100063 The Gambia SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2013 Policy Goals Status 1. Establishing an Enabling Environment Recent efforts by the government of The Gambia ensure that early childhood development (ECD) service provision is a more coordinated effort among different sectors. The new ECD Policy Framework supports the development of the National ECD Working Group and ECD representatives in each sector. Further coordination among sectors and between state and nonstate actors could increase access to and quality of ECD services. Current financial allocations are not adequate to ensure full level coverage, quality, and equity in ECD service provision. 2. Implementing Widely Government ministries provide comprehensive ECD services for mothers and children. The Gambia’s Reproductive Health Policy (2007–2014) promotes maternal and child health programs. Wide coverage exists for many ECD programs, although rural and poorer areas receive less adequate coverage and quality of ECD services. 3. Monitoring and Ensuring Quality Relevant administrative and survey data on access to ECD are collected every year throughout the country. The Ministry of Basic and Secondary Education publishes access data in May every year. An impact evaluation has been conducted to measure child development outcomes to compare the community-based ECD and Annexed ECD. Preprimary curricula have been developed and are available for teachers to use. THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 This report presents an analysis of the early childhood Nearly half of the population in The Gambia is below the development (ECD) programs and policies that affect age of 18, with approximately 300,000 children under the young children in The Gambia and recommendations age of five. The country faces high poverty rates for to move forward. This report is part of a series of reports children with high rates of under-five mortality. Recent prepared by the World Bank using the SABER-ECD government efforts have resulted in increased preprimary framework1 and includes analysis of early learning, school enrollment rates with 45.4 percent GER (Education health, nutrition, and social and child protection policies Statistics, MoBSE 2015). Table 1 provides a snapshot of key and interventions in The Gambia, along with regional and ECD indicators in The Gambia, with regional comparisons. international comparisons. In 2009 the government of The Gambia (GoTG) drafted the National ECD Policy Framework (2009–2015) in an effort The Gambia and Early Childhood to increase multisectoral efforts to meet the needs of all Development children under the age of eight. The Framework covers education, health care, social welfare, food and nutrition, The Gambia is a low-income country with a population of and water and sanitation. The Framework was drafted by 1.88 million inhabitants (2013 Census). The Gambia is the Ministry of Basic and Secondary Education (MoBSE) ranked 165th in the UNDP Human Development Index. with input from relevant government ministries, The country has a gross national income of $488 (World community partners including parental organizations, and Development Indicators 2013) per person, with 48 a multisectoral working group. The Framework pushes for percent of the population living below the poverty line increased interministerial coordination to improve access (US$1.25 a day). to and quality of services to all children, with special attention to those children living in remote areas. Table 1: Snapshot of ECD Indicators in The Gambia with Regional Comparison The Gambia Sierra Leone Liberia Ghana Mali Infant mortality (deaths per 1,000 live births, 2012) 49 117 56 49 80 Under- 5 mortality (deaths per 1,000 live births, 2012) 73 182 75 72 128 Moderate and severe stunting (below age 5, 2008– 23% 44% 42% 23% 28% 2012) Net preprimary enrollment rate (3–6 years, 2013) 27.3% 7% N/A 76.3% 3.8% Birth registration 2005–2012 53% 78% 4% 63% 81% Sources: UNICEF Country Statistics, 2012; UNESCO Institute for Statistics, 2013. 1 SABER-ECD is one domain within the World Bank initiative, Systems Approach to Better Education Results (SABER), which is designed to provide comparable and comprehensive assessments of country policies. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 1 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Systems Approach to Better Education Box 1: A Checklist to Consider How Well ECD Is Promoted at the Country Level Results–Early Childhood Development What should be in place at the country level to promote (SABER-ECD) coordinated and integrated ECD interventions for young SABER-ECD collects, analyzes, and disseminates children and their families? comprehensive information on ECD policies around the Health care world. In each participating country, extensive  Standard health screenings for pregnant women multisectoral information is collected on ECD policies  Skilled attendants at delivery  Childhood immunizations and programs through a desk review of available  Well-child visits government documents, data and literature, and Nutrition interviews with a range of ECD stakeholders, including  Breastfeeding promotion government officials, service providers, civil society,  Salt iodization development partners, and scholars. The SABER-ECD  Iron fortification framework presents a holistic and integrated assessment Early Learning of how the overall policy environment in a country  Parenting programs (during pregnancy, after delivery, affects young children’s development. This assessment and throughout early childhood) can be used to identify how countries address the same  Child care for working parents (of high quality) policy challenges related to ECD, with the ultimate goal  Free preprimary school (preferably at least two years of designing effective policies for young children and with developmentally appropriate curriculum and their families. classrooms, and quality assurance mechanisms) Social Protection Box 1 presents an abbreviated list of interventions and  Services for orphans and vulnerable children policies that the SABER-ECD approach looks for in  Policies to protect rights of children with special needs countries when assessing the level of ECD policy and promote their participation/access to ECD services development. This list is not exhaustive but is meant to  Financial transfer mechanisms or income supports to provide an initial checklist for countries to consider the reach the most vulnerable families (could include cash key policies and interventions needed across sectors. transfers, social welfare, etc.) Child Protection Three Key Policy Goals for Early Childhood  Mandated birth registration Development  Job protection and breastfeeding breaks for new SABER-ECD identifies three core policy goals that mothers countries should address to ensure optimal ECD  Specific provisions in judicial system for young children  Guaranteed paid parental leave of least six months outcomes: Establishing an Enabling Environment,  Domestic violence laws and enforcement Implementing Widely, and Monitoring and Ensuring  Tracking of child abuse (especially for young children) Quality. Improving ECD requires an integrated approach  Training for law enforcement officers in regard to the to address all three goals. As described in Figure 1, for particular needs of young children each policy goal, a series of policy levers are identified through which decision makers can strengthen ECD. Figure 1: Three Core ECD Policy Goals Strengthening ECD policies can be viewed as a continuum; as described in Table 2 on the following page, countries can range from a latent to advanced level of development within the different policy levers and goals. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 2 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 2: ECD Policy Goals and Levels of Development Level of Development ECD Policy Goal Minimal legal Nonexistent legal Regulations in some Developed legal framework; some Establishing framework; ad hoc sectors; functioning framework; robust inter- programs with sustained an Enabling financing; low intersectoral institutional financing; some Environment intersectoral coordination; sustained coordination; sustained intersectoral coordination. financing. financing. coordination. Universal coverage; Coverage expanding but Near-universal coverage Low coverage; pilot comprehensive gaps remain; programs in some sectors; Implementing programs in some strategies across sectors; established in a few established programs in Widely sectors; high inequality integrated services for sectors; inequality in most sectors; low in access and outcomes. all, some tailored and access and outcomes. inequality in access. targeted. Information on Information on Information on outcomes at national, Minimal survey data outcomes from national outcomes at national regional and local levels; Monitoring available; limited to individual levels; level; standards for standards for services and Ensuring standards for provision standards exist for all services exist in some exist for most sectors; Quality of ECD services; no sectors; system in place sectors; no system to system in place to enforcement. to regularly monitor and monitor compliance. regularly monitor enforce compliance. compliance. National laws in The Gambia promote access to health Policy Goal 1: Establishing an Enabling care for pregnant women and young children. The Environment National Reproductive Health Policy of The Gambia (2007–2014) states as one of its objectives the continued Policy Levers: Legal Framework • provision of free maternal, newborn, and child health Intersectoral Coordination • Finance services for all. Well-child visits are federally mandated An enabling environment is the foundation for the design for all children and include physical examinations of the and implementation of effective ECD policies.2 An child and serve as an opportunity for physicians to relay enabling environment consists of the following: the important information regarding child well-being and existence of an adequate legal and regulatory framework growth to parents. The policy also supports children who to support ECD, coordination within sectors and across are at risk by including provisions for follow up home institutions to deliver services effectively, and sufficient visits by appropriate health personnel. fiscal resources with transparent and efficient allocation mechanisms. Because of a drop in immunization coverage from 98 to 89 percent between 1999 and 2000, the GoTG developed Policy Lever 1.1: the Expanded Program on Immunization (EPI) by Legal Framework allocating greater funding to the program. The GoTG also The legal framework comprises all of the laws and mandated childhood immunizations in The Gambia’s regulations that can affect the development of young Health Policy (2007–2020). Through EPI, the GoTG hopes children in a country. The laws and regulations that impact to address issues related to inadequate government and ECD are diverse because of the array of sectors that donor funding, high default rates for clinics that provide influence ECD and because of the different constituencies immunization services, high staff turnover rates, and that ECD policy can and should target, including pregnant other critical issues as they may arise. women, young children, parents, and caregivers. 2 Brinkerhoff 2009; Britto, Yoshikawa, and Boller 2011; Vargas-Baron 2005. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 3 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 The Women’s Act (2010) supports pregnant women and provide one school meal a day to children in preprimary parents in The Gambia through mandated maternity classrooms that have been annexed to primary schools. and paternity leave policies. The policy supports parental leave irrespective of the employment type, National laws and regulations on child protection sector, or size of the firm. Mothers are allocated 24 services are well established in The Gambia. Under the weeks of paid maternity leave or leave with comparable Domestic Violence Act (2011), women and children are social benefits, without the loss of employment, guaranteed protection against violence and domestic seniority, or similar benefits. The Act also supports abuse. The policy focuses on women and children and fathers through the provision of 10 days of paid paternity ensures protection for victims of domestic abuse. A child leave. Table 3 presents a regional comparison of parental is considered anyone younger than 18 years of age. The leave. Violence Act protects a child’s right to report ongoing abuse. The Domestic Violence Act also includes the use Table 3: Regional Comparison of Maternity and Paternity Leave Policies of Child Courts for matters related to domestic abuse against a child or where the child is the perpetrator. The Gambia Ethiopia Liberia Ghana 24 weeks 90 days paid 90 days paid 84 days paid Mandatory birth registration has been in place since maternity leave maternity maternity maternity 1968 when the Births, Deaths and Marriages Act was for women; 10 leave at 100% leave at leave at 100% enacted. It was not until 2005, though, that the days of salary for 100% salary salary for paternity leave women; two for women; women; no Children’s Act made birth registration a legal entitlement for fathers. weeks of no leave for leave for of every child in the country. The Act renders birth paternity leave fathers. fathers. registration free and mandatory. The Act also includes for fathers. penalties for parents who fail to comply and register Source: ILO 2013. their children. The Act places the responsibility of birth The Women’s Act protects mothers against forms of registration on the father, with the mother serving as the discrimination in the workplace. Section 5.22 of the Act substitute in the event that the father fails to fulfill his describes forms of discrimination that are prohibited duty. The parents must register their children within the against mothers, including prohibition of dismissal from first 14 days after a child’s birth. employment for taking parental leave or on the basis of The Ministry of Health and Social Welfare (MoHSW) is marital status. The Act has various enforcement the only institution that is legally mandated to register mechanisms to ensure compliance including fines and child births. Divisional and district-level public health prison terms for employers who do not comply with the officers are stationed in hospitals and clinics nationwide law. and act as deputy registrars to the principal public health In addition, The Gambia has approved national policies officer. In 2004, because of lack of compliance, the to encourage salt iodization and promote fortification of MoHSW issued an administrative order, later a policy, to cereals and staples with iron. The Food Act (2005) and all public health officers to ensure registration of children the Food Fortification and Salt Iodization Regulation and issuance of birth certificates. The GoTG worked with (2006) promote healthy dietary consumption of salt and UNICEF to decentralize birth registration so that more iron, especially for pregnant women and young children. health facilities offer the service. The Children’s Act (2005) supports annexation of preprimary classrooms to primary schools in underserved areas. The Children’s Act states that the GoTG will provide financial support to preprimary grades, including ECD centers, in poor and rural areas. This Annexation Strategy involves full financial government support to preprimary classrooms annexed to primary schools. The Education Sector Medium Term Plan describes the purpose of the government’s strategy to make access to preprimary school more available and affordable for children living in poor and rural areas. The World Food Programme (WFP) works with the GoTG to SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 4 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Key Laws Governing ECD in The Gambia services for children. Most of these services are being implemented at some capacity by relevant ministries or  National ECD Policy Framework (2009-2015) departments, although no service delivery manuals are  Children’s Act (2005) currently available for ECD service providers. The GoTG  Education Policy (2004-2015) has prioritized the need for further support at the local  Women’s Act (2010) level for successful implementation of the framework.  National Health Policy (2012-2020)  Food Act (2005) The National ECD Policy (2009-2015) established the  Breastfeeding Promotion Regulations (2006) national ECD structure, composed of ECD  Salt Fortification and Salt Iodization Regulations representatives at every government level. To ensure (2006) effective implementation, the National ECD Policy  National Reproductive Health Policy (2007-2014) established the National Commission for Children along  National Nutrition Policy (2010-2020) with corresponding subnational divisions. Figure 2  Business Plan for Better Nutrition (2011-2015) displays the organizational structure of the Commission. The National Commission for Children monitors and Policy Lever 1.2: reports on the development and implementation of the Intersectoral Coordination ECD Policy. According to the framework, the Commission works autonomously and is accountable to the Office of Development in early childhood is a multidimensional the President. process.3 To meet children’s diverse needs during the early years, government coordination is essential, both Figure 2: National Commission for Children horizontally across different sectors as well as vertically from the local to national levels. In many countries, Ministry of Basic and Secondary Education nonstate actors (either domestic or international) participate in ECD service delivery; for this reason, mechanisms to coordinate with nonstate actors are also ECD Board of Directors essential. The Gambia has developed an explicitly stated National Working Group multisectoral ECD strategy, but it does not include a costed implementation plan. Meetings by the Multisectoral Workshop organized by the Department of Regional Working Group Community Development in 1999 discussed the need for increased ECD provision and improvement of existing structures as well as improved government participation Community (Cluster) Technical Advisory in ECD provision. As a result of these meetings, the GoTG Working Group Committee developed the National ECD Policy Framework (2009– 2015). Through the framework, the GoTG has renewed The GoTG recognizes the importance of local its commitment to meet the basic needs of all children stakeholders to successfully implement the ECD Policy under the age of eight, with careful attention to children Framework. A working group has been designed to allow with special needs and those diagnosed with human for the involvement of regional and community cluster- immunodeficiency virus (infection)/acquired working groups. All levels serve as active institutional immunodeficiency syndrome (HIV/AIDS). The framework structures of ECD policy implementation. The mandates that relevant ministries set aside special Institutional Multisectoral Working Group on ECD (also budget lines to support the implementation of the policy known as the National Working Group on ECD (NWGECD) and ensure that the policy framework is approved and consists of more than 30 government agencies, mainstreamed into sector policies and implemented. nongovernmental organizations (NGOs), development To date, the policy has been endorsed by the Education, partners, and religious institutions. Box 2 displays the Health, Social Protection, and Child Protection sectors. roles and responsibilities of the various levels of the The Government has established a menu of integrated National Commission. Each agency or organization is 3 Naudeau et al. 2011; Neuman 2007; UNESCO-OREALC 2004. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 5 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 responsible for acquiring the necessary support to home-based and center-based ECD programs. The implement and fulfill its responsibilities. NWGECD, with support from the MoBSE, has promoted parenting education through advocacy and funding of The National Commission of Children, spearheaded by the Baby-Friendly Community Initiative (BFCI), Mother’s the NWGECD, has developed many programs and made Club, and UNICEF’s Parenting Education Program. The progress on several initiatives. Currently the NWGECD is NWGECD has also scaled up programs for orphans and working to further promote and scale up the provision of vulnerable children (OVCs). SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 6 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Box 2: Roles and Responsibilities of the National Commission for Children ECD Board of Directors Composition and Reporting Arrangements: Headed by Policy Lever 1.3: Director of the Basic and Secondary Education Directorate (BSED). Composed of representatives of relevant ministries. Finance Reports to Permanent Secretary, MoBSE, through the Director While legal frameworks and intersectoral coordination of BSED. are crucial to establishing an enabling environment for Tasks: ECD, adequate financial investment is key to ensure that  Monitor, supervise, and report progress on the resources are available to implement policies and achieve implementation of the National ECD Policy Framework at service provision goals. Investments in ECD can yield high the level of Ministries of State and the National Children’s public returns but are often undersupplied without Commission  Monitor and supervise all ECD activities of the National government support. Investments during the early years Working Group on ECD can yield greater returns than equivalent investments  Advise ECD line ministries on policy matters made later in a child’s life cycle and can lead to long-  Hold quarterly meetings lasting intergenerational benefits.4 Not only do  Ensure functional information management system for ECD investments in ECD generate high and persistent returns, National ECD Working Group (NWGECD) they can also enhance the effectiveness of other social Composition and Reporting Arrangements: Headed by investments and help governments address multiple NWGECD Chairperson. Composed of middle-level managers priorities with single investments. from relevant government divisions. Reports to ECD Board of Directors. Chairperson serves as secretary for ECD Board of The GoTG does not have a transparent budget process Directors. to coordinate finance for ECD. The National ECD Policy Tasks: Framework (2009–2015) states that each ministry is  Coordinate, monitor, and supervise the implementation of responsible for mobilizing resources for the successful the policy framework by different stakeholders implementation of the strategy. Determining budget  Hold quarterly meetings allocation is not a coordinated process across ministries.  Provide technical support for implementation of policy activities Each ministry has its own ECD goals, responsibilities, and  Set up task teams as need arises to support implementation programs and works independently of other ministries. of policy activities. Accurate information on financial allocations for ECD is Regional ECD Working Group (RWGECD) not yet available for all relevant sectors in an aggregated Composition and Reporting Arrangements: Regional Education Office Director is Chairperson of RWGECD. Composed manner. The readily available information on financial of regional (local) -level Directors and CWGECD Representatives. allocations is from MoBSE for the education sector and Tasks: from UNICEF and other partners who have tracked their  Serve as arm of Technical Advisory Committee at regional financial contributions to The Gambia’s nutrition sector. level Table 4 provides a snapshot of development aid from  Mobilization resources for the implementation of the policy various partners for nutrition programs between 2011 framework at the regional level and 2012.  Monitor and supervise implementation of the policy framework at the regional level Table 4: External Donor Support for Nutrition Programs in The  Identify and implement specific activities to address Gambia, 2012 emerging needs External donor Financial contribution  Set up community working groups UNICEF $215,000 Cluster-Based Community ECD Working Group (CWGECD) Helen Keller International $22,000 Composition and Reporting Arrangements: Comprises World Bank $3,000,000 representatives from various local committees and organizations. Japanese Social Development $37,000 Reports to respective RWGECD. Fund Tasks: UNAIDS $2,700  Oversee implementation of the policy framework at the local Source: UNICEF 2012. level of programs  Work to ensure services are delivered to children and families 4 Hanushek and Kimko 2000; Hanushek and Luque 2003; Valerio and Garcia 2012; WHO 2005. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 7 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 5 displays data collected by the World Health efficiently and appropriately spent and help to Organization (WHO) on health expenditure regional coordinate service provision. comparisons for 2013. Compared to other countries in Intersectoral Coordination the region, out-of-pocket expenditure as a percentage of all private and total health expenditures in The Gambia  It would be helpful to clarify roles and coordination is relatively low. The GoTG has also ensured full mechanisms between the ECD institutional anchor, the government finance of EPI vaccines to increase access. NWGECD, and the National Commission for Children. Table 5: Regional Comparison of Select Health Expenditure Indicators5 The National ECD Policy Framework (2009-2015) The Sierra describes the general organizational position and role Ethiopia Mali Kenya Gambia Leone that will be played by relevant government agencies and Out-of-pocket expenditure specially created groups to support and advance the ECD as a percentage of all 48% 90% 80% 99% 77% private health expenditure agenda. The policy framework does not specify tasks for Out-of-pocket expenditure each member of the committee nor does it include as a percentage of total 21 79 37 53 43 information about raising funding or funding allocations health expenditures Government expenditure on for ECD services. health as a percentage of 2 13 5 5 5 Gross Domestic Product Finance Routine EPI vaccines No No 16 8 12 financed by government data data  Relevant ministries could consider specifying ECD Source: WHO Global Health Expenditure Database 2013. spending within overall budgets. Little information is available on levels of finance for ECD across sectors, The level of remuneration for preschool educators in though ECD budgets are described as inadequate by The Gambia is inadequate. The GoTG has a policy most government staff in various sectors. Currently the mandating a minimum wage at which public sector ECD Policy describes an ECD funding basket, but little employees must be compensated. Most lower basic information exists as to how much is allocated toward schools have an ECD program annexed to the school, and ECD by each ministry and whether strategies exist to ECD teachers have a qualification from the Gambia ensure sufficient funding is allocated. ECD College. However, such provisions do not apply to ECD representatives in each of the respective ministries could personnel in community-based ECD. A small allowance consider collectively designing a detailed, multisectoral or grant money is available for community preschool budget that accurately reflects the needs of the educators of approximately $30 per month, but this population. payment is not yet required by law. Preschool educators who work in community centers are usually volunteers Policy Goal 2: Implementing Widely and often receive either in-kind or ad hoc payments from  Policy Levers: Scope of Programs • philanthropists or community members. Coverage • Equity Implementing Widely refers to the scope of ECD Policy Options to Strengthen the Enabling programs available, the extent of coverage (as a share of Environment for ECD in The Gambia the eligible population) and the degree of equity within ECD service provision. By definition, a focus on ECD Legal Framework involves (at a minimum) interventions in health, nutrition, education, and social and child protection and  The GoTG, including the NWGECD, should consider should target pregnant women, young children, and their developing a costed-implementation plan for ECD. A parents and caregivers. A robust ECD policy should multisectoral ECD framework has been endorsed by include programs in all essential sectors and provide relevant sectors, but the framework does not include a comparable coverage and equitable access across costed implementation plan. The development of a regions and socioeconomic status, especially reaching coherent and multisectoral costed-implementation plan the most disadvantaged young children and their for ECD could ensure that funds are being more families. 5 Out-of-pocket expenditure is any direct outlay by households, goods and services whose primary intent is to contribute to the including gratuities and in-kind payments, to health practitioners and restoration or enhancement of the health status of individuals or suppliers of pharmaceuticals, therapeutic appliances, and other population groups. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 8 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Policy Lever 2.1: Figure 4: Scope of Selected ECD Interventions in The Gambia by Target Population and Sector Scope of Programs Effective ECD systems have programs established in all essential sectors and ensure that every child and expecting mother has guaranteed access to the essential services and interventions they need to live healthfully. The scope of programs assesses the extent to which ECD programs across key sectors reach all beneficiaries. Figure 3 presents a summary of the key interventions needed to support young children and their families via different sectors at different stages in a child’s life. Figure 3: Essential Interventions during Different Periods of Young Children's Development Essential nutrition programs exist in the country to target all beneficiary groups. The Gambia’s revised Nutrition Policy (2010-2020) includes nutrition programs that cover a wide range of beneficiary groups, including school feeding and HIV/AIDS-related programs as well as those with a focus on mothers and children. A comprehensive action plan and budget to finance implementation of the policy are also developed. The Nutrition Policy includes provisions to improve the nutritional status of women before, during, and after pregnancy. In particular, the policy sets strategies to support maternal health through the use of advocacy programs, expansion of existing programs, and increased collaboration among stakeholders. Box 3 on the A wide scope of programs for pregnant women and following page includes some of the strategies included young children exist in The Gambia. Figure 4 displays in the Nutrition Policy aimed at maternal nutrition and interventions that are available in The Gambia across child feeding. sectors and target beneficiary groups. While Figure 4 displays the range of existing programs in The Gambia, it Table 6: ECD Programs and Coverage in The Gambia Scale does not portray the scale of these programs, which are Number of displayed in Table 6. ECD intervention Pilot regions Coverage programs covered Education State-sponsored6 preprimary/kindergarten NA 6 NA education State-sponsored Early Childhood Care and NA 6 NA Education (ECCE) Community-based ECCE 1 2 NA Health Antenatal and newborn care NA 6 NA 6 As of 2014, there were 57 day care centers and 1,015 preprimary schools, including 345 (government), 457 (private), 76 (missions), and 137 (madrassas). SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 9 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Integrated management of Box 3: The Gambia's National Nutrition Policy (2010-2020) childhood illnesses and care NA NA NA Maternal Nutrition Improvement Strategies for development  Strengthen Micronutrient Supplementation/Fortification Childhood wellness and NA 6 NA Program growth monitoring National immunization  Expand Integrated Community-Based Anemia Control NA 6 NA Program program Nutrition  Support nutritional status assessment of women of Micronutrient support for 100% childbearing age NA 6 pregnant women (target)  Advocate for domestication of ILO Maternity Protection Food supplements for Convention 183 NA Unknown NA pregnant women  Involve men more in the advocacy process Micronutrient support for  Advocate for the enrollment and retention of girls in NA 6 NA young children school Food supplements for young NA 6 NA  Strengthen intersectoral collaboration on prevention and children control of maternal malnutrition Food fortification NA Strategies to Promote Optimal Infant and Young Child Feeding Breastfeeding promotion 100%  Advocate for provision of enabling environment to NA NA programs (target) facilitate breastfeeding at workplaces Anti-obesity programs encouraging healthy NA Unknown Unknown  Support communities to implement community-based eating/exercise programs that promote, protect, and support optimal infant Feeding programs in and child feeding practices preprimary/kindergarten NA Unknown Unknown  Strengthen and expand Baby Friendly Hospital Initiative schools (BFHI) and Baby Friendly Community Initiative (BFCI) to all Parenting Nutrition programs health facilities in The Gambia include the Vitamin and communities Parenting integrated into  Support capacity (VAS) A Supplementation health care and Program building of the providers NA 0 0 health/community programs Reproductive  Support and Child ECD Health (RCH) Program. The VAS interventions Home visiting programs to NA 0 0 program was started in 2000. The purpose of the provide parenting messages program is to reach all children between 6 and 59 Special needs months of age and postpartum mothers within eight Programs for OVCs (boarding schools and children’s NA 4 NA weeks of delivery and supplement them with high doses homes) of vitamin A. The RCH program is a nutrition program Interventions for children that targets pregnant women. Upon registration at local with special (emotional and NA 4 NA health facilities, pregnant women are given iron/folate physical) needs tablets until six weeks postpartum. Additionally, Antipoverty incentives have been designed to promote selling and Cash transfers conditional on NA 6 NA consumption of iron-rich foods. The National Nutrition ECD services or enrollment Comprehensive Strategic Plan (2010–2015) prioritizes the strengthening A comprehensive system that of programs for the full range of ECD beneficiaries tracks individual children’s NA NA NA including children, pregnant women, and mothers. needs Included in the activities is the enhancement of the NA = not available. ongoing monitoring and evaluation of programs and development of an expansion plan for underserved communities, increased training of relevant stakeholders, and procurement of necessary supplies and accessories. The Gambia’s Reproductive Health Policy (2007-2014) promotes maternal and child health programs. The policy sits within The Gambia’s National Health Policy and lays out a framework to support maternal and child health initiatives. To meet its objectives and targets, the policy sets forth strategies including improving monitoring and evaluation systems, strengthening SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 10 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 advocacy and social mobilization, and increasing first year of implementation in Regions 5 and 6 for collaboration between stakeholders. children three to six years of age. Included in The Gambia’s Reproductive Health Policy are Box 4: The Gambia’s Annexation Strategy programs aimed at promoting maternal and child well- In an effort to promote the transition from preprimary to being, including the following: primary school, the MoBSE launched the Annexation  Integrated Management of Neonatal and Childhood Strategy—the annexing of ECD centers to lower basic schools. The strategy was also a way to promote health and illnesses access to water and sanitation as well as care for OVCs in  Immunization and Vitamin A and Deworming rural and poorer areas. The choice to have only rural Initiative communities participate was also a deliberate decision in  Maternal Anemia and Nutrition Initiative the design of the strategy. Rural areas tend to have lower  Breastfeeding Promotion Program access to schools due to both distance and availability and  Child Healthy Eating and Exercise Programs (mainly fees. As of 2012, 472 ECD centers have been attached to to combat childhood obesity) lower basic schools. The annexed schools have trained  Baby-Friendly Community Initiative (BFCI). primary grade teachers to teach in the Annexed ECD using the play-oriented curriculum developed by the MoBSE. The The 3–6 Community-Based ECD Program is intended to ECD Unit within the MoBSE acts as the coordinating unit of provide children three to six years of age with all of these centers. structured play five days a week. The comprehensive program includes instruction derived from the ECCD, The Gambia’s Open Active Learning Spaces (GOALS) Policy Lever 2.2: curriculum, and parenting sessions for caretakers and Coverage ensures teacher-caretaker interaction on a weekly basis. A robust ECD policy should establish programs in all The Community-Based ECD Program, funded by the essential sectors, ensure high degrees of coverage, and Japan Social Development Fund (JSDF), was reach the entire population equitably—especially the implemented from 2009 to 2013. Recently the World most disadvantaged young children—so that every child Bank, funded by the Early Learning Partnership (ELP), and expecting mother have guaranteed access to conducted an end-of-project evaluation of the JSDF essential ECD services. program. The preliminary results show that the children Access to essential ECD health interventions for in the Annexed ECD outperformed their peers in the pregnant women in The Gambia is not universal. Table Community-Based ECD Program. Based on the results, 7 displays a regional comparison of level of access to the MoBSE has decided to expand the Annexed ECD in essential health services. Government policies support the World Bank–funded Results for Education pregnant women by providing inclusive and accessible Achievement and Development project (READ: 2014– maternity health services. As of 2012, approximately 57 2018). percent of births are attended by skilled attendants in Within the education sector, programs are established the country, and 72 percent of women benefit from at to promote early stimulation and early learning for least four antenatal visits. A benchmark to ensure that at young children from birth to entry into primary school. least 90% of women are attended by skilled attendants For young children and parents, the BFCI program and was added at the United National General Assembly’s the 3–6 Community-Based ECD Program include 21st special session in 1999 and was set forth as a parenting education and programming to promote benchmark for 2015 by the GoTG. The Gambia has been young children’s healthy development. unsuccessful at reaching this target. The Annexation Strategy, described in Box 4, provides Access to high-quality, emergency obstetric and government financial and technical support to newborn care services is crucial to reduce maternal and preprimary classrooms that are annexed to primary newborn mortality rates. Currently there is an unmet schools in poorer, rural areas. The Program for the need of 79 percent for emergency obstetric care in Improvement of Quality and Standards in Schools is a facilities. The referral system functions poorly at the new program implemented by the MoBSE and funded community level, and the problem is made worse by the through UNICEF to ensure standardization of curriculum ill-equipped and understaffed facilities also at the in all schools. The Government received $45,000 for its community level. Moreover, ongoing and steadily increasing staff attrition poses a major challenge. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 11 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 7: Regional Comparison of Level of Access to enrollment rate has been steadily growing at a rate of Essential Health Services for Young Children and Pregnant 30% since 2007, moving from 23% in 2000 to 45.4 % in Women 2015 (Education Statistics, MoBSE). This steady growth The Sierra Liberia Ghana Mali demonstrates the commendable efforts of the MoBSE in Gambia Leone One-year-old children effective programming and service delivery. The immunized against DPT 98% 84% 77% 92% 74% Government’s annexation strategy in rural areas (corresponding vaccines: DPT3ß) (2012) combined with the private sector involvement in urban Children below five with areas have contributed to the growth in preprimary diarrhea receive oral 39 73 53 35 11 enrollment (see Figure 9 for a description of the rehydration/continued feeding (2008–2012) Annexation Strategy). Private providers have been able Children below five with to meet demand in urban areas where the annexation suspected pneumonia strategy does not provide access to free public 70 74 62 41 42 taken to health care provider (2008–2012) preprimary schools. Yet, despite this commendable Pregnant women increase in enrollment since 2007, The Gambia still falls receiving antenatal care behind in providing universal initial education access to 72 75 66 87 35 (at least four times) (2008–2012) ensure that all young Gambian children start school Source: UNICEF Country Statistics 2012/ ready to learn. The level of access to essential ECD nutrition interventions is inadequate to meet the needs of young Box 5 provides an example of a partnership in Australia children and pregnant women. Table 8 displays a that helped increase funding and access to preprimary regional comparison of coverage for nutrition education for all children. The key learning of this interventions. The percentage of the population that government-led initiative was the Government’s ability consumes iodized salt is extremely low, and a high to meet public demand for preschool services. The percentage of pregnant women in the country are Government was able to ensure not only an increase in anemic. The Vitamin A supplementation coverage rate financial support for early childhood education, but for children between 6 and 59 months is considered sustained support. satisfactory for the region, and 34 percent of children are Box 5: Lessons from Australia: The National Partnership exclusively breastfed for the first six months. Despite Agreement on Early Childhood Education these practices, approximately 15 percent of children in Education is the responsibility of the state and territory The Gambia are malnourished. About 20 percent of governments in Australia. In the 2007/2008 academic these children are between 12 and 23 months of age, and years, nearly 70 percent of preschool eligible children reports suggest this is most likely because of attended, and six out of the eight jurisdictions had inappropriate weaning and complementary feeding enrollment rates above 85 percent. However, enrollment was low for specific subgroups within the population, practices. especially Aboriginal children. To address this issue and Table 8: Regional Comparison of Level of Access to Essential increase enrollment across the country, in 2008, through Nutrition Services for Young Children and Pregnant Women the Council of Australian Governments, all Australian The Sierra Liberia Ghana Mali governments jointly agreed to the National Partnership Gambia Leone Agreement on Early Childhood Education. The National Children below five with Partnership aims to provide all children with access to a 23% 44% 42% 23% 28% moderate/severe stunting quality early childhood education program by 2013, Infants exclusively delivered by a four-year university-trained early childhood breastfed until six months 34 32 29 46 20 of age (2008–2012) teacher, for 15 hours a week, 40 weeks a year, in the year Infants with low birth before formal schooling. Before the National Partnership, 10 11 14 11 18 weight (2008–2012) Australia’s investment in ECD was only 0.1 percent of GDP, Prevalence of anemia in which ranked 30th out of the 32 OECD countries, and well 75 60 62 65 73 pregnant women (2010) Prevalence of anemia in below the 0.45 percent of GDP average. To achieve quality 79 83 87 76 83 and universal coverage, all parties agreed to increased, preschool-aged children Sources: UNICEF Country Statistics 2012; WHO Global Database on Anemia sustained financial investment, which was partially aided 2010. though additional funding of 970 million USD by the Commonwealth of Australia over a five-year period. Preprimary education coverage in the Gambia is significantly expanding. The preprimary gross SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 12 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Birth registration rates in The Gambia are very low, but receiving ECCE services in private centers, missions, or strides have been made in addressing inequity in madrassas. Yet fees charged by private centers may still registration. Table 9 provides a regional comparison of create disparities in enrollment rates, with poorer birth registration rates. According to a case study families unable to pay the required fees. completed by ADEA in 2011, reasons for low and varying Figure 5: ECD Gross Enrollment Rate by Region birth registration rates include cost, distance to birth registration centers, lack of awareness on the importance of birth registration, lack of knowledge about registration sites, and mothers’ lack of information regarding their obligation to register children, among other factors. This rate has been steadily increasing since 2004 with the streamlining of birth registration processes into reproductive and maternal health services in health clinics. Currently 53 percent of children in The Gambia are registered, and although The Gambia is still a long way from achieving its goal of universal birth registration, the country has overcome some of the initial obstacles that prevented registration. Source: Education Statistics, MoBSE 2015. Table 9: Regional Comparison of Birth Registration Disparities exist in access to essential health services The Sierra between urban and rural areas. Maternal mortality Liberia Ghana Mali Gambia Leone remains a crucial issue for health officials in the country. Birth registration 53% 78% 4% 63% 81% More than half of maternal deaths occur before 35 years Source: UNICEF Country Statistics 2011. of age, and the risk of dying from a maternity-related cause is 1 in 23. According to the Reproductive Health Policy Lever 2.3: Policy, the risk in rural areas is nearly twice as high as that Equity in urban areas, because of the lack of access to high Based on the robust evidence of the positive effects ECD quality health services. Child health services for children interventions can have for children from disadvantaged younger than 18 months are limited because of both the backgrounds, every government should pay special scarcity of centers that provide Emergency Obstetric and attention to equitable provision of ECD services.7 One of Newborn Services and the availability of programs in the fundamental goals of any ECD policy should be to rural areas. Although the infant mortality rate has provide equitable opportunities to all young children and declined from 78 per 1,000 births in 1990 to 49 per 1,000 their families. live births in 2012, the infant mortality rates still remain high in rural areas, particularly in parts of the North Bank Although access to early childhood education services region. by gender is relatively equitable across regions, access by geographical region remains unequal. Enrollment Policy Options to Implement ECD Widely in rates in urban areas are higher than in rural areas The Gambia because of the relative proximity of children and families to early childhood education centers and the family’s Scope of Programs ability to pay. As displayed in Figure 5, ECCE enrollment  The GoTG provides essential health and nutrition by region varies widely: 23.5 percent in Region 5 to 56.4 services for women and children but should ensure percent in Region 2. Region 1 (Banjul/Kanifing) and more coordinated service delivery efforts. Currently the Region 2 (Western Region) are the most urban areas of GoTG provides comprehensive services for children and the country and therefore have the highest ECCE mothers in the education, health, and nutrition sectors, enrollment rates. as well as many services in the social and child protection fields. The programs vary from immunization and vitamin The private sector, including all nonstate facilities, has supplementation programs to parent education played a major role in increasing preprimary enrollment programs. The GoTG has made much progress on the in The Gambia, with the majority of enrolled children scope of ECD programs available. Currently most of the 7 Engle et al. 2011; Naudeau et al. 2011. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 13 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 programs are not operating to scale, and many of the providing enrichment classes for local birth attendants to programs are still operating as pilots in urban areas. better acquaint them with birth registration procedures. Program implementation depends on size, financing, and This could allow for information on birth registration to location of the program. Some programs have full be disseminated to more parents, especially in rural governmental support with coordinated service delivery, areas. while other programs are run by NGOs and often lack sufficient funding and support for adequate Policy Goal 3: Monitoring and Ensuring implementation. The relevant government agencies Quality should consider developing or revising existing sectoral  Policy Levers: Data Availability • Quality implementation plans to identify responsible Standards • Compliance with Standards implementing agents. Streamlining ECD-related Monitoring and Ensuring Quality refers to the existence programs will also help ensure that children and mothers of information systems to monitor access to ECD services are receiving the full scope of services. and outcomes across children, standards for ECD Coverage services, and systems to monitor and enforce compliance  The GoTG has a wide variety of programs established with those standards. Ensuring the quality of ECD to meet the needs of mothers and young children, but interventions is vital because evidence has shown that access to programs and services is limited, and unless programs are of high quality, the impact on therefore coverage is low. The BFCI program, for children can be negligible or even detrimental. example, which has proven to be successful, serves children in only two out of six regions. After successful Policy Lever 3.1: implementation and quick results, the GoTG Data Availability incorporated the BFCI program into the national Accurate, comprehensive, and timely data collection can strategy. To reach the necessary population, it was promote more effective policy making. Well-developed recommended that the Government increase financial information systems can improve decision making. In and technical support for the program. Additionally, particular, data can inform policy choices regarding the national and state ministerial bodies must collaborate to volume and allocation of public financing, staff ensure streamlining of programs intersectorally and recruitment and training, program quality, adherence to ensure wide availability. standards, and efforts to target children most in need. Equity The MoBSE routinely collects robust data on early The GoTG could consider revising the special needs childhood education indicators. Currently the MoBSE policy framework to be more inclusive of the real needs collects solid data on national and subnational delivery of this population. Distance and cost are significant of education services, including for ECD-aged children. barriers for children and families in accessing services for The MoHSW routinely collect data on indicators related children with special needs. The GoTG could consider to maternal and child wellbeing. Currently the MoHSW establishing more facilities to support children with collects data on national and subnational use of health special needs, especially in harder-to-reach areas, facilities for children on a monthly basis. Data on national including poor and rural. Currently many NGOs and coverage and usage of nutrition interventions for young community institutions are providing special needs children are collected on a regular basis through the services in the country. The GoTG could consider MICS, a nutrition surveillance program that collects data supporting the expansion of and access to such programs every six months, and through updates provided by the by offering vouchers for children to attend these schools. community registrars. Although the MoHSW receives The GoTG could consider reforming the birth data from various sources, the ministry still struggles registration system to facilitate increased registration. with often incomplete or incoherent data. The Gambia struggles with health centers and facilities The Department of Social Welfare (DoSW) collects that illegally charge for birth registration certificates. The routine data on young children and the child protection GoTG could consider including financial penalties or system. The department collects data on (1) number of other forms of sanctions against health facilities that children that enter shelters, (2) number and type of violate the mandate to reduce the number of health foster care homes, (3) number of children that enter centers that are illegally charging fees for birth baby-feeding programs, (4) number of OVCs, and (5) registrations. Additionally, the government may consider SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 14 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 number of orphanages. Like the data from the MoHSW, group is able to better support the ECD Policy data collected by the DoSW technical team are often Framework, including increasing the efficiency and incomplete and not collected on time. timeliness of data collection. While ECD data are collected, The Gambia still lacks a Policy Lever 3.2: centralized data collection system to measure child Quality Standards development goals and outcomes. Numerous partner Ensuring quality ECD service provision is essential. A focus organizations have collected information on child on access—without a commensurate focus on ensuring outcomes and published these in reports and studies. quality—jeopardizes the very benefits that policy makers The GoTG has also authorized and administered the hope children will gain through ECD interventions. The Multiple Indicator Cluster Survey (MICS), funded by quality of ECD programs is directly related to better UNICEF, in 2010. Individual NGOs and government cognitive and social development in children.8 departments collect information as needed but often without any continuity. Table 10 displays the availability Health workers are required to receive training in of selected ECD indicators in The Gambia. The issue of delivering ECD messages. Many families, especially in incomplete data is exacerbated by the lack of rural areas, are unaware of what services are available collaboration between government departments. for them, and most have never received any type of Table 10: Availability of Data to Monitor ECD in The Gambia education on positive parenting and child development. According to the ECD Policy Framework, doctors and Administrative data nurses, extension health service workers, midwives, and Indicator Tracked community health nurses are all required to complete ECCE enrollment rates by region  training in delivering messages related to ECD. The GoTG Special needs children enrolled in ECCE (number of)  has devised a strategy to make ECD knowledge Children attending well-child visits (number of) X widespread through the use of health workers and Children benefiting from public nutrition others involved in the provision of ECD services. X interventions (number of) Women receiving prenatal nutrition interventions The MoBSE has developed and put into place X preprimary curricula for children from birth to 83 (number of) Children enrolled in ECCE by subnational region months old. Preprimary curricula for children at these  (number of) ages is focused on play-based learning, including Average per student-to-teacher ratio in public ECCE  numeracy, language/communication, physical, social Is ECCE spending in education sector differentiated and emotional themes, and cross-cutting issues such as  within education budget? gender, ethnicity, special needs, and health and safety Is ECD spending in health sector differentiated topics. Additionally, for children under age three, the X within health budget? ECD Unit in the MoBSE developed 0 to 3—Partnering Survey data with Parents to Raise Happy Children. The program was Indicator Tracked developed in 2012 and is currently being piloted. The Population consuming iodized salt (%)  program is designed to be implemented by facilitators in Vitamin A supplementation rate for children 6–9  community-based ECCE centers. months Anemia (%) prevalence among pregnant women (%)  For children between the ages of three and six, the Children below the age of five registered at birth  MoBSE has developed The Gambia’s Active Open (%) Children immunized against DPT3 at age 12  Learning Spaces (GOALS). The GOALS curriculum is months Pregnant(%) women who attend four antenatal visits  divided into three terms, ranging in length between 12 (%) Children enrolled in ECCE by socioeconomic status X and 15 weeks, for a total of 40 weeks. Each class for these (%) 40 weeks is between 3 and 4 ½ hours. The curriculum is Lack of coherent, complete data has undermined the NWGECD’s ability to ascertain the status of children in play-based. the system and to make data-driven decisions on programming. The NWGECD hopes that through the recruitment of more departmental staff members, the 8 Bryce et al. 2003; Naudeau et al. 2011; Taylor and Bennett 2008; Victoria et al. 2003. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 15 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Although clear learning standards have been Policy Options to Monitor and Ensure ECD established for ECCE by the MoBSE, privately run ECCE centers tend to utilize their own curriculum and Quality in The Gambia learning standards. Routine and informal observations Data Availability by the MoBSE have shed light on the use of diverse The GoTG could improve, align, and centralize current curricula by a large majority of private ECCE centers. data collection systems to make more informed In an attempt to ensure a smooth learning continuum programming decisions related to ECD. Currently each from preschool to primary school, some nonstate ECCE sector collects its own data. No standardization is found providers have developed their own curricula. In both for the frequency of data collection or the content being the public and private sectors, efforts to create collected. This unsystematic collection of data creates continuity in curriculum have been most successful in challenges for the NWGECD, whose responsibility it is to articulate the needs of children and mothers and develop preprimary schools that are annexed to primary schools. The MoBSE is in the process of piloting the curriculum in policy in accordance with the gaps in programming and select annexed schools. rise in needs. Children with special needs, for example, are often deprived of basic ECD services specific to their Established infrastructure standards for ECCE facilities needs. exist, but there are no established registration and accreditation procedures. According to basic education Facilitate enhanced capacity of local authorities in standards, ECCE centers are required to have 64 square order to resolve issues in service delivery. Although the meters of space or 1.4 square meters per child. Other scope of programs is wide, few data are available to show accessibility and quality of services. The MoBSE began a basic requirements for the construction of ECCE facilities are also laid out in the ECD Policy Framework. However, census to collect information on preprimary enrollment because of the lack of ECCE facility registration and by region in the spring of 2013. It is important that such data be collected routinely and throughout The Gambia, accreditation procedures, such facilities are sometimes constructed and operate without government approval. including in poorer, more remote areas. The Government should work to enhance the capacity of the Policy Lever 3.3: local government officials at both the regional and Compliance with Standards subregional levels to give them the capacity and support to carry out evaluations more frequently. This more Establishing standards is essential to providing quality routine collection of data will ensure that the ECD services and to promoting the healthy development Government constantly has the most up-to-date, of children. Once standards have been established, it is accurate information on hand. The GoTG will be able to critical that mechanisms are put in place to ensure make more informed decisions to address gaps in access compliance with standards. and ensuring quality programing. Compliance with standards is not well monitored in The Gambia. The GoTG has laid out clear guidelines, Quality Standards standards, and goals in many of their ECD policies. Specific sectoral departments could develop and/or Despite this, many policies lack specificity and an overall enhance quality standards to make them more auditing mechanism to ensure compliance. Compliance actionable. Currently most governmental departments is not monitored and, when it is, not well tracked. Section have quality standards for ECD services in place that are 3 of the ECD Policy Framework places the responsibility too general. Compliance tends to be low on these for ensuring compliance with standards on the private standards. Appropriate departments should work on sector and NGOs. The policy also delegates auditing enhancing quality standards by making them more responsibilities for program implementation to specific, actionable points that relevant departmental respective departments. No clear guidelines or stakeholders can then use to better guide themselves procedures on how or when to audit are given in the with. policy framework. Ambiguity over the terms of ensuring compliance with standards has led to a lack of action on behalf of responsible parties. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 16 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Compliance with Standards The GoTG could consider developing enhanced standards and an auditing mechanism to monitor and ensure compliance across the sectors. Currently weak mechanisms exist for ensuring compliance with standards. Those mechanisms mostly exist through verbal declarations and word of mouth but do not appear in ECD policies and documents. Minimal efforts to establish such mechanisms have been made in the health, nutrition, and education sectors. It is advisable that the GoTG develop standards, especially for ECCE personnel, and create mechanisms to ensure compliance. Comparing Official Policies with Outcomes The existence of laws and policies alone does not always guarantee a correlation with desired ECD outcomes. In many countries, policies on paper and the reality of access and service delivery on the ground are not aligned. Table 11 compares ECD policies in The Gambia with ECD outcomes. Preliminary Benchmarking and International Comparison of ECD in The Gambia Table 12 presents the classification of ECD policy in The Gambia within each of the nine policy levers and three policy goals. The SABER-ECD classification system does not rank countries according to any overall scoring; rather, it is intended to share information on how different ECD systems address the same policy challenges. Table 13 presents the status of ECD policy development in The Gambia alongside a selection of regional countries. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 17 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 11: Comparing ECD Policies with Outcomes in The Gambia ECD Policies Outcomes Law complies with the International Exclusive breastfeeding Code of Marketing of Breast Milk rate (>6 months): Substitutes 34% The Gambia has national policy to Household iodized salt encourage the iodization of salt consumption: 22% Preprimary school is free but not Preprimary school compulsory in The Gambia enrollment: 45.4% Young children are required to Children with DPT (12–23 receive a complete course of months): childhood immunizations 98% Policy mandates the registration of Completeness of birth children at birth in The Gambia registration: 53% Table 12: Benchmarking ECD Policy in The Gambia Level of Level of ECD Policy Goal Policy Lever Development Development Legal Framework Establishing an Enabling Intersectoral Coordination Environment Finance Scope of Programs Implementing Widely Coverage Equity Data Availability Monitoring and Ensuring Quality Standards Quality Compliance with Standards Latent Emerging Established Advanced Legend: Table 13: International Classification and Comparison of ECD Systems Level of Development ECD Policy Goal Policy Lever The Sierra Ethiopia Kenya Liberia Gambia Leone Legal Framework Establishing an Enabling Coordination Environment Finance NA Scope of Programs Implementing Coverage Widely Equity NA NA Data Availability Monitoring and Ensuring Quality Standards Quality Compliance with Standards Latent Emerging Established Advanced Legend: SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 18 NA = not available. THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 14: Summary of Policy Options to Improve ECD in The Gambia Policy Goals  Policy Options and Recommendations  Consider developing a costed implementation plan for ECD.  Tighten and enhance coordination efforts between the ECD institutional Establishing an Enabling Environment anchor, the NWGECD, and the National Commission for Children.  Improve budgeting practices to make tracking of spending for ECD and coordination across sectors easier.  Facilitate enhanced capacity of local authorities to best identify and resolve issues in service delivery. Implementing Widely  Revise the special needs policy framework so as to make it more inclusive of special needs children.  Reform the birth registration system so it is simpler and more inclusive.  Improve and centralize data collection systems to facilitate more informed programming decisions related to ECD. Monitoring and Ensuring  Ministerial bodies could consider developing and enhancing quality standards, Quality especially for ECD personnel.  Develop and implement auditing mechanism to monitor and ensure compliance with ECD standards across sectors. Conclusion Acronyms The SABER-ECD initiative is designed to enable ECD BFCI Baby-Friendly Community Initiative policy makers and development partners to identify BSED Basic and Secondary Education Directorate opportunities for further development of effective CWGECD Community Working Group on ECD ECD systems. This Country Report presents a ECCE Early Childhood Care and Education framework to compare The Gambia’s ECD system ECD Early Childhood Development with other countries in the region and EPI Extended Program on Immunization internationally. Each of the nine policy levers are GOALS The Gambia’s Active Open Learning Spaces examined in detail, and policy options are identified GoTG Government of The Gambia to strengthen ECD. Table 14 summarizes the key policy options identified to inform policy dialogue HIV/AIDS human immunodeficiency virus (infection)/acquired immunodeficiency syndrome and improve the provision of essential ECD services JSDF Japan Social Development Fund in The Gambia. MoBSE Ministry of Basic and Secondary Education Acknowledgments MoHSW Ministry of Health and Social Work NGO Nongovernmental Organization This Country Report was prepared by the SABER-ECD NWGECD National Working Group on ECD team at the World Bank headquarters in OVC orphans and vulnerable children Washington, DC. The report presents country data collected using the SABER-ECD policy and program RCH Reproductive and Child Health data collection instruments and data from external RWGECD Regional Working Group on ECD sources. Data on access to early learning have been SABER-ECD Systems Approach for Better Education Results–Early updated in 2015. The report was prepared in Childhood Development consultation with the World Bank Human UNICEF United Nations Children’s Fund Development Gambia team and the Government of USAID United States Agency for International Development The Gambia. For technical questions or comments VAS Vitamin A Supplementation about this report, please contact the SABER-ECD WHO World Health Organization team (helpdeskecd@worldbank.org). SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 19 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 References Britto, P., H. Yoshikawa, and K. Boller. 2011. “Quality of Early Childhood Development Programs: Rationale for Investment, Conceptual Framework and Implications for Equity.” Social Policy Report 25 (2): 1–31. Bryce, J., S. el Arifeen, G. Pariyo, C. F. Lanata, D. Gwatkin, J.- P. Habicht, and the Multi-Country Evaluation of IMCI Study Group. 2003. “Reducing Child Mortality: Can Public Health Deliver?” The Lancet 362: 159–64. Engle, P. L., L. C. H. Fernald, H. Alderman, J. Behrman, C. O’Gara, A. Yousafzai, M. Cabral de Mello, M. Hidrobo, N. Ulkuer, and the Global Child Development Steer Group. 2011. “Strategies for Reducing Inequalities and Improving Developmental Outcomes for Young Children in Low-Income and Middle-Income Countries.” The Lancet 378 (9799): 1339–53. Hanushek, E. 2003. "The Failure of Input-Based Schooling Policies." Economic Journal 113: 64–98. Hanushek, E. A., and D. D. Kimko. 2000. “Schooling, Labor - Force Quality, and the Growth of Nations." American Economic Review 90 (5): 1184–1208. Naudeau, S, N. Kataoka, A. Valerio, M. J. Neuman, and L. K. Elder. 2011. Investing in Young Children: An Early Childhood Development Guide for Policy Dialogue and Project Preparation. Washington, DC: World Bank. Neuman, M. J. 2007. “Good Governance of Early Childhood Care and Education: Lessons from the 2007 Education for All Global Monitoring Report.” UNESCO Policy Briefs on Early Childhood. United Nations Educational, Scientific and Cultural Organization, New York. Tayler, C., and J. Bennett. 2006. Starting Strong II: Early Childhood Education and Care. Paris: Education Directorate of the Organization for Economic Co-operation and Development. UNESCO-OREALC. 2004. “Intersectoral Co-ordination in Early Childhood Policies and Programmes: A Synthesis of Experiences in Latin America.” Regional Bureau of Education for Latin America and the Caribbean, United National Educational, Scientific and Cultural Organization, Santiago, Chile. Valerio, A., and M. Garcia. 2012. “Effective Financing.” In Handbook of Early Childhood Development Research and Its Impact on Global Policy, ed. P. Britto, P. L. Engle, and C. M. Super, S2013. New York: Oxford University Press. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 20 THE GAMBIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 www.worldbank.org/education/saber The Systems Approach for Better Education Results (SABER) initiative produces comparative data and knowledge on education policies and institutions, with the aim of helping countries systematically strengthen their education systems. SABER evaluates the quality of education policies against evidence-based global standards, using new diagnostic tools and detailed policy data. The SABER country reports give all parties with a stake in educational results—from administrators, teachers, and parents to policy makers and business people—an accessible, objective snapshot showing how well the policies of their country's education system are oriented toward ensuring that all children and youth learn. This report focuses specifically on policies in the area of Early Childhood Development. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. THE WORLD BANK SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 21