Poverty LevelsEvolution of Poverty, Children Under 4 Years of Age 2000 to 2009 (percentage) There are 889.247 children under 4 years of age Data: CASEN 2009
Health Rates : Coverage• Professional care during child birth = 99.8%• 90% of women use the public health system for prenatal care.•79% promptly initiate their pregnancy care (before 20 weeks of pregnancy). Percentage of Children Younger than Four, according to the Provisional Health System, 2009 (percentage) 81,8% of children under four are attended to by the public health system.(*) The “Other” category includes the: “Other” and “FFAA y del orden” alternatives(**) The “None” category represents private care. Source: CASEN, 2009
Health Rates: Infant Mortality 2008 rate: 7,8 x 1.000 live births
Even though we have vanquished malnutrition and death,the full development of children remains a challenge. Source: Final Report II NATIONAL SURVEY ON THE QUALITY OF LIFE AND HEALTH 2006 Division for Health Planning. Ministry of Health.
Early Childhood Education Rates: Coverage Nursery and Kindergarten Attendance, 2000 a 2009 (percentage)Variation in percentages 2,6% 33,8% 15,3% 18,5% 87,5% 30,7% Source: CASEN, respective years
Nursery Attendance by Income Quintile, 2006 - 2009 (percentage) 2006 2009 14 13,1 12 10,5 10 9,0 8,3 7,8 8 7,1 6,6 5,9 6 4,8 4 3,0 2 0 I II III IV V Variation inpercentages 120,0% 41,4% 49,6% 14,9% -20,2% Source: CASEN, respective years
Kindergarten Attendance by Income Quintile 2006 - 2009 (percentage) 2006 2009 60 50,8 50 38,2 40 29,4 31,0 29,3 28,0 30 27,2 26,3 24,1 20,2 20 10 0 I II III IV V Variation inpercentages 12,9% 30,2% 4,8% -4,1% 33,4% Source: CASEN, respective years
Reasons for Lack of Nursery Attendance in ChildrenYounger than Two, 2009(percentage) Autonomous Income Quintile Reasons I II III IV V There is no need as they are taken care of at home. 75,7 76,0 75,1 78,7 82,2 No use for them to go at this age 10,8 11,7 12,6 8,8 10,9 Distrust in the care they would receive 3,0 2,6 1,2 3,7 1,3 They would get sick too often 1,8 1,5 4,0 1,1 2,0 There is no nursery nearby 2,3 1,1 1,1 0,4 0,5 Other reasons 6,5 7,0 6,0 7,3 3,2 Total 100,0 100,0 100,0 100,0 100,0 Source: CASEN, 2009 The “other reasons” category includes reasons such as “the schedule is not right for me”, “there are no vacancies” “access is difficult”, “economic difficulties, “”the child is disabled”, “a special facility is required” and “the child is not accepted”.
Reasons for Lack of Kindergarten Attendance in Children Between Two and Three Years of Age, 2009 (percentage) Autonomous Income Quintile Reasons I II III IV VThere is no need as they are takencare of at home. 70,5 70,0 68,7 72,9 74,8No use for them to go at this age 8,8 7,0 13,1 9,0 10,5Distrust in the care they would receive 2,8 5,3 2,7 3,3 2,6They would get sick too often 2,3 1,7 2,6 3,2 5,3There is no nursery nearby 5,3 3,7 1,7 1,1 0,1Other reasons 10,2 12,2 11,1 10,5 6,8Total 100,0 100,0 100,0 100,0 100,0 Source: CASEN, 2009The “other reasons” category includes reasons such as “the schedule is not right for me”, “thereare no vacancies” “access is difficult”, “economic difficulties, “”the child is disabled”, “a specialfacility is required” and “the child is not accepted”.
Presidential Advisory Council for the Reform of ChildhoodPolicies (2006)• Extensive participation Hearings with both national and international experts on the subject. Regional hearings with organizations and people linked to the issue. Inputs of thousands of children and adults through the Website. Committee of Childhood Ministers Law 20.379 Inter-ministerial Technical Group Public Policy Proposal Analysis and activities for the System for the Comprehensive Institutionalize ChCC implementation Childhood Protection 2006 2009 2006 2007 1 2 3 4
Its design is based on• Scientific evidence: • Consolidation and universalization of successful services and experiences (national and international evidence). • Window of opportunities (Large impact of working with early childhood). • Rate of return (very cost effective investment).• Broad consensus • Unanimous approval in Congress of Law 20.379 which institutionalizes the Subsystem for Comprehensive Childhood Protection, Chile Crece Contigo• In accordance with emerging paradigms • Social health determinants. • Focus on child rights. • Systemic Ecological Focus.
Strategic Investment For each dollar invested in Early Childhood the State saves up to eight dollars.
Multidimensionality and Intersectoriality• Childhood development is multidimensional.• Assistance must be given in a timely manner that pertains to theparticular necessities of each child.•Intersectional policies allow for the accompaniment of people’slifecycle, strengthening of resources, and a simultaneously impact relatedfactors.• Chile Crece Contigo allows for the junction of integral services that followthe path of child development during early childhood which strengthensthe impact of the actions taken. Positive Environment Early Adequate Stimulation Nutrition Health and Hygiene
What is Chile Crece Contigo?• A programme that allows for the equality of opportunities for childhood development, preventing the structural causes of poverty and supporting social mobility.• Allows for synergy among institutions : Provides, organises, integrates, and generates early childhood support benefits (from pregnancy until the child is four years old). These are provided by various public services which allows for a follow up of the development path of each child during their early childhood.• Falls within the framework of the Social Protection System.
Support Structure Central/National ChCC Design with local Communal Network expressions. Municipality Communal Level Health Education Coord. Governments Prov. P.S. Provincial Level JUNJI ChCC INTEGRA Managers Enc. Regional ChCC Health Regional Level Services SEREMI SEREMI SEREMI Health Serplac Education MINSAL MIDEPLAN MINEDUC National Level Committe of Ministers for Early Childhood
Personalized Accompaniment of development The System is entered Any of the child’s contact points after the 1st prenatal must activate the programe in check-up, no matter situations of vulnerability (Health, the week of the Municipality, Education) pregnancy Bio-psychosocial Development Support Program Health control birth Ex: Household Visit Program Health Inadequate living Health Ej: FPS implementation and derivation conditionsIdentification of vulnerability from Chile Solidariobio-psychosocialrisks accordingto protocol Social Need for vulnerability Municipality daycare Lag in Education development Differentiated Support Ex: Prioritized access to housing improvement program
Chile Crece Contigo is a network of integratedservices Public education Public system health network Unit for familial intervention FAMILY Other social services Stratification Office (FPS) Chile Crece Contigo communal network
Support and Benefits offered by Chile Crece Contigo• Bulk Educational Program with informative and interactive spaces.• Legislative improvements All children in Chile(100%)• Bio-psychosocial Development Support Program (PADBS)• Support Program for the Vulnerable New-born (PARN) children (74%) Children in the Public Health System (81,6%)• Free and quality nurseries and kindergartens.• Household visits from health teams.• Family allowance• Comprehensive attention to children lagging behind• Technical support for children with disabilities• Preferential access to welfare programs.
Pragmatic and Support ToolsMain Program: Bio-psychosocial Support Program (MDS/MINSAL).Support Program for the New-born (MDS/MINSAL).Fund for Childhood Development Support Interventions (MDS/Municipalities).Competitive Fund for Childhood Initiatives (MDS/ Public/privateimplementers).Fund for Municipal Strengthening (MDS/Municipalities).Agreements (Fono Infancia, Vulnerability Diagnosis).Bulk Education ProgramSystem for Registration, Derivation and Monitoring.Regional Technical Assistance.
PADB: Main ChCC Program (HEALTH)Bio-psychosocial Support Program Primary objective: Prevent risk situations and promote early childhood health Pregnancy Birth 0 to 4 years of age Strengthening Prenatal Personalized Attention to the Strengthening of Care for Children Development Care during Overall the Child’s in Vulnerable Labour Development of Overall Situations the Hospitalized Development Child A B C A B A B A B A PRIMARY CARE HOSPITALS PRIMARY CARE A. Comprehensive A. Strengthening of Prenatal A. Strengthening of Care for the New- Strengthening Care A. Personalized Care the Child’s A. born Hospitalized in Interventions for during Labour Neontology Health Control for Overall Children in Development Situations of B. Development of the Health Vulnerability, Plan with a Family Focus B. Comprehensive Lagging behind, B. Comprehensive Care for the New- and Deficient in born Hospitalized in B. Educational Overall Care during the C. Educating the Mother and her Pediatrics Interventions for Child Development Postpartum Period Significant Other or Companion Support
Support for the overall development of hospitalized children. Toy chestsToy carts
PARN (Kits)Programa de Apoyo al Recién Nacido (Support Program for the NewBorn) Workships: Education for Delivery of Set of parents and the family about PARN Materials Mother’s discharge from the hospital Securely • Educational booklet • Nursing pillow Attached Bundle •Sling-type baby carrier •Massage oil New-born Care •Liquid soap Package •Plastic changing table •Regenerating cream Package for an Equipped • Diapers (20) • Crib (collapsible) equipped with: Mattress, Blanket, Pen Cradle Set of sheets and a Down Quilt. • Cotton diapers (3) Baby Clothing •Bath towel • Body rompers for up to three months(2) Package • Rompers for 3 to 6 month old children •Pants for 0-3 month olds (2) • Shirts for 0-3 month olds (2) • One-piece for 0-3 month olds(2) • Two piece for 6 month old (2) • Knit cap for new-borns • Socks for 3 month olds(2) • Diaper bag
About LaggingLagging: When the child’s development process does notcorrespond to the standard expected at his or her age.Approximately 30% of children, exhibit lags or delays in theirdevelopment before they are four years old.This amount increases to 45% when it comes to children frommore vulnerable sectors.Scientific evidence indicates that timely detection allows for thespeedy recovery of the age appropriate level of development.
San Juan de la Costa Chiloé: roaming service in Buque Cirujano Videla ChañaralMulchen
Ludobus - La Florida Ludoteca Hospital of Valdivia More than 425 arrangements functioning in the country Ludobus - Rancagua
OTHER DIFFERENTIATED BENEFITS Intended for more socioeconomically vulnerable children (according to the established in law 20.379). Require the activation of the ChCC Network within a framework of Social Protection work.
Differentiated Benefits Automatic SUF. Nursery, kindergarten, partial or complete transport for mothers whowork, study, are looking for work, or are in a vulnerable situation. Preferred access to welfare benefits (Levelling of studies, inclusion inthe labour force, housing, health and mental care among others.). Technical support to children with special needs. Guaranteed access to Chile Solidario when necessary. For the 60% of the socioeconomically vulnerable population, as defined by FPS.
Bulk Education ProgramThe Bulk Education Program is the System for ComprehensiveChildhood Protection’s strategy for generating a social environmentthat is favourable for early childhood care and stimulation throughsensitization, promotion, information, and education. Website www.crececontigo.cl Radial Program “Creciendo Juntos” (Growing Together). Crece Contigo TV and audio-visual support material. Educational pamphlets and booklets. Catalogue of Reproducible Efforts, “When Copying is Good”. Monthly Informative Bulletin, “Growing Together”. Social Networks. Fono Infancia.
Main CHCC Evaluations• PADBP’s Quasi-experimental evaluation (non- concurrent cohorts over time), once the base measurement was produced.• Three sided experimental evaluation of the group workshop for child skills, “No One is Perfect”.• PADBP’s satisfaction study.• Satisfaction and PARN usability survey.• National Survey of Implementation (efficiency conditions for PADBP implementation).• Qualitative evaluation of the implementation of Bio- psychosocial Support Program• Quantitative and qualitative evaluacion of Chile Crece Contigo’s communal networks.
Some developments Consolidation and increase of relevant benefits inorder to support childhood development: research of riskfactors during pregnancy, household visits, prenatal educationand parental skills. High levels of user satisfaction with Bio-psychosocialSupport Program, and Support Program for the New-born(kits), at 81% and 94%, respectively. Systematic increase in de CHCC budgets (up 8% in2011), especially in terms or resources or support duringpregnancy and the benefit of preschool education.
Some developments Survey of 340 CHCC communal managers: theseresults will allow orientation on the use of the Funds forMunicipal Strengthening and regional technical assistanceteams. Creation of Indicators of Key Development for 100%of the communes, the object of which is to have indicatorsthat will allow us to identify how the Communal Networksare doing and what support they might need. Progressive increase in the use of the System forRegistration, Derivation, and Monitoring
Some Challenges Permanent re-installation of work networks.Consolidation of the management model. The communal teams need more support and need tolearn or improve their capacity for work within a networkframework. Quality standards ensured for all the benefits deliveredas well as access protocol of the benefits. Untreated childhood cohorts present a high frequencyof lagging and give their primary caregivers parentalstress. One third indicates not being able to support thechild. Strengthen assistance with families.
Key Concepts of the CHCC Model A single convener address on the transformation of society. Build on the country’s experience. National increase in existing interventions. Creation of new skills in the RRHH. Elimination of program overlap. Strengthening and formalization of network jobs on alllevels: • Circulation of information, management and continuous analysis of the information in order to make decisions. • The mechanics of derivations as pa practice for work. • Formalization of work networks beyond personal will.
Key Concepts of the CHCC Model Families who are primarily responsible for the upbringingand development of their children: offer more (and better)information to families. Focus on the quality of the services and benefits provided. Focus on the personalized accompaniment of each family. A welcoming and inclusive community that gives specialattention to small children. Multi-professional work teams whose main efforts andfocus are on childhood development.
Thank you The children’s future is always today. Gabriela Mistral