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Health and Learning. Coordinators' Notebook: AnInternational Resource for Early ChildhoodDevelopment.Consultative Group on Early Childhood Care andDevelopment, Haydenville, MA.9358P.Judith L. Evans, 6 The Lope, Haydenville, MA01039.Collected Works Serials (022)Coordinators' Notebook; n13 1993

MF01/PC03 Plus Postage.*Child Development; *Child Development Centers;*Child Health; Child Welfare; Community Cooperation;Developed Nations; Developing Nations; *EarlyChildhood Education; Family Programs; ForeignCountries; Integrated Services; Nutrition; *YoungChildrenFamily Support; *United Nations DevelopmentProgram

This theme issue deals with the topic of therelationship between health and learning as it applies to the care ofthe young child. It consists of three parts. The first part is alengthy article, "Health Care: The Care Required To Survive andThrive" (J. Evans), explains health and caring environments of youngchild in the given economic conditions worldwide and provides waysthat early childhood programmers can strengthen all dimensions ofchild care, including health, nutrition, education and familysupport. The second part provides four case studies of programs inIndia, Bolivia, Thailand, and Malaysia that use various strategiesfor caring for young children and their families. The article in thethird part, "Attention by International Organisations to EarlyChildhood Care and Development: An Analysis of United Nations WorldReports, 1993" (R. Myers), examines the current activities ofinternational organizations working in early childhood care anddevelopment and analyzes the latest World Reports issued byspecialized agencies of the United Nations. This article notes thatinternational organizations are beginning to recognize the importanceof the integrated nature of children's development during thepreschool years and its relationship to larger social and economicdevelopment questions. Activities of the Secretariat for theConsultative Group on Early Childhood Care and Development, news fromvarious family organizations in the network, and a list ofpublications and videos on related research and activities areincluded. (AP)

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Reproductions supplied by EDRS are the best that can be madefrom the original document.

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Coordinators'

noteAn International Resource for I

"PERMISSION TO REPRODUCE THISMATERIAL HAS BEEN GRANTED BY

5%34 v17\-\

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)."

Health and Learning:

Network Notes, Page 37

AND LEARNING

HEALTHCARE:

The CareRequired toSurviveand ThriveJumni L. EVANS .

What future would you like to see for yourchild: The way parents answer this questionmay determine whether or not the childsurvives. When parents see a future for their

child, they will do their best to provide the childwith the care required for survival even in circum-stances where very little food is available However,if parents arc hesitant or cannot give a response tothe question, the child may not survive. The latestresearch on the relationship between health, nutri-tion and stimulation argues convincingly that anadequate food supply is not enough to assure achild's survival, neither is access to micro-nutri-ents, neither is education, nor absence of disease.Children's growth and development is fosteredwhen all these variables are present, within a car-ing environment

In the following pages we will explore the dimen-sions of a caring environment, and look at ways thatearly childhood programmes can strengthen alldimensions of Care including health, nutrition, edu-cation, and family support.'

The Situation ofYoung ChildrenOne and a halt billion c hildren will he horn in thedecade of the 1990s Given economic conditionsworldwide, these children will increasingly he horn

into poverty and situations which threaten theirchances for optimal human growth and develop-ment. The quality of the environment in which mil-lions of children arc growing up is inadequate byany number of criteria. Overcrowding, lack ofpotable water and sewage face ities, lack of adequatefood, and inadequate caretaking characterise theenvironments of many young children. Frequentinfection (most commonly diarrhoea) and malnutn-non account for over 50% of all infant mortality indeveloping countries.

These statistics are likely to worsen as the num-bers living in urban areas increase, which they will.It is estimated that by the year 2000, urban popula-tions in the developing countries will increase from1 billion in 1980 to 2.1 billion. This represents a 110percent increase, compared with a projectedincrease in the world's population during that sametime period of 38 percent. A further expansion ofurban slum and squatter settlements is inevitable.

This situation is of concern to many. In recentyears there has been an attempt to focus the world'sattention on the needs of children, as evidenced bythe Summit for Children convened in September 1990,and the fact that the Conoention of time Rigl* of the addwas brought to the General Assembly of the UnitedNations in 1989. calling for universal standards forchildren in relation to survival, protection anddevelopment. But the Conoention and other docu-ments can only articulate desirable outcomes. Theydo not guarantee what will happen in the life of anindividual child. Therefore it is necessary to developpolicies and programmes at the regional, nationaland local levels to turn the wording of Conventionsinto reality. The various United Nations organisa-tions whose mandates include children have takenon the challenge, as have a wide range of non-gov-ernmental and donor agencies.

With the year 2000 in mind, specific targets havebeen set For example in terms of micro-nutrients'the challenge is to eliminate vitamin A and iodinedeficiencies and to reduce by a third iron-deficientanemia in women. (World Bank, 1993) The WorldSummit was not the only arena within which thesetargets were discussed They were endorsed by theEnding Hidden Hunger Cortical:Le in October 1991, and at

the Intern ational Conferrn«' on Nutrition in December 1992.

In terms of education one goal set forth was toachieve universal primary education by the year2000. This goal was endorsed at the Education ForAll world conference in lomtien, and reinforced atthe follow-up EFA conference in New Delhi, whereseveral related aims were proposed and debated.(These will be examined more fully in the next issueof the ( 'oordinator." Notebook)

Are these goals realistic' Only if we take a goodlook at the complex realities of people s lives andwhat we know about successfully meeting theirneeds.

To begin with we know that survival and healthydevelopment cannot he achieved without significant

A woman breastfeeds her child while another mother holds her malnourished daughter who is nolonger breastfed, Sinkor, Monrovia.

attention to young children, from their conceptionthrough age six. The basis for good physical healthand cognitive functioning in later years must beestablished during the early years The dependenceand rapid growth typical of infancy and early child-hood make children vulnerable to a variety ofhealth, nutritional, psycho-social and other environ-mental conditions. Those living in poverty are par-ticularly at risk of poor physical and psycho-socialdevelopment

Second, we know that children cannot he viewedin isolation It is necessary to recognize that they arepart of an ever-changing society. By understandingmore about changes in the family and community itis possible to identify the impact of those changeson children's growth and development. Such anunderstanding can then provide the basis for inter-vention programmes that meet the needs of childrenand their families.

Third, we are able to identify programmes thatare effective and those that are likely to fail.Successful programmes generally require an interac-tive, integrated, culturally-sensitive approach and abreadth of understanding of people's beliefs, percep-tions, needs and concerns In contrast, mono-dimen-sional programmes, which may meet short termgoals, are not likely to he sustainable. It is rarelyhelpful to impose a single solution which ignoresthe need for individuals and communities to controltheir own destinies.

Building on what we already know this articleexamines the latest research which provides us with

a greater understanding of the relationships betweennutrition, health, care, education and developmentaloutcomes for children. We begin with a look at thekey needs of young children in section I. This is fol-lowed in section 2 with data on the importance ofthe environment of Care that surrounds the child interms of the immediate family and in terms of thewider culture. In section 3 we look at the health carerequirements of young children, including reportson current research which identifies the powerfulrelationship between micro-nutrients and cognitivefunctioning and development Section 4 providesguidelines that should be followed when creatingnew programmes or introducing health, nutrition.Care and/or education components into existingprogrammes that ;eek to support children's growthand development.

The Child: KeyNeeds fromConception throughthe Early YearsIn terms of physical, intellectual, emotional andsocial well-being, the period from conception to age6 is the key to subsequent growth, development andultimate productivity Pre-natally through the sixthyear there are several distinct stages. They include:intra-uterine, intrapartum (the birth itself). postpar-tum (birth to I month), early infancy (the first sixmonths) late infancy (6- 12 months), toddler (1 to 3years), and the pre-school child (3-6 years of age).

HEALTH AND LEARNING. loot dim, tot s' Notebook. Winter t uo t

Children have different needs, depending onwhere they are within these stages. The younger thechild, the more difficult it is to disentangle thephysiological and psychological factors within theenvironment that govern health. The youngest chil-dren are completely dependent on adults. As theybecome toddlers environmental cleanliness, encour-agement of eating and vigilance in terms of thechild's safety are of utmost importance. The pre-school child is more self-reliant As noted by Engle;1992) these children "are initiated into the cultureof children, and may even become fledgling care-givers themselves... they may have developed skillsto obtain food for themselves. and the wisdom toprotect themselves a little from pathogens in theenvironment." (pg. 25)

While the general desciptu n of differencesacross tiiz ages is important, in order to create a pro-gramme for young children it is critical to havemore specific information on their needs. A delin-eation of developmental differences is provided byDonohue-Colletta (1992) for three age groups. Shedefines the needs as follows.

AN'T s HUT! I ) ) NI I I),

PI PrOtt'Cil0/1frnin physical danger

adu/Hate nuts awn

ade/pate health (arc

adults with whom to form audi blunts

,idults who Cali Iindersidlld and icspomi to their cloak

thing: to look at, touch, hear, null, and task

opporholthes to explore the world

appropriate language stimulation

Tt )1 )1 ( 1-3 YI .116 (t1 .\( I NI I I)Al I FI II AIR )VI ANI) s(1 RI (.A111:I

support in ti( oft:Jig new motor, language and thinking :kills

ma chance to develop some 111,41'14km(

help Oi hatnin# how to control their own hehavunn

opportunities to begin to learn to (at( lot themselors

daily opportunities to play with a variety of obleds

0 III DRIN AL.1"ti 3.6 (AND AIR AlIN AN ATI( on TO TI \IR AT, \I ,( ) NI I I ):

oPPorfunthes to dcorlop fine motor skills

encoutagemoit of language through talking trading,

singing

ac bribe: which will dt'i'rlop ti positwe sense of mastery

opportunities to learn /lope/a hon. helping, sharing

experimentation will, pre-writnut and pre-rcadmg skills

(hg 61)

A wide variety of inputs is required to supportchildren's growth and development. An importantthing to note is that all the inputs require someoneto interact with the child Very young children arenot capable of obtaining what they need on theirown. The importance of adult-child interaction isunderscored by the latest research which addressesspecifically the relationship between nutrition. careand development.

Children'sRequirementsfor CareThe quality of Care the young child receives deter-mines hisiher development. Engle (1992), definescare as the provision nn the household and community of time,

attention, and support to meet the physical, mental and social

needs of the glowing child and other household members. Care

includes much more than keeping the child safe andfree from harm Caregiving behaviours includebreastfecding; providing emotional security andreducing the child's stress; providing shelter, cloth-ing, feeding, bathing, supervision of the child's toi-let; preventing and attending to illness; nurturingand showing affection, interaction and stimulation;playing and socializing; protecting from exposure topathogens; and providing a relatively safe environ-ment for exploration. (Zeitlin, 1991, Myers, 1992) Asecond set of caregiving behaviours includes the useof resources outside the family, including curativeand preventative health clinics, prenatal care, theuse of traditional healers, and members of theextended family network. (Engle, 1992) All of thesebehaviours are a part of supporting the developmentof young children

The type of caregiving behaviour which isrequired depends to a large extent on the child'sdevelopmental age and the health and nutritionalrisks the child is facing. For example, during the firstyear of life the child is at the greatest risk of mortali-ty During late infancy (or when complementaryfoods are introduced) and during the toddler period,the child is at greatest risk of growth faltering.

While growth faltering may be the result of inad-equate nutrition, there is clear evidence to suggestthat it is also linked to the way young children arefed. Feeding is more than giving children food; itincludes the interactive process which accompa-nies the intake of food. The interactive caregivingprovided during the feeding process can have a pro-found effect on the child's later development.Studies comparing children who are well- and poor-ly-nourished suggest that there are positive Caringpractices associated with children with better nutri-tional status, even though the children come fromthe same type of environment as their malnourishedpeers. (Zeldin, 1993)

In the context of feeding, Caring practicesinclude frequent physical contact, being consistentlyresponsive to the child's needs and showing affec-tion to the child. Care also includes 'icilyc feedingwhich means being aware of how much the child iseating, offering the child a second helping, assistingthe child in the use of a utensil instead of expectingcomplete self-feeding, and offering praise for eating.(Engle, 1992)

The studies of feeding are but one example of

5

current research that indicates the powerful effect ofthe interaction between the child and the environ-ment on growth and development. Another exampleconies from longitudinal studies of children growingup in poverty In Hawaii, Werner (1982) was able toidentify children who were able to thrive eventhough the conditions under which they were raisedsuggested they would he malnourished and notdevelop well. She termed those children that didwell resilient. Those characterised as resilient evi-denced greater autonomy and competence (pg. 158)and clearly did better developmentally and overtime than their non-resilient peers. They did betterbecause they were able to "elicit predominantly pos-itive responses from their environment." These chil-dren were also found to he "stress-resistant" com-pared to children who elicited negative responsesfrom their environment.

In her research, Wernersought to identify what makessome children more resilient.She concluded, as have others.that the differences betweenchildren who thrive and thosewho falter are determined bythe type of interaction thatOccurs between the child andthe environment. The child'sability to thrive is greatlyenhanced by the amount ofaffective stimulation and thekind of care the child receives.This clearly supports the con-tention that it is not enough tomerely provide food. The childneeds food and Care.

Another important factor in achild's ability to thrive is thelevel of support the caregiver(most often the mother) receivesfrom others in the family andfrom society. This support playsan important role in the kind ofcare the caregiver is able to pro-vide. Recognizing thi.. fact,UNICEF has included support

on women's ability to provide care. These have beenoutlined by Engle. (1992) They include:

1. Physical health Many women in developingcountries are chronically anemic and undernour-ished. This necessarily affects both the health of thenewborn and the woman's ability to provide Care.

2 Mental health. This includes a woman's level ofself-confidence and her status within the cultureWhen women are stressed and feel they have nocontrol over their lives, the sense of powerlessnesscan debilitate them. The more they feel they cancontrol aspects of their lives, the more self-confi-dent they are and the more likely they are to be ableto give to others.

3. Women's status In cultures where women aresubordinated to others, they are frequently unableto take good care of themselves, and may well lackthe resources (physical and psychological) to care

for the child. When womenare respected and have con-

Women have always played

multiple roles that compete for

their time and physical and

emotional energy. Regardless of

the context within which child,.en

are raised, care of children,

particularly young children, is

still the woman's responsibility.

ht addition, the woman is

responsible for household

management and operations, and

economic/productive activity,

some of which takes her outside

the home. Demands on time and

energy make it increasingly

difficult for women to provide the

kind of Care their children need.

for the caregiver in theirNutrition Strategy. Adopted bythe UNICEF Board in 1990, the Strategy suggeststhat in addition to food security, access to healthcare and a healthy environment, programming mustaddress the care of children and women. Recentresearch supports the UNICEF position that all ofthese are necessary; one alone is not sufficient.

From the onset of conception, the child andmother are inextricably linked and this is maintainedafter birth through breast-feeding and psychosocialnurturing. Therefore the understanding of thehealth needs and problems of the young child startsnaturally with adequate health inputs and supportsfor the motile,. A range of variables have an impact

trol over resources, they aremore self-assured. This gener-ally yields positive benefitsfor children.

4. Women's income. The liter-ature suggests that women'swork outside the home pro-duces direct benefits for chil-dren, particularly if the salarylevel is reasonable and if thewoman has control of themonies that she earns. Inthese instances, children arelikely to have improvedhealth and participate morefully in education.

5. Education and Reliefs.

Numerous studies havedemonstrated the strong posi-tive relationship between awoman's education and childhealth and nutrition out-comes. While all the com-plexities of this relationshiphave not been explored fully,it is clear that when womenare better educated, theirchildren do better.

6. Social Supports. Moving beyond the individual,the sixth variable is the kinds of social supportsavailable to women. When women feel they are partof a community, alternative forms of child care canhe developed, agricultural production can be facili-tated through the formation of work groups. andinformal sharing of tasks is possible, relieving thestress on an individual woman. Community supportallows women to carry out a number of tasks effec-tively. L,- :k of supports may mean that many of thetasks are not done well.

7 Time. Somewhat related to the issue of socialsupports is the time that women have available for

6

'HEALTH AND LEARNING 'oordiriatots. Noiebook, Winter 100 s

Care. The many hours of labour that women spendto accomplish a range of tasks during the day hasbeen well-documented One legitimate question is:if women had more time would it he devoted tochildcare' The answer to this question is unclear. AsEngle notes, the lack of an answer is largely due tothe fact that when women are asked the questionthey find it hard to imagine having leisure time.

These variables are not static They are changingall the time as the nature of women's work changes.New economic pressures on and possibilities pre-sented to women mean they increasingly work Out-side the home, often for long hours and followingschedules that limit their availability and thus thetime they can devote to child care.

In rural areas women often work in the fields.While in many cultures women have historicallyconstituted a majority of the agricultural work force,in other settings the out-migration of men who areseeking employment elsewhere has increasedwomen's agricultural role. In addition, in sonic agri-cultural settings cash crop production and plantationeconomies have meant that women are increasinglybeing exposed to demands of rigid time and workschedules similar to those common in urban envi-ronments. In both urban and rural environmentsthere is an increase in the number of women-headedhouseholds. All of these variables have an impact onwomen's work loads

Zeitlin H9921 has studied the impacts the rapidpace of change is having on children and families.She con:Aides that many of the previous roles of theextended family are being taken on by society.Because of this, Zeitlin is concerned not only withthe families' ability to provide care. but the ability oflocal institutions to take on this function as well. AsZeitlin notes, Care is moving from the non-mone-tized dependency relationships within a family tothe monetized public realm, and money does notbuy love.

Zeitlin provides rich insight into the relationship

University. In live countries (Bangladesh, Indonesia,Nigeria, Nicaragua and Mexico), Zeitlin and a teamof researchers undertook an "intervention research"approach which encompasses academic research,operational research and the development of a pro-ject. The particular focus of this study was on therelationship between family variables and children'snutritional and developmental status

The study provides insights into the role andimpact of traditional care practices on nutritionalstatus and children's growth and development. Italso provides a view of what the future holds as tra-ditional practices are lost and modern strategics areintroduced.

To represent the complexity of the data. Zeitlindeveloped a conceptual model that is elaborated onin her discussion of practices within the various cul-tures. The basic model posits that overall childgrowth and development, while rooted in familyresources (material and social), is mediated by fami-ly management, beliefs and caring behavioursThese include: hygiene and sanitary practices; feed-ing practices; affection and attention; and academicstimulation provided to the child, all of which arccomponents of Care. Zeitlin suggests further thatfor infants and toddlers it is difficult to differentiatenutritional and developmental outcomes.

In traditional cultures care has been the purviewof the entire family kinship unit. Thus Zeldin arguesthat nutritional programmes need to address theneeds of the "family kinship unit, the human entitythat survives across generations." emphasising in thisbroader definition the family unit over time, ratherthan the individual child or the family within onegeneration.

The ability of the mother (or the primary caregiv-er) to provide care for the infant and young childdepends both on her nutritional status and the kindsof supports that she receives. The father and otherfamily members have an important role to play inthe child's survival Zeitlin found that no matter

whether the father's traditional role called fordirect involvement with the child or just sup-

In conditions where there are poverty, food insecu-rity and a high risk environment, good child Careand the social health of the family and communityare the most important variables in determiningchildren's nutritional success. (Zeitlin)

between family variables and children's developmen-tal outcomes. The Positive Deviance ResearchProject, conducted 'nom 1987 to 1992 was spon-sored by UNICEF New York and Nigeria theWHO/UNICEF joint Nutrition Support Program(JNSP) of the Italian Government and Tufts

port of the mother, in all cases, "the father'spresence, commitment and contribution wasassociated with better child nutrition." Otherswithin the kinship unit also play an importantrole in caring for, socialising and teaching theyoung child.

However, in many places the family kinshipnetwork is no longer a stable source of Care.

This makes it more crucial that programmes whichwish to meet the needs of young ch6dren addressthe many dimensions of Care directly, rather thantreating i as a background issue, or assuming thatgood care is being provided just because the child isin the company of adults. The example of the Asha

7

Sadan remand home and orphanage (at right)demonstrates this poignantly.

Zeldin found that the kinds of Care provided bytraditional and more modern parents have differentoutcomes. Looking at the relationship between Careand children's psychological development inIndonesia and Nigeria, the researchers found thatparents with more modern (i.e. Western) childrear-ing practices produce children who are more cogni-tively advanced and better nourished, and thus bet-ter prepared to participate in the modern world. Inparticular Zeit lin's researchers observed in modernfamilies:

A change m parental dicciplinc away from mina,' le physi-

cal punishment to tolorince Of slower obediencr There was

also an expect t that the child would have anunderstanding .he reasons for rules.

Prolonged parental protection. Parents accepted thechild's physical dependency up to an older age, andthey provided more attentive feeding and care.

Akre affection and intimacy. A more personal rela-tionship existed between the children and thefather and there were more recreations shared byparents and children

Inc teased verbal respoihmene, to an child. This included

the use of explanation in addition to physicaldemonstration in teaching (Zeldin, 1991, pg I

While these findings are heartening, moderniza-tion has also had a negative impact on care providedby the family. Those aspects noted specifically byZcitlin Iclude

A dehumanization of an late elll'110111nrni with increased

use of the bottle rather than the breast and thereliance on mass media rather than human interaction for entertainment

The disintegration of family and community 1111Ik and of

commitment to each other. Smaller units of owner-ship and residence lead to less sharing and more

A reduction in the ability of families and communities to

provide care given the changing demands of work out-side the home The nature of this work does notnurture stable family formation.

The fentonzation of poverty When families dissolve,the woman and her children generally fall intopoverty and lack adequate resources lor child care.

A reduction m children.c altruism Preparing children to

he autonomous tends to make them precocious, self-centered and unruly. Those children reared in moretraditional societies are more altruistic. As modern-ization occurs they become more egotistical. (pgs.11-12)

One interesting outcome of this research was thediscovery that the same characteristics of familieswho exhibited positive nutrition in circumstances ofpoverty. vere those that led to positive cognitiveand social development as well In other words,good Care yields benefits across the board in thephysical, mental and emotional realms.

Zeitlin concludes that child care practices are'evolving codes of behavior that embody a society's

Asha Sadan -A HopeFulfilledAsha Sadan is a home which affords shelterand protection for destitute and abandonedchildren, as well as serving as a remand homefor delinquent girls. This foundling homereceives children of all ages in different statesof health and nutrition. The children remainin care until they are adopted. The neonatesand sick children are assigned to nursing staffwho tend and care for them.

This is the story of the older children whowere relatively healthy, but little else.

The honorary managing committee mem-bers had noticed that the children were apa-thetic and sometimes unruly. They showed nosigns of normal growth and development. Inthe month of August '86 there were thirty-twobabies who needed help, but the managingcommittee could not fathom the reason.

The children had been provided with abeautiful nursery with fancy cots and beds andplenty of toys, but were not really allowed toplay with the toys except under supervision.There was a luxurious kitchen and a full-timecook who dished out nutritious meals at fixedtimes. But she was strictly following instruc-tions, and being anxious by nature, would pre-pare the food well ahead of time, then leave iton the counter until the specified time. The

8

A NOTE FROM THE FIELD

children spent most of their time lookinglongingly at the food, partly because theywere hungry, but more importantly becausethey had nothing better to do.

Mobile Crecbes was requested to help in run-ning the childcare centre during the day.Consequently four trained staff membersarrived at Asha Sadan to assess and assist intending the children. For the staff of MobileCreches who were accustomed to the dust andrubble of construction sites and creches withlow roofs and little ventilation, this seemedlike heaven! There were toilets with runningwater and a large kitchen. What luxury.

But the atmosphere was strangely discon-certing. The place smelled of stale urine andmost of the children were either Dying or justsitting. Some of the smarter ones were point-ing to the food on the counter and begging.The staff were flabbergasted. There was notime to be wasted in observing. They had toget down to work immediately.

Two of them attended to the physical cleanli-ness of the nursery as well as the care of thechildren. The plastic panties were replaced withcomfortable cotton ones, and toilet training wasstarted. Almost all the children had head liceand scabies These were immediately treated.

But the most important aspect of child carewas affectionate interaction, coupled withstimulating activities. These brought aboutperceptible changes in the behaviour of thechildren in the short time of a week. The chil-dren responded to the love shown to themand began to communicate with the adultswho cared for them. But when it was time forthe caregiving staff to leave in the evening,there were heartrending scenes. The childrenwould cling to them and cry bitterly.

By the end of a fortnight all this hadchanged. The children felt more secure andwere willing to wave goodbye to the care-givers, secure in the knowledge that theywould come again the next morning. Slowlythey were accepting discipline without fear.The routine of feeding children and keepingthem in bed most of the time was slowly mod-ified to include interactive, stimulating activi-ties for cognitive development.

Working with established practices thatwere unimaginative and outmoded was noteasy. There was tremendous resistance fromthe senior nursing staff who believed that

"children should be seen and not heard." Theyhad established the rules and nobody daredquestion them. For example, at feeding time,the children were seated on the floor. Bowlfulsof mashed cereal mixed with egg were shovedinto their mouths mechanically by somehelpers, with not a word being spoken. At theend of the meal, they were given water fromthe same bowls. Then the children were liftedup and put to bed.

After many laborious discussions theemphasis was shifted from feeding and dump-ing, to nurturing with love and care, as well asto activities for cognitive development. Moreattention to the children's health problemsand habit formation began to pay dividends.They were encouraged to play and to use thetoys. The children looked forward to the timeallotted for outdoor play. Soon they weredancing and singing, and the creche wasresounding with their laughter. The first fal-tering words had been uttered, showing thatthe children were normal after all.

A fortnight after the entry of Shalini,Vasanti, Shakuntala and Saraswati of MobileCackles, there was a perceptible change in thechildren. They were happier and healthier andlooked forward to each day with enthusiasm.The creche was now vibrant with eager chil-dren wanting to talk, play, learn and sing allthe time. Their social-emotional developmentwas beginning to take place.

The children's recorded weights showed anincrease of 500 grams exactly one month afterintervention. They were now feeding them-selves from little gleaming plates and enjoyedthe independence.

For Mobile Creches the experience providedmixed feelings. There was the frustration ofnot being able to change the system drastical-ly, combined with the satisfaction of meetingthe challenge and achieving success. The ini-tial trials turned into triumphs. They hadbrought joy and stability into the lives ofmany forgotten children.

At the end of six months the children hadgraduated into balwadis (pre-school). But thework is not finished yet. The staff of theremand home need to be trained for qualitychildcare, so that every child who enters thehome has a better chance of normal developmerit and a bright future.

Indu Balagopal

9

/114

perceptions of what children need to survive... andwhat society needs from the next generation." These"codes of behavior" are not easily changed. Parentsare not very responsive to what she calls "shorter-term vertical objectives" such as improved weightgain Programmes that focus solely on weight gainwithout addressing the families codes of behaviorare not likely to be very effective. She adds hervoice to the growing chorus of researchers whoargue that support of "nutrition", (often conceived ofby the health field as consisting solely ofKnowledge. Attitudes, and Practices (KAP). mustalso incorporate Care, for the child, the family andthe society.

She argues that programmes should he directedtoward:

"strengthening families, for whom child care isintrinsic to self-expression;using screening criteria to select dedicated, gen-uinely caring alternative child care providers;monitoring the emotional climate of alternativechild care...; andempowering the formation of community-Insedadvocacy and self-help groups...as these groupsaffiliate and serve out of a sense of shared purpose."

If& 14144

Children'sHealthRequirementsUnderstanding the health needs and problemsthe young child starts naturally with adequate healinputs for the mother After birth the health carequirements vary depending on the age of tchild. For example. nutrition is often a focus of prgrammes for children under three since malnuttion in its various forms contributes to about orthird of all deaths of young children in developicountries. (Engle, 19q2) With children between tages of 3 and 6, more emphasis is given to the pimotion of school-related skills and the developmtof good health habits.

Over the last five decades much has been writtabout the effects of protein deficiency on childrephysical development Children who receive Macquatc protein intake fail to grow normally, and Ivdevelop kwashiorkor, marasmus and other mildmoderate symptom' of malnutrition. Howev,recent research on the long-term effects of ProtEnergy Malnutrition (PEM) suggest there is alsolinkage between adequate nutrition during t

AND 'LEARNING ( oodmalots Noichook lt1rntn 10., f

early years and later cognition.A series of studies were carted (tut in four villages

in Guatemala A first set were conducted between1969 and 1977 Two types of nutritional supplemen-tation were provided to children up to seven yearsof age Follow-up studies were then conductedbetween 1988 and 1989 (when the children werebetween II and 24 years of age; to assess the long.term el le( is of the nutritional supplementation pro-gramme Two types of supplemental .000., weregiven. One F ,o), was a locally--tv-:,able drink thatcontains 59 kcal pet cup, but no protein. The other,Atole, was created as a substitute for the traditionalcornbased drink commonly given to young chit.&en IncaParma, developed at INCAP, was used asthe ha:-,e of the Atole drink It contained 11.5 g of

protein, 163 kcal of energy per cup Both drinkswere fortified with vitamins and iron.

Children were tested at 6 15 and 24 monthsEven at this point there were differences in chil-dren s mental development scores based on theamount of their protein intake et at 19931

During the preschool years (3-71 It) tests wereadministered annually An additicinal 12 tests wereadministered to children 5.7 years ofage The results of these studies con-ducted by various people, using differ-ent methods and different samplingprocedures showed small but consistentand significant difleienc es between thegroups. based on protein intake- thosewho took Mole did better (Pollitt et al

ly during the period of rapid growth in the brainand body (Pg 7o)

Protein intake is not the only determining factoraffecting a child's nutritional status In recent yearsconsiderable research has been conducted on therole of micro- nutrients in the short- and long-termdevelopment of the child. The findings are impres-sive. They indicate clearly that the lack of specific_nutrients when children arc' young can have lastingeffects on children's cognitive abilities later in life.

Three micronutrients, iodine, iron and vitamin A,have received considerable attention and are thetopic of a recent World Bank report on 13oI Pniclkoitr Addreing Alhronutnent Malnuinhon (1993). Thereport focusses on iodine. iron and vitamin A specif-ically 1or three reasons. First, an estimated 2 billionpeople worldwide suffer deficiencies of these impor-tant nutrients. Second, a great deal i,. known aboutthe functions of these nutrients in human growthand development. And third, all of these nutrientscan be provided to populations through the applica-tion of low-cost technologies, which have beendemonstrated to he effective in alleviating the defi-ciencies (World Bank. 19931

The findings are impressive. They indicate clearly thatthe lack of specific nutrients when children are

young can have lasting effects on children'scognitive abilities later in life.

1993 pg. 19)Over time the chi fel CIRCS between

the two groups increased The longitudinal resultswhen children reached adolescence, indicated thatthose children who icceived Atole scored signifi-cantly better on knowledge. numeracy reading andvocabulary tests than those who received FrescoWithin the Atole group. there were significant dif-ferences: Children from the lowest economic stratahenefitted the most from Mole. Those who hadMole supplementation were also more likely toenter school earlier and to complete more gladeswithin primary school Atole acted as. a "socialequalizer".

Pollitt also looked at the differences between chil-dren who received nutritional supplementationbefore and after the age of two. While nutritionalsupplementation was of benefit to children whobegan receiving it atter age two. the benefits weregreater it the children received the supplementbefore the age of 2. From this Nan concludes."This difference in -the range of effects observedamong the two groups suggests that the behavioraldevelopment of children is more sensitive to nutri-tional factors during the first years of life. particular-

9

In terms of what is knoss'n about the functions ofthese nutrients there is clear evidence that dc-licien-cies of any one of these micro-nutrients is associatedwith infant mortality For children who survive whohave been deficient in these elements. there are life-long consequences. Further, the effects of deficien-cies suffered during the early years cannot bereversed even when children are provided with thenutrients later I 11 life As noted in the World Hankreport. "When moderate or severe deficienciescoincide with critical developmental stages, theycan cause prolonged or permanent dysfunction."(pg 20)

For example, fetal iodine deficiency can result insevere, irreversible mental retardation and neurolog-ical disorders. In less severe circumstances it can bethe cause of deafness, muteness and mild to modr-ate mental retardation Vitamin A deficiency, whennot lethal, can cause blindness a handicap which isseldom catered to in developing countries Iron defi-ciencies arc' associated with prematurity and lowbirth weights (pg.21) Children suffering from Itiron can have lasting immune system problems and

1.1

growth failure, increasing the' chances of morbidityand mortality throughout childhood In terms oflearning, "iron deficiency is associated with poorattention span, inadequate fine motor skills andreduced memory retention (pg. 20) Thus del

of iron, vitamin A and iodine can have profoundlong-term consequences on children's development

'The costs associated with ales: deficiencies havebeen calculated The World Bankreport provides an example

"If a country of 50 million peoplehad the prevalence of iron deficiencyanemia iodine deli iency disorders(IDE)) and vitamin A deli( iency seen inSouth Asia. the jrm_p_e_chate costs ofmicronutent malnutrition to that soci-ety per year would be as follows

359,430 student-years (3'xi of total)wasted.1 3 million person-years of worklost.20 000 preventable deaths

000 additional severely handi-capped children.The cost of these deli, lenCle,, W01.11C1

depend on the wage' rates and the. value

of hie If conservative [estimates' aremade of these values $750 per year inwages and $1000 for life, the socialcosts of micronutrient !deficiencies)would add up to almost $1 h1111011 peryear fm the current year only or morethan 20 times the' Official I) l

mem Assistance per capita received bylow-income countries. The value' offunny productivity lost due to educa-tional failure' and disabilities adds a sig-nificant additional social burden In

addition, there is the non-qualified per-sonal and social tragedy of unne'ce'ssarydeath cretinism and blindness

Compared to the costs of deheiene les the inter-ventions to address them are inexpensive The costsof supplementing all pregnant women with itgiving everyone under 45 years of age iodine sup-plements, and supplementing all children undei-with vitamin A would cost $19 million per year.Alternatively, the costs of fortifying food and/orwater with vitamin A, iodine and iron would costabout $25 million per year Even if coverage andefficiency were 50%, the' benefits of alleviatingmicronutrient deficiencies far outweigh costs." (pg.28)

Thus the' costs of not providing these nutrientsgreatly outweigh the costs of providing them Whilethere are simple solutions in terms of what peopleneed in order to increase these nutrients in theirdiet, actually making them available and convincingpeople to include them in their diets is not simpleThe question is, how can they be provided in a cost-effective and socially-effective way

[

10

a

The process for introducing these microntitrientsinto people's diet varies. depending on the source ofthe nucomutnent (whether it is Currently producedand/or available and what it would take to introduceit whe., it is not). It is generally not successful tointroduce programmes that are "single-focussed",addressing only one set of needs. For example if cas-sava is introduced to increase caloric intake, it can

IMP

replace foods currently being grown that arc richerin iron and iodine An increase in caloric intake canmean a decrease in micronutrients. Nutritional sup-plementation efforts must take people's entire dietinto account

Cidtural and political variables are also importantin getting micronutrients into people's diet Todevelop an effective and sustainable programme itinvolves people at many levels

creating new products that are profitable' to pro-duce, linking health professionals with the busi-ness community;changing people's behaviour, which calls uponthe expertise of anthropologists, sociologists andeducators;creating demand, which could he accomplishedmore effectively with help from marketing spe-cialists;developing supportive policy, which .includeseducating and informing lobbyists and politicians;

1,2

'HEALTH AND LEARNING Coordinators' Notebook, Winter t 99 3

making adequate resources available to reachthose most in need. which may require callingupon support from international donor agencies.

The sources of iron, iodine and vitamin A arc sig-nificantly different. Iron deficiency is a result of thebody's ability to absorb only a small amount of ironfrom lood. The best source of iron is red meat, butthis is a scarce commodity for many Thus they haveto rely on legumes, grains and vegetables for ironThe population needs to be educated about theright combination of these, and the advantages ofeating them along with foods that help increase thecapacity of the body to absorb iron (i e. foods richin vitamin C).

Iodine deficiency is more of an environmentalproblem. Where iodine is not present in the soil andwater, it is not available through plants grown in thearea. Thus it has to be introduced from outsidethrough food fortification (primarily iodized salt).

Vitamin A is found in a variety of green leafy veg-etables, yellow and red fruits and vegetables and

some oils. A decrease in vitamin A intake is associat-ed with seasonality of foods and/or improper pro-cessing. Again, education plays an important role inassuring adequate intake of vitamin A

In most situations where there are deficiencies inone of these micronutrients, there are deficiencies inthe others as well. When there is food insecurity, forexample, people are likely to be deficient in all threemicronutrients. There is also a significant interactionbetween these deficiencies and infectious diseasesFor example, vitamin A deficiency combined withmeasles can produce blindness and death; iron defi-ciency and anemia increase one's susceptibility toAIDS.

While deficiencies are clearly associated withpoverty and the lack of food, food security does notassure adequate intake of these micronutrients.There are instances where people have a choiceabout foods to buy and they do not choose thosethat would give them the needed nutrients. Thuseducation is an important variable in addition to

availability.There is a complex relationship

's'

"" Nt.'s

Residents in the village of Nakasi, near Suva, Fiji,are encouraged by the government and UNICEF tocultivate their own garden plots and participate incourses to improve nutrition. A mother and childsample a dessert made with pumpkin from the ir-den, cassava and coconut milk.

between the availability in the marketplace of various micronutrients andwhether or not families actually buyand use them. Cultural values of thefamily and community and character-istics of geo-political systems canmake a difference in whether or notthese nutrients get to children. Forexample, in some cultures, it is consid-ered inappropriate for pregnantwomen to eat and gain weight. Thisattitude could greatly affect the suc-cess of a drive to improve the nutritionof expectant mothers. Thus the WorldBank document presents a case forexamining the context within whichprogrammes arc introduced to deter-mine their viability and sustainabiLty.

Levinger (1992) makes much thesame point. While in her monographPromoting Child Quality Is,ue,, Trends and

Strategies, she looked at the impact ofthe three micronutrients discussed bythe World Bank, she also included

4 research on protein-energy malnutri-,,.

don, helminthic infections (worms),E sensory impairment and temporary

hunger. In reviewing the researchstudies Levinger noted that most ofthem look at the relationship betweenthese nutritional and health variables

and children's school achievement. Levinger arguesthat school achievement is a very narrow concept,and suggests that we should instead be looking at

1.3

what she calls kiln(' Learntng Capacity, a more com-prehensive conception of child achievement

Active Learning Capacity (ALC) is a cbild'c propel:-city and ',Inlay to inicra,i with and fake optimal adrantage ofthe full complement of remrcec offered by any formal or Infor-mal learning environment. ALC is the child's ability tolearn in any context. and is the result of all the fac-tors that have contributed to the child's current sta-tus. This includes the child's history (nutritionalhealth and stimulation) and personal characteristics,the child's family. and the child's environment.

Levinger suggests that ALC is the result of aninteractive process which begins at conception.Along with Engle and Zeldin. Levinger clearly seesthe child as active rather than as a passive recipient.From birth onward, she points out, there is an inter-action between primary variables (hcalth/nutritionstate/ hunger level and cultural support) and sec-ondary variables (child/caretaker interaction, apti-tude. schooling history and learning receptiveness).

Her model drawn from a combination ofAnthropology, Epidemiology and Psychology. linksfamily. community and national institutions to pro-grammes and polices The model encourages a sen-sitiity to cultural differences and provides a tool forlooking at a child's life in terms of what she calls

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"child quality". Levinger makes a strong argumentfor focussing on the development cif children'sActive Learning Capacity as a way to improve childquality.

In their studies of Protein Energy MalnutritionPollitt et.al. (1993) present findings that would sup-port Levinger's interactional model of child develop-ment. They suggest that the effects of malnutritionon body size, motor maturation, and physical activi-ty are interrelated with delays in behavioural devel-opment over time.

"In particular we conjecture that small body size,delays in motor maturation, and reduced physicalactivity contribute to the gradual formation of stylesor modalities of social emotional and behavioralinteractions between the malnourished child and theenvironment that slow cognitive development andeducational progress." (pg.80)

They posit that children who are small in size aretreated by caregivers as if they arc younger and arcnot provided with the kinds of stimulation thatwould promote the development of new skills.Further, delays in children's motor development areassociated with delays in the development of cogni-tive abilities and social skills. And, malnutritionresults in lower levels of activity, limiting children's

Mothers learning together about nutrition, feeding and care.

14

'ft

"HEALTH ANIILEARNIN8 '..00r,foiato'Noteltook, 1,Vintet toot

ability to explore their environment. Thus theimpact of early malnutrition begins an interactivecycle that has long-term consequences.

In sum. what children bring to the learning situa-tion is a result of the complex interaction of factorsin their lives. It includes their nutritional history.general health status, and the kinds of Care andstimulation that they have received in the early

the child (age, degree of risk of malnourishment),the caregiving environment (Who takes care of thechildren? Where are children cared for? Who sup-ports the family? What institutions and programmesexist to provide support and empowerment? Arethere untapped resources within the community thatcould he used in providing better support for chil-dren's development') and local childrearing prac-

tices and beliefs that can be built upon in theintroduction of new elements. An assessmentof the existing situation also includes assess-ing who the child is. There is a need to iden-tify some of the child variables that are likelyto affect nutrition and to assess the extent towhich these need to be taken into account indeveloping a programme. For example, whatare the characteristics of the children to beserved? Is gender an issue in the culture" If so.how should that be addressed? What is thedevelopmental level of the children to be

served? What type of supports are required?The assessment should include understanding the

caregiving environment. One place to begin is tolook specifically at the situation of the caregiver,primarily mothers, in the community. What is thestatus of their nutrition and health? What supportsdo they have and what do they need? Whatresources do they have available to them? What arethe demands on their time?

In designing the assessment. anti!) (1993) wouldsuggest identifying successful or positive practices ofindividuals within the community, to be used as theframe of reference in developing support, for fami-lies. Calling this approach "Positive Deviance" shesays that rather than focussing on what families lack.-identifying, honoring and building on localstrength should he an underlying principle of alltypes of assessment, analysis and action to improve

At this point in time, when there are significant dol-lars being devoted to health programmes, when thereare millions of dollars going toward nutrition pro-grammes, and when early childhood education pro-grammes are eing created for a variety of purposes,it would be advantageous to build on current effortsand to make them more comprehensive.

years It is all these factors together that contributeto a child's development

If it takes a combination of all these variables tosupport a child s development, then programmes foryoung children and their families should consciouslyinclude them.

The final section of this article offers suggestionson how to do that

Strategies for Enhancingthe Success of ProvidingHealth, Nutrition,Care and/or EducationComponents within EarlyChildhood ProgrammesThe guidelines for programming outlined in this sec-tion come from Evans and Shah's WHO paper. andare based in part on Levinger,' approach to assessingchild quality, Engle's 'Caring AnalysisTool" designed to assess current efforts toimprove nutrition programmes in terms oftheir "enhancement of care", and the WorldBank's guidelines to assure eradication ofmicronutrient deficiencies The followingrecommendations apply to any interven-tion designed to have a positive impact onchildren's growth and development.

To successfully introduce and provide the neces-sary on-going support for the implementation ofhealth, nutrition care and education components.the following strategies are suggested:

In assessing the existing situation emphasis shouldbe put on what is happening that is supportive of

child growth and development. That should also bethe basis for developing new programmes.

Assess the Existing Situation.Before deciding what type of intervention to cre-

ate it is critical to have a clear understanding of whatexists This includes an assessment of the situation of

care." When you find individuals who are doingsomething positive (positive deviations), then youcan look at what factors allowed them to he success-ltd. For example, it only two families in a villagesend their girl children to school, you can try toidentify what makes those families different Whatsupports, beliefs, and practices have led to this posi-tive outcome?

15BEST COPY AVAILABL

Determine what programme elementsshould be introduced.

Here the focus is on specifying the kinds ofbehaviours that are to he encouraged within theprogramme. These clearly include child and parentalbehaviours. However, they also include communityand national (policy-level) behaviours. The psycho-logical and social aspects of health, nutrition andeducation need to he considered in creating andimplementing the programme.

Also important in determining the programmeelements is an assessment of the technology avail-able to help address the need. In terms of micro-nutrients, what technology can be applied to bringneeded micro-nutrients into the lives of those whoneed them? What are the technologies available interms of educational programmes? How can thesehe made available to more children and families?

Create demand for and establish the legit-imacy of the activities in relation to what iscurrently being provided.

It is important for the community to understandthe need for the programme element, whether it hevitamin A or child stimulation. in order for it to heintroduced effectively. Those to he involved in theprogramme (sponsors, community members andparents) must come to believe in the importance ofthe components that are to he introduced. Even

Begin with parent/community participa-tion in developing the programme.

Within current development planning, one of thestrategies most frequently advocated is to havestrong community participation in programmedevelopment, from the definition of the need, todevelopment of a plan of action, to project imple-mentation, to evaluation of outcomes. While thisstrategy is used in the development of many basicservices programmes, it is seen as particularly impor-tant in relation to early childhood programmes.

It is argued that since parents are the policy mak-ers in most areas of their children's lives, theirinvolvement in the design and operation of an earlychildhood care and development centre increasesthe likelihood of continuity of experience betweenthe home and school for the child. This same argu-ment is being made for parental and communityinvolvement in the implementation and manage-ment of child care programmes in developing coun-tries. The general consensus is that the greater thelevel of community involvement, the more likely itis that the programme will meet community needsand become an integral part of community life.

It should be noted, however, that the extent towhich parents can and will become involved in earlychildhood care and development programmes isdetermined by a number of variables. For example,

there is cultural variance in the degree towhich it is deemed appropriate for par-

Integrating programme components within existinginstitutional and service structures is a complex anddifficult process. The time and energy required tointroduce new components is generally underestimatedby those involved. It is not just a technical process butinvolves important interpersonal, political, bureaucrat-ic, socio-cultural and resource factors.

though there may be a child care programme inplace that is fully utilised by the community, itsomething is "tacked on" to the programme, it willnot necessarily he accepted. People need to valuethe addition and see ways that it can enhance theirlives. Before offering materials and training to intro-duce new components. it will be necessary to con-duct a needs assessment to ascertain what is alreadyknown and practiced in a particular setting. and todetermine immediate needs and desires. Then newelements can be introduced in response to theseneeds.

Once the public is demanding the service orproduct, then those responsible must he in a posi-tion to supply it, whether that he appropriate carefor young children outside the home, supports forwomens involvement in income-generating activi-ties, immunisation dosages, sources of vitamin A. orother services

ems to he involved in the education oftheir children. In some societies womenare responsible for care of the child, butdo not play a role in educating the childThus, they would not feel they should hea part of the child's on-going education.

Yet another variable is the time thatparents have available to becomeinvolved Where early childhood careand development programmes have been

developed in response to needs for day care, womenare likely to ..ave little, if any, time to be involved inthe day-to-day activities of the programme.

Another variable that affects the extent of parentand community involvement in child care pro-grammes is related to the political structure of theprogramme, and the extent to which control for theprogramme is centralised or decentralised. Wherethe programme is designed and introduced fromoutside the community, there may he little room forparent and community involvement.

When communities have limited resources, theon-the-ground commitment of communities is whatsustains programmes over time. And, in fact, whileother sponsors may provide comparatively unlimitedresources to the initial development of an earlychildhood initiative, without community belief inand commitment to the effort, the child care pro-gramme will not he successful

16

HEALTH AND C.EARNING' C'oorriiiiittors'Notebook, Wolter ityrr

Define clearly and openly the goals andlimits of the programme component to beintroduced.

Related to the need to help people see the intro-duction of new components as useful to them, it is

equally important to he clear about what that com-ponent will and will not contribute to the communi-ty. Thus those operating the programme need tounderstand clearly what the components arc andwhat their role will be in implementation. Inputshould he sought from the managing organisationon how the current programme can be changed toreach desired goals.

Sometimes people are eager to take somethingnew on-board but have no understanding of whatwill be required of them to make the new venturesuccessful. Those introducing the new componentneed to show sensitivity to he cultural, social andinterpersonal bonds that hold programmes together.Any programme that has been in place for some

There arc changes that are likely to occur withinthe agency as a result of intervention. This mayinclude a re-definition of staff roles and the supportrequired, change in the focus of the organisation interms of the services and/or intended beneficiaries.While the specifics cannot be anticipated, thepotential for changes needs to be recognised andaccommodated. Thus child care managers and care-givers need to he involved in the planning phase.

Similarly, staff need to understand that they willhe required to undertake additional training, andthey need to know if the introduction of the compo-nents is going to demand more of their time. (Forexample, recording periodic information on chil-dren's growth and development is time-consumingand may he an entirely new task for staff.) If staff arenot willing to accept the new demands on them, theprogramme will not be implemented effectively.Thus the clearer the goals and expectations are from

the beginning, themore likely it is that

1

time will have a history that has created a programme(Owe. That culture will include both formal andinformal ways of operating and communicating thatare an integral part of what the programme has tooffer Anyone attempting to enter the programmemost try to understand the culture of the organisa-tion and must not violate the norms and values thathold the programme together. It is best to listen andobserve before stepping in with recommendationsftir new action

15

the new componentswill be implementedfully.

Develop a climateof support for theeffort within thelarger socio-politi-cal arena.

The World Bankdocument (1993) pro-vides important guid-ance in terms of beingaware of and learninghow to use the politi-cal framework within acountry in support ofthe introduction ofmicro-nutrients. Thesame principles applywhen considering theintroduction of anyprogramme componentthat has an impact onchildren's development.In establishing a pro-

gramme it is important to he able to answer ques-tions such as:

What political factors might have an impact onchildren's growth and development?What is required in terms of national policy andsupport in order for the programme to he effective?Is there et-lough political will to address the prob-lem in a significant and sustainable way' If not,what will it take to get policy makers "on-board"?What legislation and laws are in place (in a vari-ety of sectors) to support the implementation ofappropriate programming?

17

II What other mechanisms need to be put intoplace" What is the process for doing so:.

Allow adequate time and resources forplanning, start-up, testing and implement-ing the programme.

Those sponsoring the introduction of the compo-nents are likely to want to get things moving quick-ly. They are aware of the urgency of getting neededservices to populations not currently being servedThey also have a good understanding of what thecomponents involve and theycan see an obvious fit with cur-rent programming However.those who will he implement-ing the component may needmore time to see the fit and toincorporate the activity intotheir daily life

Beyond the needs abilitiesand competencies of the localstaff are the bureaucratic andpolitical dimensions that needto be taken into account whenallocating time and resources tothe project. All of these factorswill mean that the programmeis likely to he implementedmuch more slowly than isdesirable

Adequate management sys-tems need to he part of anynew approach or technologyWhat are current managementcapabilities in terms of plan-ning. delivery of services andgoods. training motivationand monitoring) within thegroups expected to implementthe project:. What additionaltraining and support arerequired to make these systemsfunction effectively'

scale efforts where an infrastructure already existsthat includes facilities, basic services. staffing, train-ing and on-going support

An alternative strategy is to seek out successfulprojects. serving those most at risk, which have thepotential for going -fo-q-ale Going-to-scale refers tothe process of taking successful small-scale projectsand developing them into programmes that attemptto reach as many potential beneficiaries as possible,regionally, nationally or even worldwide. (Myers,

1992)

The ingredients for suc-cessfully going-to-scale

Given the range of variables which

have an impact on a family's life,

it is no wonder that it is difficult to

establish programmes to support

young children's development with-

in the context of the family and

community. Nevertheless it is desir-

able to create programmes that

enhance the parent's ability to

function socially and economical-

ly as well as addressing children's

needs. When both the parents and

the child are provided with a sup-

portive milieu it helps assure the

child's healthy growth, early stim-

ulation and preparation for suc-

cessful entry into the formal educa-

tional system.

111 Plan from the beginningfor programme growth and institutionalisa-tion of the programme.

One mistake commonly made in the developmentof programmes is to wait until the programme isfully functioning and coming to the end of its fund-ing before thought is given to how to sustain theeffort over time Experience would suggest that asthe programme is being planned it is important toaddress the issue of how it will be maintained overtime financially and in terms of programme qualityFrom the beginning. plans must be made in relationto the pace of growth and the long-term viability ofthe effort

In gencTil. when seeking expanded coverage, itwould he most efficient to link new input with large-

inevitably vary since COMMU-nitics possess different socialand cultural patterns, organi-sational and fiscal resources,problems, norms and history.Nonetheless. there are cer-tain pre-existing communityconditions that enhance orhinder the likelihood of suc-cess of any expansion effortThe following conditionsseem to he critical:

Political commitment at alllevels should include anappropriate supportivepolicy, adequate budgetallocations and a willing-ness to make structuralreforms where necessary.Adequate fiscal and humanresources must he avail-able. The on-going costsmust he within the com-munity's present and futuremeans The costs of a pro-gramme may vary in kindand amount from onecommunity to anotherThe model most be ade-quately developed. It

should he structurally strong vet flexible andadaptable An evaluation system should be estab-lishedAn organisational mandate should be preparedand the organisational and management skillsrequired to operate the programme should beavailable within the host agency. The staff shouldhe selected on the basis of their values and moti-vation.While an understanding of programme character-

istics is critical in supporting the expansion of achild care system, another important variable to betaken into consideration is the sponsor

HEALTH AND LEARNING (oinilinatoicNoteliook, Wink, foul

Take Into consideration the role ofsponsors in the development and support ofearly childhood programmes.

There are three levels of sponsorship programmefunding, programme monitoring/supervision andprogramme implementation or operation It is notuncommon, for instance, for those who provide ini-tial funding and/or technical support for the pro-gramme to have a time-limited involvement Theexpectation is that after the programme is estab-lished it will be maimained. at some level, by thepopulation being served In other instances. hinders.supervisors and operators arc one and the sameThose responsible for funding the programme actu-ally operate, monitor and maintain the programmeover time. Thus, in seeking ways to introduce prima-ry health care into child care settings it is importantto be able to differentiate between those who pro-vide initial support and those who maintain the pro-gramme over time.

It is necessary to acknowledge and plan for thefact that hinders, monitors and implementers. in theshort- and long-term play different roles in childcare programming and they would have differentroles in the introduction andmr upgrading of publichealth care services Mort: importantly. however todevelop a successful intervention strategy it is nec-essary to understand the organisational and bureau-cratic structure within which the sponsor operatesSponsors of early childhood programmes can hedivided into four groups:

I Non-governmental .:NG01. Private VoluntaryOnianizatioiK (PV('' Non-governmental organisa-tions exist outside any governmental structure Theycan be found within the international community atthe national level or their scope may he regional. Atthe ttem,di,,,,1 level there are a variety of groupsto g Save the Children Christian Children's Fund,Oxfam. CARITAS. Redd Barna. etc.) who are cur-rently involved in development programming.These organisations use some of their monies to cre-ate schools and community development centreswhich address the multiple needs of the child andcommunity rather than only providing services tochildren

At the national and lood levels there are church-related and welfare organisations that have devel-oped a range of early childhood programmes. Inaddition, there are voluntary organisations whichhave seen the need for early childhood programmesand have taken the initiative to develop them withintheir country. For example the Botswana Council ofWomen. a private voluntary membership organisa-tion. has raised the funds necessary to establish daycare centres to support women's increased involve-ment in the wage economy

The amount a given NGO/IWO is able to spendon early childhood activities is determined by the

organisation's mandate and related budget. Thepotential for these groups to expand their service toyoung children varies greatly among theNGO/PV0s.

2 Government. There are governmental agenciesand organisations whose involvement in early child-hood activities is based on nationally-defined needs,goals and resources. Government agencies andorganisations frequently play the role of fonder,supervisor/monitor and implementer. These ami-des are mandated to carry out national policy. Ifearly childhood programmes are seen as a nationalpriority, then a governmental ministry will becharged with the responsibility for developing,implementing and operating related programmes.Sometimes only public sector funds are used in thedevelopment of national programmes. In otherinstances, the government encourages private sectorinvolvement as well. One of the challenges of work-ing with early childhood programmes is that theyhave been de-eloped by and operated under themandate of a variety of national ministries, includingeducation, welfare, health, labour, social affairs,women's affairs, youth, agriculture, or some combi-nation of these.

Within each of these ministries the rationale forthe development of early childhood programmes,the identification of the population to he served,specific programme goals. the curriculum, staffing,and resources available to the programme are quitedifferent. In order to work with government officialswithin the various ministries, it is important to knowtheir bias and concerns if they are to he approachedto expand the range of services they currently pro-vide. For example, it will take a different strategy towork with the Ministry of Education than it will towork with the Ministry of Labour; the rationale fortheir involvement in early childhood programmingis different, they serve different constituents, andimplement different types of programmes.

It is also important to recognise that governmen-tal involvement in early childhood programmesoccurs at the regional or county level. and at thecity or local level. as well as at the national level.While being responsive to national policy, theregional and local government groups frequentlyhave a great deal of autonomy in establishing priori-ties and creating programmes designed to meet thespecific needs of their constituency.

3. Alulti-national donor agenoes. Multi-nationaldonors (e g. WHO, UNICEF, UNESCO. USAIDand other hi-lateral donor agencies) plan from aninternational perspective. They usually provideshort-term support. In general, these groups estab-lish target populations to serve. develop an agencypolicy about how that group is to be reached, andthen work with appropriate national ministries to

]9

develop programmes for the target population,based on national goals and resources. These agen-cies tend to provide funding and technical assistancewhich supports programme development; they donot provide funding for on-going programme sup-port, although they might he involved in monitor-ing the effort

4. The Cotnnuouty There are instances where thecommunity has initiated the creation of child careand/or pre-school activities for young children.Sometimes financial and technical support for theeffort is then sought from outside sources. In othercases the community provides the service itself.While this kind of community initiative will assurethe continuity of the programme, there may not beappropriate expertise within the community to max-imise the benefits that such programmes could pro-vide to young children.

Create monitoring and feedback mecha-nisms in the early stages and insure thatusers are committed to them.

An important aspect of any programme is know-ing how well the programme is doing in meeting itsgoals and objectives. In order to make this assess-ment. an evaluation or monitoring system needs tohe put into place. While quite obviously the systemshould assess the impact of the programme on thosebeing served, monitoring systems also need to hedeveloped to assess the effectiveness and efficiencyof the organisation

These systems cannot he set up and operated bypeople outside the programme. They should be anintegral part of the day -to -day activities of staff Ifstaff are involved in developing the monitoring sys-tem. and if they see how it can help them in theirwork, then they are likely to follow through andkeep the system going However, if the evaluationand monitoring activities become busywork they willhe done without much thought and they will ulti-mately have little value. When staff are able to usethe information they are gathering for planning andmaking their work more effective, the tools will beused.

In sum, because the introduction of a new pro-gramme component implies disruption of the equi-librium of the social system it should he based onmutual negotiation, clarification of intent, adapta-tion of expectations and plans. and establishment ofconsensus on roles and obligations. The likelihoodof short- and long-term programme success isenhanced by building links between the old envi-ronment and the new programme component. Thestaff and management of the on-going programmeneed to feel that the new component has somethingto otter them and that the links are beneficial tothem as well as to the population being served.

Fifty billion dollars is spent each year on 'Health'programmes In view of the profound link betweenphysical and mental health and social integration,any definition of health must necessarily include all

aspects of the child's development. Interventionsmust go beyond simply providing a one-dimensionalprogramme, whether that he nutritional supplemen-tation, immunisation, or an education programmefor children. We need to maximise resources by col-laborating across sectors If we are going to meetour goals for children in the year 2000, we need totake on the challenge of building new programmesthat reflect our knowledge of the multi-dimensional,integrated nature of young children's development.Rill RI 1\1( s

Donohue-Colletta N ('rte-Cultural Child Developmcnt ATwining (. Dori( fat Program Staff Richmond, VA. ChristianChildren's Fund,

Evans. I L. s P M Shah Child Carr Programa, a, an EntryPoint for Matmial and Child Health Components of Primary HealthCate Geneva. World Health Organisation tin press)

Engle P ('are and Chill Marl Theme paper for theIntonational Nutrition Confcrence(ICN), March 1992

Levinger B. Promoting Child Quality Issuc. Trends andStrategic, Washington I) C Academy for EducationalDevelopment. 19'12.

Myers, R The Telm Who Slum( Sfufigthrumg Programmri ofEarly Childhood Dreclopiniiit n lit Third World LondonRoutledge, 1992.

Pollnt E K S. Gorman P L Engle. R Nlartorell, ts.Rivera Early SUPPICMOILlry COg/111101:. Monographs of

the SiCletV for Research in Child Development. I gq 3 58UNICEF Food lhalth and Can UNICEF opoon and .tratigy for

a world free from hunger and inalmarmon New York. UNICEF,,m2

World Bank lint Pith IRA\ ill Addit,ing ion:fountAtakora:on Washington I) C World Bank Population,Health and Nutrition Department 1993

Werner E E Smith, R S Vidiroabli but Inom,t1.1, ALongitudinal Study of Rtsiltma and Youth New YorkMcGraw Hill Book Company 1982

Zcitlin M Nutritional Resilience in a HostileEnvironment Positive Deviance in Child Nutrition Marmon

Rwitir. 199 I -VI') 259-268Zeitlm M Child Cate and Mar:lion Tin Findings from Po,atoe

Dmnatht Rotatth Final Report to UNICEF the ItalianGovernment and Tufts LIIIIVr,liV Positive Deviance inNutrition Research Proict P987-P-m2 New York UNICEF1(193

1/

This article draws heavily from Child Care Programmes-7as an Entry Point for Maternal and Child HealthComponents of Primary Health Care by Judith L Evans andP NI Shah to he published by WHO

2 Micro-nutrient is a term that refers to the vitamins andminerals that are required by humans each day in only verysmall amounts-micrograms or milligrams-hence the term"micro .-nutrient

0

The following case studies illustrate variousstrategies for bringing health, nutrition, care and/or education components

to young children and their families. Some of these programmes had a sin-

gular focus, some were designed from the beginning to be more comprehen-

sive, and others have become comprehensive over time. They are not all

success stories, but they do provide some insights into the complexities of

developing appropriate and effective programmes.

A FoodSupplementationProgramme inIndiaFocus. Providing food Supp len, en t tio n to increase

children's intake of vitamins and iron, and providing

health services for pregnant and lactating women, to

improve the nutrition of children ageS 6-36 months.

The Tamil Nadu Integrated Nutrition Project(TINP) was begun in 1980 with funding from theWorld Bank It was designed to reduce the inci-dence and prevalence of malnutrition andimprove the health of children in the 0-3 agegroup. There was also a focus on pregnant andlactating women. One of the key features of theproject was Nutrition Surveillance. Childrenwere monitored and weighed once a month.Those who were found to he malnourished weregiven a food supplement called Wilt, made fromcereals and pulses fortified with vitamins andiron. When the child appeared to be rehabilitat-ed, the supplementation was stopped. Pregnantand nursing women also received nutritional sup-plements.

In addition to the provision of nutritionalfoods, the project had a health component whichfocussed on helping to decrease the infant mor-tality rate by providing better health care tomothers pre- and post-natally. There was also acommunication component that was designed tomotivate the population to pay more attention tothe nutritional needs of infants and young chil-dren from birth to age 3. Mass media and one-to-one contacts were the chief methods of spread-ing the word

What was the project able to achieve? Over aperiod of 6 years there was a dramatic reduction(55.5%) in severe malnutrition and also a clearupward shift in the percentage of normal chil-dren and very moderately malnourished children.

(Swaminathan, 1993) Thus the programme waseffective in reaching the children. It was muchless effective in reaching women. "The participa-tion of pregnant women and nursing mothers inthe supplementary feeding as well as the referraland health care system was poor, with low ante-natal registration and delivery services, and lessthan 50% uptake of nutritional supplements bywomen." (Swaminathan. 1993, p. 10) One of thehypothesised reasons for the lack of uptake bythe women is that the project was not sensitiveto women's work roles and timings.

Why was it able to accomplish what it did?The project was designed in such a way that itreached the poorest of the poor. It was wellstructured organisationally and administratively.And, the provision of food, rather than a cashpayment for families to buy it, helped assure thatfamilies actually had food.

What were some of the problems? There waslittle effort to get the community involved in anyaspect of the programme other than being thereceivers of the service. They were not involvedin preparing or distributing the food. Further therehabilitation was often temporary. Short-termgoals were met, but there was no attempt toaddress the issues that led to the malnutrition inthe first place, whether that be poverty or a lackof understanding of the role of care in the feed-ing process. And finally, the programme did notaddress issues of self-reliance in food or stimulatelocal production of the food which would havegreatly enhanced sustainability. In addition, noattention was paid to the psycho-social aspectsof early development.RIFERI NI( I M S Swaminathan "The Continuum of

1- Maternity and ChirdCare Support A Critique ofRelevant Laws. Polit les and Programmes from thePerspective of Women's Triple Roles A paper prescntedat the Sixth Conference of the Indian Association for

WomeMs Studies, Mysore. May 31- lone 2, 1993

19 21

The TINP programme was begun in an era when

straight supplementation was seen as sufficient. As a

result of programmes like this one and others sake,

100011s 'WPC been 10111Cd. For one thing, supplonenta_

tion in and of itself is no longer seen a< sufficient At

the very least the focus has to be on changing diets so

that the needed nutrients are present in everyday ,foods

and eating habits In the World Bank document, BestPnic tic es in Addressing Micronutrient Alalnutrition

( World Bank, 19,) i ), the authors suggest that in

developing a supplementation proranune that leads to

a (banged dirt the following questions hare to be

wised.

t 14/hose diet need< to he modified? If it is only young

children that are in dander of malnutrition. then moth-

er:, need to understand the importance of changing the

young child's diet. Or, it may be that it is mostimportant to chang e the diet of pregnant and lactating

women. In this instance other strategics would be aced.

2 Who bas the power to 3. bandy the diet? 1)oe< the

mother bane control over this or is it the gramintothei

that dictates what the child will be fed, What role

does the father play in the process,

What is most easily 3. ban!jed that will bane the

most impact? The more specific the modification the

easier it will be to make it

r. What will motioate people to change? Changes an

not likely to come about when people dIT presented

with "scientific"' information. They need to see that

there will be some immediate benefit for them if they are

going to change their behapiour.

5. What are the obstacles to changing belminow?

There is the obnious one of unarail,A10, or cost of

the appropriate food, There are also the beliefs and

attitudes that people bane about what it is appropriate

and inappropriate for people to eat, particularly preg-

nant and lactating women and infants (World Bank,1001, pg. 5 O)

.611111011111111MI

The second case study illustrates the

ways in which a multi-pronged

approach was taken, imyolving gov-

ernment, local producers, and the

community, to assure both access to

the micronutrient and sustainability

of the effort.

Iodine Deficiency(IDD) Control inBoliviaFocus. To fortify the salt supply with iodine so that

the whole population of Bolivia would have access to

and IN. fortified salt

In Bangladesh laborious handwashing of seasalt to remove mud also eliminates the salt'snatural iodine. To prevent IDD, iodine mustbe put back into the salt before it is consumed.

tiSi

'51

2022

This project was begun after a study conduct-ed in 1983 documented that 65 2% of theschool-age children had goiter problems. andthat there was a to k., cretinism rate in sonicareas. Some of the difficulties encountered inbringing iodine to the total population were awidely dispersed population with pockets of iso-lation dilficult terrain making distribution aproblem large deposits of non-iodized salt thatpeople had easy access to. and a longstandingacceptance by the people of iodine deficiency

Horn the beginning the project had stronggovernment support In 1983 the Italian g( rn-

ntent through the Joint Nutrition SupportProgramme 1NSP1 of PAHO'WHO andLII\II(F.F. funded PRONOALC.0130 a nationalprogramme to fight against goiter PRONOAL-COB() was incorporated as a branch of theNational Office of Food and Nutrition, and oper-ated through the Ministry of Health.

The programme included three approachesThe first was to increase the production and distnbution of affordable iodized salt This wasachieved Today 80% of the necessary iodizedsalt is produced domestically (both publicly andprivately). Salt producers' cooperatives were cre-ated through working with the me-existingNational Cooperative Institute. and the govern-ment produced salt As the industry developed apercentage of the profits from the sale of iodizedsalt were pumped back into the programmethrough PRONOAI.00130. subsidising the edu-cation activities and the delivery of iodine to theremote areas. PRONOALCOBO hopes toachieve financial independence in 199

The second strategy consisted of public cam-paigns to increase awareness of DI) and meth-ods of 11)1) control. The Ministry of Healthtrained community volunteers to distribute 11)1)materials and promote community acceptance.There was extensive collaboration with preexist-ing institutions. This included primary healthcare workers and facilities local NGOs. agricul-tural committees, mothers clubs and churches.The trained community health workers trainedteachers and community leaders. providing themwith materials they could use in educating oth-ers. In addition radio and television spots provid-ed information and traditional forms of education(puppet shows, theatre) were used to reach peo-ple at fairs and festivals

Third, there was direct administration ofiodine supplements to those at highest riskThese consisted of supplying iodized oil to com-munities without access to iodized salt

As a result of the programme. goiter among

school-aged children dropped to 20 6%. con-sumption of iodized salt increased from I% to98% in urban areas and from 0% to 22% in ruralareas.

There appear to be several reasons for the suc-cess of th programme First, Item the heginningthere was strong political support for the llort.This was demonstrated in the creation ofPRONOALCOBO and the fact that laws andregulations governing the production and distrib-ution of salt went hand-in-hand with the effortSecond. appropriate technologies were introduced in a timely way by the InternationalCouncil for Control of 11)1) (ICC:11)1))Machinery for the production of iodized salt wasmade available, along with expertise in how toproduce it in a cost-efficient way Third pro-gramme planning and implementation was theresponsibility of the Bolivians, not outsiders.RI it in xi i Wurld Bank, Rol Plat lit III /LUC

,\ Willa, II /I/ ,1111/1111/ 111011 I'19 i pg "(7

has this proiltannne been as effective Its it huts

mkt- the past decade, The lessons 'caviled front this and

stnufai prou would suggest that in addition to the

variables listed above, the followitig woe «nal ibuting

factors

1 Oyer lime. iodized was inuilaitie, affordable

and accepted by the people

2. An educated Nadi, began to learn the palm. of

iodized salt and changed their buying habits to

bk. lude iodized salt

t Alit/61)1e avenues were used to hring the message to

the community. The use of popular Media (both mod-

ern and traditional) helped Jot nc people's attention on

the :cut's They also learned about it through commu-

nity people they trusted and children received informa-

tion in school and brought it home. Groups people

belonged to were part of the process of getting the word

out The messages were eroywhere

The two case.; presented above illustrate the !pays in

which a very targeted programme can be introdmed

ces4tilly. In the first instance there were consider-

able problems because some of the wider contextual

issues were not addressed arid the approach did not

include a psycho - social component. in the second

case, working within and using the context were criti-

cal variables in the success of the programme. In both

instances there Was a specific product that was being

introduced.

The third case study is of a project in

Thailand where, like in Tatnil Nadu,

there was a concern about children's

nutritional status. However, quite a

different approach was taken. Rather

than focussing on applying supple-

mental foods to the child, the project

began by looking at the practices

surrounding feeding and nutrition in

order to change maternal behaviour.

Integrated Nutritionand CommunityDevelopment Projectin ThailandFocus: A reduction of malnutrition through under-

standing and building on local childrearing practices

and beliefs.

This project was begun by the Ministry ofHealth in Thailand, who conducted studies tounderstand why there was such a high incidenceof protein energy malnutrition (PEM) within thecountry. They identified what they perceived tobe three major constraints to significant reduc-tion in the level of PEM in infants and preschoolchildren: 1) a health system that did not reachthose most at risk; 2) a lack of community aware-ness about malnutrition and its impact on chil-dren's growth and development; and 3) the factthat nutrition was being viewed as a health prob-lem only: there was a lack of multi-sectorial inputinto the programme.

Taking these constraints into consideration,the government, in 1979, launched an integratedcommunity-based primary health care projectthat included supplemental feeding, growthmonitoring and parental nutrition education, allwithin a national plan for poverty alleviation.Within this broad framework, the Institute ofNutrition at Mahidol University carried out anutrition education project that was directedtoward families with the most vulnerable infantsand pre-schoolers. What is unique about the pro-ject is that the nutrition education included apsycho-social component focussing on caregiver-child interactions and on improvements in thephysical and social environment surrounding thechild.

As a basis for the project, childrearing atti-tudes and practices were studied to know whatmothers were currently doing and to determinehow that might affect children's nutritional sta-tus. Through the studies a number of nutritionaland social taboos were discovered that were notbeneficial to the child. For instance, there was abelief that colostrum was bad for the infant andthat newborns were incapable of sucking. Thismeant that breastfeeding was not begun immedi-ately following birth. It was delayed, with theconsequence that many mothers found it difficultto breastfecd and quickly turned to bottle feed-ing. Children were not receiving the nutritionwhich breastfeeding provides.

It was also discovered that mothers believedthat the normal tongue-thrusting activity ofinfants signalled that the infant was no longerhungry. Because of this belief, many infants werechronically underfed.

Another important belief that needed to beaddressed was that few mothers knew that atbirth infants were capable of seeing and hearing.As a result, mothers did not interact with theirinfants and they were left for hours in hammocksthat essentially blocked them from seeing any-thing in their environment. Related to this wasthe mother's lack of awareness of her own capac-ity to make a difference in the child's develop-ment. Mothers had little understanding of howthey could make use of existing resources to create a more nurturing environment for the childand how important it was for them to interactwith the child.

With these practices in mind, a series of inter-active videos was created. One was specificallyoriented ,oward child development, aimed atcreating maternal awareness of her child as anindividual with early perceptual ability, and theimportance of play and of mother-child interac-tion in that play and in supplementary feeding. Asecond video compared two 15-month old boys,one malnourished, the other normal. The videoidentified differences in the mother's behaviour(her feeding and caring practices) in each sce-nario, as well as differences in the food providedto the child. Health communicators in each vil-lage, wIlo served as distributors of supplementaryfood, were trained in the use of the videos whichwere presented as often as needed in each vil-lage.

An evaluation of the project was conducted toassess the impact of the project on children'snutrition. As a result of the project fewer chil-dren suffered PEM. On the basis of interviewswith mothers of under-two children, and of

observations in the home, evaluators of the pro-ject concluded that changes in the mothers'beliefs and behaviours were critical variables inimproving children's nutritional status.

Those involved concluded that videos are apowerful technique when working with illiterateadults. The visual images provided through thevideos stimulated discussion and presented moth-ers with models of behaviour which they couldimitate When observers went to the villagesthey noted more adult-child interaction, moreopen cradles, and more colostrum was beinggiven The results suggest that a focus on thepsycho-social components of feeding (i.e. care)can make a significant difference in children'snutritional status.1Z111 RI N< I kotchahhakdi. N -A Case Studv TheIntegration of Psychosoc cal Components of EarlyChildhood Declopm...nt into a Nutrition Educator,Progi amine of Northeast Thailand." a paper prepared forthe Third Inter-Agencv Meeting of the ConsultativeGroup on Early Childhood Care and Development\Washington I) C January 12-14 1988 New York. TheConsultative Group

This project illustrates how both nutrition and psy-

cho-soda I Ctilliatio 11 components can be incorporated

into a national programme of growth monitoring and

targeted cop lon en ta ry feeding with good results,

using a method that does not depend on litoacy and

which takes into account local practices

While the Thailand experience repre-

sents an attempt to create a nutrition

education programme that takes into

account the many variables that con-

tribute to a child's nutritional status,

there is a national programme in

India that is designed to not only

address nutritional needs, but chil-

dren's cognitive needs as well. It

includes not only children from birth

to age 3 but also pregnant and lac-

tating women and children through

age 6.

Integrated ChildDevelopmentServices (ICDS)in IndiaFocus: Providing children front 'both to six years of

age with C0111Prebensive, integrated services, ins hiding

nutritional supplementation, health, care and educa-

tion.

In 1974 India adopted a National Policy forChildren to ensure the delivery of comprehen-sive child development services to all children.One of the first targets for the effort were thepoorest children found in urban slums and ruralareas, particularly children in scheduled castesand tribes. Beginning in 1975 with 33 projects,Integrated Child Development Services (ICDS)has grown to 2696 projects (more than 265,000centres) in 1992, r:aching about 16 million chil-dren under 6 years 3f age. The specific objectivesof ICDS arc to:

lay the foundations for the psychological,physical, and social development of the child;improve the nutritional and health status ofchildren, 0 to 6,reduce the incidence of mortality, morbidity,malnutrition and school dropout;enhance the capability of mothers to look atterthe needs of the child.The integrated package of ICDS services

works through a network of Anganwadicow tyard) Centres, each run by an AnganwadiWorker (AWW) and helper, usually selectedfrom the local village. The AWW undergoes athree-month training in one of the more than300 training centres run by voluntary and gov-ernmental agencies Responsibilities of the AWWinclude: non - formal pre-school education, sup-plementary feeding, health and nutrition educa-tion, parenting education through home visiting,community support and participation, and prima-ry maternal and child health referrals. Support isprovided to the AWW by a supervisor (I per 20AWW) and a Child Development ProgrammeOfficer working with 3-5 supervisors) who isdirectly responsible for implementation and man-agement of each ICDS project.

All families in the area to be served are sur-veyed to identify the poorest. Those familieswith children under 6 and/or where the woman ispregnant or lactating, arc served in theAnganwadis. Regular examinations are providedby Lady Health Visitors and Auxiliary NurseMidwives. Children and pregnant women areimmunised on a scheduled basis. Three hundreddays a year food is distributed, the menu pre-

2 5

pared Iii accordance with local foods and tradi-tions Families are encouraged to bring the chil-dren t 'le centres for regular feeding Children :sweight and height are monitored. Those with

severe malnutrition are given additional foodsupplements. and acute cases are referred to mcd-

A pre -tic hoot progiamme has been developedfor year-olds who attend the centre threehours a day The AWW is encouraged to (levelop activities that stimulate the child An addi-tional service is non-formal training in nutritionand health organised for mothers and pregnantwomen. These sessions are open to all women.aged 15-45, with priority given to pi egnant andnursing women and women whose children sut-ler from repeated malnutrition.

Funding for the programme has conic fromhod, governmental and 11( to-gmernMentaI

sources The initial costs of establishing a pro-gramme are provided by the Ministry of SocialWelfare The costs ca the supplementary feeding

ogrrunnle are home by the state and the on-going operational cnsts are the responsibility ofthe Central governm;nt International donoragencies have also been involvc..d in fundingaspects of the programme LINI( El- assisted inplanning and implementation beginning in 1975Since 1982 other international agencies. forexample the World Food Programme the AgaKhan Foundation CARE NORAD LISAID andthe World Bank. have been contributing in aVariety of ways

The !CDS programme uses existing services ofdiverse governmental departMents and of volun-tary agencies for the training of K :DS workersOverall administration lies with the Departmentof Women and Child Development within theMinistry of Human Resource Development.K:DS iti monitored by the Ministry as well as theAll India Institute of Medical Science and theNational Institute lor Public Cooperation andChild I kvelopment The annual unit cost petchild per year was estimated at approximatelyUS$ I 0(1

Although the programme often operates at aminimum level of quality it has nevertheless hadimportant effects on the under-six populationlot instance a review of 30 studies of the nutri-tional impact reveals nearly unanimous resultsdocumenting a positive outcome A 1984-86comparative study clone in a number of locationsshowed ICDS/non-ICDS infant mortality rates of67 vs 86 in rural areas and 'it) vs. 87 in urbanareas. In a comparative study of effects onschooling, one researcher found that those with

ICI)S background had a higher primary schoolenrollment rate (89% vs 78%), were mole regu-lar attenders had better academic performanceand scored significantly higher tin a psychologi-cal test !Raven Colour Matrices), than non-1(1)Schildren Furthermore, the difference in enroll-ment rates was accounted for by differencesamong girls (more of the I(:1 )S gals stayed inschool). In another study. it was found that pri-mary school dropout rates were significantlylower for I(1)5 than for non-I(.1)S children fromlower and middle caste groups I I') vs 35 percentfor lower castes and 5 vs 25 percent for middlecastes)

The ICJ)S the largest programme of its kindillustrates the power of political commitment toachieve significant rates of coverage in an inte-grated programme of attention to children ages 0to 6, with important effects on health and edtica-(ion and at a reasonable cost

it RI NI is

Fwlg Iniumiatd ( lull I )c'sclopment tier v iLe, LallyChildh, )(Id Urcclnhmcnt India ( Studs' Pape' pieVaned kir I hi- [-"enunal on Fatly( hildhood1)eselopinunt hale [nom enti 12 in 1989

Nalumal [wallo td Pnblo l totoeution and ( itch!I )(VCIIIIIMCnt National Evaluation 01 lotcp,i,ocd Chdd

Des elortnicnt StA vox Ness Delhi NIP( (.1) 1,M2

What is impressive about 1(1)5 is that who) rl eras

conccincii in 1'47) that' Inas a char' understanding of

the Importance of dchocring (ono ehenswt scroi( es to

meet the multiple needs of )'owl,' children 5truitutally

flit plogramme has always imluded a focus on health

nuts thou olmatton of the young child and the

motile, Wink the l»-oqhminic has certanlly demon-

cf ra ted pocifiPc benefits for both women and children,

they are not of the madnitude that one would hope for

This is due prnmntly to the difficulty of assuring

duality because of Ih scale on which the programme

has ham implemented. ft may also be due to haoind

sm h a comprrhoisinc mandate.

1111111111111111P

While ICDS certainly provides a

vision of what should be included in

a full range of supports for young

children, it also illustrates the diffi-

culties of attempting to provide

health, nutrition and education ser-

vices to a given population. Another

approach that has been taken is to

26

develop one service first, then to add

on additional services as the need for

them is identified by the community.

Sang Kancil,Community-basedServices inMalaysia.Focus: The development of community-based services

in response to Of11111tinity-defined needs.

The Sang Kancil Project was developed withinthe squatter settlements of Kuala Lumpur,Malaysia. It was begun in 1978 by the health sec-tor in an attempt to meet the health needs ofthose living in urban squatter settlements. Therationale for working in squatter communitieswas based on the fact that they arc a growingphenomenon in the developing world. constitut-ing nearly 50% of the total urban population. Itis widely recognised that the env anment withinsquatter settlements is threatening to people'shealth, physically, mentally and in terms of psy-cho-social development

In Malaysia there was difficulty in providingservices for squatters because they occupy theland illegally and thus are not entitled to city ser-vices (water, sewage, medical care, education,etc I. Nevertheless many squatter settlements arestable communities, including people from a vari-ety of income levels The stability comes fromaffordable housing that may not be available out-side the settlement and well-developed supportsystems and-or leadership positions within thesettlement. The developers of the Sang Kamdproject developed a strategy that recognised, val-ued, and built upon the complex social systemswhich exist in the settlements.

While the health sector personnel woo beganthe project were interested in establishing prima-ry health care centres within kompungs (districts)in the settlements, they began their efforts byconducting meetings with community membersto determine their needs and priorities. The com-munity wanted a child care programme foryoung children and to create income-generatingactivities for women. Health care was not seen asa priority. Those involved listened to the com-munity. Rather than building a health centre.they established a pre-school and an income-generating project When these were well-estab-lished. then it was possible to introduce primaryhealth care, which is now widely accepted.

RI 0 kl NI( I YtiNof K Sang Kancil"Care of UrbanSquatter Settlements World t bald) Fof IOU 2,2) 278-281

1982 I

The approach of begnining with a limited focus and

incrementally providing other services to young chil-

dren and their famdies appears to be cut cessful.

However, it works best when the target population ts

relatively small It is rnuch more difficult to use this

approach when considering issues of scale.

It is apparent from the above cases,

that a progrannne needs to he

designed in response to the particular

population(s) being served, taking

into account their history, beliefs,

practices, perceived needs, expecta-

tions and ability to participate.

Programmes also need to be designed

with the active input and participa-

tion of the programme providers.

While the research on Care as it

relates to health and normal develop-

ment shows that a multi-dimensional

integrated approach is optimal, prac-

tical experience shows that this

approach requires great sensitivity

and careful planning.

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'IlEALTH-AND LEARNING (-001iiinator, Notebook. IVIIitei toot

Attention by International Organisations toEarly Childhood Care and Development:AN ANALYSIS OF UNITED NATIONS WORLD REPORTS, 1993

Robert Myers

ntcrnational organisations are paying more atten-tion to young children in the 1990s than theywere earlier The Convention on the Rights of theChild (approved November 19891. the Summit

for Children (September 1990) and the WorldConference on Education for All (March 19901. allwith their follow-up mechanisms, have helped toplace the young child on the international agendaand to provide additional impetus to national initia-tives.

But even though there are promising new depar-tures in both rhetoric and action internationalorganisations are just beginning to recognize theimportance of the integrated development of chil-dren during their preschool years and its relation-ship to larger social and economic developmentquestions ' The weakest piece in programmingintended to benefit young children continues to beattention to their mental. social and emotionaldevelopment which has not yet found its rightfulplace alongside physical development and survival

In this brief essay. I will examine critically theplace of integrated child development on the cur-rent international agenda and analyse the latestWorld Reports issued by specialised agencies of theUnited Nations family

A Promising Startin the 1990sNew attention, in the 1990s to the plight of youngchildren is evident in hiring patterns and program-ming within sonic international organisations In

addition new organisations networks and publica-tions have appeared, which focus particularly onchildren under the age of six. The following exam-ples of changes made during the last three years sug-gest increased attention to early childhood care anddevelopment issues They reflect some awareness ofthe multidimensional needs of children and theirfamilies

In August 1991 UNICEF hired a programme offi-cer. located within its "Education Cluster no

devotes full time to early childhood developmentDuring the last year UNICEF's Nutrition Clusterhas given attention to Care as an importantdimension in conceptualizing its programmes

Since 1990, The World Bank has approved loansto at least) Colombia, Venezuela ChileEcuador, Mexico. Brazil. Bolivia and India thateither focus on early childhood development orcontain a preschool or integrated early child-hood component within a broader loan.Discussions are now being held in South AfricaVietnam and the Philippines that could lead toadditional loans in this area. In 1993. the WorldBank assigned a person to work specifically onearly childhood developmentIn 1990 the international non-governmentalorganisation (NCO). Save-the-Children'USAhired a person to create an early childhood devel-opment programme This has resulted in a lune1992 programme statement titled, "StrongBeginnings An International Initiative in EarlyChildhood Development."A programme officer in early childhood develop-ment was added to the staff of The ChristianChildren's Fund in 1992The organisation Chddwatch, was formed in1992.

During the past two years, an international net-work of non-governmental organisations hasformed under the auspices of Redd Barna. to bal-ance anchor work with governments on the taskof monitoring progress toward fulfilling condi-tions of the Convention on the Rights of theChildThe first issue of Childhood, A Global Journal ofChild Research appeared in February 1993The International Forum held in New Delhi inSeptember 1993 as part of the follow-up to theWorld Conference on Education for All, devoteda session explicitly to "Early Childhood Care andDevelopment." (The next issue of the Coordinator..Nottbook will he devoted to the EFA initiative andto early childhood development seen within thecontext of the WCEFA.1

Certainly. there are additional examples of new initiatives by organisations or networks with an inter-national outreach, all of which adds up to consider-able promise for the improved condition of childrenas we approach the twenty-first century

29

Fulfilling thePromiseThese examples of new efforts by internationalorganisations do offer promise particularly whenput together with national initiatives. There are.however, other signals that suggest the need forbroader vision, for greater collaboration, for moresolid funding and for continuing vigilance if thepromise is to he fulfilled. It is still more the excep-tion than the rule to view young children and theirfamilies in a holistic integrated way The strongresearch which supports this view has yet to influ-ence the majority of health, education, or careaf forts aimed at improving young children's lives.(sec! Evans article On p

The need for greater integration and continuedeffort to promote early childhood development(ECD1 is evident as we revisit several of the exam-ples given above. In the case of UNICEF. forinstance. while noting the new appointment onemust also note that the budget provided for mohihs-ing actions (and for improving institutional capaci-tiesi m ECU is not only relatively small but was cutdrastically during iwn as ever greater priority wasgiven to bolstering primary school education. Interms of budget and action it is not evident that theadmirable attention to Care within the nutritionprogramme rhetoric in UNICEF will result in greaterintegration of the educational and psycho-socialdimensions of Care into food- related actions.

The budget provided 1(ff the early childhood pro-gramme officer within the World Bank for backstop-ping early child development initiatives is extremelysmall despite the increasing attention given in loansto this area This requires her to spend much of hertime and energy looking beyond the Bank for fund-ing

Getting early childhood care and development onthe agenda of the New Delhi meeting required astrong lobbying effort. The topic was not initiallyregarded as part of the normal discussion of basiclearning and education, despite its prominent inclu-sion in the Declaration and Framework for Actionthat resulted from the WCEFA A small contributionpledged by the United Nations Development hind(UNDPI to support the preparation of case studiesand other background documents for the New Delhimeeting had to he withdrawn, a victim of budgetcuts within the Fund

We do not wish to minimise advances made bythe organisations cited. However, in order for "smallbeginnings' in the international community to turninto "strong beginnings," much more needs to bedone This is evident also if one examines recentdocuments of the United Nations These reflect tosonic degree how international institutions arcthinking and acting

An Analysis ofUnited NationsWorld ReportsIn different parts of the United Nations. periodicreports arc published that review how well we arefaring in the world at large. Each report takes a dif-ferent perspective consistent with the particularcharge of the specialized UN agency publishing thereview These documents provide a weathervane,pointing to the extent and manner in which differ-ent UN institutions incorporate an early childhooddevelopment perspective into their thinking andtheir analysis The summary that follows is based ona review of four reports. These are:

1. UNICEF The State of tlic World Ibildrot tuo t.

New York: Oxford University Press, 1993.Published yearly for UNICEF.

2 The World Bank. I'orld Deptlopmcio Rood. loot.Investing in Health. New York. Oxford UniversityPress. Published yearly for the World Bank.

3 United Nations Development Programme(LIMO) Human Detyloinoit Report runt. New York:Oxford University Press 1993 Published yearly forUNDP.

4 The United Nations Department of Economicand Social Development Report on IN World Sooal5etuation New York The United Nations1993. Document ST. ESA 235 E, I 993,50 Rev.1Published (:\ cry lour years

A fifth report from UNESCO titled the WorldEa:Ration Report. is published even two years and isdue out before the end of the year but has not yetappeared as of the time of this writing. Here com-ment will be based On the 1991 report and on a firstdraft of the 1993 version

Obviously these reports are much broader thanour specific locus on child development Howeverthe broad trends affect child development actions inimportant ways. Accordingly, I will comment firstOn what seem to represent trends framing our partic-ular interest in the early childhood topic. I will thencomment specihcally on the place of early child-hood care and development within the reviews

Trends inInstitutionalThinkingThe following trends appear in the several reportsWe must note however that although we have triedto glVe a flavor of the reports we can not do justicewithin this limited context to the rich. thoughtfuland well-documented presentations made in eachreport

Toward a broader view of nationaldevelopment.

Although there is still a great deal of attention inthe set of reviews to the development of nations interms of economic productivity this focus has beenmodified considerably LIND!), kir instance. focuss-

3 0

'.11EALTII AND LEARNING ( oot,imalot, Notthook. Milk, 109

es on "human development" defined in terms oflongevity, knowledge and well-being derived fromincome. UNICEF classifies countries in terms ofchild mortality and juxtaposes this indicator withthe annual rate of growth in per capita GNI' toshow that there is little relationship The annual rateof reduction of fertility is also taken as an indicatorof development.

The World Bank report focusses its attention inits 1993 report on health indicators and on "the bur-

den of disease.' borne by countries. While usingGNP per capita as its main criterion for classifyingcountries, and emphasizing economic data in its sta-tistical section. indicators are also provided of socialand natural resource development.

The extraordinary report of the UN's Departmentof Economic and Social Development includes awide variety of "objective" indi-cators of social conditions andresponses that contribute to thequality of life These include

per capita GNP, life expectancy.average schooling completedper worker adult literacy. dailycaloric intake micro-nutrientdeficiencies and nutritionally-related diseases child mortalitywater availability and qualitythe number of persons perdwelling homicides and sui-cides per 100.000 people hoursworked yearly per worker. theincidence of longterm unemployment. the social securityshale of GNP and many othersThe Report also includes a sub-lecove indicator for 12 coun-tries only The level of person-al happiness among lower andhigher income groups

One result of a broader defin-ition of what constitutes national

"We have to weave development around people, notpeople around development." People's participationis discussed first in relation to the household andthen to economic, social, cultural and political par-ticipation. The review stresses that greater democra-cy and decentralization are essential to promotingparticipation A special chapter is devoted to therole of people's organisations and of non-govern-mental organisations in the development process

The UNICEF report calls for "common cause" inmobilising action to form a "'people's movement"focussing on basic needs for childrensimilar to themovements directed toward improving the status ofwomen and the environment The report notes the

important roles being played by voluntary and non-governmental organisations, the media. health pro-fessionals and educators.

A father watches his wife breastfeed their newborn baby. UNICEF sup-ports programmes that encourage fathers to participate in the care oftheir young children.

d CV e I prn C tofdefining development in terms Of human develop-ment and quality of life is that the earlier divisions

set between developing' and 'developed'. countriestend to blur much more For instance, if the numberof homicides or 'ilia( t families are taken as indicatorsthe classihc anon of countries bears little relationship

to economic development indicatorsThe broader definitions of national development

help to frame child development in terms of humandevelopment rather than treating it as a subcatego-ry under education This broader definition seemsboth logical and appropriate

N Toward greater participation andpartnership.

The UMW report states in Its introduction that

Toward a greater concern withgender issues.

In all reviews, attention is given to gent,' 2r issuesThis Is evident in the statistics presented and theexamples used as well as in the issues treated directlyin the main text. In all reports. for instance, educa-tional data include separate tabulations by gender.UNDP.s treatment in its text of the householdfocusses on gender disparities and its statistics tablesinclude data on the status of women and on female-male gaps UNICEF uses the women's movement asan example of the kind of people's movement that

might be applied to meeting basic needs for childrenand suggests that much more could be done to liber-ate women from daily cho'res, including greaterattention to family planning "At stake here is notonly the quantity of women.s deaths but the quality

3I

of women's lives Maternal mortalityis discussed in the text One of the10 basic statistical tables is titled-Women

Inserts in the World Bank reportare devoted to violence againstwomen as a health issue and towomen's nutrition. A statistical tableis called "Women in Development."Unfortunately in both the UNICEFand World Bank cases, the statisticspresented about women relate onlyto women in their maternal role (orto their education). Informationabout the employment status ofwomen is not included in their publi-cations The Department ofEconomic and Social Development'sreport presents figures on femaleunemployment and female-to-maleunemployment ratios in selectedcountries It pays special attentionalso to women's access to scienceeducation

In general. the discussions ofwomen's issues are not linked to aneed to provide quality child care.

Toward restructuringinternationalcooperation.

The LIND!' report suggests thatdevelopment assistance should be allocated to peo-ple. not countries, should favor countries in whichmilitary spending is low or being reduced, should hereadjusted more in line with population and withlevels of poverty should be used increasingly tobuild national capacities, and should increasebeyond the 7% now earmarked for human priorityconcerns UNICEF and UNDP urge a restructuringso that 20% of all technical assistance would go todirectly help people to meet their most basic needsfor food, water. health care. family planning and pri-mary education Aid should target the poorest quar-ter of recipient countries populations The UNICEFreport echoes the UNDP suggestion that reducedarms spending should become an important criteriafor aid.

The World Bank indicates that the percentage ofall aid going toward health should he increased toits pre-1980 level of 7% at once and should increaseover the next few years More assistance should goto such areas as immunization AIDS and primaryhealth care and less to hospitals. Donor coordina-tion should be improved The Department ofEconomic and Social Development calls for aSummit which among other things. would considerthe relative strengths of international voluntaryorganisations and intergovernmental organisationsand seek means of pooling their strengths

The above gives a flavor of the approaches rec-

30

dratolradim1

1-'7"

ommended in the 1993 World Reports. Let us turnIlOW to the place of early childhood developmentwithin them.

Early ChildhoodCare andDevelopment

UNDPAlthough the UNDP document

"Human Development" Report anddeals in a sensitive way with issues of

is titled aalthough itpeople-cen-

tered development, it does not include an explicittreatment of early childhood development Childsurvival is dealt with explicitly, as arc issues of mor-bidity and malnutritiontaken as indicators ofhuman development. Education enters through thetraditional indicators of literacy or years of school-ing. At a very rough level, these indicators may headequate for the purpose of classifying countriesHowever, they minimise once again, the impor-tance of physical, mental. social and emotionaldevelopment during the early years, from birth untilentry into school.

Among the 52 statistical tables presenting differ-ent developmentally-related indicators (27 fordeveloping countries; 25 for industrial countries),are tables dealing with "child survival and develop-ment -health profile," "education flows," and "edu-cation imbalances." All of the "child survival and

32

HEALTH AND LEAHNIRH ootditiatois Nortbook, r

development" indicators are health and nutritionindicators, as are the indicators for the "health pro-file." There are no mental, social or emotional devel-opmental indicators. The table on "education flows"includes a percentage figure representing the "intakerate" into the first grade of primary school.Although there are enrollment ratios for primary.secondary and tertiary levels, there is no enrollmentratio for pre-school programs. Nor is early educa-tion included in the table on educational imbal-ances.

In brief human development during the earlyyears is treated narrowly as a matter of good healthand nutrition. Moreover, although gender issues areprominent in the report and attention is given towomen's employment these are not linked to childcare issues.

The World BankIn the World Bank Report. health continues to be

treated as absence of disease and measured in termsof mortality reduction Health is not defined as pro-gression along the road to good health definedbroadly to include psychological and social health.With its emphasis on survival, defined negatively, itis not surprising to find that a broader discussion ofhealthy child development is missing from thereport The simultaneous nature of child survivaland child development and the two-way relation-ship between these two is missed.

When a link is made in the report between healthand education, that link is limited to the influence ofyears of formal education on the incidence of dis-ease.

Again, human development during the early years(child development) is treated in a very narrow way,defined by health and nutrition variables. Countriesare classified in the discussion in terms of the "bur-den of disease" that they bear as a result of sicknessand premature death.

Also worth mentioning is the fact that the WorldBank's Report emphasises household capacity forhealth prevention and care, setting it apart fromreports that continue to emphasise institutional care.It does not, however, discuss community organisa-tion or the capacity of communities (or organisedgroups of individuals) to make just demands on thehealth delivery syster.). Nor does it consider thepositive and negative effects on child health of theincreasingly prevalent substitute systems of childcare whether at home or in institutional settings

UNICEFIn The State of the World's Children, UNICEF

continues to place almost exclusive emphasis onchild health and nutrition issues. The report speaksin passing of "mental growth A one-way link ismade in the discussion in which malnutrition and

disease are seen to lead to poor mental and physicalgrowth, leading to poor performance at school andat work, and so on. The reverse effects of poor men-tal and physical (and social and emotional) growthon malnutrition and disease in the early months andyears are not considered.

The UNICEF report also speaks of 'protection"which, from the point of view of the parents, is saidto include the special protection of "love and com-mon sense". This affirmation is left at the generallevel, however, and no mention is made in thereport of how "love" is manifested, or of the impor-tance of interaction, communication and stimulationfor instance. This is like mentioning health withoutmentioning immunization or other concrete actionstaken to fortify health. When protection is put intoa broader social framework and when "outreach" bya community worker is discussed as a main way tohelp build protection, all references are to health ornutritional actions.

No direct discussion of education programmesoccurs in the UNICEF Report. One figure is provid-ed showing primary school enrollments, but there isno discussion of learning during the pre-schoolyears or of pre-school education When speaking ofeducators as an important occupational group, a pleais made for imparting basic knowledge children willneed as parents. However, the basic knowledge isdefined to include nutrition health. fertility, envi-ronmental issues and gender. Early learning andmental development are not included.

Again we see that it is difficult to take an integrat-ed view of child development and that almost exclu-sive emphasis is given to health and nutrition duringthe early years. A vision of child development thatincludes mental, social and emotional dimensions isjust beginning to penetrate the institutional thinkingas expressed in the 1993 report.

The Economic and Social DevelopmentDepartment

The chapter of this report devoted to educationand literacy does not include any mention of pre-school education or of learning in the pre-schoolyears. The WCEFA extension of the definition ofbasic education to include the early years has notbeen absorbed. Adult education and literacy arelinked in the discussion to community development,Productivity and employment but not to childrear-ing or even to health.

III The World Education ReportIn its first edition, which appeared in 1991,

UNESCO's World Education Report included a dis-cussion of "pre-primary education." The dramaticgrowth of pre-school education in developing coun-tries was noted (from one in fifteen children in 1975to one in five in 1988). Probable reasons for thisincrease are discussed. In a major section of the

33

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-11141,

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Children share their breakfast of wheat and soya mix with milk, at the UNICEF-supported Good Samari-tan Orphanage set up for abandoned or orphaned children during the war in Mount Barclay, Monrovia.

report on "continuing challenges" no mention ismade of the pre-primary period

The UNESCO report treats early learning asequivalent to formal pre-schooling, in large partbecause the available statistics arc for formal pre-schools. No analysis is made of the financing ofearly pre-primary learning or schooling.

In brief, the report treats early learning in a nar-row and formal way and in passing, without givingserious attention to the topic. It is to be hoped thatthe 1993 report will incorporate early childhoodlearning and development more directly into themainstream of its thinking.'

Early childhood mental, social and emotionaldevelopment and early learning have not found theirway into the thinking and reporting of specializedagencies of the United Nations system. This is soeven though there are a number of indications with-in the same institutions that new attention will begiven to the early years.

An integral treatment of early childhood develop-ment and a holistic view of learning and develop-ment during the early years remains difficult toachieve This is due in part to sectoral and discipli-nary boundaries both within and between organisa-tions. The health community continues to exert an

enormous influence over the way in which the wel-fare of children is viewed and addressed during theearliest years. The two-way interaction of mental,social and emotional development with physicaldevelopment and survival is only beginning to berecognised and incorporated into programme thinking.

I This essay is not !mended to provide vet another mstifi-. \12 cation for investing in early childhood care and development

For those who would like to review these arguments. seeL-Meeting Early 1..:arning Needs' produced he theConsultative Group on Early Childhood Care andDevelopment See also, b: Robert givers Thr Itrelrr WhoSurpme ;London Rciutledge, I,M3 Chapter I) or Toward AFair Shut fur Children ( Paris UNESCO. 1993. 4th edition)

2 Apparently, the phrase "mental growth" is used ratherthan development so as to avoid the confusion betweennational development and child development The term."development" is restricted to the broad process of social andeconomic development

3 An early draft of the report provides link attention toearly learning and development Suggestions have been madeto increase and improve the treatment in the I'493 report. butwhether or not the report will afford preprimary education areasonable place in the document remains to l)e sccn

34

Coor,bitatorc' Notebook. Wink, to,33

Related ResourcesProposed ActionsPartnership for Child Development.

This is a ten-year, six-country study to look ateducational outcomes for children in programmesthat include health education, de-worming andmicronutrients in the intervention. The core staff (3in the UK and 1 in the USA) work in partnershipwith Ministries of Health and Education The coun-tries selected include Indonesia, VietnamColombia Ghana and Tanzania The sixth countryhas not yet been selected. Funding for the effortcomes from UNDP WHO Rockefeller and theEdna McConnell Clarke Foundation. If vou alsowork in these countries you might want to learnmore about this protect For more information con-tact Beryl Levinger. 17 Woods Grove Rd WestportCT 06880

Micronutrient InitiativesIVACG Intonational l'itawnt A Consult:1hr( (;roup.

IVACG was established in 1975 to guide interna-tional activities aimed at reducing vitamin A defi-ciency in the world IVACG strongly supports thegoal of virtually eliminating vitamin A deficiency bythe turn of the century The XV IVACG Meetingheld 8-12 i\larch 1993 in Arusha. Tanzania. provid-ed a forum for exchanging new ideas and importantresearch findings encouraging innovation and pro-moting action programs to help reach the goal

The tocus of the meeting was on the integrationof vitamin A interventions intoexisting primary health careand food-based strategics.Representatives from 51 COUn-tnes were among the 294 poli-cy makers, implementers andscientists in health nutritionagriculture and developmentparticipating in the meetingThroughout the five-day pro-gram numerous speakers pre-sented research concerningprogress in changing dietarybehaviors related to vitamin Anewer methodologies forassessing subchnical vitamin Adeficiency consequences forhuman health and disease andphysiological functions of vita-min A

With support from a cooper-ative agreement between theNutotion Foundation Inc andthe Office of Nutrition Bureaufor Research and Development

U S Agency for International Development, theIVACG Steering Committee and Secretariat orga-nized the meeting with a local committee inTanzania. Other organisations, including bilateralagencies United Nations agencies and the foodindustry, provided additional support

A complete report of the meeting is availablefrom the IVACG Secretariat, 1126 Sixteenth StreetN W Washington, D.C. 20036 USA. Phone: 202-659- 902.1, Fax: 202-659-3917

The Almonittriou /wham was established in April1992 by the International Development ResearchCentre. the Canadian International DevelopmentAgency. LINN', and the World Bank ictioto catalyse and facilitate action to reduce micronu-«lent malnutrition by assisting developing countriesin the design of appropriate programmes. The pro-gramme focusses on the eradication of Vitamin A.iron, and iodine deficiencies

Interventions to address micronutient malnutri-tion that are being promoted include effortsdesigned to change consumer demand and behavior:fortification of basic foods and water and pharma-ceutical supplementation The goal is to help devel-oping countries to identity their problems. devisesolutions, and find the requisite remiurces to imple-ment programs (from Levinger B Piomotiug ChildQuality hism, Trued. and Sttahos Washington I) C..Academy for Educational Development. 1992

The Vitamin A Flail Sopoit Ptoittt VITAL), is asso-

ciated with the International Science andTechnology Institute and operates under a contract

35

with USAID's Office of Nutrition, Bureau forScience and Technology. In addition to vitamin A,the program also promotes the reduction of iodineand iron deficiency disorders. Principal activitiesinclude technical support to field-based projects andthe dissemination of information on micronutrientmalnutrition. The project also seeks to build orstrengthen international coalitions of implementingand policy-setting agencies. (from Levinger, B.Promoting Child Quality: issues, Trends and Strategies.Washington D.C.: Academy for EducationalDevelopment, 1992.)

ResourcesAdministrative Committee on Coordination/Subcommittee on Nutrition (SCN).

The overall role of the SCN is to promote theharmonizing of policies and activities in the field ofnutrition within the UN system. The SCN has com-piled information on nutritional trends and prob-lems in the world and on the resources available todeal with them. A range of specific issues has beenexamined, and conclusions have been published inSCN's "State-of-the-Art" series. SCN News, a peri-odic review of developments in international nutri-tion. frequently contains articles and reviews thatpertain to the linkage between malnutrition, infec-tion and school achievement.

Recent work by the SCN has dealt with control-ling micronutrient deficiencies, particularly iodine.iron and vitamin A During its 1990 meeting, thegroup embraced efforts to link nutrition and healthprograms to school enrollment and learning.

The importance of the SCN lies in its ability toreach an important network of policy makers withinthe multilateral donor community. The SCN is alsothe sponsor of the International School Nutritionand Health Network, a description of which fol-lows. (from Levinger. B. Promoting ChM Quality: Ii<ucs.

Trends and Soal Nies. Washington D C.: Academy forEducational Development, 1992, pg. 34)International School Health and NutritionNetwork.

This network, established by the United NationsCommittee on Coordination/Subcommittee onNutrition (SCN), is designed to facilitate informa-tion exchange and consensus. Its founding reflectsthe growing conviction that the relationshipbetween student nutrition, health, and learning out-comes is an important, albeit little understood issuefor both public health and education policy makers.The Education Development Center of Newton,Massachusetts serves as the Network's secretariat.

The Network will provide a vehicle for national,regional and international experts and policy makersto exchange knowledge and identify actions thatcan he undertaken to eliminate health- and nutri-tion-related impediments to school achievementInformation dissemination on current researchefforts. policies and programs will be an important

Network activity. The development of technicalguidelines in such areas as assessment (where little isknown and there are no clear-cut standards) and thepromotion of applied research are two other impor-tant Network activities.

The Network's activities will all be concernedwith two issues:

1) determining ie impact of nutrition and healthfactors on such student performance variables asenrollment, attendance, retention, repetition andrelated classroom behaviors, and, 2) identifying thebest and most cost-effective intervention strategiesto respond to the nutrition and health problems ofschool-age children in different ecological settings.

Participation in the Network is open to all SCNagencies as well as regional and national institutionswith relevant expertise. The establishment of aninternational advisory panel is planned, to overseeNetwork activities. It will be comprised of represen-tatives from developing countries and the interna-tional community of experts in the fields of educa-tion, nutrition, and public health.

The Network will be under the overall supervi-sion of Dr. Abraham Horwitz, Chair of the SCNand former Director General of the PAHO. For fur-ther information contact: Ron Israel, EDC, 55Chapel Street, Newton. MA 02160. (from Levinger,B. Promoting Child Quality. Issues, Trends and SI ra tegiei

Washington D.C.: Academy for Educational ,Development. 1992.)

Free essays on Food, Hunger and Nutrition,Primary Health Care and Development.

These are available upon request from Dr.Claudio Shuftan, Nairobi, Kenya.

Topics related to this issue of the Coordinators

Notebook include: "The Causes of Hunger and Malnu-trition: Macro and Micro Determinants": "Technical.Ethical and Ideological Responsibilities in Nutri-tion'', "Dc- Westernizing Health Planning andHealth Care Delivery: a Political Perspective","Preparing Food and Nutrition/Primary Health CarePrograms: Experiences from Cameroon and Liberia"."The Role of Health and Nutrition in Development","Survey on Attitudes to Nutrition Planning": "LowSchool Performance: Malnutrition or Cultural Depri-vation?", "Hunger and Malnutrition: Outlook forChanges in the Third World", "Nutrition Planning -What Relevance to Hunger?", "Positive Deviance inChild Nutrition. A Critique".

/ A full list and details on ordering can be requestedfrom Dr. Shuftan, Box 40874, Nairobi, Kenya. Fax2542 712190.

36

HEALTH AND LEARNING Coordinators' Notebook, Winter 1993

Related ReferencesBrazleton, T.B. "Early Intervention. \X/hat Does it

Mean?" Theory and Research in Behavioural Pediatrics, Vol1 (1982), pp. 1-34.

Cameron, M. and Y. Hofvander. Manual on FeedingInfants and Young Children. Third Edition. Oxford:Oxford University Press, 1983. Prepared under theauspices of the FAO /WHO /UNICEF ProteinAdvisory Group.

Chavez, A., H. Martinez, L. Allen and G.H.Pelto. "The Collaborative Research and SupportProgram on Food Intake and Human Function:Mexico Project, Final Report", a report submitted toUSAID, 15 November, 1987.

Dobbing, J. (ed.) Early Nutrition and LaterAchievement. London: Academic Press, Inc., 1987.

Field, T., S. Schanberg, F. Scapidi, C Bauer, N.Vega-Lahr, R. Garcia, J. Nystrom and C. Kuhn.'Tactile/kinesthetic Stimulation Effects on Pre-termNeonates", Pediatrics, Nol 77, No. 5 (May 1986),pp. 654-8.

Garmezy, N. and M. Rutter (eds) Stress, Coping andDevelopment in Children. New York: McGraw-Hill BookCompany, 1983.

Grantham-McGregor, S. "RehabilitationFollowing Malnutrition", in J. Brozek and B. Schurch(eds), Malnutrition and Behavior: Critical Assessment of Key

Issues Lausanne, Switzerland: the Nestle Foundation,1984.

Klaus, M. and J.K. Kennel] (eds). Maternal InfantBonding. St Louis: C.V. Mosby, 1982.

Landers, C. "Biological, Cultural and SocialDeterminants of Infant Development in a SouthIndian Community", in K. Nugent, B.M. Lester, andT. B. Brazleton (eds) The Cultural Context of Infancy.New York: Ablex Press, 1989.

McGuire, J. and J. Austin. "Beyond Survival:Children's Growth for National Development",Assignment Children, No. 2 (1987), pp 1-52.

Monckeberg, F. "Nutritional Rehabilitation inSevere Early Marasmus" in Proceedings of the xviiithWorld Conference of OMEP, Jerusalem, Israel, July 13-17, 1986.

Pollitt, E., K.S. Gorman, P.L. Engle, R Martorell,J. Rivera. Early Supplementary Feeding and Cognition,Society for Research in Child Development,Chicago: University of Chicago Press, 1993.

Ritchie, J. Nutrition and Families. Revised edition.London: Macmillan Education, Ltd. 1983.

Scheper-Hughes N. "Culture, Scarcity andMaternal Thinking: Maternal Detachment andInfant Survival in a Brazilian Shantytown", Ethos, Volt3, No 2 (1985), pp. 291-317.

Soemantri, A.G., E. Pollitt and I. Kim. "IronDeficiency Anemia and Educational Achievement",The American Journal of Clinical Nutrition, Vol. 42(December 1985), pp. 1221-8.

Super, C., G. G. Herrera and J.O. Mora. "Longterm effects of nutritional supplementation and psy-chosocial intervention on the physical growth ofColumbian infants at risk of malnutrition", Boston,Harvard School of Public Health, April 1987.Mimeo.

Werner, E.E. and R. Smith. Vulnerable but Invincible,A Longitudinal Study of Resilient Children and Youth. NewYork: McGraw-Hill Book Company, 1982.

Zeitlin, M., H. Ghassemi and M. Mansour. PositiveDeviance in Child Nutrition, with Emphasis on Psychosocialand Behavioural Aspects and Implications for Development.

Tokyo: The United Nations University, 1990.

37

z.

38

36

UNICEF 93-BOU0020.Maggie Muit a7-Lee

NetworkNotesActivities of the

Secretarial p 37

Network News 5

Publications mid

Videos p

Activitiesof theSecretariatChanges in the Secretariat-Cassie Landers has moved on to a new position as a UNICEFConsultant She is presently working on an exciting project todevelop five parent-education vdeos with accompanying docu-mentation for parents in Jordan West flank Morocco. Tunisia,Turkey Iraq and Lebanon The project is administered by NigelFisher out of the UNICEF Middle East and North Africa RegionalOffice

Gloria Fernandez has taken on the position of Inkirmation Off!.cur lot UNICEF in Mozambique I ler new iob started October Iwe wish her well in her new endeavor

Uur heatifilt thank, to both uu,,ut and ;form for thou tontruhnholus to IN.

onsuitatin G/00 grant m pall:Ludas for thou lulu work luodulon!I Impious

culutioNs of lb( Coordinators' NotebookJudith L. Evans joined the Sec retailat m January as Director

She was previously the Programme Officer for Young Childrenand the Family at the Aga Khan Foundation Judith will he working3 4 time lot the Secretariat, and will he using the other quarter ofher time to provide technical assistance in ECM on an individualcontract basis

Bob Myers has shifted his role to that of Associate Director,handing over many of the administrative tasks to Judith. Bob ill

also he working 3'4 time for the Secretariat, and using the fourthquarter to provide technical assistance to organizations on an indi-vidual contra( t basis

Ellen M. llfeld has joined us as editor of the Notebook andOccasional Papers. She was coauthor, with Judith Evans of GoodBeginnings: Parenting in the Early Years f High:Scope Press), andis the founder/publisher of Horse Mountain Press, a small publish-ing company in western Massachusetts

Judith and Ellen can both be reached at the Massachusetts office:6 The LopeHaydenville. MA 01039 USAPhone. (413)268-7272 Fax 1413) 268-7279

Bob can he reached in Mexico City atInsurgentes Sur 441 I

Ed 25-202TlalcoligiaD F 14430, MEXICOPhone/fax (52-5) 573.3969Along with the changes in personnel, we have re-designed our

kiwi, given the loordiiiirfo' Notebook a new look, and produced abrochure which describes the Consultative Group activities andmission. Copies of the brochure are available upon request

39

Participation in the EFAForum -A follow-up to the Education for All (EFA) Forum in lomticnThailand, was held in New Delhi, September 8-10, 1993 One of themajor time blocks within the three days was devoted to EarlyChildhood Education. To prepare for the session an ad hoc commit-tee was formed with the Bernard van Leer Foundation assuming therole of organizer, assisted by the Secretariat of the ConsultativeGroup on Early Childhood Care and Development (CC.

The presentation began with a video, First Steps, produced by theAga Khan Foundation (a complete description of the video will be inthe next issue of the (-oordwafol,' Notebook), providing a pictorial pre-sentation of the importance of 1:CCD The session continued withthe presentation of three case studies. The first was based on theVenezuela Family Day Care Project The second was a description ofthe large-scale pre-school project in Kenya which is an example ofgovernment /community collaboration in support of early childhoodeducation The third case study provided a description of an activefamily centre created in the Philippines to meet the multiple needs offamilies in the community The final hour of the session was devotedto a discussion of the issues

All those present were concerned that the enthusiasm for earlychildhood issues not dissipate alter the conference Thus, during thefinal day. those interested in early childhood issues met together todecide how to proceed It was decided to call a meeting of anexpanded group in early November. in order to develop concreteplans of action in these priority areas The meeting was convened inNew York, in November, 1993 by the Secretariat of the CC.

'The general purpose of the meeting was to promote workingtogether in common cause in order to activate and strengthen workin the field of early childhood development In line with the purpos-es established, the meeting resulted in the following outcomes: 11identification of priority issues and areas for work: 21 a plan ofaction, 3) assignment of responsibilities: and 4) plans for involvingother organizations

Responsibility for the various activities was assigned, based on theorganizations present at the meeting. The lead role with respect toparticular activities seas assigned to different organizations, each tak-ing responsibility for one or mon: of the priority areas set out At themeeting other possible collaborators were identified. A list of organi-zations that might he interested in collaboration was drawn up,many of whom are located in Europe. It was recommended. theretore, that a similar meeting be held tn Europe in early 1994 Such ameeting would have as its main purpose to extend collaboration inactivities intended to strengthen work in the field of early childhooddevelopment It would take as its starting point the outcomes of theNovember meeting in New York. We were asked to organize thisEuropean meeting.

General responsibility for keeping organizations informed ofprogress, for seeking extended cooperation, for monitoring and forsynthesizing results from the various activities within the Plan ofAction was assigned to the Secretariat of the Consultative Group onEarly Childhood Care and Development. These activities will serveas a primary focus for the Secretariat during 1994 and 1995.

The 8th Meeting of theConsultative Group -This was held in Washington D.C. March 31 April 2, 1993 In

preparation for the meeting we drafted the document Prima) le, andGuidelines to Strengthen Programme, of Early Childhood Owe lopment and

40

Activitiesof theSecretariat

Activitiesof theSecretariat

Learithig. This was discussed at the meeting and revised for distribu-tion. A document on the activities of the Secretariat during the pre-ceding year was also presented.

The Santa Marta Meetingof Networks -The "First Meeting of Latin American Networks dealing withChildhood" was held in Santa Marta Colombia from August 23-26.1993 The meeting was organised by the International Center forHuman Development and Education (CINDE) and the Secretariat ofthe CC with funding from UNICEF's offic. for Latin America andthe Caribbean and from the Interamerican Institute of the Child.The objectives of the meeting were to-

identify overlapping and complementary activities as well as gapsin the work being carried out by institutional groups concernedwith the child in Latin America,stimulate an exchange of ideas. materials and information aboutactivities among existing networks (or institutional groupingslthat share the common goal of improving the condition of chil-dren in Latin Americaexplore mechanisms to facilitate continuing exchange and collab-oration.The meeting brought together a wide range of NCO,' and donors.

These included UNICEF. UNESCO. World Bank, PAHO. TheInter-American Institute of the Child the Latin American Centre forPerinatology the Child and Family Network. REDUC La l_igaLeche OMEP Redd Barna. SC CCF The Bernard van LeerFoundation. the International Society for the Study of BehavioralDevelopment CINDE the Colombian Child and Family Institute(CFI and the Rafael Pomho Foundation

To facilitate discussion a background paper was prepared present-ing the concept of networking and an analysis of networks and insti-tutional groups in terms of their purposes forms of organisationareas of emphasis. geographic extension and types of activitiesDuring the meeting the concept of -networking" was taken beyondthe common idea of a mechanism for communication and exchange.It was defined as a new form of social organisation appropriate tothe support of social movements

As a result of the meeting several concrete areas of collaborationemerged. involving two or more of the institutions present. A com-mittee was established to look into the possibility of developing acommunication network i:hin Latin America that cuts across disci-plinary and sectorial lines A summary report of the meeting inSpanish. is being prepared by CINDE and should be ready for distri-bution by the end of 1991 The next meeting was tentatively set forMay or lone 1994 to he hosted by the Pan American HealthOrganisation.

Workshop on ChildrearingPractices and Beliefs -From October 26 -29. 1993 a workshop on Childrearing Practicesand Beliefs was held in Windhoek. Namibia Organized by theSecretariat of the CC. with support from UNICEF, and hosted bythe Univeisity of Namibia and the UNICEF Namibia office, theWorkshop provided an opportunity for government. NGOsUniversity professors and donors to sit together and look at researchon childrearing practices from Mali Namibia. Zambia, Malawi andNigeria The purposes of the wiirkshop were I) to bring togetherinformation horn existing studies and to draw implications for policyand programming 2) ti stiengthen the network of individuals and

q 1

institutions in the region who are working to improve the knowledgebase from which to build sound programmes of early childhood careand development. and 31 to create awareness among programme offi-cers in various organisations of the importance of drawing uponknowledge of childrearing practices and beliefs when establishingand conducting ECCI) programmes.

There were 25 participants at the meeting from I I African coun-tries. As a result of the Workshop an analytical framework was devel-oped on ways in which we can more effectively use traditional prac-tices and beliefs to provide support to families. The framework wasbased on the presentations and descriptions of current project,grounded in traditional practices. The report on the Workshop willbe available in early I ()94

Child Status Profile Project-During the year we were able to get the Child Status Profile Projectunderway The project which is supported by the Internationall)evelopment Research Centre (IDRC) and UNICEF will define andapply measures 111 order to determine the developmental status ofchildren just prior to entering school It will also delineate a profileof the schools readiness for the children it should receive

The International Center for Education and Human DevelopmentiCINDE I in Colombia was the first research organisation to developa proposal to develop a Child Status Profile They began their workmid-veai In October a second project seas negotiated This is withAfrican Nledical a Research Foundation f ANIREH in Kenya. Thereare two other groups that are interested in developing national pro-jects These are the Noor Al- Hussein Foundation in Jordan and theChilcl Care Development Centre in Jamaica They will come on-hoard in 1'094

The Absent Father? -Bob Myers was asked to contribute to and critique a book on thefamily being produced under UNESCO auspices by the GALA PressThe hook is being prepared for publication in 1994 m celebration ofthe International Year of the Family Bobs chapter was titled, TheAbsent Father-

Activitiesof theSecretariat

iltNK'- , ,411

44

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The non-absent father

42

Activitiesof theSecretariat

Convenio Andres Bello-Bob Myers prepared a paper for the Convenio Andres Bello thatdescribes the situation of young children in the 7 Latin Americancountries served by the Convcnio (Venezuela, Colombia, Panama,Ecuador Peru Bolivia, Chile). The paper documents internationalassistance for early childhood projects in these countries. The paperwas commissioned because the Convenio is considering some sup-port for work in this area and would like to complement rather thanduplicate efforts of others!

Child Care Programmes as anEntry Point for Maternal andChild Health Components ofPrimary Health Care -As a follow-up to a paper written earlier for the World HealthOrganisation. Judith Evans was asked to revise the document andupdate it. The resulting monograph, Child Care Prograinme: ac an EntryPoint for Alaterml Ind Chill Health Comp( um!: of Primary Health Care was

authored by Judith L Evans and P.M. Shah of the World HealthOrganisation and will be published by WHO in 1994.

Other Publications -A Spanish edition of The Twelve Who Sunnot is being published by thePan American Health Organisation in December 1993.

Pradict, ui Lain AmoiLa Plia.t 11 This report by RobertMyers is being published by CELAM and UNICEF.

Toward a Fan Start /or Chil,htu This very useful monograph writtenby Bob Myers published by UNESCO is now in its fourth editionin English and it is available in Spanish French Portuguese RussianArabic Chinese Bhassa and Thai'

In 1993 a monograph written by Judith L. Evans when sheworked for the Aga Khan Foundation Participatory Evaluation, of Chad-to (hal,l Prot« ts in India was published by the Aga Khan Foundation.

hnpionny Situation of Chil,hen lVoildwide A ('all to Action written byJudith L Evans and Robert Myers was published in High ScopeReSource in Fall, 1993

A leetinj Basic Lionoi,j N'ttd, through Plogianimo of Fatly (:bildbood (-auand DeriloNnoit written by Robert Nlyers and Judith L Evans. was abooklet prepared as a handout for the Education For All EFAIForumin New Delhi. A revised version will be distributed in conjunctionwith the next issue of the Loodnatol, Nottbook which focusses on theInternational EFA Initiative

A new Consultative Group brochure detailing the groups activi-ties was written and produced by the Secretariat.

A new quarterly newsletter called the Fundos Folio was added toour regular publications schedule The Folio is sent to all sponsoringand affiliate members of the Consultative Group, as well as to theAdvisory Committee It provides short news updates on what theSecretariat is doing and aims to create an information exchangeamong hinders inspiring greater collaboration and communication

Women and Children inEastern Europe -In fall of 01 dp..cu,,,,unr, were held with the WID office in USAID.with indi\ iduals within the World Bank I ligh Scope FoundationUNESCO and S(.1- to develop a project focussing on assessing theneeds of women and children in [astern Europe With the changesin government there have been changes m the wink pattern forwomen and in the pm% ision of (me for Young children Wilde many

43

have begun to examine the impact on women of moving to a marketeconomy it is as yet unknown what the impact of these changes areon young children. By working with counterparts in selected coun-tries (Albania, Hungary, Romania and Poland) an assessment will hemade of current child care provision in the countries, with recom-mendations for activities that could he undertaken by donor agenciesto support young children's development. Funds for the project werereceived in late 1993 from LISAID and the World Bank. The projectwill begin in 1994.

The Roles of the Members ofthe Secretariat -Through the changes that have taken place in the Secretariat overthe past months, we have taken some time to clarify the role of theSecretariat of the Consultative Group. We have found, in fact, thatwe offer a variety of services and play different roles in our interac-tions with different people and organisations. We have come up withthe following short description of what we see ourselves doing.

We have defined five key roles we are playing in relation toECCD internationally. These represent the ways various participat-ing organisations relate to us. If there are ways we can support orinteract with your organisation that are not described below, pleaselet us know.

Neiworking At the most basic level. we are nnernational netinotker,We try to keep track of who is doing what where and to let otherpeople know about it Some of you play a similar role within yourparticular Acres We try to foster communication among all thegroups we come into contact with, drawing on your news informa-tion and knowledge as well as on our own. to put people in touchwith each other

Some of this "news' is shared with a broad network of individualsand institutions receiving the Coordinators' Notebook Some is sharedmore frequently through the Fun, leN" Folio. Even more commonly.networking occurs on a personal basis in direct conversations. Notinfrequently we get calls from organisations asking about availablematerials on a particular topic. about instruments and measures orabout people who would he appropriate to carry out an evaluation oran assessment of a project in a particular country People turn to usbecause we do know who is doing what where, or. we know whereto find out and we put people in touch '.with that source some-times one of you

Taking the networking role up one notch we also create networksamong people with common interests and concerns encouraging theexchange of experiences across organisations and sectors One exam-ple of this kind of networking is the yearly meeting of theConsultative Group Another is the recent meeting held in SantaMarta that brought together various Latin American Networks, eachof which approaches programming focussed on the child from a differnt perspcctive. Yet another example resulted from work Bob hasdone in Bolivia that allowed him to help make connections betweenSCF and the government as it develops a new program of home daycare.

2. Adio ul as a I Soundinq Mod For some organisations the Secretariatand its Advisory Committee serve as a Sounding Board This is espe-cially important for organisations that are developing a programmeor looking for people outside their organisation to provide and/orcritique ideas For example, LISAID and the World Bank have turnedto the Secretariat and the Advisory Committee for programme ideasas has the Latin American Regional Office of UNICEF When wewere in India, Judith spent part of a clay with the national and

44

Activitiesof theSecretariat

Activitiesof theSecretariat

regional CCF staff, acting as a sounding board regarding new devel-opments within their programming.

On occasion, the entire network of people who receive theloordinatorc. Notebook has been used as a sounding board, for instance.when UNICEF was in the process of creating child developmentmessages for a new edition of "Facts for Life". In effect, we can soundout ideas on a personal basis, through the Advisory Committee orthrough the entire network.

3 Synthestz nig Knowledge The Secretariat has often responded tospecific needs of participating organisations by bringing togetherexisting information on particular topics. This is generally used inorder to inform their programming or to facilitate the process ofadvocacy within an organisation. As a rule, these syntheses are ofinterest to a broader audience as well and are not restricted to usewithin a specific organisation. For example, the World Bank request-ed a review of research on the relationship between early interven-tion programs and performance in primary school which Bob pulledtogether. Judith has recently completed a paper for the WorldHealth Organisation synthesizing ideas about child care programmesas an entry point for maternal and child health components of prima-ry health care.

In other cases the Secretariat brings together information on top-ics that are identified as necessary to strengthen the field as a wholeor to provide a general basis for advocacy. Specific topics may origi-nate with participating organisations, or be suggested by theAdvisory Committee, or emerge from consultations and the insightsof the Secretariat as it looks broadly across the held. The review ofinstruments and measures carried out by Cassie Landers is one exam-ple. Other examples include reviews of childrearing practices, ofchild-to-child programmes and of early language learning

The preparation of the background paper that was pro-

QualityEducation

for Alit

---------EARLY CHIGAHOOD

P51110M"F

MEETING BASICLEARNING NEEDS

duced for the EFA Forum in New Delhi and Bob's book The

Twelve Survive are examples of more general synthesiz-ing tasks

4. Go:crating loimeLigt On occasion the Secretariat hasbeen called upon to identify areas in which action researchshould be undertaken to till an important gap in knowledge.This call may come from organisations participating in theCG who have a shared interest or from discussions at theannual meetings of the Group. The Secretariat takes on theresponsibility of putting together a project within whichinterested organisations can participate. It also takes respon-sibility for coordinating the research and synthesizingresults.

An example of this action research is a project just devel-oped to assess the situation of young children in EasternEurope. described on p 41 Other examples include theSecretariat s work on the Child Status Profile (with supportfrom UNICEF, IDRC and USAII)( and work on

Childrearing Practices and Beliefs, with support from various sec-tion-, of UNICEF

5 P rot, id nig Tahiti( al A< ,i hiii e Members of the Secretariat areemployed 3/4 time with the CC, They have 1/4 time available toprovide techuiLal as,istame to organisations. which may or may not heparticipants in the CC This generally involves agency- and «Rintry-specific protects which are contracted with individual members ofthe Secretariat This work enhances the experience base of theSecretariat and the results become part of the knowledge that webring to the CG Examples include the evaluation of the Day CareProtect in India sponsored by AU an invitation from the UNICEFnational office in Nepal to assess and recommend action by UNICEF

45

to enhance ECCL) in that country; working with the World Bank toset up the family day care project in Bolivia; working with the WorldBank to assess the feasibility of adding a "head start" year to the for-mal school system in South Africa once the new government is inplace

Thus. we play several roles. The balance among these roleschanges as we develop relationships across the entire network Asthe field of Early Childhood progresses, the balance of these activi-ties will necessarily change.

Affiliate Status -We have added a new category of partnership within the CGOrganizations such as NG0s, which are not in a position to becomesponsoring members, can now become part of the CC, Network asaffiliates. The affiliate status represents a contribution of USD $500.Affiliates will have access to the Funders Folio and Occa,ionalPapers produced by the Secretariat. in addition to receiving the( ootdinator" Notebook. The idea came about as a result of inquiriesfrom NGOs about how they could be more involved in the network-ing process If you know of groups that might be interested in thistype of affiliation with the CG. please let us know.

Activitiesof theSecretariat

News from theAdvisory

CommitteeNews from Members of theAdvisory Committee -Inch! Balagopal is involved in a new advocacy group in India calledFORCES Fonrn, lot Early Childhood Car( Sean).' Using many of thematerials produced by the Consultative Group on Early ChildhoodCare and Development FORCES is presenting the case for youngchildren to policy makers within the Labour Nfinistry The intent isto have childcare concerns and programmes included in the 8th Five-Year Plan It is good to know when materials are being used. andhow

Janet Brown of the Caribbean Child Development Centre(CCDC1 has provided a lengthy report on the activities of CCDC.These are included in the NthooFk Nov, section. Her manuscript onthe role of lathers in childrearing in Jamaica has now been published

Cigdem Kagitcibasi is on a sabbatical leave for the 1993-94 acad-emic year She is a visiting professor at the Netherlands Institute forAdvanced Study where she will be doing research and writing. Shecan be reached through the following address. Cigdem KaguctbasiNetherlands Institute for Advanced Study. N1enboomlaan t 2242Wassenaar The Netherlands (Phone 31-1751-19 302 (Office) 31-

1751 10845 Hornet 31-1751-17162 ( Fax IBarnabas Otaala has been at the University of Namibia for three

years He is [ali of the Faculty of Education Barnabas was veryactive in the development of the Workshop on ChildrearingPractices and Beliefs which was organised by the Secretariat of theCG funded by UNICEF and hosted by UNICEF Namibia and theUniveisity of Namibia. Within the Faculty of Education they are inthe process of developing a diploma course in Early Childhood Careand Development

Our Apologies -In the 1)(2u:tuber 1992 edition of the Cooldmatois Notebook. there werea number of errors as a result of editing of the muck on 7-family for

46

Child Care Workers in India, by Mina Swaminathan. The article indicatedthere were 2,000 balwadis in the early 1970s, when in fact there were20,000; Anganwadi (a place) and Anganwadi worker were used inter-changeably, causing confusion: sangha was misspelt as shanga; and otherwords were incorrectly interpreted when the article was edited. Ourapologies for these errors.

NetworkNews

Save the ChildrenFoundation (SC)Strong Beginnings:

Save the Children's 'Strong Beginnings'initiative is well into its second year work-ing to convince a variety of audiences thatthe education of the young child and relat-ed work with parents and caregivers is rel-eant tO their countries needs. Garneringsupport from a variety of funding sources,the initiative is gaining some momentum

In Asia UNICEF has agreed to fund aproject in Thailand supporting early edu-cation and women s education in the con-text Of women's economic productionactivities in rural areas A factors' day careprogram is oft the ground in thePhilippines and funds are being sought tobring this to a reasonable scale. USAID inNepal has decided to provide a largebasic education- grant to the Nepal Field

Office This will locus among other thingson non-formal early childhood educationand give a needed stimulus to the excitingNepali early childhood program whichbuilds upon women s literacy groups at vil-lage level

SC. along with UNICEF and theRegional Training and Resource Centre(RTRCI for Early Childhood Devel-opment sponsored a workshop from 3IJanuary to 7 February in Singapore. -ChildSurvival and Development Parents asCatalysts" The emphasis of the workshopwas on the importance of parent involve-ment :n early childhood initiatives. Policymakers donor agency personnel and thoseimplementing EC!) programs werebrought together to explore the issues and

47

share their experiences in relation to work-ing with parents As a result of theWorkshop a regional inventory of experi-ences in sustainable. low-cost. effective[CD programmes is being undertaken.and a regional network has been createdthat will he used to continue the sharing ofexperiences with the possibility of specificcollaboration on ECD projects in thefuture. The RTRC in Singapore will func-tion as a central source of continuing sup-port for the network

In the Middle East the EuropeanCommon Market (brokered by SC UK)funded a community-based early educa-tion program in Palestinian communitiesin the West Bank and Gaza Strip.Operational details of this exciting newventure are now being worked out.Designs have been completed on a similarproposal for Jordan in Palestinian refugeecommunities in urban Amman andBedouin villages in the Ham Hamida areawhere SC already supports women's pro-duction activities Education was a majorfeature of the 1993 Middle East regionalconference for field office staff held inCyprus in late lunc, provoking consider-able interest c a the part of the Egypt,Lebanon and Pakistan:Afghanistanoffices.

In Latin America, the focal point hasbeen the emergence of low-cost models ofhome-based day care which allows lorsupplementary education of women. Savethe Children offered a seminar in SantaMarta Colombia to discuss how it mighther nme more involved in this programmearea Costa Rica, El Salvador and Bolivia

have developed proposals to begin suchefforts.

In February 1993, SC held a five-dayLatin America Regional ProgrammingWorkshop on Education and Gender inColombia The workshop brought togeth-er agencies working in the region toexplore issues related to basic educationand gender. Representatives from SCoffices and donor agencies were presentfrom Bolivia, Colombia. Cost Rica,Dominican Republic, El Salvador, Haiti,Honduras. Mexico and Nicaragua. Theworkshop provided an opportunity toshare experiences across agencies and toidentify common programme interests as abasis for collaborative education activitiesin the future.

In Africa, nail -scale experiment inMali 'Ecole du Village." a project withinwhich village people build their ownschool and support their teacher by settingaside and cultivating land on the teacher'sbehalf has gained international recogni-tion by UNESCO and UNDP and will hereceiving USAID funds for expansion. Theschedule is tailored to the agricultural yearand the curriculum is geared to the needsof a peasant farming community andtaught in the local language.

The ceasefire in Mozambiques civil warhas opened up new possibilities for work-ing with displaced populations SCsChildren and War programme is workingto reunite children with family membersThe Portuguese government andUNESCO have joined in partnership withSC in a protect addressing the social reha-bilitation of children and families return-ing to their native areas through the devel-opment of early childhood centres at thevillage level which draw on the motherssupport and offer them educational oppor-tunities

In the USA with the amalgamation ofSC's international and domestic pro-grammes. "Strong Beginnings" with itsaccent on community self-help and cross-generational activities is an approachbeing explored Discussions are underwaybetween SC International and Save theChildren Care Support Centre in Atlanta

For more information on Save theChildren's Programmes, contact, Dr. FredWood Director, Education and EarlyChildhood Development, Save theChildren, 54 Wilton Road. P 0. Box 950Westport CT 06881 (USA) Phone 203-221.4125 Fax 203-222-9176

UNESCOYCF ProjectAim and Coordinating Role:

Established by the General Conferencein November 1989, the purpose of theUNESCO Young Child and FamilyEnvironment (YCF) Project is to he acoordinating body within UNESCO forinteragency and intersectoral activities onbehalf of families and young children.Special attention will he given in thefuture to support early childhood policy-making within the framework of theJomtien World Conference on Educationfor All which named the extension of earlychildhood services as one of the pillars ofbasic education.Results March - September 1993

Within the last six months. the Unit hascontributed to several interagency co-ordi-nation meetings and has received atUNESCO key representatives fromUNICEF the Consultative Group onECU). WHO, Save the Children, theBernard van Leer Foundation, Barnardo s.and the International Children's ForumOperational Project PreparationThis has been a central concern for YCFwork since March. The following is a sum-mary of our activities in that field.

I The project has re-launched UN-ESCO activity within Cambodia and issearching for substantial external funding.

2. Negotiations have begun to extend aSaudi pre-school project to other GulfStates (Oman, i3ahrain. UAEI. the MiddleEast (centred on Jordan) and Morocco.

3. YCF rs also supporting a project onMother, Literacy in Nepal. being run bySave the Children.

4. A $100,000 Mozambique early child-hood'community development programmefinanced by Portugal has been agreedupon. A mission to Mozambique has al-ready taken place and agreement in princi-ple has been reached with Save theChildren to operationalise the project intwo provinces

5 Several meetings with the Centre In-ternational pour l'Enfance have been heldto establish a practical diploma and Mas-ters programme in Child and Family Prac-tice in a major university with outreach tourban services:

6 YCF has been invited by BUPL (EarlyLearning Teachers Union) to provide anevaluation input on programmes whichBUN.. and DANIDA are planning tolaunch in Ghana and South Africa,

7 UNICEF and Save the Children like-

48

vise requested our co-operation in region-al training programmes in ECD to be at-tended by selected country personnel,government representatives and service-delivery (NGO) people;

8. International Year of the Family (IYF)1994 for the IYF, YCF is planning, to-gether with GAZA books, a publication ti-tled Fannlie5, to he published for theGeneral Conference in 1993. Likewise, weare organizing with the International Chil-dren's Museum in Oslo NORAD and theRoyal Norwegian Ministry of Foreign Af-fairs an art exhibition The Faintly SeenThrough Children", Eyts. We arc ,.?-inning tobring this exhibition to several cities out-side France particularly to urban centresin the developing world. Several meetingshave also been held within UNESCO andwith the consortium of family NGOsaffiliated to UNESCO in order to co-ordi-nate UNESCO s input into the Interna-tional YearResearch/Information/PublicationsA major role of the YCF Unit is to con-tribute to research and advocacy on familyand early childhood topics The Unit hasbeen able

I To prepare and disseminate widely anew publication Thi Dindoiy of Sub-Saba-tii Elihtitution. some copies are avail-able on request)

2 To promote the Convention on theRights of the Child We have publishedwith the French Mmistere des Affairs So-ciales dc Ia Sant ct de la Ville. an illustrat-ed Convention for children 6-1(1 years oldFree copies may be bad upon request

3 To contribute to the 'early childhood section of the luternatioual Eluyi.lopc-illa of EihiLatioli

4. To carry forward the production anddistribution of Bob Myers Toward a FanShut for Children Our most recent reprintingin English brings our total in that languageto almost 11 000 copies The French edi-tion is now prepared and is going to press.Spanish. Portuguese Russian. Indonesianand Thai versions are available. and recent-ly we have received first copies of the Chi-nese and Arabic versions

5 To evaluate the International Dire( tort' ofthe Ytthl14 Child dud the Family Eupitoinuntwhich lists and describes 670 early child-hood organizations worldwide Hundredsof evaluation questionnaires were sent outto readers and organizations The resultingreplies show that the publication was verywell received and was highly praised as asource (if information on early childhoodactivities Respondents recommend that

49

UNESCO continue this effort, and alsopublish region- or country-specific infor-mation.

6. To publish for the International Yearof the Family, 1994, two hooks in French,Le Deoenir de Ia Famine (author DjamchidBeynharn) and Famrllcs en mutation duns tole

Sotiete en Mutation, with the InternationalCouncil of Women.

7. YCF has begun work on:- the update of the International Dircoory,- a UNESCO manual on how nations care

for young children. This manual will es-sentially he a compilation of 2000-wordbriefs or profiles on the situation of earlychild development in Member States;

a series of action research papers on thechild and the family The first title isWorkiug with Rural Communises in Nepal

some principles of non-formal educationintervention by Amy Jo Reinhold Edu-cation Research Specialist with the Savethe Children Education Unit. WestportCT The title should be available in De-cember 1993

-contributions to the research journalChildhood published by the NorwegianCouncil of Child Research UNESCOwill contribute in each issue a 2000word summary of a successfulfamily. early childhood intervention.Our first contribution which will appearin the Winter 1993 or Spring 1994 issueis ?roiec to Padres c Hiios" by JoannaHp and Ximcna Valdes YCF welcomesproposals for this feature and in pa;!icti-lar information concerning good inter-vention projects in the developingworldOur address is John Bennett YET Pro-

ject ED BAS UNESCO. 7 Place deFontenot' 75700 Paris. France Phone 133-1145- 68 -34 -15 Fax. (33-1,1 40-65-94-05

Christian Children'sFund (CCF)Key Messages for Parents Initiative:

In early 1992 a parent training programon early child development was initiatedby the international office of the ChristianChildren's Fund The following is a briefsummary of the progress and lessonslearned since this program was disseminat-ed through 23 national officesBackground

The "Key Messages' initiative was

launched after an internal program assess-ment indicated that child developmentconcepts introduced by the internationaloffice were most often translated into cen-ter -based preschool programs for 3- to 6-year -old children at the project level Oneof the goals of the initiative was thereforeto broaden the age range of children beingreached by targeting the earliest agegroup, while introducing a greater varietyof programming strategies by identifyingcaregivers as an additional group to reach.Program Design

The content of the training programwas designed around basic "messages" forall parents, and was planned to he compat-ible with UNICEF's Facts For Life bookletThe curriculum was organized aroundphysical social emotional and intellectualdevelopment, and focused on the 0 to 2-vear-old age group 'although it covereddevelopment up to the age of 6 Toensure that the content was sensitive toculttual factors. program officers from rep-resentative national offices ii;sted towork together in ideiv.kiing key conceptsthat would forma u curriculum for par-ents. Each national oitice could then adaptthis core of information in developingtheir own training program.Program Implementation

Most national offices have responded tothis initiative by first focusing on thedevelopment of training materials appro-priate for illiterate parents. Some officesbut not all have worked with parents as afirst step in understanding local caretakingpractices and the kinds of information thatparents need. Other olfic:_s have devel-oped materials and identified critical infor-mation by consulting experts Althoughwe encourage the first method we are notyet able to show that one strategy is Ilenerthan the other In most cases thoughprint and visual materials ale but onemethod of communication Video pup -pc-try drama etc often serve as alternativeand mutually reinforcing modes of com-munication.

The second, and most problematicalmajor area of focus is the training strategyitself Most offices have used a two-stepapproach Trainers train project-level staffand members of parent committees whoin turn train parents In some cases thislast step is further broken clown so thatcertain parent volunteers arc trained andthese volunteers work with a selecther of families in their communityEvaluation

In evaluating these naming strategics

national offices have found that one-shottraining events with annual follow-upswere not sufficient to maintain the pro-gram. For example. CCF-Indonesia foundthat the initial interest and enthusiasm ofparents died out when trained project staffwere unable to provide satisfactoryanswers to their (the parents') questions.Project staff training was not sufficientpreparation for the kinds of questions par-ents began to ask Furthermore, there wasno mechanism for enabling the trainers tolearn about and respond to the changinginformational needs of the project staff.Lessons Learned

To overcome these problems, someoffices have regionalized the use ofresources. For example a few offices havelocated expert staff in a region so that theyhave more frequent contact with a clusterof projects In doing so, the original con-cept of establishing a training program hasbeen modified In its place is the goal ofestablishing an ongoing and two -was- dia-logue between beneficiaries and resourcepeople Bob Myers has suggested that theconcept of key messages implies a top-down delivery of a pre-fabricated truthand that the programs may benefit fromdeveloping themes for discussion" insteadWhile a number of offices developed keymessages based on information and care-giving practices coming from the "but-unit we have found that establishing anongoing discussion is a critical and elusivegoal.

Bernard VanLeer FoundationFounded m 1949 the Bernard van LeerFoundation s central objective is toimprove opportunities for voting childrenwho live in disadvantaged circumstancesThe Foundation uses two main strategiesto accomplish this objective.

it supports the development of innova-tive field-based approaches in the areaof early childhood development and

it shares relevant experience with as widean audience as possible in order to influ-ence policy and practiceThis means that the Foundation sup-

ports projects in the field and also advo-cates for policies and practices that will(Acme improved conditions lor children'Mc Foundation believes that in circler toimprove opportunities for young children

50

it is necessary to work with people whosurround them and who can have an influ-ence on their lives. This: includes parents,siblirgs, other family members, communi-ties. organisations that provide services,local and national governments and inter-national institutions.

The projects focus on children frombirth to eight years of age who are leastable to benefit from educational anddevelopmental opportunities because ofsocial and other forms of disadvantage Akey objective in initiating and implement-ing projects is that their work will havelasting effects This could mean that theproject itself becomes self - sustaining orthat the lessons learned stimulate andinform other work Currently 127 projectsare being supported by the Foundation in45 countries around the world

Meetings involving project staff haveproved highly effective in sharing skills,ideas and experiences about such topics asteam building training methods. publica-tion and documentation evaluation andinstitutionalisation Particularly interestingin this respect were sub-regional work-shops in Belgium USA and Australia.among other countries

Elsewhere Brazilian projects have col-laborated to bring a national early child-hood database on line; in Australia a week-long 'Mobile Muster- involving projectworkers and the Federal Department ofHealth Housing and CommunityDevelopment sought better ways to coor-dinate mobile services for remote families,in France, an international conference forpractitioners in day care for young chil-dren was convened; in South Africa theSouth African N :work Trust began tofocus its activities around project staffdevelopment, in Morocco, Atfale held athree -clay conference which broughttogether practitioners. academics and gov-ernment officials to explore ECD and fur-ther the spread of programmes across thecountry and in Latin America, REDUC(Latin American Network for Informationand Documentation in Education) under-took a five-country survey of the state ofECD practice and is now publishing theresults

The Foundation produces a newsletterfour times a year. each with its own themeFor 1993 these were, "Where have all thefathers gone'" "Building on people'sstrengths" 'Children in conflict'', and"Resources and resource centres In 1991they launched a series of Studies and

51

Evaluation Papers. These are short back-ground papers which represent ECD fieldexperiences and findings, and includeanalysis and reflection. In 1992 six titleswere added to the list. Two came fromAfrica and covered "Contextual ChildDevelopment" and "Survival andDevelopment." One each came fromPakistan, "The Role of Afghan RefugeeWomen"; France. "Parent-run Day CareCentres" Scotland, "Parents in a NurserySchool" and the Middle East, "AlteringPractice in a Children's Home."

For more information write to:Communications Section Bernard vanLeer Foundation. PO Box 82334 EH, TheHague, The Netherlands. Phone: 131-701351-20-40. Fax. (31-70) 350-23-73.

Caribbean ChildDevelopmentCentre (CCDC)Major Activities

1 In January 1993 the report on TheContlibtaion of Car *call Alm to (13( Family A

lanniall Pilot was issued. This resulted in avariety of spin-off activities throughoutthe year One was the production of amanual to replicate the group discussionseries used to obtain part of the study dataThe manual contains background data onthe study, guidelines for facilitators inestablishing groups and eight session out-lines for discussion The manual is beingfield tested in Barbados. Jamaica andTrinidad The second set of activitiesincluded presentations on the study in avariety of national and international meet-ings Third a further research project hasbeen developed between CCDC and theUniversity of the West Indies, looking atGender Socialization in the CaribbeanThe study will he conducted in Dominica,Guyana and Jamaica, funded by UNICEF.

2. In late 1992, CCDC was contractedby the Child Support Unit of the Ministryof Local Government to conduct an evalu-ation of Jamaica's day care services. Theevaluation was completed in August 1993The report suggests that limited resourcescould best he spent on child developmentpromoters within a community. A call wasalso made for a policy group to articulatethe Government's commitment to pre-school age children, to be coordinatedwith all Ministries offering family supportprogrammes to young children

3. The Urban Basic Services Project ofthe Ministries of Health and LocalGovernment completes its third year atthe end of 1993. CCDC administers theDay Care Outreach Component. During1993 a research component was added totest the impact of project activities onchildren and their parents.

4. In January, Dr. Jaipaul Roopnarinc. aprofessor from Syracuse University, spenta month at CCDC Several collaborativeprojects resulted from his visit. ProfessorRoopnarine and Janet Brown. CCDCCoordinator, will Co-edit a textbook ofarticles by colleagues on aspects of parent-child socialization in the Caribbean, to hepublished by Ablex Publishing Companyas part of its series on Advances in AppliedDevelopmental Psychology Also, a jointUniversity of Syracuse1University of the\Vest Indies research proposal has beendeveloped to look further at families offirstborns, and to test an intervention tostrengthen parental investment in infantcare. focussed on fathers as well as moth-ers

5 Parenting Partners a task group ofprofessionals from 8 agencies developedthe Parenting Partners manual, publishedin October This two-volume set isdesigned for use by people facilitating par-ent groups Jamaica% Coalition for BetterParenting will distribute the manualthrough training workshops A televisionseric, is also being planned by ParentingPartners

For more information contact. JanetBrown, Caribbean Child DevelopmentCentre. University of the West IndiesP.O Box 141. Mora, Kingston 7 JamaicaPhone- 809- 927 -1618. Fax: 809-927-1920

ChildwatchInternational(CI)The Convention on the Rights of theChild and the Plan of Action adopted atthe World Summit for Children providethe terms of reference as well as a commonagenda for the improvement of the situa-tion of children. They also define a newinternational standard for policies to pro-vide children with optimal conditions forsurvival, protection and development, aswell as a new commitment of cooperationbetween nations.

CHILDWATCH INTERNATIONAL isa response of the research community to

the Convention and the summit Plan ofAction. CI is a network of institutions andprofessionals involved in research for chil-dren with the aim of initiating and coordi-nating research and information projectson children's living conditions and theimplementation of children's rightsResearchers studying issues related to thelives of children and young people canprovide important knowledge to facilitateand support the Convention. Researcherscan define the baseline situation of variousgroups of children, develop indicators tomeasure accomplishment of the goals, andpropose and develop strategies to improvethe situation

CHILDWATCH focusses on: thedevelopment of an international researchagenda, capacity-building within regionaland national child research centres, groupsand networks: networking amongresearchers and dissemination of researchresults. and creating a dialogue betweenresearchers and policy makers for the pur-pose of developing strategies for implementation of the principles of theConvention.

Initial funding for CHILDWATCH hasbeen provided by the Norwegian Ministryfor Children and Family Affairs. Fundingof specific activities is sought from a vari-ety of sources. For example, the SpanishMinistry of Social Affairs covered thecosts of a meeting in June 1994, and theNorwegian Centre for Child Research(NOSH) has co-sponsored several work-shops. UNICEF is involved with CI in thedevelopment of a project on children'srights indicators.

For further information contactCHILDWATCH INTERNATIONAL,Network for Child Research, P.O. Box1096, Blindern. N-0317 Oslo, NORWAYPhone (47) 22-85-48-41 Fax: (47) 22-8552-53

52

Publications and Videos

Sig rifitant Bemfits: The

High/Scope Perry

Preschool Study

Through Age 27

In I. 51 11WI INI I H V\NH I) P VG i !KARI

S \ I:NI 1 I v:1)

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1-hundn Depelopmeni and

Faintly Siudies in India: at:

Agenda for Research andPolicy

Fit 1( /Rs, TS SAR \`,W \ 1111

\NI) B11111 KVII:

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The High/Scope Foundation has recently published the latest find-ings from the High/Scope Perry PreschoolProject Conducted by theHigh/Scope Foundation of Ypsilanti, Michigan, the study has beenunderway since the mid 1960's. Through the years this longitudinalstudy has examined the lives of 123 African Americans horn inpoverty and at high risk of failing in school. At ages 3 and 4, theseindividuals were randomly divided into two groups a programmegroup that received a high-quality, active learning preschool pro-gramme and a non-programme group that received no preschoolprogramme. Follow-up interviews were conducted, examining bothacademic and life-style dimensions of the participants' lives Resultsof the study have been published periodically. Now, the results arcavailable as the study has followed these individuals through age 27.This most recent study, within which 95% of the original study par-ticipants were interviewed. also included data gathered from school,social services and arrest records.

As in earlier phases of the study, there are significant differencesbetween those children who attended preschool and those who didnot For example the children who attended the high quality active-learning preschool programme at ages 3 and 4 have fewer criminalarrests. higher earnings and property wealth and greater commit-ment to marriage at age 27 than those children who did not attendpreschool Over participants' lifetimes the public is receiving an esti-mated $7.16 saving tin terms of fewer social services needed andgreater contributions made) for every dollar invested in preschool.

The High:Scope Perry Preschool study and similar studies suggestthat early childhood programmes have significant, lasting benefitsbecause they.

empower children by enabling them to initiate and carry out theirown learning activities and make independent decisions.

empower parents by involving them in ongoing relationships asfull partners with teachers in supporting their children's develop-ment.

- empower teachers, by providing them with systematic inservicecurriculum training supportive curriculum supervision. and obser-vational tools to assess children's developmentFor more information contact. High/Scope Press. 1100 N River

St . Ypsilanti, MI 48198-2898. Phone 313-485-2000 Ext 274. Fax:31 3-485-0704 Price, LISI) $25 00

Childcare, early childhood education and the family are all widelyrecognised as being of fundamental importance This is especially soin India where with increasing rates of infant survival. more andmore children are being brought up in circumstances which exposethem to delayed or debilitated development in the crucial earlyyears.

This timely volume underscores the need to develop appropriateprograms and policies for child and human development which areculturally specific. To this end the contributors advocate thegrounding of research in rigorous theory while incorporating alterna-

5 3

tive formulations which go beyond description and focus on process-es Besides identifying issues and problems, the contributors suggesta range of possible solutions They stress the need for and outlineways of achieving an interface between research, program and poli-cy, and the desirability of effective and coordinated efforts to dis-seminate knowledge for the benefit of both practitioners and policymakers

An Important feature of this book is that it contains a truly inm.-disciplinary approach which considerably enriches the discussion.With its emphasis on the linkage between policy and research andon developing pragmatic 1-trograms based on theory and soundmethodology, this hook will interest scholars, activists or policymakers engaged in child development, social work. sociology andpsychology. (from the bookjacketi

This hook is aimed at front-line planners, managers and practitionersworking at the district health level in developing countries who aimto prevent and reduce maternal mortality in line with the SafeMotherhood global initiative.

It should also be useful to those who plan or teach in schools, orthose in informal adult education.

The book. which can be used as a field manual as well as a text-book. explains what Safe Motherhood means and how to mobilizeand plan for it as well as giving practical guidelines There is a chap-ter on \vhy the district level is so important for Safe Motherhoodwhile another places the mother herself at the center for thinkingand action

The knowledge skills and actions most needed at the communitylevel are considered :ind the need for partnership between variousdistrict development .2c tors is looked at

The importance of carefully designing a momtoring and evalua-tion system for assessing progress is also considered while the finalchapter focuses on the importance of research for Safe MotherhoodThe book also contains appendices a short glossary of words mostcommonly used a list of references for further reading, plus a list oftechnical text hooks for health practitioners at the district level

The author. who is a Senior Freelance Consultant in InternationalHealth, says the aim of the hook is to help a broad range of peopleget the message of Safe Motherhood

Tioring flir TO( is available from TALC P 0. Box 49. St Albans.Herts. ALI 4AX United Kingdom. Price £5.50 plus P&P.

This hook is for people concerned with overcoming child and adultcommunications problems It is aimed mainly at community-basedrehabilitation workers and others who help with disabled children,but it should also be useful to doctors and nurses concerned with pri-mary health care and teachers who need to understand the difficul-

laced by pupils with communications problems.Pinirnig and Comintffiftailon 1),ordcr, helps readers understand what

communication involves and how it develops, then goes on to dis-cuss ways in which we can observe communication and sonic of theways in which it may fail to develop. Other sections deal with thecommunications problems of deaf people and the problems of men-tally handicapped and cerebral palsied children On the practicalside, information is given on how to help a slow child develop lan-guage and how to help a very mentally handicapped child to com-municate Details are also given on hearing aids and how to observehearing and hearing loss

r7 4

Timing the Tide: A Safe

Motherhood District Action

Aianual

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TI.V. Aii \t Li CI

TALC, 1: K t993

Hearing and

Comm ation I)isorders,

Ia Si If WIR/ \ND S SNI11

WIN) \RD TALC LI K 1993

&boot In:proponent in the

1)cycloping World Art

evaluation of the Aga Khaii

Foundation Proorarnme

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HIV Infection iii

Children - Slide Set

The book is written in plain English and each section has questionsto help readers gauge how much they have learned and understood.

The authors arc- Sheila Wirz, a stmior lecturer at the NationalHospital's College of Speech Sciences in London and Sandy\Vinyard. a lecturer in rehabilitation studies at the University ofSouthampton. Both have extensive experience as speech therapistsand in specialist training for rehabilitation workers in the UK andabroad

Available from TALC, P.O. Box 49, St. Albans Hew, AU 4AX,United Kingdom Price 03.80 plus ..2.00 p&p

Since 1967 the Aga Khan Foundation has promoted high-qualityeducation in the low-income countries of Asia and Africa. This eval-uation took a closer look at the principles underlying the Aga KhanFoundation's School Improvement programme It explored in partic-ular two projects one in Bombay. India and the other in Kisumu.Kenya. The report analy both existing research and original datafrom schools and classrooms. It will be of interest to anyone involvedin improving ,chools through innovative development programmes.

Contents include a review of literature on school improvementthe developing world; a case study of the project in Kisumu whichincludes an interesting account of clinical methods of staff develop-ment a case study of the project in Bombay which emphasisedchild-centred learning. a summary of the evaluation principles under-pinning the Aga Khan foundation model of school improvementthis includes messages about student-centred learning, methods ofstaff- training project management and cost issues; an appendix illus-trating the extensi:e range of instruments used in the study

Available From The Scottish Council for Research in EducationSCREt for i:10 including postage in the UK (elsewhere add C.2.501

ISBN 0 947833 79X. SCRE 15 St. lohn Street, Edinburgh EH8 8)RUnited Kingdom. Tel-(03I ) 557-2944. Fax:(03 I 1 556-9454

Teaching Aids At Lower Cost (TALC). A new slide set 148 slideswith script dealing with HIV infection in children is now availablefrom TALC in St. Albans. It is aimed at doctors and other healthworkers who care for children with HIV infection especially thosewho are responsible for teaching others. and medical students.

Although knowledge of the natural history of HIV infection inchildren remains incomplete. this set aims to provide health careworkers with the information that is already available.

The set 1 divided into sections covering transmission diagnosis,clinical manifestations. neurological problems. prognosis, and man-agement issues

The commentary warns that HIV-infected pregnant and newly-delivered women need careful counselling to help them cope withthe uncertainties that they face. and says they need up-to-date 'idol--illation about the risk of infection for the baby, and factors whichmay influence the risk It says that the role of hreastfeeding in trans-mission of HIV is "extremely difficult" to study, and that the benefitsand possible risks of h--eastfeeding are different in different parts ofthe world

The text concludes that the rational policy for countries in sub-Sahara 0 Afric.a is to continue to promo.c breast feeding for allwomen whatever their HIV status, because although HIV carriessome risk of infection, not breastfeeding carries a greater risk for the

child who may die of malnutrition, diarrhoea, or respiratory intecnon The commentary says that the disease is still too new for us to

55

know how long a child horn with HIV infection may remain wellafter birth but signs and symptoms often show within four to fivemonths.

It goes on to list symptoms and abnormalities related to HIV suchas enlargement of lymph nodes, and diseases, such as tuberculosislikely to he encountered by children with HIV-damaged immunityOther sections deal with counselling and community care and thecommentary concludes with a list of information and resource mate-rials

Available Imm TALC. P 0 Box 49. St. Albans. Hefts, ALI 4AX.United Kingdom Price L9 60 for filmstrip and text with slide framesfor self-mounting. 00 for a ready-mounted set -%vith text Pricesinclude P&P for surface mail, for airmail please acid Li 80 If you arein a developing country deduct 00 from the quoted prices.

UNICEF s Women's Development Programme has taken an impor-tant step HI its strategy to mainstream gender with the mtroductionof its quarterly newsletter ADVANCE The newsletter is a responseto the need for networking. as well as the sharing and exchange ofinformation as the drive to integrate gender issues into UNICEF sprogramme process accelerates.

In the introductory newsletter published July-Sept 1993. there isa letter from the Editorial Board It is included here as it provides agood overview of ADVANCE

We. in the Women s Development Programme Section arcpleased to present the first issue of our quarterly newsletter Womenand Girls ADVANCE ADVANCE emerges from our conviction thatan essential component of the move towards women s empower.meat. is the sharing of ideas successes and lessons learned in ourwork to promote the well-being of women and girls

The newsletter is also a response to the need for us to share withcolleagues and counterparts our critical partners in our work tomainstream gender throughout UNICEF s programme process theactivities and new initiatives of the Section

Future publications of ADVANCE will rely greatly on the input ofour colleagues and counterparts in the IR:Id We encourage yourfeedback. letters to the editor. sharing of case studies articles andother materials relating to Gender and Development (GAD) Yourinvaluable input will help provide additional information on activi-ties in your region and enrich the quality and contents ofADVANCE.'

For more information about subscribing or contributing toADVANCE contact UNICEF Women s Development Programme(DH-40DI 3 United Nations Plaza New York, New York 10017Phone 212-702-7262'7268 Fax 212-702-7148

This Newsletter aims to provide information on life skills educationworldwide

V'e want to spread awareness of the value of teaching skill, forlife to children and adolescents in school settings and to encouragenew initiative by sharing up-to-date news about what is going on inthe area of Ilk- skills education in various parts of the world In thisway we aim to open up a channel for communicating ideas within aglobal network of workers in this held The Newsletter will come outat six-monthly intervals for a limited period in order to help formand consolidate the network

Rich issue piesents information on life skills for children of various

ages offers news on WI 10 Programme aLriitic`, reports on Plo-5 6

ADVANCE - a veto

newsletter from the Women's

1)etylopment Programme at

UNICEF.

Skills lot Life Newsletter a

network coordinated by the

W1-10 Dirision of A lental

Health.

Childhood A Global

Journal of Child Research

grammes and research related to the topic, and presents reports fromparticular countries.

To be included on the mailing list for the Skills for LifeNewsletter, write to: Dr John Orley, Senior Medical OfficerDivision of Mental Health. World Health Organization, 1211Geneva 27, Switzerland.

IMOOd is a new quarterly journal. which first appeared in February1993. It is published in association with the Norwegian Centre forChild Research by Munksgaard International Publishers Ltd. ofCopenhagen. Denmark

The first issue contains the following articles. I. Gabarino,'Childhood what do we need to know:', B E Andersson. U.Kill Holm and K. Sandqvist. -Rising Birth Rate in Sweden: a conse-quence of the welfare state and family policy7-.. N Kobayashi, "ChildEcology a theoretical basis for solving children's problems in theworld A.I Odchiyi. "Sex-role Patterns implication for AIDS inchildren7- B Bakken, -Prejudice and Danger. the only-child inChina.

USA subscription price for four issues is USD $122.00 includingairspeed delivery DKK price is 700 00 including postage. For moreinformation and subscription forms contact NIUNKSGAARDInternational Publishers Ltd 35 Nora. Sogadc, P.O Box 2148 DK-1016 Copenhagen K, Denmark Tel. 45 33 12 7(1 30 Fax -45 3312 93 87 Or regional office. Munksgaard International PublishersLtd.. 238 Nlain Street. Cambridge MA 02142-9740 LISA. Tel ,1(617(547-7665 fax +1 (617) 547-7489

5 7

Ti TAI1VF GROL11, ON EARLY a )(11) CARL AND DIATLOPMENT (CC) is an inter

national interagcnc glom, dedicated to imprming the condition rtt \ oung children at risk TheCC grounds its work in a crossdisctplinaiy stew of child kale and decelopment

Launched in P18.1 the CG has taken as its main purpose the fostering of «immunication among internationaldonor agencies and their national counterparts among decision makers (tinders researchers programme

pro\ icier,. parents and communities with the goal cif strengthening plogrammes benelitting young children and

their familiesThe CunwItame (;roup and icptc,,cmcil hs us ',rt. I VIM Ili, in\ Irides an International

Advisolv rimmittee and a broad -based network of participating organisations and individuals who share a cormmitment it histering the and health\ de\ elopment of young chddirmThe CC is housed in 1.1NI(.1-1- AdmunstratRe backstopping is provided by the I iigh Scope Foundation Financial

support t n till' at ..,mss from participating organisations

GOALS

l's( RI .55I. I HI- KN)wt.EimE BASE The CC gathers syndic-sizes and disseminates information on

Juldrens des Annmcnt (hawing horn held c`, traditional 's Isdnm and scientific research

AS A CA 1,11-Ysl. The CC, works to increase awareness of issues af tec um; children decd."ping materials and strategies to help none communities organisations and governments fromrhetoric to mach( e !torn poln v to prnglarnmtne.To BUILD BRIDO1 s The CC fosters networking among those with common conc erns and interestswinking actress sectorai divisions putting people in touch with the wink of others by of ganisingmeetings hs disseminating intormation through publications and Ins seising as a communicationspotent

SFRVI: As A SoUNDING BOARD The CG engages in dialogue with (under, and decision-makersabout decelopmnis in the field pun ding the base for polies formulation planning programmingand implementation

isio,n11. i oid4c4dord ,pgam,atmn.,

programme design implementation and es aluation and in the nn ming of technical papers and re-

portsThe ( Nati hook rs produced twice annually It is one of out networking tools Each issue foe

cusses on a particular issue or topic as well as offering network news We try to provide information

on the most appropriate research held experience and practices to benefit inch\ 'duals working with\ "um,. children and their families \sce encourage sou to share this inhumation with the other networks cou take part in Feel free to cops portions of this Noir book and dissemmatc the information to

those who could benefit horn it Please let us know ahout any programmes or efforts benehtting\ 'HM12 c hIldIal and their families in which you may he involved

For further information and to subscribe contact:

Dr ludith Tsarso The Lope

Han denville NiA WO USA

Tel t 413, 268-7272Fax 413,268 -7279

The Consultative Group can also be reached through:

Dr Robert MyersInsurgentes Sur 4.111

Ed 25.202-flak oligia

I) F 14430 NIFNK ('Tel las 52 5. 571-3'169

CG Secretariata House

Three (lotted Nations PlazaNew York New York 10(117

Tel _21_,702 723Fa. 212.702-7149

58BEST COPY AVAILABLE