Embed Size (px)
Citation preview
Investing in Young Children for High Returns
April 18, 2014 IOM Forum on Investing in Young Children Globally Amina Denboba Rebecca Sayre Quentin Wodon
Presentation Overview
1
• Beyond Interventions: Policy and SABER
2
• Some Good News: World Bank Focus on ECD
3
• Cost-Effective Interventions? A “Top 25”
4 • SABER-ECD and Example of Finance Policy Lever
5 • Conclusion
# 1 - World Bank Focus on the Early Years
World Bank Education Sector Strategy 2020: “Invest Early. Invest Smartly. Invest for All.”
• The World Bank recognizes that learning and developmental needs must be supported early and are critical for individual’s success in work and in life.
ECD programs benefit from cross-sectoral support. In addition to the Education Sector Strategy, both
• 2012 Social Protection strategy highlights the need to invest in stronger systems to protect health and well-being of children and families
• 2009 Health, Nutrition & Population strategy emphasize the need for investing in and protecting the very young.
# 1 - World Bank Investments in ECD
Focus on ECD operations/activities
Included: operations/activities focusing on ECD
Not included: broader operations/activities benefiting
young children but not focused specifically on ECD
Focus on three sectors
Education
Health, Nutrition, and Population
Social Protection
Not included: other sectors (W&S, others)
Analysis of trends in commitments/activities
For lending and grants
For analytical work ( country sector work, technical assistance, knowledge products, impact evaluations
# 1 - Operations: $3.3 billion over 2001-13
Source: Sayre, Devercelli, Neuman, Wodon, 2014
Source: Sayre, Devercelli, Neuman, Wodon, 2014
# 1 - Analytical, Advisory, and Partnership work: $51 million invested over 2001-13
# 2 - 25 Key Cost-Effective Interventions for Young Children and Families
# 2 - 25 Key Cost effective Interventions for Young Children and Families
Increasing preschool enrollment to 50 percent of all children in low- and middle-come countries could result in lifetime earnings gains from $14-
$34 billon. High quality ECD programs targeting vulnerable
groups in the United States have an annual rate of return of 7-16 percent.
Iron supplementation for pregnant mothers costs from $66
(African sub-region with very high adult and high child
mortality) - $115 (Southeast Asian sub-region with high rates of adult and child mortality) per
disability-adjusted-life-year (DALY) saved.
Immunizations can have a benefit-to-cost ratio up to 20:1
# 2 - Over time: 5 integrated packages
Education/Learning Black Box
Quality of policies &
institutions
Quantity & Quality of Inputs
Quality of policy implementation
Learning for All
SABER Policy Frameworks
Measures of Policy
Implementation
Quality of Service delivery
Impact Evaluation and
Service Delivery
Student Assessment
EMIS and Census Data
# 3 – Policy & Implementation: SABER
Education inputs
Learning for All
Quality of policies &
institutions
Quality of policy
implemen-tation
Quality & quantity of education delivered
Education Cycles
Quality Resources &
System Support
Governance & Finance
Student Assessment
Teachers
ICT
School Health & School Feeding
Workforce Development
Tertiary Education
School Finance
School Autonomy &
Accountability
EMIS
Engaging the Private Sector
Education Resilience
Equity & Inclusion
ECD
All children have the opportunity
to reach their full potential
Policy Goals
Legal Framework Intersectoral Coordination Finance
Establishing an Enabling Environment
Scope of Programs Coverage Equity
Implementing Widely
Data Availability Quality Standards Compliance with
Standards
Monitoring and Assuring Quality
Policy Levers Outcome
Effe
ctiv
e E
CD
po
licie
s
# 4 - SABER-ECD Framework
Indicators are averaged in each domain, policy goal, and policy lever to benchmark education systems as latent, emerging, established, or advanced
Latent
Emerging
Established
Advanced
Does not meet acceptable standard
Shows progress toward meeting acceptable standard
Meets acceptable standard
Above acceptable standard, continuously improving
SABER Benchmarking
What Matters
Country report status
Country bench-
marking
Data
Taking a closer look at
ECD Systems
Download data
View ratings
Compare countries
Legal Framework
SABER-ECD Implementation
= SABER-ECD complete (16 countries)
= Ongoing data collection/analysis (23 countries)
= Piloted SABER-ECD instruments (13 countries)
= Pipeline (5 countries)
50+ countries have participated, more expected
SABER-ECD Finance Policy Lever Classification
Budget processes for ECD are mostly not coordinated across sectors
02468
10
No Criteria Criteria areused in one
sector
Criteria areused in 2 to 3
sectors
Criteria areused in all
sectors
i) To what extent does the budget use explicit criteria at the national or sub-national level to decide ECD spending?
LIC LMIC UMIC
0
2
4
6
8
10
No Expenditure onECD are
reported in 1sector
Expenditure onECD are reported
in 2 sectors
Expenditure onECD are reported
in 3 or moresectors.
iii) Can the government accurately report public ECD expenditures?
LIC LMIC UMIC
0
5
10
15
20
No coordinationmechanisms
Joint budgetplanning sessionsthat include 1 to 2
sectors
Joint budgetplanning sessions
that include 3sectors
Establishedbudget planningcommittees that
include allessential sectors
ii) To what extent is determining the budget a coordinated effort across ministries?
LIC LMIC UMIC
Financing for ECCE is largely inadequate; Financing for ECD in the health sector varies
0
1
2
3
4
5
6
7
8
Less than 1% 1% to 5% 5% to 9% 10 or more%
i) What percentage of the annual education budget is allocated towards preprimary
education?
LIC LMIC UMIC
0
1
2
3
4
5
6
7
8
9
Less than 25% 26% to 59% 60% to 89% 90% and above
ii) What percentage of routine EPI vaccines is financed by government?
LIC LMIC UMIC
Burden of finance may not be equitably distributed across various segments of society
0
2
4
6
8
10
12
10 or moretypes of fees
8 to 9 types offees
4 to 7 types offees
0 to 3 types offees
i) According to policy, what types of fees are levied for ECD services?
LIC LMIC UMIC
0
2
4
6
8
10
12
14
16
40% or more 25% to 39% 15% to 24% Less than 15%
ii) What is the level of out of pocket expenditures as a percentage of total health expenditures?
LIC LMIC UMIC
Remuneration of ECD professionals is typically insufficient
02468
10
Less than 50%of primary
teacher salary
50-74% ofprimary
teacher salary
75% but lessthan 100% of
primaryteacher salary
Parity in paywith primary
teachers
i) Is the remuneration for preprimary teachers entering the field competitive?
LIC LMIC UMIC
0
2
4
6
8
10
12
No Yes
ii) Are community-based childcare center professionals paid by the government?
LIC LMIC UMIC
0
2
4
6
8
10
No Yes
iii) Are extension health service professionals paid by the government?
LIC LMIC UMIC
# 5 - Conclusion
Good news: Higher focus on ECD
ECD investments are the right thing to do, but also the smart thing to do economically
Important to identify and scale-up cost-effective interventions providing high returns
But important as well to undertake a systems approach to identify areas for improvements
3 policy goals in SABER ECD
Establishing an enabling environment
Implementing widely
Monitoring and Assuring Quality
Family Support Package
Birth to Six Years
Major gains: improved physical and socio-emotional development, improved cognitive development
Intervention Illustrative Cost Potential Impact
Maternal education Varies greatly by country
Maternal education is a significant predictor of children's enrollment in ECCE
programs with the highest enrollment found among those children whose
mothers were more highly educated (Greenberg, 2011).
Planning for families Varies greatly by country
Family planning services decrease likelihood of death due to maternal causes:
control over fertility decisions, indicated by desire for pregnancy, can lead to
reduced risk of maternal mortality (Seyfried, 2011).
Parenting & social
support networks &
community
education
$13 (Mauritania)-$1,393 (Qatar)
per child/year for home-visiting
program (Van Ravens & Aggio,
2008)
$4 (Bangladesh)-$10 (India) per
child/year for national community-
based programs (Mason et al,
1999)
Increased parenting knowledge lead to more home stimulation and learning
activities for children (effect sizes from 0.32-0.86), and in turn higher child
development outcomes, including higher cognitive and language development
(effect sizes from 0.32-0.97) (Engle et al, 2011).
Social assistance
transfer programs
$156-432 per household per year
for CCT programs with nutrition
component (Latin America)
(Bassett, 2008)
Targeted income support through CCTs reduce poverty; increase household food
consumption and dietary diversity (Ruel & Alderman, 2013); yield higher rates of
school attendance, birth registration, access to health services, and parental
concern about the health and education of their children; they also reduce child
labor and domestic violence (Barrientos et al, 2013)
Prevention &
treatment of
maternal depression
Varies greatly by country
Community-based interventions with paraprofessionals can reduce depressive
symptoms (effect size 0.21 to 0.62), improve maternal sensitivity and infant
attachment, infant health, and time spent playing with infants (Walker et al,
2011).
Family Support Package…continued
Parental Leave &
Child care Varies greatly by country
Parental leave for 10 weeks is associated with a reduction in rates of neonatal mortality,
infant mortality and under-five mortality (Heyman, Raub, Earle, 2011); Government-
supported childcare provision is associated with higher rates of women’s labor force
participation and lower gender inequality (ILO, 2010) For impact of quality childcare,
see preschool package.
Child protection
regulatory
frameworks
Varies greatly by country
Violence-prevention interventions can reduce stress reactions in young children (effect
size 0.56 to 0.91); Improving institutional environment of non-parental group
residential care can lead to significant benefits in child cognitive and social-emotional
competence (Walker et al, 2011).
Access to
healthcare Varies substantially by country
Access to healthcare and health insurance that covers basic services affects the health
and nutritional status of children (Alderman et al, 2013).
Micronutrients:
Supplemen-
tation and
Fortification
$0.20 per person/year for flour
fortification w/ iron, folic acid, zinc
(Fiedler et al, 2008); $1.20 per
child/ year for Vitamin A sup
(Neidecker-Gonzales et al, 2007);
$0.05 per person per year for salt
iodization (Horton et al, 2008)
Micronutrient supplementation for pregnant women can reduce risk of low birthweight
babies by 88% and preterm births by 97%; Children whose mothers consumed iodized
salt may have 10-20% higher developmental scores and higher birth weight (3.82-6.3) ;
Iodine supp. for pregnant mothers can reduce risk of cretinism (severely stunted
physical/mental growth) at 4 years by 27%. (Bhutta et al, 2013) ; Vitamin A
supplementation can reduce risk of child mortality (6-59 months) by 24 % (Horton, et
al, 2008);
Access to safe
water
$2 per household per month for
rural water intervention
(Rijsberman & Zwane, 2012)
Improved water quality may reduce the risk of diarrhea by 52% (Cairncross et all, 2010)
Adequate
sanitation
$3-5 per person for delivery of
Community Sanitation Program
(Rijsberman & Zwane, 2012)
Adequate sanitation may reduce open defecation by 20% and is associated with a 0.1
standard deviation increase in child height (Spears, 2013).
Hygiene and
hand washing
No additional cost if included in
community nutrition programs
Hygiene and hand washing may reduce incidence of diarrhea by 30% (Horton, Shekar,
McDonald, 2010; Mason et al, 1999)
Pregnancy Package
Conception to Birth
Major gains: prevention of maternal and neonatal mortality, reduced risk of anemia and low birth weight
Intervention Illustrative Cost Illustrative Impact
Antenatal visits
$6.7–7.34 per
pregnancy (Uganda)
(UNFPA, 2004)
Antenatal visits reduce the risk of maternal and
neonatal death (UNICEF, 2009).
Iron and folic acid
supplementation for
pregnant mothers
$3.00 (Indonesia,
Kenya, and Mexico)
per pregnancy
(Horton, 1992)
Iron and folic acid for pregnant mothers can yield a
gain of 58 g in birthweight and reduce the risk of
anemia at term by 21% (Bhutta et al, 2013).
Counseling on adequate
diet for pregnant
mothers
No cost if part of
antenatal visits
Counseling on adequate diet for pregnant mothers
reduce the risk of low birthweight and stillbirths
(Bhutta et al, 2013).
Birth Package
Birth to 6 Months
Major gains: prevention of infant morbidity and mortality, and maternal mortality
Interventions Illustrative Costs Illustrative Impacts
Attended
delivery
$10 for clean birthing kits for
6 women (UNFPA, 2008)
Clean delivery practices can prevent infections (which
account for approximately 35 percent of newborn deaths).
Institutional/skilled attended delivery can prevent asphyxia
(which causes 23 percent of newborn deaths) (UNICEF,
2009).
Birth
registration
$0.23 (Tanzania)-$0.83
(India) per event of civil
registration (Abou Zahar, et
al, 2007)
Birth registration protects children’s right to identity and
access to services including access to immunizations and
healthcare, education, and social assistance; It protects
children against early marriage and child labor.
Exclusive
breastfeeding
through 6
months
$0 to breastfeed;
$0.30-0.40 per birth to
promote breastfeeding
(Horton, et al, 2008)
Infants who are breastfed are six times more likely to
survive, six times less likely to die from diarrhea and 2.4
times less likely to die from acute respiratory infections in
the first six months(Jones et al, 2003); breastfeeding is also
associated with higher intelligence scores (mean difference:
4.0 points) (Horta & Victora, 2013).
Child Health & Development Package
Birth to 5-6 Years
Major gains: prevention of child mortality, reduced risk of stunting and anemia
Intervention Illustrative Cost
per Beneficiary Potential Impact
Immunizations
$30 (Low income
countries) per live
birth (WHO, 2009)
Immunization reduces child morbidity and mortality (Barnighausen et al, 2009).
Growth monitoring
and promotion
No additional cost if
included in community
nutrition programs
GMP can lead to a 1.5% reduction in deaths before 36 months (at 99% coverage); a
0.25 increase in height-for-age Z score; and a 15% reduction in prevalence of
stunting at 36 months of age (Bhutta et al, 2008).
Therapeutic zinc
supplementation for
diarrhea
$1 (India) per child per
year (Robberstad et al,
2004)
Therapeutic zinc supplementation can lead to 14% fewer episodes of diarrhea and
15% fewer episodes of severe diarrhea or dysentery; 25% fewer episodes of
persistent diarrhea; 9% reduced risk of mortality (Horton et al, 2008).
Optimal feeding
practices
$40-80 per child per
year (Horton et al,
2010)
Optimal feeding practices can reduce stunting (height-for-age Z score) by 0.25
(without food supplements/cash transfers)to 0.41 (with food supplements/cash
transfers) (Lassi, et al, 2013)
Deworming
$0.25 (developing
countries globally) per
child/year (Hall,
Horton, de Silva, 2009)
Deworming is associated with a 5-10% reduction in anemia in populations with
high rates of intestinal worms; one-dose of deworming drugs may increase weight
by 0.58 kg (Bhutta et al, 2013).
Preschool Package
Three to Six Years
Major gain: school readiness
Intervention Illustrative Cost
per Beneficiary Potential Impact
Quality early
childhood education
programs
$58 (Mauritania)
to $3482 (Qatar)
per child /year
(Van Ravens &
Aggio, 2008) for
ECCE for 3-5 year-
olds
Quality early childhood education programs increase child
development scores on one or more measures of child development
(literacy, vocabulary, math, quantitative reasoning) with an effect size
range from 0.13 to 1.68; Preschool is associated with improved
school performance in second and third grades and effects can be
even larger in adolescence (Engle et al, 2011)
Transition to
primary Varies by country
Quality improvement in early primary grades (integrating
ECCE/Early primary experience, teacher training on classroom
strategies for young children, smaller class size, etc.) can improve
learning outcomes, school attendance, pass rates, and promotions
and reduce dropout and repetition rates (Arnold et al, 2008).
Principle 1: Conduct an ECD Diagnostic & Establish a Comprehensive Strategy
SABER-ECD help countries conduct such diagnostics: collects, analyzes, and disseminates comparable international data on national and sub-national ECD systems (both on ECD policies and ECD programs).
Based on ECD diagnostic and taking into account costs and funding, countries should prioritize interventions with three considerations in mind:
Start early
Address risk factors
Target the most vulnerable
Principle 2: Coordinate & Implement Widely
What is usually seen in policies for young children and families
Source: Adapted from F. Mustard, Canadian Institute for Advanced Research
Principle 2: Coordinate & Implement Widely
Importance of Taking an Integrated Approach to ECD Policies
Source: Adapted from F. Mustard, Canadian Institute for Advanced Research
Principle 2: Coordinate & Implement Widely
Diversity of entry points for policies and programs related to nutrition, healthcare and hygiene, education, child protection, social protection and, poverty alleviation.
ECD interventions can take place in a variety of settings including a child’s home, a preschool or childcare center, a health post, clinic, or hospital, or a community center.
Coordination is critical both horizontally between sectors and vertically between the central government and local authorities.
Principle 3: Integrate Services to Achieve Synergies & Cost Savings
Evidence suggests high annual rates of return to many of ECD interventions, but integrated interventions that address multiple needs of young children are likely to yield the greatest results
Care for Child Development : an example of coordinated efforts to address health, education, and nutrition.
In a context of tight budgets, integrated services help reduce unit costs of providing services, e.g. by reducing the time and travel costs needed to reach beneficiaries.
Principle 4: Monitor, Evaluate, & Scale Up
Comprehensive monitoring systems help track ECD investments and promote effective policymaking.
Systems that track vulnerable children are especially useful to promote effective targeting, referrals, and follow-up.
Chile Crece Contigo (Chile Grows with You or CCC) : an example of effective and comprehensive monitoring system.
Monitoring systems should include data from multiple sources (household and child surveys; national administrative data).
Impact evaluations are critical to help identify what works and what does not, and areas for improvement in programs.
SABER-ECD Policy Classification Rubric
37
ECD Policy Goal Policy Lever Scope of Indicators
Establishing an Enabling
Environment
Legal Framework
7 indicators (14 sub-indicators) that assess the extent to which laws and regulations are in place to protect young children and promote healthy development.
Coordination 4 indicators (4 sub-indicators) that evaluate the level of coordination across sectors, at the level of service delivery, mechanisms for coordination with non-state stakeholders and the existence of an ECD strategy and institutional anchor.
Finance
4 indicators (10 sub-indicators) that assess the extent to which adequate financing is provided, transparency of the budget process, sustainability of revenue, mechanisms to transfer funding and the relative burden of finance on segments of the population.
Implementing Widely
Scope of Programs
2 indicators that assess the extent to which interventions target all relevant beneficiaries and are established in all essential areas of focus.
Coverage 4 indicators (11 sub-indicators) that asses the coverage of essential ECD interventions.
Equity 5 indicators (9 sub-indicators) that assess equity in ECD service provision across regions, socioeconomic status, urban-rural locations, gender and children with special needs.
Monitoring and Assuring
Quality
Data Availability
4 indicators (with 2 sub-indicators) that assess a country's monitoring and evaluation system and ability to track key ECD data accurately.
Quality Standards
5 indicators (13 sub-indicators) that assess quality standards for personnel, learning standards and curricula, infrastructure, service-delivery and accreditation/registration.
Compliance with Standards
3 indicators (6 sub-indicators) that assess the ability of the system to monitor and enforce compliance with established ECD standards.
Some References
Denboba, A., R.K. Sayre, Q. Wodon, 2014, Investing in Young Children for High Returns. Washington, DC: The World Bank. (forthcoming).
Sayre, R.K., A.E. Devercelli, M.J. Neuman, Q. Wodon, 2014, Investing Early: Review of the World Bank’s Investments in Early Childhood Development. Washington, DC: The World Bank. (forthcoming)
Neuman, M. J., and A. Epstein Devercelli, 2013, What Matters Most for Early Childhood Development, SABER Working Paper Series, No. 5, Washington, DC: The World Bank.
Naudeau, S., N., A. Valerio, M.J. Neuman, L.K Elder. 2011. Investing in Young Children: An early Childhood Development Guide for Policy Dialogue and Project Preparation. Washington, DC: The World Bank.
