• Opinion
  • January 4, 2019
  • 10 minutes
  • 1

How using the health sector can unlock early childhood development’s potential

Opinion: The future of the field will involve a more integrated approach and starting younger

This piece was written by Matthew Frey, Director Global Integrated ECD/Nurturing Care Program, PATH. For more like this, see our early childhood newsfeed


Child development is a hugely complex neurological, social, biological and cultural process. Improving child development outcomes is also one of the most important endeavours of any government if it is to ensure growth, stability and the well-being of its people.

Today we are experiencing a convergence of scientific understanding of child development and programmatic evidence around how to improve long-term outcomes. We now understand that this process must begin from conception, not preschool, and that the health sector holds the key to helping children thrive as well as survive.

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This convergence demands action. The good news is that the global community is coalescing in an unprecedented way to support governments, communities and families so that more children can reach their potential.

Redefining early childhood development

When I began my career in child-focused health and development in Nepal 25 years ago, early childhood development (ECD) was a very different field. ECD was widely understood to target children from age three to help prepare them for primary school.

Governments, donors and partners invested in expanding the network of public and community-based preschools. They wrestled with questions of how to ensure that curricula were relevant to diverse populations, how to meet demand for teachers and staff, and how to demonstrate the impact of formal ECD education on improving primary results.

As my career took me to Haiti and later Vietnam, the field of ECD stayed largely true to these objectives.

Non-formal education and community-based programs began to reach younger children (zero to two years) and their caregivers, but most large-scale efforts for those youngest children still focused on health, nutrition and later HIV/AIDS. Child development did not figure prominently, at least in most lower income countries, consistent with the urgent need to reduce childhood morbidity and mortality under the Millennium Development Goals.

A quiet revolution has taken place in our understanding of brain development

Yet in recent decades, as more children have been surviving worldwide, a quiet revolution has taken place in our understanding of brain development. New brain science has opened our eyes to the power of basic caregiving, stimulation, early learning and protection practices that appear to be decisive in helping children to meet their full development potential in later years.

Overwhelming evidence from longitudinal studies now tells us that the simplest of practices around care, communication, play and affection — when consistently received from pregnancy onwards — will contribute to children being more likely to grow up as healthier, better-educated adults, with improved socioeconomic outcomes.  

Conversely, a window has also been opened onto the long-term damaging consequences to children of caregiver depression and exposure to violence and trauma during early years. This research led to a rethinking of how society supports and serves parents and other caregivers.

Leveraging the health sector to reach caregivers and children

In 2012, PATH, an international organisation focused on global health innovation, invited me to lead its efforts to determine the role that ECD should play within its varied global health platforms.

The literature was pointing clearly to a need to reach families of children under three with child development services, but evidence-based examples of how to best fill this gap were scarce.

A review of existing approaches in sub-Saharan Africa revealed an abundance of expensive vertical “parenting” programs with little potential for sustainability and reach, and with limited linkages to the public sector that hold the keys to scalability.

The health sector is the only sector that interacts routinely with families from the most critical time of early pregnancy through two years of age

A closer look in multiple countries confirmed that the health sector is the only sector that interacts routinely with families from the most critical time of early pregnancy through two years of age — the first one thousand days in which caregiving interventions have the greatest impact.

We found that typically the health sector has 15-30 touch points with families during this period, offering a rich and unexploited opportunity to support child development while also addressing health and nutrition needs.

PATH has since collaborated with national and subnational leaders, the World Health Organisation, UNICEF and other partners to refine a comprehensive health sector-based model.

Today, this model is operational in 11 districts of Kenya and Mozambique, covering approximately two million people, and is being expanded. The model embeds child development into the DNA of the health system, including policies, technical documents and packages, job aids, workforce training curriculums, indicators and supervision tools.

PATH has demonstrated the operational feasibility of this approach and is now evaluating its impact on child development outcomes.

Positive initial evidence and experiences are driving regional and national expansion and informing a growing global movement to bring together health, nutrition, responsive caregiving, stimulation, early learning and protection into an integrated whole — nurturing care. This should become part of routine standard of care in all countries.

The global community is increasingly aligned to support this process, as evidenced by many governments and multilaterals coming together to launch the Nurturing Care Framework at the World Health Assembly this year.

The recent creation of the global Early Childhood Development Action Network (ECDAN) and its endorsement by the G20 gives impetus and resources for improved cross-country knowledge exchange, collaboration and advocacy in support of national level action.

The regional introduction of the global Nurturing Care Framework to seven countries of Eastern and Southern Africa this October illustrates the global community’s intent to collaborate for country-level uptake of the new framework and the eagerness of governments to embrace this agenda.

More governments are stepping up and seizing the opportunity to invest early

With momentum building, more and more governments are stepping up and seizing the opportunity to invest early with the promise it will pay economic and social dividends in the future.

For example, the Ethiopian Ministry of Health recently organised an ECD sensitisation workshop to raise awareness among relevant ministries, partners and donors and to formulate plans to integrate and institutionalise Nurturing Care.

The Mozambique Ministry of Health has taken similar actions and has been making steady ECD integration progress across its various programs for nutrition, maternal and child health.

And in Western Kenya, an exciting model has emerged from the County of Siaya where the Governor has prioritised ECD for youngest children as his signature issue. The governor mandated all government ministries and partners to integrated Nurturing Care as part of his Smart Start Siaya Campaign, created a cross-ministerial committee to manage the process, and codified ECD as law within the Child Health Policy just approved by the Assembly and the executive.

These are but a few examples of exceptional leadership that is reshaping ECD in support of national and subnational development goals. The cost of this integrated health sector-based approach to nurturing care is low. The time to invest is now. — Matthew Frey

(Picture credit: Unsplash)

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