User:Phaello/sandbox/Early Childhood Development/Perspectives on Integrated Early Childhood Care and Development: The Lesotho Practice

PERSPECTIVES ON INTEGRATED EARLY CHILDHOOD CARE AND DEVELOPMENT: The Lesotho Practice

A PAPER PRESENTED AT THE LESOTHO NATIONAL EDUCATION DIALOGUE FROM 8TH TO 10TH NOVEMBER 2006 AT THE NATIONAL CONVENTION CENTRE, MASERU
Prepared by Phaello Ntšonyane

Introduction
The child is part of the future of a country; so as we speak of the economic, political, scientific and technological future we should not leave behind a child, who forms the most important component of any presumed future. The child therefore is the corner stone of the development of a country. This only shows how important it is to ensure that we provide good programmes of Integrated Early Childhood Care and Development (IECCD). Through this National Dialogue I believe that we are going to work together to come to a common understanding of what we mean by IECCD and where we are in terms of access and quality provision of IECCD programmes. It is also my sincere believe that we will together try to understand the challenges we face in IECCD and come up with strategies that could be employed to improve the current status of IECCD services and programmes.

What is IECCD?
The period of Early Childhood stretches from 0 to 8 years of age. During this period children’s needs are met by particular sectors such as Health (0 – 2), ECCD (3 – 5), and Early Years Primary Education (6 – 8). A child's ability to think, form relationships, and live up to his or her full potential is directly related to the complementary effect of good health, good nutrition, and appropriate stimulation and interaction with others. A large body of research has proven the importance of early brain development and the need for good health and nutrition for a child to develop to his/her full potential. As some of the cross-cutting issues, the early years period also recognises the importance of addressing HIV and AIDS, Gender, Child Rights and Environment issues from the early development of the child.

Health
Early childhood, from birth to age 8, is a time of rapid development when ill-health can have its most profound consequences like stunted physical growth, and adverse effects on mental and intellectual development. Many of the most prevalent infections and diseases tend to have their highest prevalence during this phase and are associated with late or non-enrolment in school, slow progression through school, and enhanced risk of dropping out. For many of the most prevalent conditions, cheap and simple interventions which have proved to be effective, such as immunization against measles, ORT for diarrhoea, and drugs for parasitic infections, are already employed.

A comprehensive program of care for young children, however, extends beyond disease control. The rate of recovery from measles, for example, is enhanced by Vitamin A supplementation; over half of child mortality in low-income countries can be attributed to malnutrition. The promotion of early child development implies the need for the early delivery of a comprehensive package of interventions through a cost-effective and sustainable approach.

Nutrition
The effect of under-nutrition on young children (ages 0-8) can be devastating and lasting; it can retard behavioural and cognitive development. Lack of good nutrition can have negative impact on health and ability to learn among other things. Good nutrition is the first line defence against numerous childhood diseases. Depending on how one eats, the body prioritizes on how to make use of the food. In the event that the body does not get enough food, according to Sagan and Druyan (1994) “…The body has to make a decision about how to invest the limited foodstuffs available. Survival comes first. Growth comes second. In this nutritional triage, the body seems obliged to rank learning last. Better to be stupid and alive than smart and dead”.

Most of the children in ECCD Home base programmes are orphaned and vulnerable children who hardly get enough food let alone one that is nutritious, it is therefore imperative that a feeding programme is carried out. Research has shown that children who receive combined nutrition and stimulation programs simultaneously perform better than those who receive either type of intervention alone. IECCD projects can help prevent and address malnutrition by providing supplemental feeding in centre-based and home-based settings.

The challenge here is how to make sure that the feeding programmes don’t only depend on donor funding, but measures are taken to make them sustainable on long term basis.

IECCD Programs can help monitor growth and provide food supplements and micronutrients; and can help with such existing public health efforts as mass immunizations. Some programs may specifically aim at changing parent behaviour by educating parents about the health and nutrition needs of their children.

While different ministries and departments are able to do their part when it comes to services and practices meant to help children develop, integration can help to better coordinate services and increase chances of success. All other stakeholders should be seen to be involved as opposed to just being participants.

All services that provide care, education or any intervention that leads to the development of children belong to the same field, what matters most is for the services to contribute to holistic development of the child. Every child and family should have a right to coordinated services for the holistic development of the child. Some efforts are being made towards realising the need for full collaboration between ministries and departments in issues relating to child care and education, but more still needs to be done.

For instance some of the collaborative efforts between IECCD and Lesotho College of Education (LCE) are plans to offer pre and in-service training for IECCD teachers. While it appears that there is the will from LCE to train IECCD teachers, it is however long overdue. Based on what has been known in the past about the early years, coupled with the resent research on brain development, early childhood is so much an important area that the issue of institutionalized teacher training for IECCD caregivers must have priority.

Additionally earlier in the year Training of Trainers was held for 30 IECCD trainers and recently 52 home base caregivers were trained on educational and professional issues in IECCD.

Why IECCD is Important
Benefits of ECD interventions can be found in the following areas:
 * High intelligence scores
 * High and timely school enrollment
 * Less grade repetition and lower dropout rates
 * High school completion rates
 * Improved nutrition and health status
 * Improved social and emotional behavior
 * Improved parent-child relationship
 * Increased earning potential and economic self-sufficiency as an adult

Ensuring healthy child development, therefore, is an investment in a country's future workforce and capacity to prosper economically as a society.

Child Development and The Socio-eco-cultural Environment
The development of every child is not only dependent on the genetic make up. Environment seems to play an important role. The “nature-nurture” controversy has gone on for some time, but recent brain research seems to emphasize the role played by the environment on child development. It is clear that the child is born with a frame-work which can hardly show any development without stimulation from environment. The frame-work in this case is the genes inherited from parents. The environment refers to the physical environment, the social and cultural aspects. A child is born with its natural genetic traits, although the combinations will differ from one person to another. Different cultures define and assign different developmental tasks to the same genetic make-up.

There is variability in developmental goals in different societal contexts. A child’s cognitive activity takes place within a cultural context. For one to understand cognition in any cultural context he/she needs to understand the concerned cultural values. For instance, in the rural setting, for a boy child to be showing positive signs of development he should be seen to be knowledgeable in dealing with domestic animals and probably agricultural activities, able to model with clay, “a tsebe ho bofa tonki”, “a tsebe ho palama pere”, etc. Children in a rural setting acquire skills and knowledge of how to look after and care for animals and crops. In the urban areas it is different. The boy has to be able to operate electrical/electronic equipment, has to be able to make toy cars using pieces of wire, has to know how to ride a bicycle etc. All these examples show that it is what happens in a community that influences the development of the child. Development is taken as a progress in skill, understanding and perspective, regarding problems and their appropriate solution, as defined by the local culture (Rogoff, 1990). It does appear then that cognitive performance is intertwined with cultural context. Intelligence develops differently in different physical and cultural environments; and can be better described by different cognitive skills developed in and valued by a particular culture (Ohuche & Otaala 1981).

The socio-eco-cultural environment involves a number of levels in the community; the inner-most level is the family, parents and siblings. The next level is the neighbourhood, the extended family and the school. There are also levels that affect the child indirectly; these include the parents’ work place, societal norms and values, government policies and laws.

The child’s environment is not static, it is always changing: there will be birth of the child’s siblings, time to enter school, moving from one residential area to another and there will be parents’ divorce etc. All these will modify existing relationships. The child and his/her environment produce new conditions that will affect development.

The time at which the environmental change takes place affects the impact of that particular change to the child — the arrival of a new sibling will have a different impact on a toddler from the impact it will have to a school age child.

These environmental changes can be imposed on the child – as in the examples above – but the changes can also arise from within the child, because as they get older they select, modify and create many of their own settings and experiences. As much as children are affected, and their development is influenced, by environment, the environment also gets affected and modified by children. That is to say that the behaviour and characteristics of children can also affect parents/adults and siblings.

Brain Development
Recent research has shown that the biological being of the child, inherited from parents, only determines things like how many brain cells he/she is born with and how they are arranged; and many other biological processes. It provides only the framework for development.

The first five years are very important for the child’s brain development. What one does and says can help make connections in the child’s brain for the development of thinking, feeling, moving and learning. If the connections are reinforced from time to time they may have life long effects. Positive interactions a child has with adults, and the caring he/she receives present stimulation that makes the brain form these vital connections (Newberger May 1997). For these connections to form, stimulation is needed; and after these first five years the rate of connections is slower (Dodge & Heroman 1999). If there is little or no stimulation the brain will make a small number of connections – very little of brain development takes place.

What kind of Stimulation
Normal interactions with the baby like talking to him/her; singing to the baby; prodding him/her to smile or laugh; simple cuddling and all kinds of positive things that mothers and older siblings do in trying to initiate play or communication with a baby is what triggers the important and necessary connections in the brain. Talking to the newly born while she/he stares at you goes a long way in providing stimulation necessary for the development of the brain.

Good or bad it will affect the connections
A stressful experience such as physical or emotional trauma triggers a stress-sensitive system that causes production of cortisol (a hormone) in the brain. High levels of the hormone kill some of the brain cells and breaks down some of the connections that had already been formed in certain areas of the brain. Warm and responsive care turns off the stress-sensitive system quickly and efficiently. Children who have been emotionally neglected or abandoned early in life are more likely to have learning difficulties, among other things (Newberger May 1997).

Windows of Opportunity
According to research there are times when brain develops more rapidly, and if the time goes by without proper stimulation for development, the opportunity is lost. These periods are called ‘Windows of Opportunity’ (Newberger 1997). For an example: eye sight in infants must be developed within the first three to four months, if the necessary stimulation is not provided the child will never be able to see (Dodge & Heroman 1999). Some of these windows of opportunity remain open for a longer time, but learning is easier at certain times referred to as ‘sensitive periods’.

These windows open wide during the early years and begin to narrow as the child gets older. If the windows of opportunity are missed (i.e. if the brain does not receive the appropriate stimulation during a "critical period") it is very difficult, though often not impossible, for the brain to re-wire itself at a later time. In abnormally deprived situations, lack of stimulations may result in impairment of the child, it does not mean that the child can't learn a new skill, it just means that it will take a lot more effort, with appropriate interventions for the child to finally learn the skill. For example here in Lesotho there are about 2000 children with special needs in the IECCD programmes.


 * Are our IECCD programmes ready to accommodate all children including those with special needs?
 * Do they have the capacity, infrastructure and facilities to enrol children with special needs?
 * Are we not going to run the risk of such programmes only keeping these children without actually meeting their needs?
 * We may have children with mental retardation, physical disabilities, learning disabilities and many other conditions, but do we have people who know how to deal with this kind of children in the IECCD programmes?

Nonetheless, information from MOET is available to show that, the ECCD Unit works in very close collaboration with the Special Education Unit, to address all issues of special educational needs from as early as IECCD level. To this, one is rightly informed that the IECCD Unit has been assisted by the latter to develop and add a manual on special education, into the Parenting Skills and Education manual that is used to train caregivers and parents. Furthermore, one acknowledges the Ministry’s intentions to address special educational issues through draft policy statement that “MOET will provide coordination of the education of children with special educational needs/disabilities and create a network of services at all levels of education, so as to foster children socialization and disseminate information”.

Research shows that 90% of brain growth is in the first three years of life. At around 4 years too many connections in the child who was exposed to stimulation have been made. Connections that are not repeatedly stimulated get pruned (Berk 1999). Healthy brain connections depend on healthy human connections. From the first day a child needs a stimulating interaction.

With this information available to us it becomes apparent that there is a challenge in IECCD provision in the country because the programme seems mainly to cater for children of ages 3 to 5/6. Apparently there is yet no programme for ages 0 to 3, a very critical period during which some vital opportunities are missed.

The Current Situation
IECCD in Lesotho is community based and driven. When projects are initiated from and by communities that is a good sign. Following introduction of ECCD programme (centre based) in the early 1970s the home based programme as another approach was introduced in 2001 targeting mainly orphaned and disadvantaged children. Initially the programme was piloted in four districts, and it has now been expanded incrementally to all districts. This year Ministry piloted attachment of Reception classes to 10 government primary and 1 community school with the intention to reach children in the most disadvantaged and remote areas.

Access
There are currently 64 home bases, and about 1,180 IECCD centres and 11 Reception classes nation wide putting IECCD access at 33%. The Ministry of Education and Training is aiming at increasing access to 40% by 2007, and to 70% by 2015. In the next year Reception classes will be attached to 100 more government primary schools. The numbers of orphans due to HIV and AIDS is steadily increasing in the IECCD centres, hence putting many children at risk of lack of proper care, nutrition, health and access to early stimulation.

The need to increase access for all disadvantaged groups cannot be overlooked. While it is a good thing to want to increase access, the question is how this is done. Increasing the number of home bases is one way of doing it, however, it is important to ensure that quality is maintained. Expansion of attachment of the Reception class for 5 year old children who are in their last year of IECCD is an initiative that must be undertaken. Lastly, on going efforts need to be made to ensure continued existence of the IECCD centres.

Training
The Ministry of Education and Training, through the IECCD Unit and with support from UNICEF and World Bank, is mainly responsible for training of caregivers, which is in-service. The caregivers themselves hold varying educational backgrounds whose levels need to be upgraded to provide them with professional and pedagogic skills.

Policy issues
Some of the factors that have been responsible for weakening early childhood education in Lesotho are unintended effects of Ministry’s education policies. The free primary education policy which indeed was put in place with good intentions and in line with some of the international declarations, has, I believe, to some extent  had a negative impact on IECCD in Lesotho. The policy affected early childhood education in two ways: first, because provision of early childhood education services in the centre based programmes is too costly for many families (and currently very many IECCD programmes are the fee-paying centre-bases), parents decide to hold their children from accessing IECCD services where they have to pay fees, until the children are ready to start their primary education which is free. Second, some of the parents seek early admission for their children into primary education rather than take them for IECCD services, because they do not have to pay fees in primary education.

Unless other initiatives are put in place to harmonize developments made for education by Ministry, others may deem such policies as lacking integration and coordination of services between different programmes of MOET or that some of the world declarations that nations become signatories to, are not sufficiently adapted by the individual countries to take into consideration their readiness and local contexts before recommendations are made for implementation.

At this juncture, one acknowledges the fact that IECCD provision in Lesotho is a responsibility of the communities. Government, through MOET, provides support to the communities in several ways; like in-service training, regulating and monitoring the programme and linking the programme to other partners who can provide support to children, such as feeding or providing teaching-learning materials. Therefore, in the case of IECCD, government does not pay caregivers/teachers in the centres and home-bases. As a result, due to poverty, many parents are unable to pay the small fees charged at the IECCD centres hence caregivers do not earn regular income, thus many get demotivated and leave.

In the Home base programme, caregivers are people who work with their own children to provide early stimulation hence they do not get any kind of remuneration; they do the work for the love of their children.

Reception classes are now being attached to government primary schools, as indicated earlier. Based on the situation on the ground, the assumption is that children enrolled in those reception classes do not pay fees. The fact that this is an assumption, right or wrong, only shows one thing, that the policy regarding this issue is not clearly spelt out. If at all the children in the reception classes are not going to pay any fees, then this means that it is highly likely that, where possible, children will move from IECCD centres, where parents pay fees, to government schools reception classes. If this happens it will offset the intended increase in access. It will be a repeat of what happened when government first introduced Free Primary Education and some IECCD centres were on the verge of closing as a result of movement of children from the centres to Free Primary Education, under age as they were.

Children enrolled in the reception classes are those who are at least 5 years old in the first half of the year in which they start reception class. They take one year in an IECCD programme, and go into grade one in the next year. Some of the children will be going into the IECCD programme for the first time; this will need a programme that will be enough to give children all the skills they need before proceeding into primary.

Conclusion
With the information and knowledge at our disposal on Early Childhood matters, it is imperative that we consciously take deliberate actions to:


 * Have the IECCD Draft Policy adopted and implemented to improve overall service delivery for children.
 * Strengthen Home base and Centre approach through regular training of caregivers, parents and communities to ensure sustainability and quality of the programmes.
 * Collaborate with all relevant stakeholders e.g. Social Welfare, Health and Local Government, to ensure that programmes for the 0 – 3 are implemented and closely monitored.
 * Handle attachment of reception classes to primary schools with utmost care so as not to let it defeat the purpose it is intended for.

Whatever we do for and about children must take into cognisance “the best interests” of the child.