Growing strong: The quest to accelerate progress in early childhood development
By Dr Poonam Khetrapal Singh WHO Regional Director for South-East Asia
Investing in children’s growth will advance health and development. Doing so must be a priority
Early childhood is arguably the most crucial stage of life. Brains develop. Bodies grow. Social skills are learnt, and character is built. So important are the early stages of life that they can define a person’s future, from the likelihood of lifelong health to outcomes in cognitive and physical ability. This in turn affects the prospect of living a full and productive life and making a positive contribution to society. Accelerating Region-wide health and development is therefore incumbent on investing in early childhood and ensuring each and every child gets the best start possible.
The potential to do so is clear. In recent years WHO South-East Asia’s Member States have made dramatic progress in reducing child mortality. Between 1990 and 2017, for example, under-5 mortality was slashed by 70%. Neonatal mortality declined by 60%. Last year alone, 3.5 million more children under-5 – including 1.3 million newborns – survived as compared to 1990, with almost all Member States achieving the Millennium Development Goal on reducing child mortality. Commendably, four Member States have already met the global Sustainable Development Goal (SDG) target on under-five mortality. These outcomes are in keeping with the Region’s Flagship Priority of ending preventable maternal, newborn and child deaths.
As Member States sustain this progress, the need to invest additional resources in early childhood development (ECD) must be grasped. At the same time as enhancing health equity, research shows that for every dollar spent on ECD the return can be as high as 13 times, due in large part to ECD’s capacity to help overcome the effects of stunting (which 37% of children in the Region suffer), and other early childhood adversities that can cause poor development, mental health problems, obesity and heart disease among other conditions.
Though enhancing ECD requires action across multiple areas of government, including the education and nutrition sectors, the health sector has a crucial role to play, especially from conception to the age of three, which is the critical period for brain development. As outlined in the recently developed global framework on ‘Nurturing Care for Early Childhood Development’, in addition to the Region’s own strategic framework, there are several steps countries can take to advance ECD’s game-changing potential and provide the responsive care needed.
First, high-level political leadership and buy-in must be secured. Doing so is fundamental to ensuring impactful policies to advance ECD are devised and then implemented at the grassroots, including at primary health care centers. It is also fundamental to ensuring underprivileged or at-risk populations are targeted as a priority. Importantly, adequate funding must be allocated to programmes aimed at enhancing ECD, and must be provided on an ongoing, long-term basis. ‘Equity from the start’ must be more than a mantra.
Second, concerted efforts should be made to fortify and scale up interventions, starting from the antenatal period, as part of a broader focus on frontline care. Community health and nutrition workers are crucial to promoting ECD, at the same time as providing ongoing health services for newborns and children, including necessary vaccines, monitoring weight and growth and providing appropriate care where needed. As part of this, the promotion of breastfeeding is vital. Breastfeeding is, after all, proven to provide the strongest foundation for lifelong health and optimal nutrition. It should be encouraged at all times, along with complementary feeding beyond the age of six months.
Third, families should be supported to boost ECD themselves. In the early years of life, parents (whether working or stay-at-home), close family members and caregivers are the best providers of nurturing care, including by giving love, promoting bonding and attachment, and stimulating their newborns and children through age-appropriate activities. Making families aware that simple play and communication for at least one hour a day has the power to shape a child’s destiny should be a priority among policymakers, with effective communication strategies key to achieving this outcome, alongside continued investment in maternal health.
WHO is working to promote these outcomes and support Member States harness the full power of ECD. In addition to working with countries to implement the Region’s strategic framework, in July of this year a WHO-organized meeting was held with parliamentarians from across the Region to chart the path forward. That will be followed by the Partners’ Forum 2018 in New Delhi in December, which will bring together 1200 partners dedicated to implementing the UN Secretary General’s Global Strategy for Women’s, Children’s and Adolescents’ Health, including ECD, which is integral to the ‘Thrive’ objective outlined therein.
The future looks increasingly bright. Region-wide, the quest to accelerate progress in ECD is growing stronger by the day. That quest must continue. It must also be scaled up. ECD’s capacity to revolutionize health and development in the space of just one birth cohort must be fully comprehended and leveraged by both high-level political leaders and citizens alike. Should this happen, and should decisive action be taken, the future will not only be ours; it will be every generation’s to come.