Programmes that work

With some notable exceptions, Sweden for example, the systematic evaluation of the effectiveness of ECD has only just begun. To date, there are no comparable national studies that connect ECD to improvements in either the psychosocial development of the child⁵⁵ or the child’s overall well-being. Reasons for this vary: There is little consensus on the best indicators of change in a child’s psychosocial development, nor is there systematic monitoring of programmes. Definitions of the age group under study differ (for example, 0-3 years, 0-6 years, 0-8 years), as do the definitions of ECD. There is also the fundamental question of how, if at all, to measure change in the ‘whole child’.

The absence of hard data is especially the case for children under three years of age, and this absence handicaps the youngest age group when decisions are made based on numbers, such as in traditional scientific research, economic policy and budget allocations.

Despite such limitations, there is a considerable body of evidence, collected over 25 years of local and subnational programming by a number of organizations, to support every aspect of ECD and every argument in its favour. The cumulative effect of the many positive changes that flow from ECD, however constituted and at whatever scale, has been to raise consciousness about ECD programmes and increase the demand for more.

ECD has saved millions of lives and improved millions more. There is little dispute that early health and nutrition interventions in a child’s life, or in the life of a mother, make a significant difference in the child’s long-term survival, growth and development. In addition, the success of immunization and literacy campaigns in saving young lives and improving the health status and social well-being of generations has been extensively documented, as has the relationship between improved nutritional status of pregnant women and the improved health status of the child. The life-saving effects of clean water and improved sanitation practices, demonstrated in village after village and country after country, are close to being a universal truism.

Grand-scale programmes. In both industrialized and developing countries, national pre-school programmes have been so clearly good for so many children for so many years that some are being extended to include younger children and others are being looked to as models by other countries. A study in Ontario (Canada), for example, called for a provincial ‘first tier’ programme for early childhood development that would be as important to preparing the children of Ontario for success as are school systems at the elementary, secondary and post-secondary level. The community-based programme is proposed as an antidote to what the authors describe as “the real brain drain,” i.e., investing more in children after they are six years old than before, despite the fact that the major brain development happens before a child is three.⁵⁶ Ontario is far from alone in seeking to prudently align investments with opportunity, as country after country around the world expand its early childhood programmes.⁵⁷

And then there are models that might well be called the ‘grandparents’ of them all. In Sweden, considered to have one of the most advanced childcare systems in the world, local governments subsidize childcare for nearly half the children in the country from when they are born until they enter school. Day-care centres and family childcare homes are well funded and regulated, well staffed with highly trained workers and designed with the child’s developmental needs in mind. Studies, regularly and systemically conducted, consistently find that the girls and boys who spend their earliest years in Sweden’s day-care system grow to be creative, socially confident and independent adolescents.⁵⁸

Since 1959, Cuba has incrementally built a national system of day-care centres and early childhood and pre-school education programmes that today reaches 98.3 per cent of the children in the 0-6 age group. In 1992, Cuba, with support from UNICEF, created Educa a Tu Hijo (Educate Your Child) as a national programme of community-based services for young children and their families. Depending on over 14,000 promoters and more than 60,000 volunteers, the programme reaches 600,000+ children in this age group, including 440,000+ young girls, and their families.

Future mothers and fathers receive information and counselling about healthy pregnancies and child development during health visits to doctors and nurses. Families with children under two years of age are visited once or twice a week and guided through activities that enhance their babies’ development. Children between age two and four and their families go on weekly or semi-weekly group outings to parks, cultural facilities and sports centres with counsellors trained in child development and family participation. And five- to six-year-old boys and girls from mountainous, rural and remote areas travel to primary schools with their families for classes and family discussions once or twice a week.

Cuba has developed its approach to early childhood care through both traditional and participatory research, the latter method further engaging families and communities in the responsibilities of early childhood. The Cuban system has had measurable success in increasing the developmental and educational achievements of Cuba’s children. A 1998 comparative study of third- and fourth-graders in 11 Latin American countries, for example, found that Cuban children scored significantly higher in third-grade mathematics and third- and fourth-grade Spanish than their counterparts (see Figure 9).

Another long-standing success story is in the United States, where the national Head Start programme began in 1965. This massive venture involves approximately 1.3 million individual volunteers and 1,400 community-based non-profit organizations and school systems in providing comprehensive developmental services to approximately 800,000 children ages three to five and social services for their families. Over the last 35 years, Head Start has prepared nearly 18 million young children for later success in school with graduates of Head Start performing at above expected levels in early literacy, numeracy and social skills (see Figure 10 below).

In 1994, Early Head Start expanded on the original programme to include families with children under three years and pregnant women. It includes comprehensive health services including services to women before, during and after pregnancy, nutrition, early education in and out of the home and parent education. In fiscal year 1999, funding for both Head Starts was $4.66 billion.

Panel 7. Respecting the rights of the Indian child