Panelists speaking during the Perspectives on Governance session addressed the institutional architecture that is essential for governments to manage national policies on young children. Constanza Alarcón noted that previous panels had discussed various aspects of programs needed for implementation and scaling up, including quality, integrality, and the intersectorality, and queried the panelists about how they have organized their work to manage the different frameworks of the public policies related to early childhood development. She asked the panelists to address the following questions:
- What are the public policies for early childhood development that have been implemented in each country, and what are the entities responsible for managing and leading these policies?
- What institutional arrangements are necessary for implementing plans and programs for early childhood development?
- What is the role of intersectoral activities, and how do they interact to create early childhood development policies?
- Are there any additional mechanisms to support early childhood development policies?
Panelists described their experiences implementing early childhood development policies and programs through strong leadership and governance structures in their respective programs.
STRUCTURING NATIONAL EARLY CHILDHOOD PROGRAMMING IN JAMAICA1
Maureen Samms-Vaughan spoke about the experience of moving from multiple agencies undertaking child-focused programs to national coordinated programing, the process of which has evolved over the years in Jamaica. She described three stages that the country went through to reach the current state:
- Obtaining comprehensive information on the status of children and programs for early childhood. This happened in Jamaica in the late 1990s.
- Establishing a cross-sectoral state institution to take responsibility for the early childhood sector. The Early Childhood Commission Act in 2003 created such a government entity.
- Developing and implementing a comprehensive cross-sectoral national strategic plan for early childhood. Samms-Vaughan explained that this first occurred from 2008 to 2013 and is currently in its second phase (2013–2018).
Samms-Vaughan expounded on these stages. Information gathering, she remarked, requires not only information on current status in all sectors—health, social sector, and education—but also understanding past practices. “In short,” she stated, “it was important for us to understand where we were and how we got there.” She gave the example of high preschool enrollment in Jamaica; 95 percent of children are in school by age 3 years. This was not due to government policy, but rather part of the history and culture of Jamaica. It was important to know this, she argued, because it teases out the difference between community demand and government intervention, and affects the process of change. Additionally, the information-gathering process also discovered gaps in childhood care: (1) less than one-third of parents received parent support, particularly those with children with disabilities; (2) though enrollment in preschool was high, there were issues with quality and inequity; (3) research showed that existing early childhood activities were poorly coordinated; and (4) there was a need for a single coordinating body.
In response, the Early Childhood Commission’s (ECC’s) role was established to take responsibility for the early childhood sector and coordinate activities within a legal framework that ensured a sustainable, cross-sectoral approach. The ECC’s responsibilities include guiding pol-
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1 This section summarizes information presented by Maureen Samms-Vaughan, Early Childhood Commission of Jamaica.
icy and program development, monitoring implementation, regulating schools, consulting stakeholders, coordinating activities, seeking additional funding, conducting research, and ensuring public awareness.
The ECC led the development of the strategic plan, using all available research, internationally and locally, as well as public consultations, which ensured community input into the plan. The strategy included five objectives, the first of which involved parenting. This led to the creation of a national parenting policy with standards and support. The second and third objectives focused on children up to age 3 years, and included improving the quality of child care at clinics, early identification of children with disabilities, and improvement of psychosocial stimulation. The fourth and fifth objectives addressed children aged 3 to 6 years and focused on regulating preschools, including training of staff and developing a child-centered curriculum. Underpinning these five objectives was a cooperative framework with clear responsibilities and targets for partners, and a data-monitoring, collection, and evaluation process.
Samms-Vaughan noted that the ECC is governed by a board representing the Ministries of Health, Education, Labor and Social Security, Finance, the Child Protection Agency, and the Planning Institute of Jamaica, as well as a number of independent and private-sector partners. This ensures the cross-sectoral nature of the commission, which is further bolstered by the position of the Director of Cross-Sectoral Coordination. Moreover, while the strategic plan is also cross-sectoral, the objectives are met within each of the ministries, who sign memoranda of understanding with the ECC and include the plans in their budgets every year. Samms-Vaughan closed by acknowledging that developing this structure was challenging and might not work for every country, but it has resulted in some successes nonetheless.
MOTHER OWL: PUBLIC POLICY IN PERNAMBUCO2
Ana Elisabeth de Andrade Lima spoke about the challenges and successes of Mãe Coruja, or Mother Owl, a program that creates a network of care to reduce maternal and infant mortality. The program is implemented in the state of Pernambuco, which Lima explained is situated in the northeast of Brazil and has a population of more than 8 million. Pernambuco experiences high levels of inequality between urban and rural areas of the state, as found in a 2007 study conducted by the administration. This study also identified the need for a program that promotes the health and well-being of the new generation of young children.
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2 This section summarizes information presented by Ana Elisabeth de Andrade Lima, Government of Pernambuco in the Secretary of Health, Brazil.
Mãe Coruja has been part of the state policy since 2009, and has been implemented in 105 municipalities. The name carries significance, Lima remarked, because the owl is the only bird that can see 360 degrees, which corresponds to the philosophy of the program. She emphasized the importance of having knowledge of partners and stakeholders who work together to see the picture as a whole.
Lima noted that Mãe Coruja is monitored at the central state level every month, with regional committees to monitor and evaluate, and implementation at the local level. With the help of nine participating state secretariats, the program supports women’s empowerment to increase literacy and reduce truancy, facilitates registration at maternity wards to ensure prenatal follow up, provides support for women farmers, supports income-generation activities, and provides psychosocial assistance. Additionally, data collected on registered women and children is accessible online to facilitate real-time intervention.
Lima emphasized the importance of coordination and monitoring, as well as ensuring buy-in at all levels for effective governance. There is strong political will, but engagement by all partners can help sustain the program in the event of a change in administration. Lima also stated that the government has made strong investments in human capital and resources, including technology.
After 8 years of program implementation, Lima noted that while Brazil has seen an overall reduction in infant mortality, Pernambuco saw the greatest rate of reduction, particularly in those municipalities where Mãe Coruja was present. She remarked that the government is now working on an early childhood development program based on the Chilean model, and with this, Pernambuco is building a new history and a new life for every child.
Cristina Lustemberg, coordinator for Uruguay Crece Contigo, explained that 8 percent of the population of Uruguay is below the age of 5 years. In 2005, 64 percent of children were below the poverty line; today, this number has significantly improved, with Uruguay producing the greatest drop in poverty in Latin America in that time period. However, despite strong reforms, there is still a concentration of poverty in families headed by women or with young children.
Lustemberg further explained that progress has been made with the development of programs and policies focused on women and children.
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3 This section summarizes information presented by Cristina Lustemberg, Uruguay Crece Contigo.
For example, structural reforms in the health system—in benefits, norms, and services—led to a more holistic approach to the health of women, while there have also been considerable efforts on building up the child immunization program. In 2008, a National Strategy of Children and Adolescents was developed. These actions have led to Uruguay becoming a leader in the region in social development. Additionally, she remarked, an intersectoral framework was created to guide the planning of policies for children and adolescents through 2030, in health, education, and other social sectors. This was coupled with a strong fiscal effort on the part of the government to fund those priorities that improved children’s health and development, and led to an increase from 4 percent to 5.8 percent of the national budget on social expenditures.
In 2012, research was conducted that highlighted gaps in early childhood and early adolescence. This led to a development of a policy based on the Chilean model, Crece Contigo, to be implemented to meet the needs of highly vulnerable populations, pregnant women, and children below age 4. This policy was developed in coordination with the Office of Planning and Budgeting in the Office of the Presidency. Lustemberg explained that all of the stakeholders recognized this was not an area to be addressed within any one sector but rather an undertaking that would cut across sectors to institutionalize strong management of policies of early childhood.
Lustemberg stated that a program was created under the codirection of the ministers of health and social development, with suitable technical space and strong leadership and support from all of the government institutions and ministries that address early childhood, such as health, education, housing, labor, and others. Additionally, she remarked that there are strong governance structures in place, including involvement at the local level, to carry out a national policy successfully.
The goal was to create a comprehensive program that guaranteed the rights of households with pregnant women and children less than 4 years old, Lustemberg said. However, they faced several challenges in accomplishing this goal. First, there was fragmentation in the policies that affect early childhood across sectors. In particular, without coordination, there was a failure to see the full scope of what families needed. Second, there was a lack of coverage, particularly for children between birth to age 3. A law passed in 2008 required children at 4 to attend school; however, there were not enough preschools for younger children. Additionally, the health system was unable to produce long-term results for improving child development. And finally, policies were not reaching the extremely vulnerable populations, such as those stuck in generations of poverty, who often had low literacy and high rates of adolescent pregnancy. Lustemberg observed that a different approach was needed for these populations, and a new
program was created that focused on social and educational empowerment, skill-building, strengthening institutional capacities, and following up with vulnerable populations. Lustemberg explained that there was a particular focus on vulnerable populations, because they have discovered that identifying and following up with households of extreme poverty changed all of the vulnerability indicators they had measured.
She closed by referencing a need for integrating a gender approach into early childhood work, but argued that policies needed to be integrated, with common goals and objectives, and strong leadership.
COORDINATING EARLY CHILDHOOD MANAGEMENT IN COLOMBIA4
Constanza Alarcón shared lessons learned from the Colombian experience of expanding and scaling up programs for early childhood. Colombia has a high rate of poverty in childhood, and the government is directing the coordinated management of different sectors to create programs that guarantee rights, rather than focus on risk or vulnerability. The programs should also include women’s health prior to conception and during pregnancy, as well as the integral development of children after infancy. Alarcón remarked that programs should also be intersectoral in nature. She cautioned, however, that there are multiple ways to practice intersectorality. It could be focused on coordination, in which sectors work together with their own responsibilities but with the knowledge of what others are doing. Another approach could involve focusing on competencies of various sectors to identify where they intersect in order to complement the service. Intersectoral management in this case would focus on those intersections; she noted that each sector has its own agenda and identifies where to converge their goals. In Colombia, she explained, an Intersectoral Committee was established in the Presidency of the Republic, which convenes all of the sectors and delegates responsibilities by competency.
In a discussion following the presentations, panelists addressed the inclusion of fathers and other caregivers in their work. De Andrade Lima explained that Mãe Coruja intends to reach the whole family. She remarked that the inclusion of fathers happened naturally, and they are active participants in promoting the health and well-being of their chil-
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4 This section summarizes information presented by Constanza Alarcón, Presidency of the Republic, Colombia.
dren. Samms-Vaughan described Parents’ Places, the operational aspect of the National Parenting Policy. There are three levels of Parents’ Places: (1) places where parents can receive written information, primarily in rural areas; (2) parenting classes through which parents are provided with support from a trained parent facilitator; and (3) referral services provided to parents, and these high-level services would often be located where other services exist, such as hospitals. She noted that the parenting policies address the importance of fathers, which is important in Jamaica where many children live in households without a father figure. In the case of Uruguay Crece Contigo, Lustemberg acknowledged the inclusion of fathers, uncles, and grandfathers in communication materials. She argued that the country must undergo cultural changes in order to bring the male figure into practices and policies, and to further the discussion about the relationship between father and child.
One participant asked the panelists to address best practices for maintaining quality during the implementation of programs in the field. De Andrade Lima explained that from the beginning, Mãe Coruja has aligned competencies and knowledge across all their professional sectors. The program includes modular education, as well as continuing education for all staff, and there are routine meetings among partners at local, regional, and central levels. Lustemberg noted that staff in their field programs are highly trained and specialized. She also observed that they receive psychological training as well, so they can adequately respond to some of the difficulties their beneficiaries might be experiencing. Samms-Vaughan spoke about training and capacity for parent facilitators. All field staff in the ECC are trained as parent facilitators, and they certify and provide support to early childhood parent places.
While there is still a focus on reducing infant mortality, panelists indicated that there has been significant progress in other areas as well. They pointed out that some of the focus has shifted to improving the quality of life for children, including cognitive development and family dynamics. Panelists also shared thoughts on ensuring that programs are responsive to emerging needs, which are identified through strong monitoring and evaluation methods. In particular, as top-level goals are met, issues of inequity become evident, as well as the need to address them. The three panelists felt that while policies and programs need to maintain alignment and fidelity, diversity of culture and context can mitigate the impact of programs if not more specifically tailored.
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