Stepping Up Early Childhood Development

This World Bank report is a guide for policy makers and practitioners about how to invest in young children. "It identifies 25 essential ECD [early childhood development] interventions that can be delivered through five integrated packages at different stages in a child’s life, spanning the education, health, nutrition, water, sanitation, and social protection sectors. These five packages of interventions are: (i) the family support package, (ii) the pregnancy package, (iii) the birth package, (iv) the child health and development package, and (v) the preschool package. The document also lays out four ...principles that countries can follow to design and implement successful ECD strategies: (i) prepare an ECD diagnostic and strategy; (ii) implement widely through coordination; (iii) create synergies and cost savings through integrated interventions; and (iv) monitor, evaluate, and scale up successful interventions."

The guide introduces the reasons for investment in ECD and how the guidelines can assist service professionals in delivering improved health and learning outcomes for infants and young children. In 2010, the World Bank published the STEP framework as a way to "think about how countries can help individuals to lead productive lives. STEP stands for Skills Toward Employment and Productivity. The framework identified five steps through which individuals can progress and learn throughout their life. This document elaborates on ECD, the first of those five steps."

Areas of key interventions include nutrition, health, water and sanitation, education, and social protection. Each of the packages described for support at the various stages of development have a chart of interventions with illustrative costs and impacts. Some communication aspects of the packages include:  the family support package - 

• The family support package - 
1. Maternal education: "Evidence demonstrates the importance of girls’ education for ECD."
2. Counseling for family planning including having the desired number of children and the spacing and timing of births.
3. Education about early stimulation, growth, and development: "Reaching parents and caregivers through parenting support and home-visiting can promote early stimulation, optimal caregiving, and healthy feeding practices and thereby improve outcomes for children. Home visiting programs can deliver messages to parents about the health, growth, and overall development of young children."
4. Education on water, sanitation and hygiene (WASH) and especially access to clean water.
• The pregnancy package -
1. Antenatal care: "Antenatal care visits provide opportunities for healthcare providers to deliver a package of services including screening tests, counseling on reduced workload, treatment for identified complications and behavior change communication to increase women’s skills in identifying danger signs and potential complications."
2.  Counseling on adequate diets for pregnant mothers: "Undernutrition during pregnancy can affect fetal growth and development."
• The birth package -
1. Skilled attendance at delivery: Skilled health personnel present during delivery and available referral facilities equipped with quality emergency obstetric care can impact the risks at birth to both mother and infant.
2. Birth registration: "Birth registration is a first step to reach children with the services they need to fully develop."
3. Exclusive breastfeeding: "Promotion of exclusive breastfeeding is one of the most promising interventions for improving child survival in the first six months of life."
• The child health and development package -
1. Immunisations: Starting at birth, a complete course of childhood immunisations, reaching all children, can reduce child morbidity and mortality.
2. Nutrition, therapeutic zinc supplements for childhood diarrhoea, deworming, and prevention and treatment of malnutrition are proven interventions, including community-based management of acute malnutrition - in-patient care for severe acute malnutrition; out-patient care for severe acute malnutrition without medical complications; and community outreach.
• The preschool package -
1. Preprimary education: "Young children need sustained access to supportive, nurturing environments that provide a high degree of cognitive stimulation and emotional care throughout the early years."
2. Continuity to primary: "Young children should possess the school readiness skills necessary - physical health and well-being, social competence, emotional maturity, language and cognitive development, communication skills and general knowledge - in order to be able to learn effectively in school."

Key ECD policy principles "can help countries design and implement strong ECD policies and programs." Countries should:

(1) Prepare a multisectoral ECD diagnostic and strategy - "As part of the Systems Approach for Better Education Results (SABER), the World Bank has recently developed the SABER-ECD tool to help countries conduct such diagnostics."

(2) Implement widely through effective coordination mechanisms - "Recognizing the holistic needs of young children and the variety of settings and services in which these needs can be met, thinking multi-sectorally in policy design and coordinating interventions between stakeholders is key to ensure effective and comprehensive ECD service delivery."

(3) Create synergies and cost savings among interventions - For example, the "Care for Child Development (CCD) approach considers health care encounters with young children and women as opportunities to strengthen families’ efforts to help their children grow.... [H]ealth workers can share with families...: 1) how to improve play, communication, and responsive feeding activities that stimulate learning of their children; and 2) how to be sensitive to the needs of children and respond appropriately."

(4) Monitor, evaluate, and scale up successful interventions - For example, Chile Crece Contigo (Chile Grows with You or CCC) starts during the mother’s initial prenatal check-up, at which point an individual scorecard is created for the child to provide what is needed through integrated services of the family support unit, public health system, public education system, and other social services.

In conclusion, the document recommends early intervention for beneficial impacts that are cost effective.