Kosovo EARLY CHILDHOOD DEVELOPMENT SABER Country Report 2021 Policy Goals Status 1. Establishing an Enabling Environment Kosovo has a relatively well-established legal framework supporting early childhood development (ECD). The legislation for the education, health and nutrition and social protection sectors is separate. The only connection is made with the recent Law on Child Protection. Primary healthcare is provided free of charge, but preprimary education charges fees that may be subsidized by the government. Intersectoral coordination is a serious weakness of the system along with lack of a multisectoral ECD policy and a lead institutional anchor across the health, nutrition, education, and social and child protection sectors. Levels of spending on education, social assistance and health services are generally low. 2. Implementing Widely Kosovo has a variety of ECD programs in the key sectors. Coverage rates of essential health and nutrition interventions are generally high but could be increased. Enrollment rates in early childhood education for children ages 0-5 are very low, while enrollment for age 5-6 has reached 92%. Coverage of social assistance is low compared with need. Efforts are needed to raise public awareness of the importance of the period from birth to three. A number of child and social protection schemes to support ECD exist. A lack of data makes it difficult to assess whether ECD services are provided equitably across the population. Young children with disabilities may not receive quality services. 3. Monitoring and Assuring Quality Kosovo gathers several types of administrative and survey data on ECD. Data that allows for disaggregation based on rural/urban location are not available, and few data are available on children with disabilities. Professional development requirements and service delivery and infrastructure standards are established for preprimary schools, but less so for health and social protection. Due to lack of monitoring mechanisms, it is difficult to gauge how well these standards are met. Individual children’s development outcomes are not monitored in a systematic way. KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Kosovo and Early Childhood Development (ECD) Early childhood development (ECD) has become a high priority for the government of Kosovo in the last decade. The government increasingly recognizes the importance of a strong early childhood development system to build the country’s human capital and strengthen its economy. While policies and programs targeting young children are fairly well-developed in the sectors of health, nutrition, child protection, and social protection, policies and interventions in early childhood education are still emerging. Kosovo experienced solid economic growth over the last decade with an average of 3.6 percent until the recession of 2020, but it is expected to gradually rebound in 2021 with real activity only reaching pre-pandemic levels in 2022 (World Bank 2021). While Kosovo is classified as an International Development Association (IDA) country and characterized by Fragility, Conflict and Violence (FCV), its GDP per capita of US$4,458 puts it in the upper-middle income category. Its population of roughly 1.8 million people is relatively young, with an average age of 26 years which is the lowest in Europe. While the fertility rate has declined substantially from 4.5 births per woman in 1985 to 2.02 births today, it is still higher than much of the rest of Europe. In order to fuel the country’s continued economic growth, Kosovo’s young population will need skills demanded by a modern economy. The foundations of many of these skills are built during the first few years of life. In particular, girls, children from disadvantaged minority groups, and children living in rural areas will need to develop these skills in order to contribute to the economy and to promote shared prosperity. Even so, equity and gender gaps in access to economic opportunities remain one of the country’s main challenges. Kosovo lacks a multisectoral strategy on early childhood development—a major weakness—although there are nascent efforts to develop leadership and coordinate child development across sectors. Developing and implementing a strong multisectoral strategy and coordination mechanisms to provide integrated services and ensure efficient use of resources will be substantial challenges and should be a top priority. Across sectors, the country lacks a strong system for data collection, analysis, and evaluation on early childhood development programs. Constrains for any intervention are incomplete or disfunctional information systems making it impossible to have real time or valid data for informing programs and policymaking. Additionally, public expenditure on early childhood development is difficult to gauge, as spending on young children is generally not disaggregated from sectoral budgets. Kosovo provides a number of essential services for maternal and child health and nutrition, although there is room for improvement in coverage of services. A lack of data makes it difficult to discern if these services are equitably distributed across the population. However, subsector studies, such as the Home Visiting report, provide documentation that access to services and outcomes are not distributed evenly. The probability of survival to age 5 in Kosovo is 98.5 percent, close to the average for Europe at 99.3 percent (HCI, World Bank 2020). Child protection laws and services are established, however, the coverage across the country is still a challenge to provide the care for vulnerable families and children. With regards to social protection, the Social Assistance Scheme program supports families with financial vulnerabilities and requires that school-age children are enrolled in school, but no evidence that the condition is monitored for full compliance exists. The SAS includes an additional payment for children. Criteria for benefitting from this Scheme are narrowly established and many of the poor are not defined as eligible. Other social assistance programs that are targeted based on disability, for example, do not specifically target children’s needs, rather it is a packaged for all citizens.1 International assessments of Kosovo’s education system suggest that the system is not performing well. The OECD’s 2018 Programme for International Student Assessment (PISA) places Kosovar students’ average performance on math, science and reading as third from the bottom of seventy-seven participating countries. The results showed that a 15-year-old Kosovar student falls behind 4 years of education in science, math, and reading. Additionally, the World Bank’s Human 1 It is worth noting the clarification of the term citizens and the need to differentiate it from residents. Most of the programs, such as the Social Assitance Scheme, are not eligible to foreign residents living in Kosovo. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 1 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Capital Index (HCI) shows that children born in Kosovo today will be 56 percent as productive when they reach adulthood as they could be if they received strong education and health services. Kosovo’s HCI is lower than the average for the Europe and Central Asia (ECA) region. Children in Kosovo can expect to complete 13.2 years of pre-primary, primary, and secondary education by age 18. However, after adjusting years of schooling for the quality of learning, this is equivalent to only 7.7 years of education. Kosovo has recognized increasing participation in early childhood education as a key priority in the Kosovo Education Strategic Plan 2017-2021. This is a continuation and deepening of earlier efforts which show that gross enrollment in pre- primary grew from 77.4 in 2012 to 93.1 in 2019/20. The next push is for expansion of access to pre-school which remains inadequate in its coverage of only 7 percent of children 0<5 years old. The participation rate for age group 3<6 is 38.1 percent. While there has been an emphasis on expansion, children in public pre-primary only spend about two hours at school per day and quality is lacking. While early childhood development in Kosovo faces a variety of challenges, the country has the opportunity to build a strong ECD system that draws on a growing body of evidence and international best practices on how to promote child development. Making these investments in its youngest citizens are necessary to establish the foundations for the country’s future economic growth. The 2006 Law on Pre-school Education provides the basis for delivery of early childhood education. It is currently under revision, and it holds a potential for further developments in the system. In addition, the recent Law on Child Protection has also provided an indication that Kosovo has been moving towards prioritizing ECD. Table 1: Snapshot of ECD indicators in Kosovo with regional comparison North Kosovo Albania Bulgaria Romania Serbia Macedonia Indicator Roma, Ashkali Overall & Egyptian Infant Mortality (deaths per 1,000 live 15.0 26.0 8.61 5.62 5.34 5.69 4.62 births, 2019) Below 5 Mortality (deaths per 1,000 9.68 16.0 27.0 6.73 6.1 7.0 5.3 live births, 2019) Moderate & Severe Stunting 4.0% 15% 11.3% 7% 4.3% 12.8 5% Gross enrollment rate in preprimary 93.1% (1) N/A 83% (2) 81% 36.8% 87% (3) 63.9% education Birth registration 98%* 95%** 98% 100% 100% 100% 100% * Registered and with a birth certificate is 89%, **Registered and with a birth certificate is 85%. Source: MICS (Kosovo) 2019-20; MICS (North Macedonia) 2019; MICS (Serbia) 2019; UNICEF State of the World’s Children Database 2019; (1) Kosovo Ministry of Education Science and Technology Annual Statistics 2019; (2) SABER ECD Albania Country Report; (3) SABER-ECD Romania Country Report 2019. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 2 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Systems Approach for Better Education Results – Early Childhood Development (SABER- ECD) SABER – ECD collects, analyzes, and disseminates comprehensive information on ECD policies around the world. In each participating country, extensive multisectoral information is collected on ECD policies and programs through a desk review of available government documents, data and literature, and interviews with a range of ECD stakeholders, including government officials, service providers, civil society, development partners and scholars. The SABER-ECD framework presents a holistic and integrated assessment of how the overall policy environment in a country affects young children’s development. This assessment can be used to identify how countries address the same policy challenges related to ECD, with the ultimate goal of designing effective policies for young children and their families. Box 1 presents an abbreviated list of interventions and policies that the SABER-ECD approach looks for in countries when assessing the level of ECD policy development. This list is not exhaustive, but it is meant to provide an initial checklist for countries to consider the key policies and interventions needed across sectors. Three Key Policy Goals for Early Childhood Development SABER-ECD identifies three core policy goals that countries should address to ensure optimal ECD outcomes: Establishing an Enabling Environment, Implementing Widely and Monitoring and Assuring Quality. Improving ECD requires an integrated approach to address all three goals. As described in Figure 1, for each policy goal, a series of policy levers are identified, through which decision-makers can strengthen ECD. Strengthening ECD policies can be viewed as a continuum; as described in Table 2, countries can range from a latent to advanced level of development within the different policy levers and goals. Box 1: A checklist to consider how well ECD is promoted at the country level What should be in place at the country level to promote coordinated and integrated ECD interventions for young children and their families? Health care • Eight antenatal care visits through pregnancy, per WHO guidelines • Skilled attendants at delivery • Childhood immunizations • Well-child visits which monitor motor, linguistic, socio-economic, and cognitive development Nutrition • Antenatal nutrition, including folate and iron. • Breastfeeding promotion • Salt iodization • Iron fortification Early Learning • Parenting programs (during pregnancy, after delivery and throughout early childhood) • High quality and affordable childcare for working parents • Free preprimary school (preferably at least two years with developmentally appropriate curriculum and classrooms, and quality assurance mechanisms) Social Protection • Services for orphans and vulnerable children • Policies to protect rights of children with disabilities and promote their participation in/ access to ECD services • Social assistance or income support to reach the most vulnerable families (could include cash transfers, etc.) Child Protection • Mandated birth registration • Job protection and breastfeeding breaks for new mothers • Specific provisions in judicial system for young children SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 3 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 • Guaranteed paid parental leave of least six months • Domestic violence laws and enforcement • Tracking of child abuse (especially for young children) • Training for law enforcement officers regarding the particular needs of young children Source: SABER ECD What Matters Most? Framework Paper 2013, World Health Organization 2016. Figure 1: Three core ECD policy goals SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 4 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Table 2: ECD policy goals and levels of development Level of Development ECD Policy Goal Minimal legal Developed legal Non-existent legal framework; some Regulations in some Establishing an framework; robust framework; ad-hoc programs with sectors; functioning inter- Enabling inter-institutional financing; low inter- sustained financing; sectoral coordination; Environment coordination; sectoral coordination. some inter-sectoral sustained financing. sustained financing. coordination. Coverage expanding Universal coverage; Low coverage; pilot Near-universal coverage but gaps remain; comprehensive programs in some in some sectors; Implementing programs established strategies across sectors; high inequality established programs in Widely in a few sectors; sectors; integrated in access and most sectors; low inequality in access services for all, some outcomes. inequality in access. and outcomes. tailored and targeted. Information on Information on outcomes Information on outcomes from Minimal survey data at national, regional, and outcomes at national national to individual Monitoring available; limited local levels; standards for level; standards for levels; standards exist and Assuring standards for provision services exist for most services exist in some for all sectors; system Quality of ECD services; no sectors; system in place to sectors; no system to in place to regularly enforcement. regularly monitor monitor compliance. monitor and enforce compliance. compliance. Source: SABER ECD What Matters Most? Framework Paper 2013 Policy Goal 1: Establishing an Enabling Environment ➢Policy Levers: Legal Framework • Intersectoral Coordination • Finance An Enabling Environment is the foundation for the design and implementation of effective ECD policies.i2 An enabling environment consists of the following: the existence of an adequate legal and regulatory framework to support ECD; coordination within sectors and across institutions to deliver services effectively; and, sufficient fiscal resources with transparent and efficient allocation mechanisms. Policy Lever 1.1: Legal Framework The legal framework comprises all of the laws and regulations which can affect the development of young children in a country. The laws and regulations which impact ECD are diverse due to the array of sectors which influence ECD and because of the different constituencies that ECD policy can and should target, including pregnant women, young children, parents, and caregivers. National laws and regulations promote healthcare for pregnant women and young children. The legislative framework in Kosovo supports antenatal visits and skilled delivery for pregnant women. However, there is no provision for standard screening for HIV and sexually transmitted diseases (STDs). Healthcare provisions for young children require complete immunization and four well child visits. The legislation also provides free and accessible healthcare for children for which they are entitled to free well child visits and free immunization. In addition, the various health services children receive 2 Brinkerhoff, 2009; Britto, Yoshikawa & Boller, 2011; Vargas-Baron, 2005 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 5 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 are also free in the public system as regulated by internal Ministry of Health (MoH) protocols. It is worth noting that while services are free, the health system is chronically low on medication, equipment, and supplies. National laws and regulations promote appropriate dietary consumption by pregnant women and children . The legislative context guarantees and promotes breastfeeding and breast milk substitute, iron fortification, and salt iodization. Kosovo has adopted a law on breastfeeding promotion (Law No. 05-L .023 on the Protection of Breastfeeding, year 2015) and new mothers receive services at birth to inform and help with breastfeeding. The law specifies that every employed breastfeeding woman is entitled to one or two hours of paid time each day, at the beginning, in the middle or at the end of the working hours, in agreement with the employer. In order to claim such time, she shall notify the employer in writing and provide the certificate issued by the doctor, which confirms that the employed woman is breastfeeding. Policies protect pregnant women and new mothers and promote opportunities for parents to provide care to newborns and infants in their first year of life. According to the Law on Labor (No. 03/L-212 of year 2010), maternity leave is guaranteed up to one year with three quarters of the year paid, and there are provisions for job protection. During the first six months of maternity leave, payment is made in an amount equal to 70 percent of the employee’s basic salary; and during the following three months, maternity leave is paid by the Government of Kosovo, in an amount equal to 50 percent of the average salary in Kosovo. The employed woman then has the right to extend her maternity leave for another three months without payment. The employer may not terminate the employment relationship of a woman while she is on maternity leave, except on the grounds of collective dismissal. For fathers, only three days of paid leave at birth or adoption and two weeks unpaid leave after birth but before the child turns age 3 is guaranteed by legislation. The father of the child may assume the rights of the mother if the mother dies or abandons the child before the end of the maternity leave. The right of the maternity leave after the first six months may be conveyed to the father of the child in agreement with the mother. The Law on Labour also establishes that a parent for a child that requires special care due to health conditions and/or permanent disability, shall be entitled to work part-time, until the child is two years old. Table 3 provides a sample of leave policies from the region. Table 3: Comparison of maternity and paternity leave policies in Europe and Central Asia Kosovo Albania Bulgaria North Macedonia Romania Serbia 270 days paid 9 months in case of 1 140 days maternity leave, maternity leave but child, 12 months for 2 126 days maternity 7 days paternity leave365 at reduced salary, or more children with leave and 10 days days of cumulative One year paid plus next 95 days 410 days minimum 28 and paternity leave at 85% pregnancy and childcare maternity leave unpaid leave. 3 days maternity leave; maximum 45 days pay, funded by leave. Pregnancy leave and before delivery. 45 days government through starts 28-45 days before paid paternity leave 15 days employment after delivery are and 2 weeks unpaid paternity leave worker contributions. birth. 365 days is the leave protection mandatory; 7 days paid Childcare leave until for the 1st and 2nd child. It leave. Applies to paternity leave public & private child is two years old is 2 years for the 3rd and sector. next child Source: Kosovo Law on Labor, No. 03/L-212r, Article 49; World Bank 2019; SABER-ECD Albania Policy Instrument 2015; SABER-ECD Romania Policy Instrument 2018. National laws promote early childhood education. The Law on Pre-university Education, No. 04/L-032, 2011, promotes early childhood education starting from age 0, however, education is only considered compulsory starting from ages 5-6 which is pre-primary or grade 0. For the school year 2019/2020, enrollment in pre-primary was about 92 percent (MESTI, EMIS). Through curriculum policy (Kosovo Curriculum Framework, 2011), education for ages 5-6 is meant to be treated as a transition to school, with primary school starting at grade 1. An objective of the Kosovo Education Strategic Plan, 2017- 2021, is to put in place measures to increase participation of children in pre-school education. However, it does not address early childhood development from an integrated perspective of ensuring a coherent approach and quality aspects including the dimensions of health, nutrition, and social protection. There is no systematic analysis of demand and supply SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 6 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 by geographical region, however the assumption is that the demand is greater especially in urban areas. Limited capacities in the public sector has led to the creation of private providers in early childhood education. A number of laws establish the social protection system in Kosovo, the most important of which for ECD are those that govern the provision of social assistance, social services and, most recently, child protection. The social assistance legislation (Law on the Social Assistance Scheme in Kosovo No.2003/15 and Law No. 04/L-096 on Amending and Supplementing the Law on the Social Assistance Scheme) is the basis for the country’s only poverty -targeted social assistance program. As written, the law poses certain restrictions on access to poverty-targeted monthly financial transfers, including to poor families with young children. The Government of Kosovo has started reforming this legislation to inter alia improve the access to social assistance for all poor families with young children. Child protection policies and services are covered under a variety of laws. The new Law on Child Protection, 6/L-084 that was just approved and entered into force in July 2020, has marked significant progress in Kosovo’s policy landscape as an initiative to abandon the past experiences of a fragmented approach to ECD. The law provides mechanisms for child protection as well as foresees mechanisms that will enable inter-institutional cooperation between various stakeholders with a clear focus on public sector organizations. The Government has taken measures to reduce family violence including the development of a specific strategy (National Strategy of the Republic of Kosovo on Protection on Domestic Violence and Action Plan 2016-2020) for addressing family violence for the period 2018-2022. Similarly, the new Law on Child Projection supports measures and mechanisms that contribute to the reduction of family violence. The current legislation set up does not state legal provisions for training for judicial services for children. However, legislation requires that social workers have understanding of the work with children. Laws are in place for orphans and vulnerable children to receive a range of ECD services. For children with disabilities, laws promote their participation and access to ECD services. These measures are stated in the Law on Social and Family Services, No. 02/7-17, year 2007. Kosovo has a solid legal basis for child protection practices. The recent legislation approved in 2019 and entering into force in July 2020 (Law on Child Protection 06/L-084) has marked a significant development in the area of early childhood development. It will serve as a basis for further development of practices. The area of social and child protection is mainly governed by the Law on Social and Family Services, No. 02/L-17/year 2007, which is further detailed into Administrative Instruction 12/2012 on procedures for providing housing for orphans and other vulnerable children. The protection of abandoned children is regulated mainly through the Law on Family No. 2004/32 and the Law on Social and Family Services 02/L-17. Under the Section on Alternative Forms for Child Care (Article 11) of this Law, it states the Department for Social Welfare (DSW) is responsible to make all arrangements for abandoned children and provide suitable long-term care (Article 11.3). To assist the DSW in the management and oversight of the care of children for whom it has direct responsibility, the Ministry appoints a Child Placements Panel (Article 11.8). The Centre for Social Work, on behalf of the DSW has a duty of care and is at all times obliged to safeguard the child’s safety and act as a good parent would towards a child who has been abandoned as well as report to the DSW any risks or help needed (Article 10.7 and 11.1). The Law on Social and Family Services is currently being revised. Box 2. Key laws and regulations governing ECD in Kosovo • Law on Preuniversity Education No. 04/L-032, 2011 • Law on Preschool Education No. 02/L-52, 2006 • Law on Child Protection No. 06/L-084, 2019 • Law on Health No. 04/L – 125, 2013 • Law on Social and Family Services No. 02/L-17, 2007 and Law No. 04/L-081 on Amending and Supplementing the Law No. 02/L-017, 2012 • Law on Social Assistance Scheme in Kosovo No.2003/15 and Law No. 04/L-096 on Amending and Supplementing the Law on the Social Assistance Scheme No.2003/15, 2012 • Law on Material Support for Families of Children with Permanent Disability Law, No. 03/L-022, year 2008 • Family Law of Kosovo No. 2004/32 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 7 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Policy Lever 1.2: Intersectoral Coordination Development in early childhood is a multi-dimensional process.3 In order to meet children’s diverse needs during the early years, government coordination is essential, both horizontally across different sectors as well as vertically from the local to national levels. In many countries, non-state actors (either domestic or international) participate in ECD service delivery; for this reason, mechanisms to coordinate with non-state actors are also essential. Kosovo does not have a specific multi-sectorial strategy or operationalized coordinated effort on ECD. The government does not have a proper strategy and policy for inter-sectorial coordination in support of all aspects of early childhood development. However, efforts have been made through the recent Law on Child Protection approved in 2019 and ratified in July 2020 (No. 06/L-084) to initiate cross sectorial coordination efforts in the area of child protection and child rights. The law cannot be considered a comprehensive multi-sectoral ECD strategy, which is still fragmented across the ministries of health, education, and social welfare. However, the law has provided the space for two coordinating mechanisms to be established, including an office on child protection at the Prime Minister’s office and an Interministerial Committee on Child Rights. It remains to be seen how soon and how well these mechanisms will become operational and support the desired outcome of having an institutional lead in providing a well-coordinated and coherent support to child development. Box 3 describes Chile’s multisectoral policy that ensures children receive all the services essential to their optimal development. Box 3. Chile’s Multisectoral ECD Policy and Implementation A multisectoral ECD policy is a comprehensive document that articulates the services provided to children and key stakeholders involved, including responsibilities of service providers and policy makers. The policy should also present the legal and regulatory framework in a country and address any possible gaps. Typically, a policy can include a set of goals or objectives and an implementation plan that outlines how they will be achieved. The benefits of doing so are manifold. The preparation process requires all stakeholders to contribute, which in turn promotes a more holistic approach to ECD and identifies possible duplication of objectives by individual stakeholders. Another benefit is that the policy framework clarifies the boundaries within which all stakeholders are to operate and can create accountability mechanisms. One such example is Chile Crece Contigo (“Chile Grows With You”, CCC), an intersectoral policy introduced in 2005. The multi-disciplinary approach is designed to achieve high quality ECD by protecting children from conception with relevant and timely services that provide opportunities for early stimulation and development. A core element of the system is that it provides differentiated support and guarantees children from the poorest 40% of households key services, including free access to preprimary school. Furthermore, the CCC mandates provision of services for orphans and vulnerable children and children with special needs. The creation and implementation of the CCC has been accomplished through a multisectoral approach at all levels of government. At the central level, the Presidential Council is responsible for the development, planning, and budgeting of the program. At each of the national, regional, provincial, and local levels there are institutional bodies tasked with supervision and support, operative action, as well as development, planning and budgeting for each respective level. The Chile Crece Contigo Law (No. 20.379) was created in 2009. At present, Kosovo has made some initial steps to establish an institutional anchor to lead early childhood development. According to Article 16 of the new Law on Child Protection, the institutional anchor is foreseen as an inter- ministerial committee supported and led by the Prime Minister’s Office of Good Governance. Since the law has only recently been promulgated, no progress has been noticed yet on the inter-ministerial coordination of all actors on the ground. The present reality remains a fragmented approach to service delivery between various sub-sectors and state and 3 Naudeau et al., 2011; UNESCO-OREALC, 2004; Neuman, 2007 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 8 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 non-state actors. In recent years, the three main ministries – education, health, and social welfare – have initiated an informal task force to coordinate the efforts in child development, however, it remains an informal initiative. The new law on child protection has the potential to lead to a more formalized and sustainable mechanism within the Good Governance Office with representatives from the line ministries since it provides for the establishment of the Interministerial Committee on Child Rights. The institutional anchor for ECD in Jamaica is described in Box 4. Box 4. Jamaica’s Institutional ECD Anchor In 2003, the Government of Jamaica established the Early Childhood Commission (ECC) as an official agency to govern the administration of ECD in Jamaica (Early Childhood Commission Act). Operating under the Ministry of Education (MoE), the ECC is responsible for advising the MoE on ECD policy matters. It assists in the preparation as well as monitoring and evaluation of ECD plans and programs, acts as a coordinating agency to streamline ECD activities, manages the national ECD budget, and supervises and regulates early childhood institutions (ECIs). The ECC includes a governance arm comprised of the officially appointed Executive Director, a Board of Commissioners, and seven sub- committees representing governmental and non-governmental organizations. It also has an operational arm that provides support to the board and subcommittees. The ECC is designed with representation from all relevant sectors, including education, health, local government and community development, labor, finance, protection, and planning. Each ministry or government agency nominates a representative to serve on the Board of Commissioners. The seven sub-committees which provide technical support to the ECC board are comprised of 50 governmental and non- governmental agencies. Vertical coordination between the municipal and central level and coordination within the municipal level of different actors and sub-sectors need enhancement. The coordination between health, education and social welfare at municipal level is similar to coordination at the national level, and there is room for improvement. Coordination between municipality and central level are somewhat better in the sense that responsibilities of policy design and policy enactment are clearly divided between two levels. However, more should be done in terms of the actual coordination at the level of service delivery and its quality. There is significant scope to improve the coordination of ECD services at the local level, particularly to support improved tracking of children, referral between services and targeting of interventions for poorer and marginalized communities. For example, a recent evaluation of the Home Visiting Program pointed to the governance challenges associated with improving referrals and integrated service delivery. At present there is a lack of clarity on how referrals within the health sector and from one sector to another should best function, and if referral pathways are best facilitated through protocols and guidance mandated at the central or municipal level. There is similarly a lack of guidance as to how social workers could help ensure that the poorest children receive the range of ECD services required to support good outcomes. Collaboration between state and non-state stakeholders in ECD exists, but there is potential for it to be enhanced. The current legislative framework does not provide measures and provisions for a proper and well-coordinated cooperation between state and non-state stakeholders at the level of planning policy and coordinating implementation efforts across the sectors of health, education, and social welfare. However, the MFLT’s has established practices of using NGOs to deliver social services. The MFLT issues awards to NGOs on an annual basis to provide social services, which also includes care for children.4 At the level of developing new legislation, there are practices in place that provide for consultations with the stakeholders including private and NGO sector. In the education sector, there are provisions for cooperation between municipalities and communities for establishing early childhood education centers at the pre-school level that could be considered a form of partnership. 4Each year, the MFLT provides 30 to 40 percent of the budget to support various programs implemented by the NGOs. The budget has no formula for distribution but that is done based on set goals for each year. There is a call for application and successful NGOs get funding. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 9 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Policy Lever 1.3: Finance While legal frameworks and intersectoral coordination are crucial to establishing an enabling environment for ECD, adequate financial investment is key to ensure that resources are available to implement policies and achieve service provision goals. Investments in ECD can yield high public returns, but they are often undersupplied without government support. Investments during the early years can yield greater returns than equivalent investments made later in a child’s life cycle and can lead to long-lasting intergenerational benefits. 5 Not only do investments in ECD generate high and persistent returns, they can also enhance the effectiveness of other social investments and help governments address multiple priorities with single investments. The budgeting processes in early childhood development are still weak and not fully transparent. The budget for the three sectors (education, health, and social protection) is publicly available information. Budget allocation to some extent is based on the prior year and follows similarly every year. The health budget is planned as a per capita funding throughout the country with children being accounted for in the population size in that municipality but without featuring the dimension of ECD. The education budget is planned at the central level and channeled to municipalities through specific municipal grants on a yearly basis. It uses a per capita school financing formula for financing pre-university education in municipalities, and pre-school is also included. The financing formula in education reflects the student numbers served, the geographical location, and the teacher student ratios as stated in relevant legislation. For social protection, government allocates funding annually for a range of social assistance programs.6 Funding for social assistance programs is based on need, that is, any person or household that is eligible is entitled to receive support. However, in practice, eligibility criteria are narrowly set which significantly restricts the size of the programs. For the only poverty-targeted program, analysis shows that annual allocations have fallen over time. The level of funding to social assistance is low. The total budget for SAS benefits to Category 2 households for 2019 was 11,258,132.50 Euro. Total budget for the supplemental payment for children age zero (0) to eighteen (18) through SAS during 2019 was 3,111,600 Euro. During 2019, 24,352 families and 51,860 children benefited from the SAS scheme. Social services are funded through municipalities and provide the funding for the work of Centers for Social Welfare operating at the municipal level. The budgeting process is kept separate in each of the sectors and no cross-sectorial coordination in budgeting can be evidenced and this links to the challenges of intersectoral coordination that have been indicated in this report. The funding in early childhood development is generally considered low and in need of improvements. For example, in the education sector, though general funding in terms of per capita funding are not very low, the high expenditures on salary lead to the conclusion that the funding in this sub-sector is far from satisfactory and needs to be revised to reflect the orientation towards development of services and quality. In health, it is much harder to see evidence of prioritizing child development through the existing funding mechanisms since child development programs are not separated out from general services. For social protection, the SAS includes a child grant that is provided to all beneficiary households with children. In contrast, funding to disability grants and social services is not disaggregated by the age of the recipient. Expenditures in ECD are not adequately reported. Though government can report the totals spent in education, health (as citizens rather than children), and social protection (as amounts spent in certain schemes, in some cases, noting the number of children in beneficiary households), it is not possible to obtain publicly available data or thorough analysis of expenditures (such as expenditures disaggregated by various social background of categories served etc.). In other words, the expenditures are certainly available at the Treasury Office/Ministry of Finance, Labor and Transfers (MFLT), but they are not processed and analyzed further for reporting and decision making. Kosovo spends 4.6 percent of GDP on education, equivalent to 16 percent of the total government budget, and 3 percent of GDP on health or 10 percent of government budget (Kosovo health system is predominantly tax funded). In the health 5 Valerio & Garcia, 2012; WHO, 2005; Hanushek & Kimko, 2000; Hanushek & Luque, 2003 6 Funding for social insurance/social security is not considered in this report. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 10 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 and social protection sectors, analysis of expenditures that benefits children or promotes ECD objectives is less straightforward because these objectives are set within larger programs that tend to be targeted to families or people of all ages. However, in education, some detail on early childhood education spending can be obtained. Approximately 0.1 of GDP is spent on early childhood education covering ages 0<5, and 0.2 percent of GDP is spent covering pre-primary education for ages 5<6. This is equivalent to 0.4 percent of total government budget spent on ECE (age 0<5), and 0.5 percent of overall government budget spent in age 5<6 pre-primary education. The expenditures as compared to the overall expenditures in pre-university education are as follows: 3.1 percent of budget is spent for ECE for ages 0<5. While 6.9 percent of total expenditures in education is on provision of pre-primary grade 0 (age 5<6). Table 3 shows Kosovo’s education and pre-primary education spending in comparison to other countries in the region. Table 3: Public expenditures on preprimary education in selected ECA countries. Kosovo Albania Bulgaria North Macedonia Romania Government expenditure on education as 4.2% 3.61% (2017) 4.09% (2017) N/A 3.10% (2017) percentage of GDP Preprimary expenditure as percentage of 0.2% N/A 0.94% (2017) N/A 0.31% (2017) GDP Government expenditure on education as percentage of total government 16% 11.44% (2013) N/A 9.08% (2015) expenditure Preprimary expenditure as percentage of total government expenditure on 6.9% 7.2% 25.34% (2013) N/A 10.3% (2016) education Preprimary expenditure as percentage of 0.5% 0.8% 2.9% (2013) N/A 1.0% (2016) total government expenditure Source: Kosovo Ministry of Finance 2019; UNESCO Institute of Statistics; Ministry of Education and Sports, SABER-ECD Policy Instrument, 2014. (Albania); The World Bank Databank retrieved from https://databank.worldbank.org/indicator/UIS.XGDP.0.FSGOV?id=c755d342&report_name=EdStats_Indicators_Report&populartype=ser ies While health financing data is limited for Kosovo, information from recent years points towards total health expenditure and the health share of the government budget being low relative to the regional and GDP per capita comparators. The available figures indicate that there is a need to increase public spending on health, within this broader context of limited resources, interventions in early childhood development are among the most cost-effective investments in the health sector. In 2018, the GoK’s spending on health was 3 percent of GDP and health accounted for approximately 10 percent of total government spending. This is below the contemporary average for South Eastern Europe (SEE) and the EU, which in 2018 were approximately 28.3 percent of general government spending and 9.9 percent of GDP, placing Kosovo among the lowest in Europe.7 Table 4 compares health expenditure indicators in Kosovo with other countries in the region. The impact of a lack of investment in health is reflected in high out of pocket (OOP) spending, which contributes to impoverishment. In 2014, OOP spending was estimated to account for one-third of total healthcare expenditures and approximately 80 percent of households in Kosovo incurred OOP health payments.8 These were primarily for medicine, pharmaceutical products, and medical devices. The incidence of payments also indicates that the poorest are less well protected from the financial risks of maintaining their health. Households with a higher age of the household head, belonging to the two poorest quintiles and having disabled and aged members of the household were significantly more at risk of catastrophic health expenditure. 7https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Healthcare_expenditure_statistics#Developments_over_time 8In 2014, the OOP expenditure represented on average 27.3 percent of total spending in Western Balkans countries, and 13.9 percent share in the EU. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 11 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 The GoK has recently embarked on a health financing reform, recognizing that Kosovo has all three of the factors that drive catastrophic health expenditures: (i) health services requiring OOP health payments; (ii) low household capacity to pay; and (iii) a lack of pre-payment mechanisms for risk pooling. Developing targeting mechanisms to support households- at-risk and including key early childhood development interventions within the basic benefit package will be key to facilitating much needed improvements in maternal and child health outcomes. Table 4: Regional comparison of select health expenditure indicators. North Kosovo Albania Bulgaria Romania Serbia Macedonia Total health expenditure as a 3% 6% 8% 7% 5% 10% percentage of GDP Out of pocket expenditure9 as percentage of private health > 30% 52% 47% 36% 21% 37% expenditure General government expenditure on health per capita (adjusted for No data 541 612 927 708 1,250 purchasing power parity) Routine EPI vaccines financed by 100% 100% 100% 100% 100% 100% government Source: WHO Global Health Expenditure Database; UNICEF 2013; SABER-ECD Policy Instrument for North Macedonia, 2015. SABER-ECD Policy Instrument for Romania, 2019. WHO Immunization financing indicators, retrieved from https://www.who.int/immunization/programmes_systems/financing/data_indicators/en/ Staff remuneration for ECD personnel is relatively attractive. The staff working in ECD areas are largely contracted as public servants, given that these services are delivered by government. In education for example, the difference between the salaries of pre-school and primary school teachers is very small. Pre-school teachers are considered well paid in relation to the other public sector employees such as employees in the ministries. They are paid an equivalent of 80 percent of primary school teachers’ salary. Salaries of social workers and midwives were said to be comparable to the education sector per informant interviews from the respective ministries. However, for social services, the grade/coefficient for a social worker varies from 7 to 6.5 which is a salary amount of 400-450 Euros and the grade/coefficient for SAS worker is 5.5 - 6 which is a salary amount between 320 - 340 Euros. This salary scale is lower than that of education sector or other public sector categories. Policy Options to Strengthen the Enabling Environment for ECD in Kosovo Legal framework: A definition on the meaning of the right to early education would clarify better the government’s intended depth of support and importance placed on ECD. Currently, it is foreseen that only age 5-6 is compulsory for young children, hence the government should reconsider this with the view of addressing low participation rates from ages 3-5.10 Though this is related to lack of access, the vision for ECD development should be built into the big picture of prioritizing education policy making and funding in Kosovo. The process should also incorporate the elements of quality in addition to participation and balance between the two as necessary. The current standards in place should be seen more as a driving force for ECD development and not only as reference points for curriculum development. One policy option Kosovo should consider is to gradually make enrollments for ages 3-5 mandatory and complement this with facilitating alternative financing models 10The age of 5-6 years is still not mandatory. The Law on Pre-University Education stipulates that this age group will become mandatory if the physical and financial conditions are created. The age of 5-6 years is intended to become mandatory with the new Law which is being prepared with the Law on Early Childhood Education. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 12 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 for ECD as well as efforts to increase infrastructure capacities. The increase of capacities should be gradual and well planned. A reform of the Social Assistance Scheme (SAS) could provide better poverty coverage, and evidence shows it would improve the reach to more children in need. The SAS is the only poverty targeted social protection program in Kosovo and covers 28,276 families, with 55,285 children.11 However, the SAS remains small in comparison with need, given the poverty headcount of 18 percent12 and with categorical benefits. While overall spending on social protection has increased over the past decade, relative spending on SAS has decreased, as has the number of beneficiaries. The MFLT intends to reform the SAS through the submission of a new Law to Parliament. This reform is based on analysis carried-out by the World Bank, which showed that changing the eligibility criteria by (a) removing the categorical filters and (b) adopting a new poverty test; and, adopting a new “optimal” equivalency scale13 for setting the level of the benefit would significant improve the impact of the SAS on poverty. The reformed SAS would reach 28,547 families, with 85,969 children.14 Intersectoral Coordination: Develop and adopt a multisectoral ECD strategy incorporating education, health and nutrition, and child and social protection. The strategy could be derived from the new Law on Child Protection and led by the mechanisms foreseen in it or from the new Law on Early Childhood Education since the drafting of an intersectoral strategy is included in this draft law. The strategy should contain vision statements for early childhood development in Kosovo. This strategy should provide for roles of individual ministries and other stakeholders, as well as provide for mechanisms and inputs for coordinated actions at the municipal level. It should also include a detailed and costed action plan for a period of at least 5 years and be linked with the midterm expenditure framework at the national level. An example of a country that has developed an effective multisectoral ECD policy is Chile’s Crece Contigo Program (Grow with you). See Box 3. As a next step, the establishment of an institutional anchor to coordinate ECD between ministries and actors would facilitate leadership on ECD. It is recommended to capitalize on the momentum of the recent adoption of the new law on child protection to lead the efforts for providing an institutional anchor for ECD in Kosovo. This should be linked with the idea of developing a comprehensive strategy (see above). The central structures should have their own operational budget and need to be established more as leading rather than administrative units. Additionally, there should be incentives and accountability mechanisms to encourage ministries to work together to achieve outcomes rather than to work in isolation and/or competition. As an example, the ECD coordination lead in Jamaica is described in Box 4. To promote children’s holistic development, establish guidelines on the provision of integrated ECD services. For integrated services to be provided and accessed by those in need, the first step the government should make is to define a menu of ECD services that families and children are to receive. Within the process of developing a strategic plan and action plan, government should develop clear guidelines on the provision of integrated services for ECD that span the three main sectors (education, health, and social protection) as well as across public and non-public sector. Evidence from other countries shows that social protection (particularly social workers) can play a key role in ensuring that poor children receive the full range of ECD services. The provision of the services as integrated rather than individual inputs is crucial for the treatment of families as units that need coherent support from various sectors supporting early childhood development. It will be important for policy makers to build consensus on how to best facilitate and coordinate referrals at the central and municipal levels, given the lack of clarity and the variation of how referrals are handled currently among different municipalities. Two tools that could facilitate integration of services and improved service delivery are: a stronger health management information system and a more comprehensive child growth and developmental monitoring program. In 11 World Bank. Social Assistance Scheme Study: Assessment and Reform Options. 2019. Estimations based on HBS 2016. Current number of families in SAS is 24,198 households (March 2020). 12 based on the national poverty line in 2018 13 This scale is designed to maximize the new scheme’s impact on poverty reduction. It is less generous than the OCED equivalenc y scale. The details are found in World Bank 2019. 14 Based on simulations in: World Bank. Options for child benefits in Kosovo. World Bank, 2019. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 13 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 other settings, these tools have been instrumental in ensuring the timely identification of developmental delays and facilitating service provision for vulnerable and marginalized children. In other countries, social workers have been central to ensuring poor children receive the full range of ECD services. Finance: Establish a system to allow for identification of ECD spending in each sector. The current planning, financial management, and reporting system – including monitoring the efficiency of expenditures – should be advanced for better analysis, evaluation of effectiveness and policy making. It is essential that in all the three sectors, it is clear for those in charge of implementing ECD policies (and all interested stakeholders) how much is spent on ECD sub-sectors. Knowing what is being spent in each sector is essential for program planning and evaluation and is a key component of a strong finance system. To support ECD with adequate financing and increase transparency, efficiency, and equity, it is necessary to use clear criteria for budgeting. There is an urgent need for Kosovo to intervene in the system of planning finances that relate to ECD. The idea of a financing formula that is being used in the education sector could be used as a model for health and social services by taking into account the numbers of children served and the input in quality services to be provided. The policies and programs should be supported with adequate finances and the formula should reflect the priorities that Kosovo sets for itself – be it in the dimension of increasing access and/or quality of services. Criteria and formulas should be crafted to ensure equitable use of resources. The formula should reflect the various dimensions of the policies and programs including the services for marginalized groups. Children from marginalized backgrounds typically require more funds for services, not less. The government should determine if spending on ECD across sectors is sufficient to ensure quality services. This may take the form of allocating more national funds to ECD to expand and increase quality of services and/or efficiency or current. The funding for ECD is currently hidden within bigger policies. Thus, there is a need for more earmarked funding aligned to priority policies for ECD. For the education sector, studies suggest that a public investment of 1 percent of GDP is the minimum required to ensure provision of quality early childhood education.15 Policy Goal 2: Implementing Widely ➢ Policy Levers: Scope of Programs • Coverage •Equity Implementing Widely refers to the scope of ECD programs available, the extent of coverage (as a share of the eligible population) and the degree of equity within ECD service provision. By definition, a focus on ECD involves (at a minimum) intervention in health, nutrition, education, and social and child protection, and should target pregnant women, young children and their parents and caregivers. A robust ECD policy should include programs in all essential sectors; provide comparable coverage and equitable access across regions and socioeconomic status – especially reaching the most disadvantaged young children and their families. Policy Lever 2.1: Scope of Programs Effective ECD systems have programs established in all essential sectors and ensure that every child and expecting mothers have 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. 15 Neuman & Devercelli, 2013 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 14 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Figure 3: Essential interventions during different periods of young children's development Source: What Matters Most for Early Childhood Development -Framework Paper. SABER Working Paper Series, No. 5, 2013. In Kosovo, ECD programs are established to benefit pregnant women, young children, and parents/caregivers, however, not all the programs are widespread or accessible by all. Among the areas of care and services that appear to be underdeveloped are those for screening and treating maternal depression, the promotion of fathers’ engagement with their children, parenting education, and playgroups for infants and very young children. A number of interventions are available in the health and nutrition sector. Antenatal care, immunization, and well-child visits are all services that are delivered through existing health programs in Kosovo. Child immunization is compulsory, and protocols have been established for its implementation. Micro-nutrition support and breastfeeding promotion practices exist throughout the country through the home visiting program that is operational in 22 municipalities with plans for expansion to all 38. The government has set up the home visiting program with the support of UNICEF and Action for Mothers and Children (AMC), a local NGO. Within the home visiting program, midwives, doctors, and social workers are trained on several specialized topics related to working with children of early ages. In addition, child feeding programs (supported by UNICEF) are in place in four municipalities. Limited access in early childhood education continues to be a major challenge. To expand access to early education, currently three types of programs are promoted: public, private, and public/private partnerships. Public programs are fully funded by government (staffing, land and building, operational costs), use the national curriculum, and receive continuous professional development opportunities. Registered and licensed private schools are also invited for professional development, are encouraged to use the national curriculum, and through licensing are regulated to meet at least the minimum facilities and education standards. Community-based centers are a public/private partnership where government provides the land for building or the premises and the partner donor, NGO or private entity is responsible for the rest. In this model the municipality may also subsidize half the monthly cost for qualifying families for a certain period determined in a bilateral agreement. Currently, there are no other alternative approaches for ECE such as partial days, in- SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 15 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 home programs, parent and child playgroups, etc. There are currently 44 public early childhood education centers, 124 private licensed early childhood centers (almost double not licensed but operating), and various community-based centers working under public private partnership arrangements.16 For children 0 to <5 currently there are 4,164 children in public centers and 5,229 in private centers. For the age 5-6, which is also considered as grade 0, a transition to primary school, there are 23,650 children. Most of these children attend the public education system at 21,660 children (MESTI Annual Statistics 2019/20). The government through curriculum reform (formally adopted in 2011 and implemented in stages after that) has made participation for children ages 5-6 mandatory. It has dramatically increased enrollment to 92 percent in 2019, mostly by adding preprimary classes to existing primary schools. As a response to COVID-19, in 2020 MESTI launched the first online platform "Distance Education - Care, Development and Early Childhood Education for the ages 0- 6 to assist parents, caregivers, and educators in carrying out daily activities with young children at home. For ages 0-5 the supply of ECE services is severely lacking, but there is also an unclear picture of demand for such services. The prevailing opinion in the MESTI is that there is a great demand in urban areas for access to preschool, however, the capacities of the system are limited. Due to lack of research, it is difficult to ascertain how much demand there is from the public for such services across the country. The fact that there are a number of private (licensed and unlicensed) early childhood education centers (which are generally more expensive and in poorer physical conditions than public centers) may be an indication that there is demand by parents for more early childhood education and care services. Any expansion of programs in rural areas may require some effort to raise awareness of the importance of early childhood education among the public in order to build demand for these services. Kosovo has a number of child protection interventions established under the Law for Social and Family Services to care for vulnerable children. These are foster care and adoption, the program for the abandoned children, guardianship, and placement in families. The Guardianship Authority within the Centre for Social Work (CSW) is responsible for the protection of children and ensures that services meet the standards set out in the United Nations Convention on the Rights of the Child. Children are placed for adoption through the CSW’s Children’s Placement Panel according to Article 11.22 of the Law. The Department of Social Welfare places children in foster families. Article 11.14 ensures that a child only be placed in a family that shares the children’s ethnic, linguistic, and religious background, and social workers visit monthly to ensure children are adequately cared for. Children whose parents cannot care for them can be placed with other families through the Guardianship program. Legal provisions in Article 206 of the Family Law on Kosovo No. 2004/32, guarantee the placement of children with disabilities, neglected children or children with disabilities. It also regulates the competencies required for guardians and the purpose of the guardianship of minors. Kosovo has one poverty targeted SAS which provides a monthly cash transfer to families and a child supplement. Access to SAS is restricted to families in which all members are unable to work (due to age, incapacity to work, or caregiving duties) and to families with only one member able to work if the family takes care of at least one child under the age of 5. These families need to demonstrate they send their children to school. There is also a cash transfer program that support families that take care of child(ren) with a severe disability. Currently, the coverage through SAS schemes is considered low as compared to the need and the categorical filters are very restrictive leaving out many families and children in need. In addition, the SAS is disadvantaging larger families in the proportion of benefits that account for number of family members. See Box 5 for more detail on the SAS. 16The community-based centers are counted under private providers due to their legal status. Of the 124 licensed private early childhood education centers, 9 are community-based centers established in Pristina and managed by School Boards, and another 31 community-based centers have been opened in various locations with the assistance of Save the Children and UNICEF. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 16 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Box 5: Social Assistance Scheme (SAS) Unlike other countries in the Region, Kosovo has only one social protection program that selects beneficiaries based on their poverty status: Social Assistance Scheme (SAS). Coverage of the poor population with SAS is low, as only about one third of the bottom quintile receives SAS benefits, and it is below rates of program coverage observed in other countries in the region. This low rate of coverage is driven in part by the eligibility criteria, which are narrowly defined. According to the SAS legislation introduced in the beginning of the 2000s and reformed in 2012, to be eligible for SAS, firstly, applicant families should fall into one of two narrowly defined categories: Category I – all family members are dependent and none is employed, and Category II - families can have one family member who is able to work but must be registered as unemployed with the Employment Agency. All other family members must be dependent. In addition, the family must be parenting at least one child under the age of 5 or providing permanent care for an orphan under the age of 15. Secondly, applicants are subject to a poverty test that assigns scores based on sources of income (excluding certain categories, such as pensions), household composition, ownership of some type of assets, and observable living/housing characteristics. In addition, the SAS benefit is a flat rate which slowly increases with family size and covers a lower share of the consumption needs of larger families compared with smaller ones. Indexation of the benefit is ad hoc and discretionary despite existing legal rules. As a result, the SAS’s benefit incidence does not correspond to the country’s poverty profile, the coverage rate is significantly lower than the poverty rate and has been declining over time. This has important implications for the contribution of the SAS to achieving ECD objectives in Kosovo, as children are more likely to reside in poor household and households that tend to be larger. Source: World Bank. 2019. Kosovo Social Assistance Scheme Study: Assessment and Reform Options. Policy Lever 2.2: Coverage A robust ECD policy should establish programs in all essential sectors, ensure high degrees of coverage and reach the entire population equitably–especially the most disadvantaged young children–so that every child and expecting mother have guaranteed access to essential ECD services. Access to essential health and nutrition interventions for pregnant women is generally high, however, there are still pockets of underserved areas. More than 94 percent of pregnant women benefit from 4 antenatal visits, but this is down from almost 98 percent in 2014 (MICS Kosovo 2014, 2019-20). It is noted that in smaller or more rural municipalities, only family physicians are available, which then puts the burden on pregnant women to have to travel and pay to see a specialist obstetrician/gynecologist away from where she lives. For the overall population, 100 percent of births are attended by skilled attendants and for rural areas, it is one percentage point lower. More than 90 percent of children are registered at pre-primary across the country, while 29 percent of children are breastfed at the age of below 6 months a decline from 39 percent as measured in 2014 (MICS Kosovo 2014). Table 5 shows regional comparisons of access to health and nutrition interventions for pregnant women. Currently, Kosovo does not have a mandatory HIV screening for pregnant women. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 17 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Table 5: Regional comparison of level of access to essential health and nutrition interventions for pregnant women Kosovo Albania Bulgaria North Romania Serbia Macedonia 95% Skilled attendant at birth 100% 99% 99% 100% 98% Pregnant women receiving antenatal 94% 97% N/A 97.3% 76% 98.3% care (4 visits) Percentage of HIV+ pregnant women N/A N/A N/A N/A >95% N/A receiving ARVs for PMTCT Prevalence of anemia in pregnant women 23% 34% 29.7% 31.8% 30% 33.6% Source: MICS Kosovo 2019-2020; UNAIDS, 2012; UNICEF, 2010; WHO Global Database on Anemia, 2006 Source: MICS North Macedonia 2018-2019, MICS Serbia 2014, SABER-ECD Policy Instrument for Romania 2019. Immunization coverage to protect from serious childhood illnesses like DPT decreased from 2014, and full coverage of other primary health care services for young children is lacking. The DPT vaccine covers diphtheria, pertussis, and tetanus, and little more than 12 percent of children in Kosovo are not fully immunized against DPT. Pertussis, also known as whooping cough, can be very serious for young children and is highly infectious. Cases of DPT and measles have been on the rise in Europe in recent years due to lower immunization coverage. In Kosovo 9 percent of children 24-35 months old are not immunized against measles (72 percent for Roma, Ashkali and Egyptian children). For children below age 5 with symptoms of pneumonia, 73 percent are taken to see a health care provider, but less than 39 percent are treated with antibiotics. Table 6 compares access to health interventions in the region. Table 6: Regional comparison of level of access to essential health interventions for ECD-aged children Kosovo Albania Bulgaria North Macedonia Romania 1-year-old children immunized against DPT 87.3% (2019) 99% 94% 98% 94% (corresponding vaccines DPT3ß) Children below 5 with suspected pneumonia 73.1% (2014) 69.6% N/A 92.7% N/A taken to health provider Children below 5 with diarrhea receiving oral 35.2% (2014) 54% N/A 62% 76% rehydration salts Source: MICS (Kosovo) 2019-2020 and 2013-2014; Human Development Index 2019; UNICEF, State of the World's Children, Childinfo, and Demographic and Health Surveys. SABER-ECD Policy Instrument for North Macedonia, 2015; SABER-ECD Policy Instrument for Romania 2019. Available data on stunting, breastfeeding, anemia, and birth weight suggest that essential nutrition interventions for young children in Kosovo have a good base but scope to improve. Table 7 shows the most recent data available on key child nutrition indicators in the region. According to MICS Kosovo 2019 data, the stunting rate in children below age five in Kosovo is 4 percent, but it is much higher for Roma, Ashkali and Egyptian children at 15 percent. The average stunting rate in upper middle-income countries in 2017 was 6.4 percent, and in high income countries the average is 2.5 percent. Stunting is defined as low height (or length) for age and restricts a child’s long-term growth potential as well as the potential to succeed in school and in jobs. Stunting can indicate poor health, nutrition and development and rates are often higher among marginalized groups. Despite the country’s breastfeeding promotion policies, the exclusive breastfeeding rate until six months is only 29 percent, down from almost 40 percent as measured in 2014 (MICS). Returning to work is often one reason why mothers stop breastfeeding, but Kosovo has a fairly long maternity leave period and low employment rates for women. Infants with low birth weight slightly increased from 5.4 (2014) to 6.0 percent (2019). This rate is much higher for babies born to families of the lowest income quintile (8.7%) and for Roma, Ashkali, and Egyptian families (16.7%). Anemia in preschool children for Kosovo is unknown, but for all school age children the average is 15.7 percent. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 18 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Table 7: Regional comparison of level of access to essential nutrition interventions for ECD-aged children Kosovo Albania Bulgaria North Romania Serbia Macedonia Children below 5 with 5% 4.0% 11.3% 7% 4.3% 12% moderate/severe stunting 13.3% (0-2 months) 12% Infants exclusively breastfed until 6 6% (2-3 months) 29.0% 37% 27.5% 16% months 2% (4-5 months) Infants with low birth weight 6.0% 3.6% 8.8% 9.2% 8% 6% (2009) 15.7% for 29.5% Prevalence of anemia in preschool 39.8% school age 31% 26.7% 25.8% aged children (moderate) children Source: MICS Kosovo 2019-20; MICS North Macedonia and Serbia, 2019; WHO Global Database on Anemia, 2006; SABER-ECD Policy Instrument for Bulgaria 2013; SABER-ECD Policy Instrument for North Macedonia, 2015; and SABER-ECD Policy Instrument or Romania, 2019. Birth registration in Kosovo is almost universal. Ninety-eight percent of children are registered at birth in Kosovo, which is on par with other countries in the region. Those children registered and possessing a birth certificate drops to 89 percent. Birth registration is a key component of child and social protection systems and is necessary to access many services. Table 1 shows birth registration rates in the region. Participation in early childhood education is still far from satisfactory. In the education sector for the 2019/20 school year, participation of children in early childhood education is 7 percent for the age group 0<5, whereas for age group 0<6 it is 20.6 percent (the participation of children 5<6 is 93.1 percent and is treated as compulsory within the education system). The participation rate for age group 3<6 is 38.1 percent.17 The access to ECE has thus rightly been determined as a priority for Kosovo, however, the pace and capacities for extending public provision has proven that Kosovo will not be able to easily address the existing situation. It will need to look for alternative forms of programming for expansion. Social assistance schemes are available and being implemented across the country , but as mentioned above, coverage is low and discriminate against larger households which tend to be poorer and have more children. In addition, the criteria for social assistance also includes the economic standing of the family that is determined by the secondary legislation of the ministry (Law on Social Assistance 2003-15). According to the latest decision of 2018, the monthly allowance ranges between 60 and 180 Euros per month depending on family size. In addition to this financial assistance, the families approved for the social assistance scheme receive 5 Euros per month for every child of age 0-18 years as support for fostering the children’s education and health. Currently, there are about 50,000 children included in the scheme. In 2019, a total of 2,276 children with disabilities received social assistance in the form of monthly payment of 100 Euros per month. During 2019, for this scheme a total budget of 2,775,300 euro was invested in support for families with children with disabilities. Additionally, DPSF data show that in 2019 a total of 9 children with disabilities were placed under family care with an amount of 350 Euros a month. Policy Lever 2.3: Equity Based on the robust evidence of the positive effects ECD interventions can have for children from disadvantaged backgrounds, every government should pay special attention to equitable provision of ECD services. 18 One of the fundamental goals of any ECD policy should be to provide equitable opportunities to all young children and their families. 17 MESTI EMIS, KAS 2019/20. 18 Engle et al, 2011; Naudeau et al., 2011 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 19 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 In an effort to foster improved quality and equitable access to basic healthcare services for all, in 2020, the government announced that the coverage scheme for the Law on Health Insurance would go into implementation. Enactment of the health insurance reform should support improved access to ECD services and help to close equity gaps for families in need. Aligned with the health insurance reform, the poverty targeted mechanism for health insurance exempt categories should ensure equity in access for poor households with children. For all early childhood health outcomes, children from the poorest quintiles and from the Roma, Ashkali and Egyptian communities fair worse. For example, while moderate and severe stunting for children under 5 is low in the general population, it poses a serious risk to vulnerable communities. Across the country, stunting is concentrated in the poorest quintiles in both ethnic majority and minority groups. Fifteen percent of Roma, Ashkali and Egyptian children are at risk of stunting. This evidence indicates deep inequity in quality of early outcomes, particularly for vulnerable populations. Additionally, while nearly three quarters of children in Kosovo 24-35 months old are fully immunized, just 38 percent of Roma, Ashkali, and Egyptian children are.19 This gap poses risks not only for children of these communities but for wider public health. The legislation provides for equal access and services for children with disabilities. However, not all children have access to adequate services and data are not reported in a manner that sheds light on the gaps in service provision. The Law on Child Protection and Law on Supporting Families who have permanent special needs (nr.03/L-022, 2008) defines special needs as, "Children with permanent physical and mental disability are considered children aged from birth to age 18 with permanent residency in Kosovo, who are incapable of performing daily life activities without the care of the other people.” The Law on Child Protection, Article 64 provides for the measures that children with disabilities can be supported to receive services in well-being, education, and health for free that best meet the children’s needs. There are data on the equity dimension of ECD provision, but their analysis and use in programming is poor. The annual education statistics, produced by MESTI, records enrollment at the preprimary level separated by gender and by type of center (public and private). It is also broken down by municipality. From the breakdown we can see that enrollment is concentrated in urban areas and there are only a few community-based centers that function in a handful of municipalities. It also shows that at pre-primary, enrollment favors boys at a 1.07 ratio to girls. Children’s enrollment across the ethnic groups is recorded, but numbers are very low, and it is difficult to tease out any further detail. Some social services are contingent on parents sending their children to school, so this may help encourage families eligible and enrolled in social services. The curriculum and teaching materials are translated in minority languages, however ECE is provided in mother tongue only if the majority of children in a class speak that language. For social protection, there are administrative data on the distribution of benefits by municipality, by sex of applicant, and number of children. There is also the SAS study and data from the HBS. The SAS aims at protecting against falling into poverty but also against other risks like disability, unemployment, and caregiving responsibilities, including for children. In general, the assessment is that they do not meet all the needs of everyone and at the desired level. Policy Options to Strengthen Implementing Widely for ECD in Kosovo Scope of Programs: Consider establishing maternal depression screening and treatment and raise awareness about this condition and its associated risks. Maternal depression is a major public health problem around the world and poses threats to mothers and their children’s long-term health and development. Given the importance of the issue and its prevalence, maternal depression screening and referral to treatment should be standard of care. Low cost interventions delivered by social workers or community health workers can provide effective treatment for many mothers. This screening and basic treatment or referral could be incorporated into the home visiting program. 19 MICS Kosovo 2019-20 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 20 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Establish awareness programs to promote fathers’ engagement, caregiving, and positive parenting. Programs to improve fathers’ engagement with their children can substantially improve children’s cognitive and social skills and development outcomes. It also promotes gender equality. The same applies to the policies that support and foster father’s involvement in caregiving. Current practices of paternity leave are not favorable for this and should be reviewed in the future. In addition, government should plan programs of awareness raising and support for fathers potentially through home visits, healthcare workers, or at community centers. Consider establishing playgroups for parents, grandparents, or other in-home caregivers of infants or very young children to engage in developmental activities in a group setting. A parent or other community member who receives a minimal level of training could facilitate the group. The playgroups could provide opportunities to model how to engage in stimulation activities with very young children and can provide developmental messages and social support for parents. As part of the reforms to the social protection system, consider adding parenting education components to social protection programs. This could link financial assistance with services that promote behavior change among parents to support children’s development. Coverage: Examine the reasons for the low breastfeeding rates that persist despite breastfeeding promotion programs and maternity leave policies. Extending awareness raising programs that increase breastfeeding rates could be a starting point. There is a need for more empirical evidence on reasons behind low rates and identify ways to address those in addition to awareness raising. See Box 6 for an example of a breastfeeding promotion campaign in Brazil that successfully increased breastfeeding rates. Increasing participation in ECE needs to be prioritized along with quality of provision. The government should address the issue of low participation of children in ECE. Within this debate, there is a need for a systemic and clear analysis and an action plan on how to address this over the long term. It should not only be seen as constructing building/preschool classrooms but rather as a coherent approach to multiple strategies that provide good quality services through public, private, and community-based services. This will require examining all options of premises available, determining the number of available trained staff, as well as the dedicated financial resources required for implementing the strategy. Box 6. Brazilian campaign to increase breastfeeding rates. Brazil’s campaign to promote breastfeeding is an example of a successful effort to change public perceptions and healthcare practices, resulting in significant increase in breastfeeding. The campaign was initiated in 1980 by the National Food and Nutrition Institute. UNICEF and the Pan-American Health Organization helped to develop public awareness materials that addressed the lack of informational materials on breastfeeding in Portuguese. Instructional brochures were widely distributed to mothers. A media campaign featured radio, television, and print media spots and endorsements by well-known personalities. The WHO and UNICEF held training courses on breastfeeding for healthcare workers and managers, and the Baby Friendly Hospital Initiative was widely implemented to initiate early feeding. A coalition of numerous actors helped make the campaign a success. Associations of medical professionals, community leaders, politicians, mothers’ groups of the Catholic church, and the media were all engaged in the effort. The exclusive breastfeeding rate rose from 3.6 percent in 1986 to 40 percent in 2006. Source: Implementation of Breastfeeding Practices in Brazil: http://www1.paho.org/English/DD/PUB/NutritionActiveLife-ENG.pdf SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 21 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Equity: Ensure that there are adequately trained personnel and specialists to make inclusive education a quality education for children with disabilities. The staff that work with children should be adequately trained in handling the sensitivities of disabilities children as well as the technical skill to provide the specific services that the child needs. For ECE staff, training is even more urgent, and government should provide additional support for addressing learning difficulties and other developmental challenges within the ECE institutions. Continue to expand efforts to address low preprimary enrollment in rural areas and selected ethnic minority communities. Outreach to communities and parents should be an important component of these programs. Failing to address the lack of preprimary education and other ECD services will only increase the inequalities between rural and urban areas, and between various communities living in Kosovo. Roma, Ashkali and Egyptian communities are reported as needing more awareness raising and support to increase the enrollments and attendance. Reform the child and social protection programs to better address the needs. The reform of the SAS should reflect the eligibility criteria that prioritize families in need such as poorer and larger families. In addition, the access of marginalized groups to social assistance and services should be analyzed and as a result make necessary, informed changes in the existing mechanisms to promote their inclusion in the SAS and support their access to a full range of ECD services Policy Goal 3: Monitoring and Assuring Quality ➢ Policy Levers: Data Availability • Quality Standards • Compliance with Standards Monitoring and Assuring Quality refers to the existence of information systems to monitor access to ECD services and outcomes across children, standards for ECD services and systems to monitor and enforce compliance with those standards. Ensuring the quality of ECD interventions is vital because evidence has shown that unless programs are of high quality, the impact on children can be negligible, or even detrimental. Policy Lever 3.1: Data Availability Accurate, comprehensive, and timely data collection can promote more effective policymaking. Well-developed information systems can improve decision-making. In particular, data can inform policy choices regarding the volume and allocation of public financing, staff recruitment and training, program quality, adherence to standards and efforts to target children most in need. Kosovo does not yet have a national Health Information System (HIS). Fragmented data across many systems currently makes it difficult for the government to measure performance and match outputs (the extent to which spending and services reach various children) to outcomes (the impact of these services on child well-being). This lack of coordination also affects how families are able to navigate the system—especially those with less education, access barriers, or ethnic minority populations. As a result, children in need often miss out on available services. Moving forward with development of an HIS also provides a chance to integrate ECD information systems in the three sectors and connect resources, records, and outreach strategies, as well as improve child development monitoring and tracking. The government collects data on the socio-economic background of children in early childhood education centers. In addition, data are collected for access to early childhood education centers based on the ethnicity, municipality, and gender. On the other hand, data are not available on the geographical (rural vs urban) location of students and children with disabilities. For children with disabilities, the government has started to collect some of the data for children attending special education centers but not yet for children in mainstream centers. There is a lack of child growth and development monitoring (CGDM) mechanisms. In Kosovo, CGDM is not systematically assessed at the population level to gauge whether children are reaching key developmental milestones. While educators SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 22 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 and teachers in early childhood education centers have reference points for monitoring child development, such mechanisms at systematic level at national or municipal level do not exist. No data are collected for child development in the cognitive, linguistic, and social-emotional dimensions. CGDM programs have been a flagship ECD intervention in many countries. They can be an effective way to facilitate and monitor child health and educational outcomes, as well as to improve parental stimulation and engagement with their children. They also provide opportunities to track and identify developmental delays, which is critical to ensuring that children and families can access critical interventions. A recent report on the home visiting program identified a number of constraints to a developing an effective CGDM program including: the training and supply of health workers, the service delivery model, the current structure of home visiting programs, and the need to digitize and improve the tools to support a CGDM program. Reviewing the guidance and current service provision will be key to understanding the gaps that need to be plugged to build a comprehensive CGDM program for all children and those who need specialized and differentiated services. Data on ECD staff qualifications and background are lacking. For education, at the school level, this data may be kept, however, in the centralized data on educators and teachers, details are not available. There is a lack of data on the educational and professional qualifications of educators working with young children, even though the standards of qualification are clearly specified in regulations. While the general observation is that all educators are meeting the minimum requirements, the MESTI is not able to report in detail about the type of qualification educators have. Table 10. Availability of data to monitor ECD in Kosovo (✓= yes, X=no) Administrative Data: Indicator Tracked ECE enrollment rates by region ✓ Children with disabilities enrolled in ECE (# of) ✓ Children attending well-child visits (# of) ✓ Children benefitting from public nutrition interventions (# of) X Women receiving prenatal nutrition (# of) X Average student-to-teacher ratio in public ECE ✓ Is ECE spending in education sector differentiated within education budget? ✓ Is ECD spending in health sector differentiated within health budget? X Individual children’s development outcomes X Survey Data Indicator Tracked Population consuming iodized salt (%) ✓ Vitamin A supplement for children 6-59 months (%) X Anemia prevalence amongst pregnant women (%) ✓ Children below age of 5 registered at birth (%) ✓ Children immunized against DPT3 at 12 months (%) ✓ Pregnant women who attend at least four antenatal visits (%) ✓ Children enrolled ECE by socioeconomic status (%) X Policy Lever 3.2: Quality Standards Ensuring quality ECD service provision is essential. A focus on access – without a commensurate focus on ensuring quality – jeopardizes the very benefits that policymakers hope children will gain through ECD interventions. The quality of ECD programs is directly related to better cognitive and social development in children.20 20 Taylor & Bennett, 2008; Bryce et al, 2003; Naudeau et al, 2011; Victoria et al, 2003 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 23 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Kosovo follows international standards of care for ECD (antenatal, birth and postnatal), however, lack of resources leads to an improvised or adapted standard of care. Also, an absence of coordinated referral systems and standardized clinical protocols leaves healthcare institutions, that are often understaffed, struggling to provide quality and patient- centered services. Approaching the quality of ECD-supportive health services should involve a focus on competent and coordinated care. Pregnant women, newborns and their families should be able to rely on their needs being understood, detected, and managed in an integrated manner. In this way, systems are competent and effective when they are user focused. Health workers are required to receive training in delivering ECD messages (developmental milestones, childcare, parenting, and early stimulation, among others). The home visiting program provides that training to a variety of health workers along with materials for sharing those ECD messages to educate mothers and families. For hospitals and health centers there are construction standards and rigorous registration procedures for these health facilities. Learning and child development standards are established but translating them into practice remains a challenge. A pre-primary curriculum is available, but it could be improved to be more developmentally appropriate. Learning and development standards for children ages 0-6 are clearly stated in the Standards document for Early Childhood Development and Education (2011). The standards are elaborated in detail for certain age groups in language and communication, physical, socio-emotional development as well as general knowledge area. These standards are used as a guiding document for the provision of early childhood education. While standards are clearly developed, Kosovo struggles with curriculum development for this level. The existing curriculum of 2011 is a bit academic and content oriented, rather than play based. While Kosovo initiated a whole package of curriculum reform for pre-university education in 2011, the curriculum design for the early childhood development has not yet been finalized. In the last two years there has been a push to redesign the preschool curriculum, but it has stalled. There is a relatively regulated standard for qualification of staff dealing with child development. In education, the pre- service training for preprimary teachers and educators is regulated within the standards of teacher education. To work with children in a pre-school setting, educators and teachers are required to have a bachelor’s degree in early childhood development, which is available at public universities. Also, the applicable regulation on staff employment, in cases when there is no applicant with a bachelor’s degree in pre-school education, the upper secondary qualification of nursery school is also acceptable particularly for working with the 0<3 age group. As regards the training standards, there is a mandatory practicum within a formal training pre-service education program at the bachelor level and there is an institution at MESTI level (State Council for Teacher Licensing) that enforces these standards. Administrative Instruction 05/2017 on teacher licensing provides a framework for standards for qualification of educators and teachers. The pre-service qualification standards for educators trained at Bachelor level is that all programming needs to reflect a total of 25 ECTS (European Credit System) in a 240 ECTS Bachelor level program of practical training spread around 4 years of programming. While the training for pre-primary teachers and educators is regulated under the teacher education standards and the related teacher licensing qualifications, it is noted that there are five universities in Kosovo that prepare future educators and these programs are not all harmonized which poses a challenge for unifying the educational programs that prepare future educators and consequently ensuring the quality of educators they produce. The accreditation of higher education institutions' programs should ensure that programs that train pre- school teachers (ages 0-5) follow applicable standards for the professionalism of educators in Kosovo. In-service training for ECD professionals is available but not systematic. Health workers working with the Home Visiting Program are provided with a five-day training (11 modules) on child development. The modules cover a wide range of topics and are well structured to address child development and well-being support to parents/caregivers and young children. Social workers are also expected to have formal qualifications and training to work with children. There are no systematic standards to evaluate the competency of the social worker nor formal provision of training on the job despite sporadic professional development opportunities that have been available. In-service training for teachers is available SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 24 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 across the country, but the offerings are not well placed to serve the child development targets, and access to professional development opportunities is rather limited. Infrastructure standards exist for early education facilities, but in the health sector there is no particular facilities customization for young children. In 2018 the government established infrastructure standards for private and public early childhood education facilities. However, it is not known yet how many existing premises in the public or private sector fulfill these infrastructure and construction standards. There is no inspection or monitoring mechanism in place to ensure compliance with the applicable standards. The standards for health facilities also exist, but they are more of general standards rather than child development oriented. Service delivery standards for ECE are established, although there is room for improvement. Standards promote small teacher student ratios for ECE in Kosovo as stated in the Administrative Instruction 22/2013 on teacher student ratio in pre-university education. These standards specify that ratios should be as follows: ages 1-2 is 12 students to 2 educators; ages 2-3 is 14 to 2 educators; ages 3-4 is 20 to 2 educators; ages 4<5 is 22 to 2 educators; and ages 5<6 is 24 to 2 educators. While student teacher ratios are very good throughout ECE and coverage of 5<6 year olds is relatively high, the number of hours in school are very low, with an average of about 2 hours per day. This presents a challenge for delivering a quality ECE program with measurable positive results in such little time. The issue of curriculum for early childhood education is an important area to address. While Kosovo has focused heavily on reforming the pre-university education curriculum to shift towards a competency-based education philosophy, the curriculum reform for early childhood education was attempted but now stalled. The existing curriculum is still considered academically focused with very little orientation to holistic child development and play-based pedagogy. Licensing standards for the operation of early childhood education institutions exist. The standards for licensing of private early childhood education institutions stipulate child to educator/teacher ratios, minimum certifications for educators/teachers, and facility standards as well as the requirement that the institutions should provide 2 square meters per child in addition to the provision of adequate hygienic facilities for children. These standards are meant to regulate the private sector, according to the Administrative Instruction 15/2016 on licensing and registration of private institutions, however they are applied the same as in the public and community-based centers. Additionally, the private schools are encouraged to follow the public ECE curriculum. Policy Lever 3.3: Compliance with Standards Establishing standards is essential to providing quality ECD services and to promoting the healthy development of children. Once standards have been established, it is critical that mechanisms are put in place to ensure compliance with standards. A comprehensive analysis of Kosovo’s compliance with WHO standards for maternal and neonatal care is limited by lack of data availability, however, data from the MICS 2019 survey addressing some of these standards point to a good base level of compliance. For example, antenatal care coverage was reported to be 94 percent, with 100 percent for women having been seen at least once by a skilled health personnel and 100 percent of births were attended by a skilled attendant. However, the varied measures of the maternal mortality rate over the years suggests that standards, processes, and compliance with international norms can be improved. In a 2013 mixed-methods study looking at the determinants of implementing maternal health guidelines found several barriers to success.21 These included: a lack of communication between clinicians and ministry representatives; a lack of communication across clinical groups that provide obstetric care; and, a lack of integration across the entire healthcare system, including rural and urban centers. The challenge of integration was attributed to the legacy and impact of conflict on investment in and the organization of healthcare services and points to the importance of defining and setting feasible and manageable goals for improvement. 21 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3846581/pdf/1748-5908-8-108.pdf SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 25 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 It is unclear to what level staff in ECD meet the qualification standards due to poor data. In general, there is a lack of data in Kosovo on the background of staff working in early child development. In the education sector, compliance with professional standards for pre-primary teachers and kindergarten or preschool teachers is generally believed to be high, however there is no reliable data on the background of educators and teachers working with children ages 0-5. The general observation from officials that were interviewed is that Kosovo has sufficient qualified staff to work in early childhood education for the current enrollment and even if coverage were to expand. No reports are available that provide details on types and levels of qualifications. Similarly, there is no data available systematically on the background and qualifications of health workers. The requirements are clearly stipulated in Regulation No. 05/2012 on Classification of Jobs in Civil Service that social workers need to possess at the time of employment. Among the wide range of qualifications, there is a clear indication that the qualifications (such as social work education, pedagogy etc.) need to reflect skills and knowledge on child development. However, the terms of reference for the social workers are somewhat vague and not systematic across municipalities. Standard student to teacher ratios set by the MESTI are met. The MESTI EMIS report on Statistics and Indicators 2018/2019 states that for children from 0-59 months (0 <5), the student to teacher ratio is 9.5 students to an educator. Whereas for children from 60-72 months (5-6), the ratio is 20.5 students to one teacher. Kosovo has clear standards on teacher student ratio for early childhood education and currently these standards are met. Implementation of ECD facilities’ standards are not adequately monitored. No monitoring mechanism exists nor is there data available on the percentage of facilities that meet the applicable standards. In health and social protection, there is not yet any initiative to address standards implementation. There are regulations on how to enforce the private providers of ECE through the process of licensing by the MESTI, yet there are almost double the amount of private providers operating without a license in comparison to those that have been licensed by the MESTI, according to MESTI officials. Many private operators register their business but fail to obtain the licensing. Additionally, there is no data on whether private providers meet the construction standards that are in force. The licensing regulations for private providers focus more on the quality of facilities such as space availability, hygienic facilities, and staff qualifications rather the infrastructure quality such as appropriateness of the space and other facilities for the age of the children. For public providers, there is no inspection processes in place, and consequently there is no data on how well they comply with the applicable standards. Policy Options to Strengthen Monitoring and Assuring Quality for ECD in Kosovo Data Availability: Move forward with the plan and implementation of a digitized national health information system with a view towards creating a social registry and data exchange across the ECD services. Introduce a culture of assessment and evaluation leading to use of information for informing ECD policies and programs. The data available serve as a set of statistics, however, there is still a lot to do to introduce a culture of assessment and evaluation. This can be adopted in the service delivery level in order to understand the issues around the quality of services provided to inform policy making and improvement of practices. Establish a comprehensive child growth and development monitoring system. For any future multisectoral strategy and implementation plan for coordinated ECD services, it would be key to include a CGDM system to measure set targets for early child development. Such a program goes beyond ensuring compliance with immunization regimens or checking height and weight and is best used as a tool for facilitating parental understanding of cognitive, socio-emotional, linguistic, and motor skill milestones. Increasing the number and quality of home visits and aligning them with child developmental milestones will be critical to facilitating improved outcomes, particularly for marginalized and at-risk groups. However, the supply side intervention of increasing the number of trained health, education and social workers are important enablers. There is also significant scope to improve the materials for developmental risk detection, as well as to digitize checklists SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 26 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 to make monitoring and referrals easier and faster. CGDM programming is also useful for facilitating school-readiness. The program in Kosovo currently has a checkup at aged 3 as the key gateway from the health to education sector, and more can be done to strengthen this school readiness in advance of this milestone. Quality Standards: Health workers should be engaged in sharing information with parents on developmental milestones and how to promote their children’s development. Initially, the health workers need to be prepared through training and materials to be able to help the parents understand the child development standards and ways in which they can contribute their share in the overall child development. This type of information could be shared for the first time during a woman’s antenatal care visits, and then at a child’s well-child visits. The preprimary curriculum and staff training requirements should be revised to promote children’s holistic development. The existing curriculum is overly focused on academics and is not play-based. Staff working in early childhood education should be trained to address child development from a holistic perspective and understand developmental milestones and basic observance of possible health and social welfare issues. Compliance with Standards: Developing a monitoring/inspection mechanism(s) and dedicated funding to ensure standards in ECD are met is an important step for understanding and more effectively addressing ECD outcomes. It could start by introducing more rigorous and well-resourced quality assurance mechanisms for monitoring child development and achievement of the expected outcomes. Additionally, digitizing monitoring/ inspection forms so that information is available within and across the sectors provides access to data in real time, allows for better coordination, and less bureaucracy for service providers and end users. The government should also focus on developing more advanced integrated information management systems to monitor the achievement of child outcomes, compliance with licensing and facilities standards, and data on ECD staff background, qualification level, training etc. To better ensure the quality of private providers of early childhood education, incentives for licensing and better coordination with registration for small businesses should be introduced. It is estimated that the number of private registered preschools in Kosovo are double those that have also sought licensing from the MESTI. Incentives for completing licensing such as small business tax breaks, streamlining the process for licensure, and inclusion in annual professional development for service providers/educators could make it more attractive for small business to follow through with licensing. Linking the registration and licensing process for preschools could also help ensure both steps are taken simultaneously. Comparing Official Policies with Outcomes The existence of laws and policies alone do 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 Kosovo with ECD outcomes. Some policies are generally having the intended effect, but coverage is not universal. For example, the gross preprimary enrollment rate of 93.1 percent and the DPT immunization coverage rate of 87.3 percent mean that about one out of 20 children are not receiving the benefits of those policies. The breastfeeding promotion policies only result in less than 29 percent of children up to 6 months exclusively breast fed. Table 11. Comparing ECD policies with outcomes in Kosovo ECD Policies Outcomes Breastfeeding promotion policies Exclusive breastfeeding rate (6 months): 29% Mandatory one-year attendance in preprimary education Gross preprimary enrollment: 93.1% Mandatory course of key childhood immunizations One-year olds with DPT coverage: 87.3% Mandatory birth registration Completeness of birth registration: 98% SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 27 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Preliminary Benchmarking and International Comparison of ECD in Kosovo On the following page, Table 12 presents the classification of ECD policy in Kosovo 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 provides a breakdown of the indicators associated with the policy levers, the benchmark rating, and a summary justification based on the SABER ECD rubric. It also provides the aggregated benchmarks for the three policy goals most important for supporting a strong policy environment for early childhood development. Table 12. Benchmarking early childhood development policy in Kosovo ECD Policy Goal Level of Development Policy Lever Level of Development Legal Framework Establishing an Enabling Inter-sectoral Coordination Environment Emerging Finance Scope of Programs Implementing Widely Coverage Emerging Equity Data Availability Monitoring and Assuring Quality Quality Standards Emerging Compliance with Standards Latent Emerging Established Advanced Legend: SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 28 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 29 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Table 14 presents the status of ECD policy development in Kosovo alongside a selection of OECD countries and regional comparators. Sweden is home to one of the world’s most comprehensive and developed ECD policies and achieves a benchmarking of “Advanced” in all nine policy levers. Table 14 provides the SABER-ECD classifications for several ECA countries in which the SABER-ECD analysis has been conducted. Kosovo’s level of development is generally similar to many of these countries according to the SABER analysis. Table 14. International classification and comparison of ECD systems in ECA Level of Development ECD Policy North Policy Lever Goal Kosovo Albania Armenia Azerbaijan Bulgaria Macedoni Romania a Legal Establishing Framework an Enabling Coordination Environment Finance Scope of Programs Implementing Widely Coverage Equity Data Availability Monitoring Quality and Assuring Standards Quality Compliance with Standards Latent Emerging Established Advanced Legend: Conclusion The SABER-ECD initiative is designed to enable ECD policy makers and development partners to identify opportunities for further development of effective ECD systems. This Country Report presents a framework to benchmark Kosovo’s system with other countries in the region and internationally. Each of the nine policy levers are examined in detail and some policy options are identified to strengthen ECD are offered. Attendance in pre-primary education for five and six-year olds is foreseen as compulsory and enrollment rates are high for that age group, but enrollment rates for children below five are in the single digits. Kosovo faces a substantial challenge to expand access to quality ECE and will need to use a variety of service delivery modalities to achieve this. Increasing participation in ECE is particularly important in rural areas and among some minority groups. While there are service delivery standards in place, there are areas that could be improved. The existing curriculum is under revision, and the new curriculum should take a developmentally appropriate approach that focuses on children’s holistic development. Professional development will be needed to ensure that teachers can implement a new curriculum. The law guarantees access to quality inclusive education for children with disabilities, but in practice access to services may be limited. While public spending on education has increased in recent years, the expenditure may not be yielding improvements in educational quality. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 30 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 The Kosovo ECD policy analysis shows that Kosovo is similar to regional comparators. It appears that that legislative framework is very well established. However, the issue of intersectoral coordination remains at a latent stage. Kosovo ranks at the established level in terms of defining standards for ECD provision whereas the compliance with those standards is at the emerging stage. Data availability, addressing equity of services, and financing of the ECD sector are all still emerging. Kosovo needs to carefully plan its way forward in addressing the ECD initiatives by starting with a comprehensive intersectoral strategy and action plan. The plan should be costed, and resources provided for the scale of intervention that Kosovo needs. Expanding access to services and implementation of programs is certainly a priority for Kosovo ECD, however, it is also critical that the implementation of programs addresses the issues of equity and quality of services delivered. Within this context, the need for monitoring the development of children against the well-defined milestones should be a priority. Interventions to support parents to promote their children’s development could be developed and integrated into existing programs. The programs can be expanded particularly in the health and social protection sectors while access in ECE is an urgent matter. Along with the increase of participation in ECE, the quality of curriculum and learning materials should be seen as a priority too. Kosovo needs a well-organized system of data collection and information management in order to introduce the evidence-based practice culture in the ECD sector. Table 15 summarizes the key policy options identified to inform policy dialogue and improve the provision of essential ECD services in Kosovo. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 31 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Table 15. Summary of policy options to improve ECD in Kosovo Policy Dimension Policy Options and Recommendations • Define the meaning of the right to early education services and consider mandating two years of preprimary education. • Develop and adopt a multisectoral ECD strategy incorporating education, health, nutrition, child Establishing an protection and social protection. Enabling • Establish an institutional anchor to coordinate ECD between ministries and actors. Environment • Establish guidelines on the provision of integrated services to promote children’s holistic development. • Enhance the budget process and criteria for ECD. • Use clear criteria for budgeting to increase transparency, efficiency, and equity. • Establish a culture and practice of assessment and evaluation. • Establish a comprehensive child growth and developmental monitoring system as part of a future multisectoral ECD strategy and implementation plan for integrated services. Implementing • Prepare and engage nurses, doctors, and other health workers to share information with parents Widely on developmental milestones and how to promote their children’s development. • Revise the existing funding mechanisms and increase the number of benefits in child development programs across health, education, and social welfare. • Establish maternal depression screening and treatment and raise awareness about this condition and its associated risks. • Expand programs for parents that share messages on young children’s development and positive parenting, and especially on the importance of the period from birth until preschool entry. • Establish programs to promote fathers’ engagemen t with their children and caregiving. • Add parenting education components to social protection programs. Monitoring and • Examine the reasons for the low exclusive breastfeeding rate, despite breastfeeding promotion Assuring Quality programs and maternity leave policies. • Ensure that there are adequately trained personnel and specialists to make inclusive education a quality education for children with disabilities. • Continue and expand efforts to address low preprimary enrollment, especially in underserved rural areas and Roma, Ashkali, and Egyptian communities. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 32 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Acknowledgements This Country Report was prepared by Blerim Saqipi, Senior Education Consultant and Principal Researcher; Angela Demas, Team Leader and Senior Education Specialist at the World Bank; and Lindsay Adams, ECD Consultant. The report was prepared in consultation with other members of the multisectoral World Bank ECD team for Kosovo: Mrike Aliu, Human Development Specialist; Sarah Coll-Black, Senior Economist, and Naomi Rupasinghe, Health Specialist. The following consultants also provided research assistance and comments: Ms. Edita Alo, Ms. Ilirjana Bajraktari, Ms. Boryana Gotcheva, and Mr. Timothy Carroll. The report presents country data collected using the SABER-ECD policy and program data collection instruments and data from external sources. The report was prepared in consultation with the Government of Kosovo, namely the key informants: Ms. Laberi Luzha Department Head for Early Childhood Education, Ministry of Education, Science, Technology and Innovation, Mr. Mentor Morina and Ms. Blerina Thaci, Ministry of Finance, Labor and Transfers, and Dr. Merita Vuthaj, Ministry of Health. The team is grateful to donor partners who participated in a data validation workshop, provided feedback on the policy benchmarking outcomes, and provided insight on various policies and laws underpinning ECD in Kosovo, among them Save the Children and UNICEF. The team also thanks peer reviewers for their thoughtful comments: Christine Lao Pena, Sr. Human Development Economist; Adelle Pushparatnam, Education Specialist; and Veronica Silva Villalobos, Sr. Social Protection Specialist of the World Bank. Acronyms ECD Early Childhood Development ECE Early Childhood Education (used interchangeably with preprimary or preschool) ELDS Early Learning Development Standards EU European Union GER Gross enrollment rate GoK Government of Kosovo MESTI Ministry of Education, Science, Technology and Innovation MoH Ministry of Health MFLT Ministry of Finance Labor and Transfers UNICEF United Nations International Children’s Emergency Fund WHO World Health Organization References Britto, P., Yoshikawa, H., Boller, K. 2011. “Quality of Early Childhood Development Programs: Rationale for Investment, Conceptual Framework and Implications for Equity.” Social Policy Report, 25 (2):1-31. 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, Early Online Publication, 23 September 2011. Doi:10.1016/S0140-6736(11) 60889-1. European Commission. 2017. “Education and Training Monitor 2017.” Publications Office of the European Union, Luxembourg. Eurostat. European Commission Database Hanushek, E. (2003). "The Failure of Input-Based Schooling Policies." The Economic Journal 113; 64-98. Hanushek, E. A. and D. D. Kimko. (2000). “Schooling, Labor-Force Quality, and the Growth of Nations." The American Economic Review, Vol. 90, No. 5, 1184-1208. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 33 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 Naudeau, S, N. Kataoka, A. Valerio, M. J. Neuman, L. K. Elder. 2011. Investing in Young Children: An Early Childhood Development Guide for Policy Dialogue and Project Preparation. World Bank, Washington, DC. Neuman, M. & Devercelli, A. 2013. "What Matters Most for Early Childhood Development: A Framework Paper." SABER, World Bank, Washington DC 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. OECD (Organisation for Economic Co-operation and Development). 2011. “Starting Strong III: A Quality Toolbox for Early Childhood Education and Care.” OECD Publications, Paris. Promundo https://promundoglobal.org/ 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. UNESCO Institute for Statistics Database UNICEF. 2020. Multiple Indicator Cluster Survey – Kosovo. Vargas-Barón, E. 2005. “Planning Policies for Early Childhood Development: Guidelines for Action.” Paris: UNESCO/ADEA/UNICEF (United Nations Educational, Scientific and Cultural Organization/ Association for the Development of Education in Africa/United Nations Children’sFund). Victoria, B. H., L. Adair, C. Fall, P. C. Hallal, R. Martorell, L. Richter, and H. S. Sachdev 2008. “Maternal and Child Undernutrition: Consequences for Adult Health and Human Capital. “The Lancet 371 (9609): 340-57. World Bank 2021. Subdued Recovery Western Balkans Regular Economic Report, No. 19. World Bank, Washington, DC. World Bank. 2020. SABER-ECD Policy Instrument, Kosovo. World Bank. 2020. SABER-ECD Program Instrument, Kosovo. World Bank. 2020. Human Capital Index Kosovo Brief. World Bank, Washington, DC. World Bank. 2019. Social Assistance Scheme Study: Assessment and Reform Options, World Bank. Washington, DC. World Bank 2019. Technical Note. Maternity, Paternity and Parental Leaves in Europe: Comparison of Family-related Leave Policies and Key Legal Provisions with Implications for Kosovo. Technical Note, World Bank, Washington, DC. World Health Organization Global Health Expenditure Database World Health Organization Maternal Mental Health webpage. https://www.who.int/mental_health/maternal- child/maternal_mental_health/en/ World Health Organization 2016. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. WHO, Geneva, Switzerland. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 34 KOSOVO ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2021 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 policymakers 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. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 35