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Evaluation report

2011 Cambodia: Evaluation of the UNICEF’s Early Childhood Development Programme with Focus on the Government of Netherlands Funding (2008-2010): Cambodia Country Case Study Report



Executive summary

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Background:

This report presents the results of a retrospective evaluation of policy and programmatic initiatives to promote early childhood development (ECD) in Cambodia, with an emphasis on those supported by the United Nations Children’s Fund (UNICEF) in partnership with the Government of Cambodia (GoC). Cambodia was selected as one of the 4 case study countries for the broader evaluation of the UNICEF-Government of Netherlands (GoN) Cooperation Programme on ECD which aimed to promote comprehensive approaches to ECD in 10 selected countries with a focus on sustainable policy development and partnerships to scale up successful interventions.

Purpose/Objective:

This report presents the results of a case study of strategies and activities to promote ECD in Cambodia. The evaluation team conducted the study as part of an evaluation of the United Nations Children’s Fund (UNICEF)-Government of Netherlands (GoN) Cooperation Programme on ECD, 2008-2010. The UNICEF-GoN Cooperation Programme emphasizes three strategic objectives: (1) capacity building, (2) knowledge generation and dissemination, and (3) mainstreaming ECD into policies and programmes for young children. In addition, the Cooperation Programme on ECD focuses on cross-cutting issues, such as use of a human rights based approach to planning and providing ECD services, as well as gender equity and outreach to the marginalized.
For the Cambodia case study, in May 2010, the evaluation team conducted five days of in-country data collection, including field visits to locations where ECD–related services are offered. The primary data sources were: (1) interviews with members of the UNICEF country office (CO) staff, representatives of national ministries and provincial offices involved in providing services related to ECD, members of local commune councils, volunteers providing education and health-related services, and representatives of nongovernmental organizations (NGOs) involved in ECD programming; (2) observations of community preschool classrooms and sessions of Community-Integrated Management of Childhood Illnesses (C-IMCI)/Baby Friendly Community Initiative (BFCI) services at locations selected by UNICEF Cambodia staff; and (3) focus groups with parents of children enrolled in community preschools and focus groups with parents of children not enrolled. In addition to these primary data sources, we reviewed a range of secondary sources, including reports and strategic plans, data from surveys and management information systems, and the results of external studies.

Methodology:

To explore the design, processes, and results of ECD programming, we conducted a retrospective study employing qualitative analysis methods. The study focuses on initiatives that UNICEF has supported in cooperation with the government and other partners, as expressed in a logical framework for ECD programming in Cambodia (presented in Appendix A) that was developed and specified in consultation with key stakeholders. The analysis primarily addresses UNICEF, government, and partner activities prioritized for investment of the GoN funds and completed as of September 2010, the end of the study period. Specific services and initiatives supported through this investment included Community-Based Preschools, Home-Based Preschools, the PS initiative, the Baby-Friendly Communities Initiative (BFCI)/Community-Integrated Management of Childhood Illnesses (C-IMCI), and the Baby-Friendly Hospital Initiative (BFHI). The report also provides findings and conclusions about the role of the GoN funding in catalyzing and strengthening new and ongoing ECD programming.

The study explores the following topics and questions, which are based on the terms of reference for the evaluation of the UNICEF-Government of Netherlands Cooperation Programme on ECD:
• Appropriateness and alignment of ECD programming with national vision and priorities for young children. Why were specific programming strategies adopted? How well do they align with national priorities as expressed in development plans and strategic documents?
• Planning, management, and coordination. How successful have planning and coordination for ECD programming been within and among UNICEF, the government, and development partners?
• Effectiveness in expanding coverage of ECD services. Have strategies to increase coverage contributed to changes in service availability or participation rates? If so, how?
• Effectiveness in building capacity for ECD. How successfully has programming increased the capacity of service providers, caregivers, and decision makers to support ECD? What capacity gaps exist?
• Effectiveness in generating knowledge for ECD. How successfully has programming promoted measurement of children’s development and family and community care and increased the knowledge base regarding the effectiveness of ECD interventions?
• Effectiveness in mainstreaming ECD into policies, plans, and services. How, if at all, has the level of national and subnational engagement and ownership of ECD changed?
• Quality and efficiency of ECD services. What is the current quality of ECD services provided, and how has it been enhanced through ECD programming? What is known about the costs and efficiency of ECD services?
• Sustainability and scalability of ECD services. What factors have supported or inhibit sustainability and scale-up of ECD services?
• Use of a human rights based approach to programming, gender equity, and reaching the most disadvantaged. How successfully has programming involved key stakeholders in design and implementation? How have national and local context been taken into account in programme design and implementation? To what extent has programming promoted gender equity and access among marginalized groups?
• Lessons learned. What general lessons emerge from the strengths and weakness of the design and implementation of ECD programming in Cambodia, as well as its results?
The study was guided by a case study matrix (Appendix B) that details specific research questions and links the questions to relevant programming outputs or outcomes and indicators. Several elements of the case study matrix directly align with components specified in the UNICEF-Government of Cambodia programme of cooperation; others are designed to addresses issues and results that are important to the broader evaluation of the UNICEF-GoN Cooperation Programme on ECD.

Data Collection

Data for the case study is drawn from primary and secondary sources. In May 2010, researchers from the evaluation team and a local consultant conducted primary data collection during a five-day visit to Cambodia. The visit included field visits facilitated by UNICEF Cambodia staff to locations where ECD programming is implemented in Kampong Thom and Kampong Speu provinces. Our data collection activity during the country visit comprised the following components:
• Interviews with key informants. We interviewed members of the UNICEF CO staff, representatives of national ministries and provincial offices involved in providing services related to ECD, members of local commune councils, volunteers providing education and health-related services, and representatives of nongovernmental organizations (NGOs) involved in ECD programming.
• Observations of ECD programming. We observed four community preschool classrooms and two sessions of BFCI/C-IMCI at locations selected by UNICEF Cambodia staff.
• Focus groups with parents. We conducted two focus groups with parents of children enrolled in community preschools and two focus groups with parents of children not enrolled. Focus group participants were recruited with the assistance of UNICEF Cambodia and its local partners.


Appendix C presents details regarding primary data collection for the Cambodia case study—specifically, a list of individuals interviewed and focus groups conducted. In addition to these primary data sources, we reviewed a range of secondary sources including reports and strategic plans, data from surveys and management information systems, and the results of external studies. Appendix C also includes a list of documents reviewed for the Cambodia case study.

Analysis Methods

We employed two main qualitative evaluation methods in analyzing case study data: (1) thematic framing and (2) triangulation. Thematic framing involves the systematic review, sorting, and interpretation of data according to a specified structure. Our analysis was structured around the questions, outcomes, and indicators specified in the case study matrix. We used triangulation to confirm patterns or identify important discrepancies across data sources and respondents participating in interviews and focus groups.

Findings and Conclusions:

The report presents case study findings in nine areas. We summarize these findings below.
Appropriateness and Alignment with National Goals and Priorities

Programming on ECD under the UNICEF-Cambodia Programme of Cooperation aligns with priorities of the Government of Cambodia as expressed in national strategic development plans and sector strategic plans. Programming reflects an emphasis on support for CPS and HBP expansion to meet enrollment targets outlined in National Strategic Development Plans for 2006-2010 and 2009-2013 and the Education Strategic Plan. The country programme also conforms to national priorities regarding health and nutrition through projects focusing on breastfeeding and community-based health promotion. A focus on capacity building for commune councils in social service delivery is in keeping with good governance elements of Cambodia’s overall development strategy, as expressed in the National Strategic Development Plan.
ECD programming has supported progress toward holistic approaches to ECD but does not consistently emphasize integrated services. The National Policy on Early Childhood Care and Development advances a vision of holistic services for children from conception to age six, founded on close collaboration among government institutions that serve women and children. Some activities under the country programme reflect important steps toward comprehensive, integrated service for ECD, including support for integration of basic health and nutrition information in CPS and HBP curricula and the integration of messages on psychosocial development into C-IMCI. However, some opportunities for integrated or comprehensive services have not been realized. For instance, programming has not emphasized building connections between health and education services at the commune level.
Effectiveness: Increasing Access and Coverage

Enrollment rates for pre-primary education services have risen since 2006-2007 but fall short of government targets. Nationwide, 20 percent of children ages 3 to 5 were enrolled in some type of pre-primary education during the 2009-2010 school year, according to EMIS (Education Management Information System) data from MOEYS. Between the 2006-2007 and 2009-2010 school years, enrollment among 3-to-5-year-olds in all types of pre-primary education (including state preschools [SPS], CPS, HBP, and private preschools) increased approximately 5 percentage points nationwide. In UNICEF-supported provinces, the increase in pre-primary enrollment among 3-to-5-year-olds between 2006-2007 and 2009-2010 was slightly greater (5.6 percentage points). Comparing the number of 3-to-5-year-old children enrolled in CPS and HBP programmes over time, a marked increase is evident in data from 2006-2007 to 2009-2010; the number of children in CPS grew by 35 percent, and the number of children in HBP by 40 percent. These figures indicate that efforts to expand access to early education have produced positive results but failed to meet goals established by the Cambodian government. Current rates of enrollment fall short of the 2010 targets for 3-to-5-year-olds (30 percent) and 5-year-olds (50 percent) specified in the Education Sector Strategic Plan.
C-IMCI coverage is higher for modules on breastfeeding and complementary feeding than those on other topics. UNICEF measures coverage of community-based health interventions for ECD by the number of health centers and villages that have implemented specific C-IMCI modules. (Nine C-IMCI modules have been or are expected to be put into service.) In the six provinces targeted for UNICEF support under the 2006-2010 Community Programme Action Plan (CPAP), according to UNICEF data, the highest level of coverage has been achieved for the C-IMCI module on breastfeeding and complementary feeding; this module has been applied in more than half of health centers and villages. The module on home care of sick children has reached 28 percent of health centers and 26 percent of villages, while the module on prenatal and antenatal care has been rolled out in just 9 percent of health centers and 7 percent of villages. The C-IMCI module on psychosocial development had not been implemented in any health centers or villages as of August 2010.
Effectiveness: Building Capacity for ECD

The ability of the MOEYS Early Childhood Education Department to facilitate cooperation on ECD at the national level appears to have increased. Our interviews with representatives of MOEYS suggest that the capacity of the Early Childhood Education (ECE) Department to serve as a coordination point for ECCD policy and programming has been enhanced. The main evidence for this change is the department’s role in shepherding the adoption of the national ECCD Policy over the past two years. This process required extended consultation across the 11 involved ministries, as each made contributions to the policy and conducted reviews of it.
Commune council members reported that they are able to oversee CPS functions ably but their ability and commitment to leveraging resources for ECD appears to vary. Members of commune councils we interviewed conveyed that they did not have difficulty managing their functions related to implementation of CPS and were supportive of efforts to expand preschools. Nevertheless, we noted differences between the two councils we interviewed in the extent to which they appeared to devote commune resources or leverage other resources to support ECD services. These differences were apparent, for example, in the variation in the physical structures available for CPS. Assessments by UNICEF Cambodia note additional issues linked to tentative local support for CPS in some communes, including minimal compensation for teachers and a “slow down” in functioning due to waning attention from the community over time (UNICEF Cambodia 2010a). In addition, the Commune Focal Point for Women and Children (FPWC) and the Commune Committee for Women and Children (CCWC)—which play important roles in advocating for issues related to women and children and in requesting budget allocations and partnerships that promote inclusive, quality services— may face challenges in terms of limited decision making power in the commune, confidence in their roles, and understanding of planning processes, according to studies of FPWC and CCWC capacity (Ministry of Interior [MOI]/UNICEF Cambodia 2009). These factors may hamper the ability of Focal Points and CCWCs to influence decisions related to social service provision.
Gaps exist in national, provincial, and local capacity for monitoring of ECE services. Although pre-primary education services are monitored at multiple levels and by multiple stakeholders, it is not clear that the information collected consistently supports tracking of progress toward goals or quality improvement. At the national level, MOEYS conducts periodic monitoring visits and collects data on preschool enrollment that are disaggregated by type of preschool, child’s age, and child’s gender. However, these data do not include the percentage of children from the poorest families, the percentage of children who have disabilities, or other key categories of disadvantaged and marginalized children. At the local level, CPS and HBP services are monitored by Provincial and District Offices of Education, as well as by FPWC. A monitoring checklist is available for CPS. Because the form does not adequately address aspects of quality related to teacher-child interactions, however, its use as a tool for providing instructive feedback to teachers is likely to be limited.
The Parenting Support initiative has encountered difficulties in positioning and implementation. Key informants indicated that the role of the PS initiative relative to other services and initiatives is unclear, and it has faced challenges in implementation. Of particular concern is the possible redundancy of this service given the other sources of parenting information available, such as HBP, BFCI, and C-IMCI. In addition, capacity to implement the initiative fully has been reported to be low. Our discussions with key informants suggested that these issues are well known, but a clear plan for addressing them has not been developed.
Trends in key indicators suggest parents have improved some health- and nutrition-related caregiving practices, such as early and exclusive breastfeeding. Evidence for improvements in psychosocial care is limited and primarily anecdotal. Increases in rates of early and exclusive breastfeeding since 2000 suggest that campaigns and initiatives such as BFHI and BFCI may have influenced parenting behaviors related to early nutrition. Mothers participating in a focus group we conducted at the site of a C-IMCI session indicated knowledge of appropriate breastfeeding practices. However, the persistence of high maternal mortality rates suggests that information regarding prenatal health and safe delivery is not being communicated as effectively as possible.
Capabilities regarding ECD programming are high within the UNICEF CO, but further definition of the framework for ECD programming is needed. UNICEF Cambodia staff members demonstrated knowledge and expertise regarding ECD and a commitment to advocating for a holistic approach to the care and education of young children. Some staff members, however, expressed uncertainty regarding the organization’s definition and priorities involving ECD, noting that nearly all UNICEF’s programming could be construed as supporting ECD. Staff members also wondered how to reconcile the concept of holistic ECD with sectoral approaches to promoting young children’s survival and development.
Effectiveness: Generating Knowledge for ECD

Creation of Early Learning Development Standards (ELDS) has been completed and is expected to support curriculum revision. MOEYS has created and adopted ELDS for 3-, 4-, and 5-year-olds with support from UNICEF. The standards reflect a holistic view of development, covering areas including physical and health development, moral and cultural development, social and emotional development, awareness and thinking, and language development. UNICEF Cambodia has reported that the standards are expected to be used for a revision of preschool curricula in 2010.
Studies related to participation in pre-primary education services conducted to date have provided useful information on the results of preschool attendance. The UNICEF country programme has supported multiple studies related to outcomes for children who participate in ECE programmes. Although this research does not provide conclusive evidence of the effects of preschool services, the findings generally reinforce the notion that community-based preschool models are beneficial to children. A recent study of SPS, CPS, and HBP found that children who participated in any type of preschool had higher developmental functioning than those who did not (Rao and Pearson 2007). The study also found no differences in functioning between children attending CPS or HBP; children attending SPS scored significantly higher than CPS or HBP children, however. These findings suggest that enrolling children into either CPS or HBP will increase the likelihood of favorable outcomes, but preschools with highly trained teachers may be even more advantageous. Results from a subsequent longitudinal study of the same sample of children indicated that children who participated in pre-primary education services were more likely to enter primary school at the right age than those who did not (Miyahara 2007).
Costing of ECD interventions remains a knowledge gap. FTI (Fast Track Initiative) is currently conducting a study of the costs of CPS and HBP, but completed analyses of the costs of providing various ECD services in Cambodia were not available at the time of our site visit. It is apparent that certain types of interventions are intended to cost less than others; for instance, the CPS and HBP approaches to pre-primary education certainly require less expenditure on staff than the SPS model. However, without clear and reliable information on the per-capita costs of these services, planning for expansion or maintenance of existing services is difficult. It is also unclear what resources might be required to support enhanced monitoring processes for CPS and HBP services. This information is necessary for government agencies that may be considering taking steps to promote quality improvement.
Effectiveness: Mainstreaming ECD into National Policies and Services
The national ECCD policy establishes the government’s commitment to promoting ECD and is a step toward more coordinated planning and provision of services. The national ECCD policy delineates specific commitments to activities supporting ECCD from 11 national ministries. Participants in the policy-creation process noted that its adoption was facilitated by clarification of each ministry’s role in ECCD and an emphasis on the idea that MOEYS’s coordinating function would not impinge on the responsibilities or purview of other ministries. Mechanisms for supporting coordination across ministries and sectors must still be created. Strategies for accomplishing goals related to ECCD, and indeed, further specification of the goals themselves, are also needed. In addition, many representatives of MDAs (ministries, departments, and agencies) we interviewed were unaware of the policy—probably because of its recent adoption; awareness-raising regarding the policy will be another necessary element of its implementation.
Policy and planning for ECD and inclusion of children with disabilities has also progressed, but implementation faces substantial obstacles. Among the most disadvantaged groups, disabled children are of particular concern in Cambodia, which has one of the highest rates of disability among developing nations. The publication of the Policy on Education of Children with Disabilities in 2009 by MOEYS and the recent development of guidelines for community-based rehabilitation by Ministry of Social Affairs, Veterans, and Youth Rehabilitation (MOSVY), both relevant to ECD, provide some evidence of mainstreaming of ECD for vulnerable populations into national policy. However, many challenges to full implementation of these policies exist, including lack of resources to address the needs of people with disabilities, the small number of NGOs working on these issues, and the social stigma that disabled people in Cambodia continue to face.
At the national level, funds budgeted for pre-primary education programming remain a very small percentage of overall education funding. The MOEYS budget for pre-primary education in 2010 is 1.2 billion riel—approximately 0.6 percent of the total budget (MOEYS 2009, Yoshikawa et al. 2010). Although the 2010 pre-primary education budget is 9 percent larger than the previous year’s, the small proportion of the overall education budget devoted to pre-primary education does not appear to be in keeping with the government’s stated prioritization of early education or the fact that achievement of enrollment goals is unlikely. The relatively low allocation for pre-primary education may reflect an expectation that donor partners and NGOs will continue to play a substantial role in supporting preschools.
Efficiency and Quality of ECD Services

CPS sites we observed varied widely in quality of teaching methods, use of materials, and facilities. CPS teachers demonstrated mixed levels of ability to apply creative teaching techniques and manage classroom activities. In one site, the teacher successfully engaged students in a series of small group activities, which helped facilitate participation among many children and more frequent interactions between the teacher and individual children. In another site, the teacher relied more on closed-ended question-and-answer approaches, such as calling children to the blackboard to respond to a specific query. Differences were also apparent in the availability and use of materials in the classroom. We did not observe children freely accessing books or other reading material in any site. Finally, the quality of shelters and availability of sanitation facilities was not consistent across sites we observed. Some sites featured a shelter or classroom for CPS to meet and included access to a latrine. Other locations did not offer a sufficiently protected area for children and teachers to gather, and no latrine was available.
Weaknesses in monitoring and technical assistance affect efforts at quality improvement. We identified several limitations in current monitoring and technical assistance procedures. These include ambiguity in quality standards for CPS and HBP and lack of communication of standards to all provincial, district, and commune officials involved in overseeing pre-primary education services; lack of precision of quality assessment; infrequent or irregular monitoring; and insufficient targeting of technical assistance.
Parent participation is not adequately addressed in CPS services. Parent involvement in preschool education is a key element of service quality and can enhance learning for both children and parents. By design, the HBP engages parents in the process of educating their children and demonstrates to parents how they can take an active role in supporting child development. The CPS model does not currently include specific mechanisms for engaging parents, and current training for CPS teachers may not adequately address the importance of parent engagement.
Planning, Management, and Coordination

Intersectoral coordination on ECD is currently limited. We saw very little evidence of coordination on planning or implementation of ECD services across national ministries or local-level agencies. At the national level, ministries have not engaged in joint planning for ECD, and it does not appear that services are co-located or coordinated. For instance, health screenings or other health-related services for families and children are not offered during CPS or HBP sessions. Opportunities for volunteers engaged in pre-primary education services to receive health-related training also appear to be rare. This lack of intersectoral coordination may be due to several factors, including continued reliance on sectoral approaches to planning; the absence of structures to facilitate ongoing communication and coordination across sectors; and the absence of clear models or plans for integrated services, which would more clearly define goals for cross-sectoral collaboration. Implementation of the National ECCD Policy offers an opportunity to increase connections among MDAs in different sectors by establishing coordinating bodies and identifying concrete opportunities for collaboration and integration in service provision.
Results-based management and planning for ECD is inhibited by the absence of comprehensive indicators for ECD and incomplete monitoring of programme-specific results. Some respondents expressed a lack of clarity regarding how to assess the status of ECD holistically. Although UNICEF and its partners currently monitor indicators for many discrete elements of ECD, such as preschool enrollment and rates of early and exclusive breastfeeding, there is no defined set of indicators to assess progress related to children’s psychosocial development.. In addition to existing school readiness standards (available in the ELDS for 5 year-olds), new indicators and measurement systems need to be identified and implemented to capture the range of outcomes related to holistic ECD. In addition, UNICEF and its partners have not systematically measured outputs or outcomes related to changes in capacity among key stakeholders in ECD, although capacity development at all levels is a major goal of ECD programming. There is a need for clearer definition and more consistent monitoring of outcomes in this programming strand.
Coordination related to ECD activities appears to occur reliably among UNICEF sections. UNICEF Cambodia staff members have an awareness of shared responsibility for ECD, as evidenced by distribution of Dutch funds across multiple sections and collaborative programming on C-IMCI. The Seth Koma section’s intersectoral work related to local governance also seems to facilitate its collaboration with the Education and Child Survival sections on ECD issues. Finally, senior-level staff we interviewed indicated that establishing a culture of creating linkages and working together was a priority for the country programme; this culture facilitates coordination across sections.
Incorporation of Human Rights Based Approach and Strategies to Improve Equity and Participation of the Disadvantaged and Marginalized
Programming approaches emphasize participation of local stakeholders in planning and implementation. UNICEF Cambodia’s focus on promoting localization of social services, including pre-primary education, is in keeping with principles of a human rights based approach. This strategy promotes the capacity of duty-bearers at all levels to meet needs in their communities. In addition, the HBP in particular represents a culturally sensitive approach to providing pre-primary education that engages parents in a participatory learning process. Similarly, programming approaches that employ village volunteers, such as C-IMCI, increase the likelihood that local context will be taken into account in service provision.
Gaps in access appear to exist for disadvantaged groups, including the poorest families. The poorest families may be unintentionally excluded from pre-primary education services, particularly CPS. Families of children not enrolled in CPS who participated in our focus groups noted they did not send children to CPS because attending to their livelihoods was a higher priority and prevented them from taking time to get children to and from school. Village officials also suggested that parents whose children are malnourished may not send them, because a snack is not available, and children are unable to focus on the teacher if they are hungry. In addition, it was reported that parents in one village we visited were expected to make a small monetary or in-kind contribution toward the stipend of the CPS teacher if their children enrolled. Thus, problems related to access may result, in part, from perceptions among parents that sending children to CPS will interfere with economic pursuits, that children are not healthy or nourished enough to attend, or that payment will be required. The extent to which the poorest families do, in fact, access services is unclear, as data on enrollment are not disaggregated by poverty level. The same is true for children with disabilities, ethnic minorities, and children living in remote areas.
MOEYS data indicate that boys and girls are accessing pre-primary education services in roughly equal numbers. According to data from the MOEYS EMIS, girls represented 50 percent of all 3-to-5-year-old children enrolled in preschools in the 2009-2010 school year. In all three preschool models, roughly equal proportions of boys and girls participate.
Limited representation of women on commune councils may have implications for provision of services to women and children. The commune councils we interviewed were entirely male, except for the commune FPWC. At the commune level, women do not appear to be well represented among people making policy for ECD. The minority status of women on these councils also is likely to make the responsibility of the FPWC to advocate for women and children’s issues more challenging.
Sustainability and Scale-Up of ECD Services and Initiatives

Decentralization in governance of services for young children appears to have bolstered ownership of ECD at the provincial and local level in UNICEF-supported provinces, increasing the potential for sustainability. Our interviews with provincial, district, and commune-level officials suggest that their roles in overseeing and operating ECD services have increased their knowledge of ECD and may motivate efforts to sustain services over time. Key informants at high levels of the provincial government expressed an understanding of health, nutrition, and education issues relevant to young children and an appreciation for importance of early education. Although these officials’ views may not be representative of those across the country, their responses suggest that devolving responsibility for ECD services has increased awareness of ECD and the potential that services will be sustained.
Sustainability of ECD services is susceptible to changes in the level of donor support or local allocations for services, and to problems in local management. The national government currently provides little to no funding for pre-primary education services other than SPS, putting established CPS and HBP sites at risk of closure if donor funding is not available or if competing priorities result in a reallocation of resources at the local level. Although CPS and HBP are relatively low-cost modes of providing pre-primary education, they do require expenditures for teacher compensation, materials, and ongoing training and monitoring. In addition, services may be interrupted if local-level officials do not expeditiously address such issues as teacher or volunteer turnover.
Local control over financing and implementation appear to have influenced the pace of scale-up for CPS and HBP. With very limited budgets at their disposal, local-level authorities are unlikely to implement services that require substantial investment of financial resources. Although the CPS and HBP models do require certain financial or human resources to operate, they appear to be relatively economical approaches compared with SPS. (The actual costs of these models are expected to be elaborated through an FTI-funded study of CPS and HBP costs, which is currently underway.) The feasibility of implementing CPS and HBP in a resource-limited environment increases the potential that they can be scaled up.
Decentralized implementation of services necessitates ongoing efforts to train and provide technical assistance to local-level administrative entities. The pace of scale-up of ECD services in Cambodia is affected by how quickly and willingly local-level administrators can assume responsibilities for managing services. UNICEF’s Seth Koma programme has worked closely with commune councils in the provinces it supports, to increase capacity and build commitment to social service provision. It is unclear how quickly or effectively commune councils in areas that are not benefiting from similar support can assume responsibility for initiating and maintaining provision of ECD services.
Conclusions
We draw conclusions about progress that has been made and ongoing challenges faced by Cambodia and its partners as they continue to develop ECD policy and support programme implementation and scale-up.
Appropriateness and Alignment with National Goals and Priorities
• ECD programming is highly appropriate for promoting holistic ECD and mainstreaming ECD into other sectors, particularly health, but it has not fully addressed opportunities for cross-sector integration, especially at the local level.
• ECD programming in Cambodia is aligned with national priorities as expressed in national policies and plans.
Effectiveness: Increasing Access and Coverage
• Efforts to expand access to ECD services have produced positive results, but coverage rates have not yet met Cambodia’s goals due to insufficient government resources for expansion and constrained capacity to initiate and manage services at the local level.
Effectiveness: Building Capacity for ECD
• Capacity to implement ECD programming has improved at the local level.
• Additional capacity building in the areas of monitoring and supporting programme improvement is needed at all levels.
• Additional capacity-building support is needed in the area of parenting support to provide efficient and integrated programming that results in parental behavior change.
Effectiveness: Generating Knowledge for ECD
• The recently completed ELDS have the potential to strengthen curriculum development, programme monitoring, and support for programme improvement.
• Recent descriptive studies of child outcomes for children who participated in pre-primary education services are promising and suggest that more rigorous evaluation may be warranted, as well as costing information for scaling up services.
Effectiveness: Mainstreaming ECD into National Policies and Services
• Although the ECCD policy establishes the government’s commitment to ECD, national budgets for pre-primary education remain small.
• Expansion of BFCI and C-IMCI through revision of modules to incorporate messages on psychosocial development represents a step toward integrated services for ECD.
Efficiency and Quality of ECD Services
• Cambodia’s system for monitoring ECD programming has the potential to support quality-improvement efforts, but system improvements are needed.
• Quality of CPS services can be improved by taking steps to better involve parents.
Processes for Programme Planning, Management, and Coordination
• Integration of ECD programming across sectors can be enhanced by greater intersectoral coordination at both national and local levels.
• Measurement systems and programme-quality indicators should be designed to support programme planning and management.
Incorporation of a Human Rights Based Approach and Strategies to Improve Equity and Participation of the Disadvantaged and Marginalized
• Lack of data on pre-primary enrollment by income group and disability status limit capacity to monitor access for disadvantaged and marginalized populations and target them for enrollment.
Factors Affecting Sustainability and Scale-Up
• Decentralization has fostered scale-up of ECD services and increased potential for sustainability as local communities take ownership of ECD programming.
• Scale-up of ECD services is likely to require continued capacity building and other supports at the commune level.
Role of the UNICEF-GoN Funding
• GoN funding provided key support for capacity building related to implementation of ECD services at the local level and for integration of ECD into community-based health initiatives.

Recommendations:

We offer the following recommendations to enhance ECD programming in Cambodia:

Appropriateness and Alignment with National Goals and Priorities

Government of Cambodia: Continue to develop structures and processes that promote integration of services across sectors. With the recent passage of the ECCD policy, Cambodia should develop intersectoral structures at both the national and local levels to facilitate implementation of the policy and integration of services. These structures may include coordinating bodies for representatives of relevant MDAs, service providers, and others at the provincial and local levels.

UNICEF: Continue to advocate for comprehensive approaches and connections among services to ensure promotion of holistic ECD. UNICEF can provide technical support and lessons learned from other countries about setting up intersectoral coordinating structures at all levels and identifying opportunities for integrating existing services. In addition, UNICEF can educate government officials about the benefits and efficiencies of intersectoral planning and implementation.

Increasing Access and Coverage

Government of Cambodia: Develop strategies to continue expanding access to pre-primary education services to meet targets set by the Education Sector Strategic Plan. As part of the planning process for ECCD, Cambodia should develop strategies for expanding access to pre-primary education services that include plans for financing and capacity building at the local level to oversee and mange programming.
Government of Cambodia: Continue to expand coverage of C-IMCI modules, especially the module on psychosocial development. Cambodia should move forward with implementation of C-IMCI modules, monitoring their implementation, and assess parent knowledge and behavior change as the modules are implemented.

UNICEF: Continue advocating for increased resources for pre-primary education services to support expanded access. For example, UNICEF should provide technical support for ECCD implementation planning, especially in the area of costing and financing.

Capacity Building for ECD

Government of Cambodia: Conduct a capacity assessment to identify current resources and gaps related to planning and delivering ECD services. While a capacity assessment has been completed for CCWCs, Cambodia would benefit from a broader appraisal of national resources related to ECD. The assessment should identify strengths and gaps related to the ability of government, service providers and parents to support ECD.
Government of Cambodia: Take steps to enhance the existing ECD monitoring system including aspects of quality related to child-teacher interaction in local monitoring tools. Develop consistent monitoring tools to be used at the local level that are designed to facilitate provision of feedback to teachers and support continuous improvement.
Government of Cambodia: Explore options for supporting national and local structures for ECE oversight in the use of monitoring results for improvement of service delivery. Cambodia and its partners need procedures for regular and consistent monitoring and reporting on service delivery. Cambodia should explore options for enhancing existing data systems to collect information on monitoring indicators. In addition, officials at national and local levels could benefit from training in how to collect and use these indicators to examine implementation progress and how to work with service providers on continuous improvement.
Government of Cambodia: Consider options for refining the Parenting Support initiative to reduce redundancy with other services and identify training needed to increase capacity to support its implementation at the local level. Review possible redundancies across Parenting Support, HBP, BFCI, and C-IMCI, and determine how to align parenting messages across them for consistency, clarity, and efficiency. Consider providing additional training to village-level facilitators across these programmes to ensure consistent messaging and appropriate use of materials.

UNICEF: Provide technical support for enhancing existing ECE monitoring tools and systems to include additional measures and to use the information gathered for service improvement. Rather than create new systems that might not be sustainable, UNICEF can provide technical support by assessing options for integrating indicators of programme implementation and child outcomes into existing data and monitoring systems. UNICEF could also provide technical support and training for local-level officials on how to use these indicators to monitor programme performance and direct support and resources to address areas of need identified through monitoring.

Knowledge Generation for ECD

Government of Cambodia: Begin using ELDS and other resources as the basis for developing indicators and targets for ECD programming and standardized tools for collecting and reporting data on these indicators. The ELDS, for example, can be applied in creating assessments of children’s developmental progress. These data should be reported to decision makers at various levels for use in programme planning and decisions about where to direct resources for capacity building as well as scale-up.
Government of Cambodia: Initiate rigorous impact evaluations of selected ECD interventions. Descriptive studies of children’s outcomes show promising results, indicating that more rigorous evaluation is warranted. The planned scale-up of CPS, in particular, provides an opportunity for implementing rigorous evaluations. Well-designed research and evaluation projects should be conducted to provide strong evidence about whether services are producing desired results for children and parents. Evidence of effective interventions would be invaluable in efforts to increase funding for ECD services. A rigorous evaluation that included an implementation study would also identify gaps in the service delivery system and provide data to guide programme improvement.
Government of Cambodia: Conduct analysis of budget allocations and financing for ECD services and initiatives in Cambodia. Clear and reliable information on per capita costs of ECD services, as well as financing options, is needed to plan for ECCD implementation and inform decisions about whether and how to scale up individual programmes. Information about the resources required to support enhanced monitoring processes could help the government take steps to promote quality improvement.

UNICEF: Collaborate with other donors to support rigorous impact evaluations of selected ECD interventions. UNICEF should support the Government of Cambodia in building the evidence base for ECD interventions. One method of support is to pursue pooling of resources and expertise with other development partners to facilitate the planning and implementation of evaluations of key interventions.

UNICEF: Develop or commission a study on potential financing options for ECD services in Cambodia. UNICEF should support the Government of Cambodia in identifying sources of continued financing for ECD services, including pre-primary education. Analysis of current budget allocations and funding streams for ECD across sectors would help identify sources of financial support and gaps.

Mainstreaming ECD into National Policies and Plans

Government of Cambodia: Continue mainstreaming ECD into sectoral policies and planning to promote integrated services. National development plans and policies in key sectors, including education, health, and social protection, should identify services and targets relevant to ECD. In addition, cross-sectoral policies and plans should include options for integrating and coordinating services across sectors. The ECCD National Plan of Action for should be viewed as a key instrument for promoting service integration.

UNICEF: Continue to advocate and provide technical assistance related to integration of ECD services, such as the incorporation of health and nutrition services into pre-primary education models. UNICEf’s provision of technical assistance and support for ECD service development and provision should include advocacy for mainstreaming of community health services into CPS and HBP. These models have high potential as an access point for a variety of services related to holistic ECD.

UNICEF: Advocate for budgeting and fiscal space for ECD. UNICEF should work with country counterparts and other partners to ensure that ECD remains a priority as national and local budgets are developed. Without sufficient funding, the ECCD policy cannot fulfill its potential as a means for preparing children for primary school.

Quality and Efficiency of ECD Programming

Government of Cambodia: Prioritize advancement and maintenance of quality, through enhanced standards and monitoring, during CPS and HBP expansion. As scale-up plans are developed, resources should be allocated for development and implementation of quality standards and monitoring systems that can support improvement, so that quality is maintained as scale-up proceeds.
Government of Cambodia: Develop strategies to improve parent engagement in CPS services. The CPS model does not currently include specific mechanisms for engaging parents. Several possible methods for increasing parent involvement could be successful. First, CPS could require that teachers meet regularly with parents to discuss each child’s progress. To support the provision of useful information to parents, teachers could be trained to conduct a simple assessment of children at the beginning and end of each school year. Second, CPS could provide opportunities for parents to volunteer as classroom assistants. Assistants could aid the CPS teacher in managing the classroom and ensure that all children are engaged in activities; the role of parent assistants would need to be clearly defined and communicated. Third, CPS could facilitate the creation of associations of CPS parents. Parents of children attending CPS could gather regularly to discuss needs in the school and communicate concerns or recommendations to village and commune leaders.

UNICEF: Provide technical support to enhance monitoring tools and support parent engagement in CPS services. UNICEF should provide technical assistance focused on enhancing quality in pre-primary education. In particular, support should be offered in the areas of developing and implementing monitoring tools, providing ongoing feedback to CPS teachers for continuous improvement, and creating pathways for enhancing parent participation in CPS services.

Planning, Management, and Coordination

Government of Cambodia: Establish ECD coordinating bodies and identify concrete opportunities for collaboration and integrated service provision to increase connections among MDAs in different sectors. At both national and local levels, intersectoral coordinating bodies are needed to ensure involvement of multiple sectors in the development of holistic programming for children and families. Development of intersectoral working relationships can also enhance a sense of shared responsibility to ECD over time.
Government of Cambodia: Develop a set of indicators to assess children’s progress in psychosocial development and school readiness. Cambodia should develop a set of indicators that align with its goals for children to facilitate progress monitoring. Indicators should be used across all ECD services and initiatives.
Government of Cambodia: Measure outputs or outcomes related to change in capacity among key ECD stakeholders. Because local-level capacity building is central to Cambodia’s strategy for implementing and scaling up ECD, a set of indicators is needed to assess whether local-level officials have gained the knowledge and skills needed to manage and oversee ECD programming, identify gaps in knowledge, and redirect resources where additional training is needed.

UNICEF: Provide technical support for establishment of ECD coordinating bodies and identification of opportunities for integrated service provision. UNICEF can, for instance, support the Government of Cambodia in specifying the responsibilities and functions of ECD coordinating bodies and in training their members on strategies for service coordination.

UNICEF: Provide technical support to help Cambodia develop indicators and integrate them into existing data and monitoring systems. For example, UNICEF could commission a paper on contextually appropriate indicators for ECD in Cambodia and work with the government to assess options for integrating these indicators into existing data systems and monitoring tools.
Incorporation of Human Rights Based Approaches and Strategies to Improve Equity
Government of Cambodia: Begin developing strategies for targeting children with disabilities for enrollment in ECD, in line with recent national policies that promote service access for this population. Targeted outreach campaigns may be needed to educate parents of children with disabilities about the availability of ECD programming. Special efforts may be needed to identify children with disabilities, educate their families and communities about the necessary programming, and adapt environments to include them in pre-primary education.
Government of Cambodia: Track pre-primary enrollment rates separately for children from disadvantaged groups to facilitate monitoring their access to programming. Disaggregated data for children from disadvantaged groups—including children from the poorest families, children with disabilities, and children living in rural areas—in pre-primary education is needed to assess whether these children have equitable access to services. Targeting strategies can then be developed to increase access to specific groups as needed.

Sustainability and Scale-Up

Government of Cambodia: Using efforts in UNICEF-supported provinces as a model, expand capacity-building support to commune councils to facilitate further scale-up of ECD. Site visit interviews indicate that local-level capacity building provided to commune councils in UNICEF-supported provinces may have been effective in preparing local officials to manage and oversee ECD programming. A similar model should be considered for other districts as ECD is scaled-up more broadly.

UNICEF: Increase coordination with the other donors globally to explore integration of ECD services into existing programmes and increase ECD service coverage. Many donors provide sectoral funds to address needs in Cambodia. By raising awareness about ECD among existing donors, the Government of Cambodia and its partners, including GoN, could extend ECD’s reach and integration into other services currently funded. Also, the government of Cambodia could seek to form a donor group for ECD by asking for specific contributions from donors for implementation of the ECCD policy. Donors could coordinate, pool resources, and contribute to specific goals or activities in the ECCD policy.

Lessons Learned (Optional):

Cambodia’s experience designing and implementing programming to promote ECD offers lessons in policy development and service integration, monitoring of services and outcomes, sustainability and scalability, and reaching the most disadvantaged. Key lessons include:

Advocacy for intersectoral ECD policy must be sustained and can build upon sectoral efforts. Development and approval of Cambodia’s National ECCD Policy occurred over years and included periods of limited activity or progress. UNICEF and its partners remained engaged in the effort and used the expectation of expansion in ECD services with FTI funding as motivation for clarifying government policy in this area. Meanwhile, education- and health-specific policies and plans moved toward incorporating goals and strategies supporting ECD. These sectoral commitments to ECD were helpful in delineating the roles and responsibilities of individual ministries in the national policy.
Achieving holistic services for ECD requires an explicit vision for cohesive service provision and clear avenues for intersectoral coordination. Although progress has been made in incorporating information on psychosocial development into community health interventions, provision of ECD services in Cambodia remains largely uncoordinated across sectors. Without clear expectations or structures for collaboration across sectors, it is difficult to identify and pursue opportunities for more comprehensive, coordinated services.
Monitoring processes must be clearly defined and consistent to promote service quality. Processes for monitoring community-based ECE in Cambodia currently lack quality standards and tools that support continuous improvement. Developing clear, evidence-based guidelines for quality and aligning monitoring tools to support these standards are essential steps.
Appropriate and comprehensive indicators of ECD should be identified and measured to track progress toward stated goals. UNICEF and its partners in Cambodia already track many aspects of ECD, particularly those related to health and nutrition. Definition of goals related to policy implementation, children’s developmental status, and improved school readiness has been less systematic, however, inhibiting measurement of progress on ECD. Defining and collecting data on a set of ECD indicators is necessary to clarify the goals of ECD programming and facilitate assessment of its results.
Linking ECD to governance reforms is apt to create a basis for sustainability. Devolving responsibility for ECD service provision to the local level has the potential to broaden the number of duty-bearers who understand the importance of ECD and to promote widespread capacity building to implement or oversee ECD-related services. It also encourages the development of cost-efficient models of ECD interventions. A risk of this approach is that resource allocation at the local level may not favor social services.
Expansion of the evidence base on ECD interventions supports scale-up. UNICEF Cambodia and its partners have supported timely and targeted research to provide information on the results of community-based pre-primary education interventions. This information has helped justify additional and continued investment in these services.
Strategies for reaching the disadvantaged and marginalized must be clearly delineated to increase access. As noted above, despite mention of disadvantaged groups in national policies and plans, evidence of systematic, concerted action to increase access among the disabled, ethnic minorities, and the poorest is scarce. What appear to be needed are plans of action, including a timetable and funding commitments, that provide clear guidance regarding next steps. Cambodia’s Master Plan for Education for Children with Disabilities provides a model, although the plan has not yet been fully implemented.



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