FORUM ON INVESTING IN YOUNG CHILDREN GLOBALLY OVERVIEW
In January 2014, the Board on Children, Youth, and Families of the Institute of Medicine (IOM) and the National Research Council (NRC), in collaboration with the IOM Board on Global Health, launched the Forum on Investing in Young Children Globally (forum). At this meeting, the participants agreed to focus on creating and sustaining, over 3 years, an evidence-driven community of stakeholders that aims to explore existing, new, and innovative science and research from around the world and translate this evidence into sound and strategic investments in policies and practices that will make a difference in the lives of children and their caregivers. Forum activities will highlight the science and economics of integrated investments in young children living in low-resourced regions of the world across the areas of health, nutrition, education, and social protection. As a result, the forum will explore a holistic view of children and caregivers by integrating analyses and disciplines that span from neurons to neighborhoods and discuss the science from the microbiome
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1 The planning committee’s role was limited to planning the workshop. The workshop summary has been prepared by the rapporteurs (with the assistance of Kimber Bogard) as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the IOM. They should not be construed as reflecting any group consensus.
to culture. Moreover, the forum will support an integrative vision to strengthen human capital. This work will be done through the forum and will engage in a series of stakeholder consultative sessions or public workshops, each focusing on specific aspects of science integration, bridging equity gaps, and implementing and scaling evidence-informed efforts.
A set of forum goals includes supporting the development of integrated science on children’s health, nutrition, education, and social protection and working with policy makers, practitioners, and researchers to raise awareness of integrated approaches to improve the lives of children and their caregivers. Forum objectives to meet these goals are expected to accomplish the following:
- Shape a global vision of healthy child development across cultures and contexts, extending from preconception through at least age 8, and across currently siloed areas of health, nutrition, education, and social protection.
- Identify opportunities for intersectoral coordination among researchers, policy makers, implementers, practitioners, and advocates to improve quality practices in public and private settings and bring these practices to scale, in the context of the economics of strategic, integrated investing in young children.
- Inform ongoing conversations and activities of groups working on issues related to young children globally such as the sustainable development goals and indicators being developed.
- Identify current models of program and policy financing across health, education, nutrition, and social protection, within the framework of reproductive, maternal, newborn, and child health that aim to improve children’s developmental potential. This information could be used to illuminate opportunities for new financing structures and forms of investments that may be more effective in improving child outcomes and potentially drive economic development.
The forum’s first workshop, “The Cost of Inaction,” was held in Washington, DC, in April 2014 and focused on the science of promoting optimal development through investing in young children and the potential economic consequences of inaction. In August 2014, the forum hosted its second workshop, in New Delhi, India, focusing on financing investments for young children, and highlighted opportunities and barriers for financing.
The third workshop, and the subject of this summary, was held in
São Paulo, Brazil, on November 11, 2014, and focused on scaling program investments for young children globally. It touched on four broad domains: impact, scalability, sustainability, and governance. Constanza Alarcón, chair of the workshop planning committee, noted four goals of the workshop in her opening statements:
- The exploration of the impact of programs and their cost-effectiveness, and types of investment that could support both
- A discussion of how to progress from pilot testing to implementation of public policy, including maintaining quality
- Clarification of criteria for ensuring sustainability of programs and their funding
- Examination of potential steps toward institutionalization and governance of policies and architecture of programs focused on young children
A complete statement of task of this workshop is shown in Box 1-1.
BOX 1-1
Statement of Task
The Institute of Medicine and the National Research Council, in partnership with Fundação Maria Cecilia Souto Vidigal in São Paulo, Brazil, is pleased to announce a new workshop on Scaling Program Investments for Young Children Globally: A Workshop on Evidence from Latin America and the Caribbean. An ad hoc committee will plan and conduct an interactive public workshop featuring presentations and discussions that highlight efforts made to scale program investments across health, education, nutrition, and social protection that aim to improve children’s developmental potential. Speakers will explore four topics around scaling up program investments: (1) evidence of impact for effective models; (2) scalability of program models; (3) sustainability of programs; and (4) governance.
A set of research presentations will synthesize up-to-date evidence on effective programs and interventions in Latin America and other regions, including an account of their strengths and challenges. Speakers will address scalability and sustainability of program investments and how to maintain quality at scale, with a focus on approaches in culturally and ethnically diverse contexts and issues of decentralization, local capacity, and information systems for monitoring and evaluation. Presentations and discussions will include the perspectives and experiences of policy makers and ministers who have scaled up programs and worked toward implementing early childhood services into a comprehensive national policy.
ORGANIZATION OF THE WORKSHOP SUMMARY
The workshop summary is organized into eight chapters, starting with this introduction. The second chapter highlights the importance of integrating education, health, and social protection when making investments in young children, and also discusses investments made by the World Bank in an effort to promote healthy child development. Chapter 3 describes the Grand Challenges initiative established by The Bill & Melinda Gates Foundation, and more specifically, Brazil Grand Challenges, to include work on preterm birth, and Saving Brains, as well as partnerships between the Ministry of Health in Brazil, Grand Challenges Canada, and Fundação Maria Cecilia Souto Vidigal. Chapter 4 describes the impact and effectiveness of large-scale interventions related to health, sanitation, and child development, along with challenges of implementation and the criteria needed for scaling up. The next chapter addresses opportunities and challenges of maintaining quality at scale and scaling up; processes for monitoring and evaluation, and data information systems; and best practices for building local capacity and addressing culturally and ethnically diverse populations. Chapter 6 focuses on governance perspectives, and addresses public policies for early childhood development and the role of intersectorality in implementing programs and systems on a national level. Chapter 7 highlights themes that were discussed in group breakout sessions related to results-based financing, measurements and indicators, and methodologies for measuring public investments in young children. The final chapter provides a summary of the themes that emerged during the workshop on scaling program investments for young children, and it identifies potential steps for moving forward. Additionally, many of the chapters also include a summary of the discussion session during which panelists answered questions posed by workshop participants.
Programs and policy strategies highlighted in this summary were selected by this workshop’s planning committee based on a number of different factors: program effectiveness and available evidence; challenges and barriers programs encountered; approaches to adapting to different cultural contexts and diverse populations; and strength of investment in various levels of government, among others. Information about these programs and policy strategies are detailed in Box 1-2.
Guilherme Gonçalves welcomed members of the forum, panelists, and workshop participants to São Paulo, Brazil. He emphasized the importance of supporting the healthy development of children in diverse
BOX 1-2
Summary of Programs and Strategies That Focus on Early Childhood Development and the Integration of Education, Health, Nutrition, and Social Protection
Health Center-Based Intervention for Parents
- Implemented in Antigua, Jamaica, and St. Lucia.
- The program’s aim is to improve home environments and ensure children have interactive caregivers and opportunities to learn. Parenting activities are integrated into existing health services.
- Training involves 1- to 3-day workshops followed by monthly supervision and coaching.
- Evaluation showed benefits to children’s cognition and parents’ knowledge of child development.
- Annual cost is $14 per child, which includes staff time, training, and materials.
Home Visiting Intervention in Colombia
- An adaptation of the Jamaican home-visiting program, which introduced psychosocial stimulation and micronutrient supplements into 1-hour weekly home visits.
- The program’s aim is to promote healthy child development and strengthen mother–child interactions.
- Materials were adapted for cultural appropriateness. Home visitors were women within the municipalities, and they underwent a 2- to 3-week training session. Mentors were women with undergraduate degrees, and they received a 6-week training session (Attanasio et al., 2014).
- Evaluation found a significant effect on children’s cognition, though less than the Jamaican intervention.
- Annual cost per child is $515; however, the cost can be reduced through the participation of local mentors (Attanasio et al., 2014; Delpiano and Vega, n.d.).
Sanitation Program in Salvador, Brazil
- Implemented in Salvador, Brazil, in 1997.
- The aim was to improve sewerage coverage and evaluate the effect of the citywide sanitation program on diarrhea morbidity in young children.
- The evaluation found that the prevalence of diarrhea fell by 21 percent.
- The budget for this intervention totaled 440 million U.S. dollars, and funding for half came from the Inter-American Development Bank (Barreto et al., 2007).
Programa Saúde da Família (Family Health Program) in Brazil
- Family Health Program (FHP) has been part of the Unified Health System since 1994, and it was implemented in 82 percent of Brazil’s municipalities by 2004.
- The aims of FHP are to emphasize the importance of primary health care and to work toward a comprehensive health system.
- The evaluation looked at the effect of FHP services on infant mortality between 1996 and 2004 and showed a significant reduction in infant mortality (Aquino et al., 2009; Rasella et al. 2010).
Bolsa Familia Programme
- A widespread conditional cash-transfer program that was launched in 2003 and provided cash transfers to poor households.
- Evaluation examined the effects of Bolsa Familia on poverty-related deaths of young children and found that the program led to reduced mortality rates for children under the age of 5; as program coverage increased, mortality rates decreased.
- Large-scale, evidence-based interventions are implemented by political decisions, yet the context and public perceptions of the benefits are crucial to its success.
- Transfer amounts vary by family income and composition, and monthly transfers range from 18 to 75 U.S. dollars per person (Ministério do Desenvolvimento Social e Combate à Fome, n.d.; Rasella et al., 2013).
Chile Crece Contigo
- Created in 2006 by a presidential advisory council and implemented in 2007.
- Its aim is to articulate, organize, and integrate early childhood care from pregnancy to age 5. This includes providing public services and monitoring the developmental trajectory of young children.
- Governed by the Ministerial Committee on Early Childhood, which includes the Ministry of Health, Education, and Social Protection (Bedregal and Torres, 2013; Delpiano and Vega, n.d.).
Primeira Infância Melhor
- Developed in 2003 and written into law in 2006, it was implemented into 268 municipalities in Rio Grande do Sul, Brazil (Primeira Infância Melhor, 2014).
- The program’s aim is to help families understand child development in order to establish strong parent–child bonds through home visiting services.
- Governed by Ministries of Health, Education, and Justice and Social Development Justice and Human Rights, Policies for Women, Culture, Health, Education, and Labor and Social Development.
contexts throughout Latin America and the world so they can reach their full potential.
Following Gonçalves, forum co-chair Ann S. Masten introduced the forum as a collaborative learning community of experts in diverse fields from around the world who are working together to identify and facilitate
Early Childhood Commission of Jamaica
- The Early Childhood Commission Act was established in 2003; the comprehensive, cross-sectoral plan for early childhood was designed and implemented between 2008 and 2013.
- The aim was to establish a nationally coordinated program that takes responsibility for the early childhood sector and coordinates activities to ensure a sustainable cross-sectoral approach. This involves program development, monitoring and evaluation, and ensuring public awareness in the health, social, and education sectors for young children.
- Governed by the Ministries of Health, Education, Labor and Social Security, Finance, Child Protection Agency, and the Planning Institute of Jamaica.
Mãe Coruja (Mother Owl)
- Established in 2007 by the Consultative Council in the State of Pernambuco, Brazil, and written into state policy in 2009.
- The aim is to provide care for pregnant women and their children up to age 5 years.
- Coordinated by the First Lady of the State of Pernambuco and supervised by the Governor and an executive committee that includes the Department of Health, Advisory Committee, state and regional coordinators, and local offices (de Andrade Lima et al., 2013)
Uruguay Crece Contigo
- A National Strategy of Children and Adolescents was developed in 2007 in Uruguay, and the program was launched in 2012.
- The aim of Uruguay Crece Contigo is to meet the needs of highly vulnerable populations, pregnant women, and children below age 4 by creating a comprehensive program that guaranteed the rights of households with pregnant women and children.
- The policy was developed in coordination with the Office of Planning and Budgeting in the Office of the Presidency, and the program was created under the codirection of the Ministers of Health and Social Development, along with the support from all government institutions and ministries that work in early childhood (Presidencia Oficina de Planeamiento y Presupuesto, 2014).
use of the best evidence and practices for investing in young children and child development. She described that the momentum, rationale, and energy behind the forum developed from a growing worldwide recognition that programs and policies need to focus beyond child survival by planning for healthy childhood development. The growing body of
evidence in diverse fields contributes to an understanding of holistic early childhood development, and stakeholders in the field of early childhood development now understand that early childhood experiences are deeply linked to the health and well-being of both individuals and communities in which they live.
Echoing Masten’s remarks, Alarcón emphasized the importance of building a learning community, and encouraged opening the conversation to those who help influence public policy, including academics, social society, corporate entities, and multilateral financial systems. She noted that this learning community can contribute to transforming the lives of children and improving the conditions in which they live.
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Attanasio, O. P., C. Fernández, E. O. Fitzsimons, S. M. Grantham-McGregor, C. Meghir, and M. Rubio-Codina. 2014. Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: Cluster randomized controlled trial. BMJ 349:g5785.
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Bedregal, P., and A. Torres. 2013. Chile crece contigo: El desafío de crear políticas públicas intersectoriales. Santiago, Chile: Instituto de Politicas Publicas, Facultad de Economia y Empresa, Universidad Diego Portales.
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Delpiano, P. V., and M. C. Vega. n.d. Chile Crece Contigo: Factores de éxito en una política integrada de desarrollo para la primera infancia. http://earlychildhoodmagazine.org/our-focus-category/quality-early-learning/enriching-the-home-environment-of-lowincome-families-in-colombia-a-strategy-to-promote-child-development-at-scale (accessed May 1, 2015).
Ministério do Desenvolvimento Social e Combate à Fome. n.d. Bolsa Familia. http://www.mds.gov.br/bolsafamilia (accessed May 1, 2015).
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