initiative produces comparative data and knowledge on education policies and institutions, with the aim of helping countries systematically strengthen their education systems. SABER evaluates the quality of education policies against evidence-based global standards, using new diagnostic tools and detailed policy data. The SABER country reports give all parties 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 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. THE WORLD BANK SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 2