/ 18 November 2011

The cries SA can’t ignore

Few people have a better view of the benefits of proper care, stimulation and nutrition of children under five years of age — and of the perils of ignoring these — than Ruth Faku. Taken out of school years ago to care for her ailing mother while her father was on Robben Island, she dreamed of becoming a teacher.

Later, as a young mother growing up in East London, she felt the absence of any daycare for one-to-five-year-old children in her community. And so she acted, setting up a crèche in her home in the early 1990s. Within a month she had more than a dozen children to care for.

Now Faku runs the Imizamo Yethu daycare centre in East London. In operation since 1995, the centre has more than 60 children. The children — and, critically, their parents — are benefiting from education, nutritional advice, healthcare and a safe place while their mothers are at work.

“Our centre needs more support,” Faku said, “but there are places out there with absolutely nothing and so many mothers who can’t get their children into a centre. I have seen what happens to these children — no stimulation, violence, abuse and all the dangers of being unattended, like burns and accidental poisoning. But the children who go through a place like ours start school bright and with a real chance of succeeding. Every teacher tells us the same thing.”

From Faku in East London to the medical journal The Lancet, the same tune is being sung: early childhood is the most effective and cost-efficient time to intervene to address inequalities and break the intergenerational cycle of poverty.

The economic benefit
In two articles published this year in The Lancet researchers set out ways in which parents, childcare experts and policymakers can mitigate the risks and help level the playing field. The potential impact on South Africa is colossal. The researchers calculate that getting half of children into preschool or early childhood education programmes in 73 low- and middle-income countries, including South Africa, would have an eventual economic benefit of $33-billion.

The roots of many of the problems begin in very early childhood, before the second birthday. But the ramifications stretch into adulthood, resulting in economic, educational and social inequality within the nation and between South Africa and other countries. On this the research is unambiguous: poor nutrition, maternal and family stress and poverty affect brain development from the prenatal period or earlier.

Among the evidence considered by researchers co-ordinated by the Global Child Development Group, with support from the United Nations Childrens’ Fund (Unicef), were studies from South Africa that mirrored wider results globally. Poor children are particularly challenged because risks tend to occur together and these risks have a cumulative effect.

“Inequalities in [developing] countries are established in early childhood and contribute to lifetime differences,” concluded the researchers.

Any one of more than a dozen risks could harm a child, but in combination, cumulatively and starting in very early childhood — or even before birth — they are almost guaranteed to wreck a child’s chances in life.

But the report is also full of high impact, cost-effective answers. “There have been a number of approaches to improving young children’s development,” said one of the authors, Professor Pat Engle, “but the two most well investigated are early education centre programmes and a variety of types of parenting programmes, such as group sessions or home visits. Often parenting programmes are linked to a health system, nutrition programme or community development effort.”

Home-based protective factors, such as breastfeeding, parent-to-child stimulation, maternal nutrition and support visits to caregivers, help counteract some of the problems faced by disadvantaged children, regardless of their HIV status.

The importance of educating mothers
The research is very clear on the importance of educating mothers and the need to support parenting at a home. This kind of back-up, with good-quality preschooling, conditional cash-transfer schemes such as child grants and educational media, are important elements in tackling the risks and work best when integrated into wider health programmes.

“Over the past five years South Africa has made strong progress,” said Unicef’s representative in South Africa, Aida Girma. “The number of children enrolled in early childhood development centres has risen from 16% to 43%.” Unicef-supported programmes the government has introduced include home visits to encourage interaction between mothers and their babies — which improve maternal sensitivity and infant attachment — and caregiver programmes for home stimulation of HIV-positive children, which have resulted in a significant improvement in development after a year.

The research published in The Lancet makes it clear that, if investments are made continually, the resulting benefits are substantial. And these fiscal benefits do not take into account the other advantages of increasing childhood development services, such as reduced crime or improved parenting. However, scaling up projects into wider initiatives still has some way to go.

The challenge now is to take early childhood development across the country. On this the report is unambiguous: “Unless governments allocate more resources to quality early childhood development programmes for the poorest segment of the population, economic disparities will continue to exist and to widen.”

Global financial uncertainty remains a challenge everywhere and yet the report is clear: governments and donors simply can’t afford not to invest. The report finds that early childhood development could give a seventeen-fold return on investment if a country increased early childhood enrolment to 50%. Faku may not have such data in front of her. But she has the experience of seeing children grow and learn. The combined message is the same. The time to act is now.

Gordon Alexander is director of the Unicef Office of Research.