Developing a nurturing care framework for early childhood development: Consultation meeting

22 September 2017, New York, United States of America

More than 70 participants from government, donors, civil society, United Nations, health and education professionals took part in a rich consultation on developing a common Nurturing Care Framework for actions and results in early childhood development, during a side event at the UN General Assembly in New York.

The Lancet series Advancing early childhood development: from science to scale (2016) highlighted the importance of nurturing care in the first 1,000 days – from conception to age two – as the foundation for child development. This Framework will make a case for the strong role of the health sector in the key investments and propose concrete actions in the early moments and years of a child’s life as a fundamental approach towards supporting health, productivity and social cohesion along the life course, and to achieve the Survive, Thrive and Transforms goals of the Global Strategy and Sustainable Development Goals (SDGs).

This meeting was the first in a series that will help shape the Nurturing Care Framework set to be launched around the time of the 71st World Health Assembly in May 2018. WHO, in collaboration with UNICEF, and supported by the Partnership for Maternal, Newborn & Child Health and the ECD Action Network, are leading this initiative, with the aim of consulting governments and other stakeholders on the relevance and content of the Framework and to seek their early engagement towards its implementation.

Anshu Banerjee, Director, Global Coordination Family, Women’s and Children’s Health, WHO and Ted Chaiban, Director Programme Division, UNICEF in their opening remarks spoke of the body of evidence around brain science and the need for “getting it right” in the early years. Both emphasized that there is a lot to be gained from investing in the early years, the critical role of the health sector in reaching families and children with services, highlighting the extensive experience of countries that have already prioritized investment in early childhood development (ECD). Both stressed the importance of working in partnership and across sectors to support the six point agenda for action outlined in the Early Moments Matter report.

Marcos Barraza speaking at the consultation to develop an nurturing care framework, New York.
Honourable Marcos Barraza, Minister for Social Development and Director, Chile presents findings from the country’s ECD programme.

High level representatives from Chile and China opened the consultation by sharing learnings from their experiences. Honourable Marcos Barraza, Minister for Social Development and Director, Chile Crece Contigo, described how the government integrated a multi-sectoral early childhood development programme – Crece Contigo (Chile Grows with You) – into the country’s public health system, through an enabling environment supported by national policies. The programme – which has just been expanded to reach children from 5 to 9 years – is currently benefitting 1.6 million children with a special focus on the most vulnerable and reducing inequities.

Key lessons that have come out of this programme include the need for collaboration between and within sectors and agencies to overcome resistance to approaching child development holistically; ensuring that there is a budget for child development across sectors; and understanding that if there is no policy dedicated to children, there is no opportunity for their well-being.

Speaking to China’s experience, Madam Song Wenzhen, Deputy Director-General, the Office of National Working Committee on Children and Women, described the country’s 2030 Action Plan for Health of Women and Children. The plan has put in place a program for children’s development, specifically for the youngest children. As a result of this action plan, enrolement in pre-primary education has increased considerably; there are programs for free pregnancy check-ups, disease screening, and growth monitoring to ensure proper child development.

Nutrition improvement programs are also being implemented in rural areas and programs for community- based ECD offers multi-sectoral involvement from a range of government sectors. Implementation research supported by UNICEF has shown that a package of integrated health, nutrition, WASH and responsive caregiving interventions improved development outcomes by 18% in children in resource constraint communities. Early childhood development programs in China have not been without their problems and Madam Song Wenzhen pointed to the challenge of activating community services to reach families and children early and at critical times.

Joan Lombardi, Senior Advisor, Bernard van Leer Foundation, presented ten key messages from the Lancet series Early Childhood Development: from Science to Scale launched in 2016, bringing together state-of-the-art evidence underlining the importance of nurturing care in the first 1,000 days. The Lancet, she said, confirmed WHAT needs to be done, and there is a need to focus on the HOW.

Madame Song Wenzhen speaking at the consultation to develop an nurturing care framework, New York.
Madam Song Wenzhen, Deputy Director-General, the Office of National Working Committee on Children and Women, describes the country’s 2030 Action Plan for Health of Women and Children.

Bernadette Daelmans, Coordinator, Maternal, Newborn, Child and Adolescent Health at WHO gave an overview of the proposed aim and format of the Nurturing Care Framework, as well as its objectives and guiding principle. She also highlighted the importance on broad-stakeholder consultation – including with policy and decision makers in countries of all regions – as an important aspect of the process that will unfold in the next 8 months towards the finalization of the Framework. Pia Britto, Chief and Senior Advisor, Early Childhood Development, presented the 6 point agenda in The Early Moments Matter for every child report.

WHO has welcomed the 6 point agenda as a critical entry point for the development of a practical, results-oriented common Nurturing Care Framework:

  • Prioritizing investment in each of the sectors that leads to the delivery of the ECD package and outcomes;
  • Promoting leadership that brings together multiple ECD sectors;
  • Recognizing that this cannot be achieved solely through service delivery. There must be an enabling environment (e.g. policies must be in place to ensure 6 months parental leave, breastfeeding etc.);
  • Extend pre-primary from 1 year to 2 years;
  • Prioritize the 4 indicators in the SDGs that are linked to ECD;
  • Drive demand – it is important that families understand and know what they can ask for and what their children’s rights are.

These opening presentations set the stage for a lively discussion and questions from the participants ranging from the role of social protections to measuring the impact of ECD programs. Dr Tina Chisenga, Assistant Director, Ministry of Health, Zambia shared their experience and the progress achieved since 2012, when the Ministry of Health joined the Ministry of Education to work together towards the implementation of the child health and development package. By working across a number of issues, including infectious diseases, reproductive health and nutrition, and bringing the responsible departments together towards implementation of the packages, progress accelerated. As a result of the political leadership in the country with the Vice President personally engaged, Zambia not only achieved a substantive reduction in under- five mortality but could also bring down the rate of childhood stunting.

Mrs Lynette Okeng’o, Executive Director of the African Early Childhood Network and champion of ECD in Kenya, also articulated that it was initially not easy to fully engage the health sector as a partner but at present the Ministry of Health in Kenya is taking the responsibility and leadership on integrating resources and policies in support of nurturing care into early childhood development and health work. She also articulated the importance of creating an enabling environment, through the adoption and implementation of relevant policies and services, both at clinical and community levels. Incentivizing community health workers and working with civil society are important. Both speakers welcomed the development of a common Nurturing Care Framework to strengthen the hand of policy makers on where and how to invest.

Participants also heard about the experience of BabyWash from Dan Irvine, Senior Director of Operations, Sustainable Health at World Vision International. He highlighted a cluster of interventions in health, nutrition, clean water and safe sanitation that naturally come together to support health and development in the early years, and for which tools have been developed. Multisectoral coordination is critical, however, it is not always easy to achieve. But as a wise proverb says: ‘if you want to go fast, go alone; if you want to go far, go together’. Under the umbrella of a Nurturing Care Framework, the global community is poised to take concerted action to accelerate progress and to maximize opportunities for funding, such as being provided by the Global Financing Facility and World Bank. Partnerships, such as PMNCH and the ECD Action Network will facilitate the linkages, between sectors and work areas, and between the actors on the ground and those that work on global policies and investments for children.

The meeting concluded with next steps, summarized by Helga Fogstad and Bernadette Daelmans, who called upon participants to be engaged with the development of the framework, participate in the on-line survey on the draft document that will open towards the end of the year, and work together to ride this unique ground swell for child development focusing on the earliest moments and years. Contact: nurturingcare@who.int.