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Advantages and Disadvantages of Integration_Pablo Stansbery_10.16.13

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Advantages and Disadvantages of Integration_Pablo Stansbery_10.16.13

  1. 1. Early Childhood Development + Health/ Nutrition
  2. 2. Caregiver/Family Child Family Home to Early Learning Environment Birth PreSchool to Primary School Child’s Development Prenatal Birth - 3 Ages 3 5 Ages 5 - 8
  3. 3. 1. Early Experiences Matter
  4. 4. 2. Social Referencing
  5. 5. 3. Nature versus Nurture Approaches to Learning
  6. 6. Milestones for early motor development
  7. 7. Promise of Preschool in Africa Mozambique 2011
  8. 8. ECD ACCESS Conventional Pre-Primary (GMR, 2012) Country Sub-Saharan Africa Birundi 1999 2010 10 1 17 9 Comoros 2 22 Ethiopia 1 5 21 65 South Africa
  9. 9. Development risks at baseline Risks Stunting Percentage 42.3% Risk of delays in fine motor skills (36-41 months) 70% Risk of developmental delays (36-41 months) 65% Orphaned Caregiver does not know how to read 10.01% 42% 51.35% Caregiver does not speak Portuguese Source: Authors calculation from the baseline data for the impact evaluation (2008)
  10. 10. Peabody: Receptive Vocabulary (2008)
  11. 11. ECD/Preschool Conclusions  ECD/Preschool model effective at:  Target Children:  Increasing primary enrollment & attendance  Improve pro-social behaviors & decrease hyperactivity behavior  Improving hygiene practices and reduce diarrhea & skin infex  Reducing children’s time working on family farm  Older Siblings:  Increasing in school enrollment  Parents:  Changing parenting practices  Increasing labor market participation  NO IMPACT: Improve child growth (stunting)**
  12. 12. What’s Trending: ECD ACCESS Integrated, innovative, scalable Home-based (Essential Package) Community Healthcare Workers (C4D) Cascade ECD-Health Fairs Parent-Child Community Gatherings Mobile Program Interactive Radio/ Phone Messages/ Email/ TV
  13. 13. Interventions with stunted children highlight the importance of stimulation  Integration of health, nutrition and education/cognitive stimulation (comprehensive programs) has larger and sustained impacts for children Non-stunted children DQ 110 Supplemented and stimulated 105 Stimulated 100 Supplemented 95 Control 90 85 Baseline 6 mo 12 mo Grantham-McGregor et al, 1991 18 mo 24 mo
  14. 14. 4. Integrated Programming: Nutrition/Stimulation
  15. 15. ECD Lifespan Approach Economic Strengthening / Health- Nutrition / Women’s Development Adolescent s Pregnancy Birth to 30 days 1 month to 3 years 3 to 4 years Nutrition/Food Security Adolescent Development Maternal and Child Health 5 to 6 years 7 to 8 years Primary Education School health and nutrition Child Protection, Global Warming, AIDS
  16. 16. Integration: Program + (ECD)  Maternal and Child Health  WASH  Maternal Education  Emergency Response  Youth  HIV/Protection  Resiliency and Peace Building  Basic Education (Emergent Literacy)
  17. 17. “Advantages and Disadvantages of Integration: Opportunities for Integrating Early Childhood Development (ECD) and Nutrition Programming” Ann M. DiGirolamoa, Pablo Stansberyb, , Mary Lung’ahoa,c a CARE International; b Save the Children; c Nutrition Policy & Practice Annals of the New York Academy of Sciences entitled “Integrated Interventions in Child Development, and Nutrition (forthcoming) Dr Mandana Arabi, Dr Maureen Black, Dr Lia Fernald, Dr Sally McGregor, Dr Ted Wachs, Dr Susan Walkers, Dr Aisha Yusafzai
  18. 18. Health Nutrition ECD (HNECD) Advantages Staff workload Supervisory Responsibilities 3. 2. 1. 2. 1. Cost effectiveness of HNECD programming Challenges Common language activities Co-location of services 3. Coordinated messaging 4. HNECD programs protect and promote children’s growth and development across multiple domains 4. 5. Training/Orientation
  19. 19. ECD Menu of Services
  20. 20. USG Children in Adversity 1. Build Strong Beginnings 2. Put Family care first 3. Protect children from violence, exploitation, abuse and neglect
  21. 21. 2 new ECD Resources
  22. 22. Essential Package Building Blocks 1. Positive caregiver-child interaction 2. Developmentally- appropriate approach 3. Link to broader systems of integrated care 4. Eliminate barriers to care and support
  23. 23. Activities parents can do with child… 0-2 months
  24. 24. Pstansbery@unicef.org
  25. 25. Group Discussion 1. Identify examples of promising practices of integrated programming. 2. Post- MDG agenda: Where sits early childhood? Should there be a separate ECD goal or embedded in current health/ nutrition goal. What might that look like?

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