90092 Sierra Leone SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2013 Policy Goals Status 1. Establishing an Enabling Environment The Child Rights Act 2007 adheres to the United Nations Convention on the Rights of Children. Efforts to improve legislation to promote the health and nutrition of women and young children and to ensure children receive preprimary education are ongoing. Coordination is low between sectors, and the level of financial investment in ECD is insufficient. The draft national ECD strategy aims to improve finance and coordination. 2. Implementing Widely The scope of ECD programs addresses all beneficiaries. Coverage and quality, however, remain inadequate. High inequity in access by socioeconomic status and between rural and urban locations persists. Targeted interventions are required to reach the most underserved children. 3. Monitoring and Assuring Quality Coverage of household survey data, such as from MICS and DHS, is national and includes some indicators on child development outcomes. However administrative data are sparse. Service delivery and infrastructure standards and compliance mechanisms for ECD provision are not developed in Sierra Leone. THE WORLD BANK SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 This report presents an analysis of the Early Childhood SABER – Early Childhood Development Development (ECD) programs and policies which affect young children in Sierra Leone. This report is part of a SABER – ECD collects, analyzes and disseminates series of reports prepared by the World Bank using the comprehensive information on ECD policies around the SABER-ECD framework.1 The Country Report includes world. In each participating country, extensive analysis of early learning, health, nutrition and social multisectoral information is collected on ECD policies and and child protection policies and interventions in Sierra programs through a desk review of available government Leone, along with regional and international documents, data and literature, and interviews with a comparisons. range of ECD stakeholders, including government officials, service providers, civil society, development Sierra Leone and Early Childhood partners and scholars. The SABER-ECD framework presents a holistic and integrated assessment of how the Development overall policy environment in a country affects young Sierra Leone is home to approximately 5.5 million children’s development. This assessment can be used to people, of which 1.1 million are below the age of 14. identify how countries address the same policy The civil war, which lasted from 1991 to 2001, challenges related to ECD, with the ultimate goal of destroyed much of the country’s infrastructure, designing effective policies for young children and their displaced a generation of youth, and dismantled the families. provision of social services. Since this period, the Box 1 presents an abbreviated list of interventions and country has reestablished aspects of the social system, policies that the SABER-ECD approach looks for in including provision of ECD services. Although infant and countries when assessing the level of ECD policy child mortality rates have been reduced significantly development. This list is not exhaustive, but is meant to during the last decade, these rates remain very high by provide an initial checklist for countries to consider the international standards. The Child Rights Act (2007) is key policies and interventions needed across sectors. an important achievement towards developing an effective legal framework for ECD, yet substantial gaps 1 SABER-ECD is one domain within the World Bank initiative, Systems remain. Access to essential ECD interventions is low, Approach to Better Education Results (SABER), which is designed to and too many children are not captured within the provide comparable and comprehensive assessments of country formal education system. The Government of Sierra policies. 2 Leone (GoSL) has developed a draft ECD policy that, if Link to UNICEF Country Statistics for Sierra Leone: http://www.unicef.org/infobycountry/sierraleone_statistics.html adopted, has the potential to substantially increase cohesion amongst ECD stakeholders and promote holistic ECD. Sierra Snapshot of ECD Indicators in Sierra Leone with Regional Comparisons Ghana Kenya Liberia Mali Leone Infant Mortality (deaths per 1,000 live births), 2010 114 50 55 74 99 Under-5 Mortality (deaths per 1,000 live births), 2010 174 74 85 103 178 Moderate and Severe Stunting (below 5), 2006-2010 36% 28% 35% 42% 38% Birth registration 2000-2010 51% 74% 60% 4% 81% 2 Source: UNICEF Country Statistics, 2010 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 2 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 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 • Standard health screenings for pregnant women • Skilled attendants at delivery • Childhood immunizations • Well-child visits Nutrition • Breastfeeding promotion • Salt iodization • Iron fortification Early Learning • Parenting programs (during pregnancy, after delivery and throughout early childhood) • Childcare for working parents (of high quality) • 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 special needs and promote their participation and access to ECD services • Financial transfer mechanisms or income supports to reach the most vulnerable families (could include cash transfers, social welfare, etc) Child Protection • Mandated birth registration • Job protection and breastfeeding breaks for new mothers • Specific provisions in judicial system for young children • 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 in regards to the particular needs of young children Three Key Policy Goals for Early Childhood decision-makers can strengthen ECD. 3 Development Strengthening ECD policies can be viewed as a continuum; as described in Table 1, countries can range from a latent SABER-ECD identifies three core policy goals that countries to advanced level of development within the different should address to ensure optimal ECD outcomes: policy levers and goals. Establishing an Enabling Environment, Implementing Widely and Monitoring and Assuring Quality. Improving 3These policy goals were identified based on evidence from impact ECD requires an integrated approach to address all three evaluations, institutional analyses and a benchmarking exercise of top- goals. As described in Figure 1, for each policy goal, a performing systems. For further information see “Investing Early: What series of policy levers are identified, through which Policies Matter” (World Bank, forthcoming). SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 3 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Figure 1: Three core ECD policy goals Table 1: ECD policy goals and levels of development Level of Development ECD Policy Goal Minimal legal Regulations in some Developed legal Non-existent legal Establishing an framework; some sectors; functioning framework; robust framework; ad-hoc Enabling programs with sustained inter-sectoral inter-institutional financing; low inter- Environment financing; some inter- coordination; coordination; sectoral coordination. sectoral coordination. sustained financing. sustained financing. Near-universal Universal coverage; Low coverage; pilot Coverage expanding but coverage in some comprehensive programs in some gaps remain; programs Implementing sectors; established strategies across sectors; high established in a few Widely programs in most sectors; integrated inequality in access sectors; inequality in sectors; low services for all, some and outcomes. access and outcomes. inequality in access. tailored and targeted. Information on Information on outcomes at Minimal survey data Information on outcomes from national, regional available; limited outcomes at national national to individual Monitoring and local levels; standards for level; standards for levels; standards exist and Assuring standards for provision of ECD services exist in some for all sectors; system Quality services exist for services; no sectors; no system to in place to regularly most sectors; system enforcement. monitor compliance. monitor and enforce in place to regularly compliance. monitor compliance. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 4 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Policy Goal 1: Establishing an Enabling Preprimary education is the responsibility of the Ministry of Education, Science and Technology (MoEST). Environment Currently, there are no laws or regulations that  Policy Levers: Legal Framework • guarantee free preprimary education for young Intersectoral Coordination • Finance children. According to two newly drafted proposals, the Government White Paper on the Gbamanja Commission An Enabling Environment is the foundation for the of Enquiry Report 2010 and the draft National design and implementation of effective ECD policies. 4 Education Policy (2010), the GoSL is proposing An enabling environment consists of the following: the implementing three years of compulsory preprimary existence of an adequate legal and regulatory school for children aged 3 to 5. Primary schools framework to support ECD; coordination within sectors commences at age 6. Implementing three years of and across institutions to deliver services effectively; compulsory preprimary school is extremely costly and and, sufficient fiscal resources with transparent and would also strain existing capacities such as classroom efficient allocation mechanisms. space and numbers of teachers. The state of preprimary Policy Lever 1.1: school in Sierra Leone is discussed in more detail in Legal Framework Policy Goal 2 of this Country Report. National laws mandate some provision of healthcare The legal framework comprises all of the laws and for pregnant women and young children. The Ministry regulations which can affect the development of young of Health and Sanitation (MoHS) is tasked with children in a country. The laws and regulations which providing healthcare for pregnant women and young impact ECD are diverse due to the array of sectors which children. The Child Health Expanded Program on influence ECD and because of the different constituencies Immunization requires all children to receive a that ECD policy can and should target, including pregnant complete course of childhood immunizations 5. Vaccines women, young children, parents, and caregivers. to prevent Mumps, Rubella, and meningitis are to be introduced in the next phase of the program. According National laws and regulations are being developed to to the MoHS’s Free Healthcare Services for Pregnant promote appropriate dietary consumption for and Lactating Women and Young Children in Sierra pregnant women and young children. The National Leone document, children are required to have well- Policy on Iodized Salt Consumption (drafted in 2011) aims child visits; however no policy or regulation guarantees to make salt iodization mandatory, and is currently children free access to well-child visits. awaiting approval by Cabinet. Sierra Leone is presently developing a policy to mandate iron fortification of food The MoHS offers voluntary health screening for HIV and staples such as wheat, maize, and rice. The policy will STDs to pregnant women who attend antenatal clinics or complement and reinforce the National Food Fortification who are referred. If a pregnant women is HIV positive, she Alliance, which is a group that works closely with the is put on antiretroviral (ARVs) to prevent mother-to-child industry and food-importing agencies to assess standards transmission prior to, during, and post birth. In the first and regulations for imported and domestically produced three months of 2012, 40,063 pregnant women were foods. According to the 2007 UNICEF report, “Protecting tested, and 652 were diagnosed as HIV positive and Breastfeeding in West and Central Africa,” Sierra Leone is provided with free medication (representing 1.2 percent one of five countries that have drafted a policy based on of pregnant women tested during this time period). the International Code for Breast Milk Substitutes, an international resolution intended to serve as a minimum requirement for all countries to protect infants and young children. The policy is still awaiting Government approval. National laws and regulations are being developed to promote early learning. 5 EPI complete course of immunizations targets the following vaccine preventable diseases: tuberculosis; diphtheria; 4 Brinkerhoff, 2009; Britto, Yoshikawa & Boller, 2011; Vargas- pertussis; tetanus; poliomyelitis; measles; hepatitis B; Baron, 2005 Haemophilus influenza type b; and yellow fever. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 5 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABERCOUNTRY REPORT |2013 Table 2: Regional comparison of parental leave policies Sierra Leone Ethiopia Ghana Liberia Mali 84 days paid 90 days paid 84 days paid 90 days paid 98 days paid maternity leave at maternity leave at maternity leave at maternity leave at maternity leave at 100% salary for 100% salary for 100% salary for 100% salary for 100% salary for women; no leave for women; two weeks women; no leave for women; no leave for women; 3 days at fathers. of paternity leave for fathers. fathers. 100% salary for fathers. fathers. Source: World Bank’s Women, Business and the Law database, 2012 National laws and regulations promote opportunities effort to unite organizations that advocate for the rights for parents and caregivers to provide care to newborns of children. and infants during their first year of life but do not The Commission for Disability advocates for the rights offer pregnant women and new mothers necessary of people with physical and mental disabilities. protection and benefits. According to Article 14 of the According to the Disability Act 2010, ECD services to Services Trade Group Collective Agreement of people with disabilities are primarily provided through December 14th, 2010, women formally employed in the MoEST and MoHS and by non-government and either the public or private sector are entitled to 84 community-based organizations. Data are insufficient to days of maternity leave, paid at 100 percent of salary. In examine the level of access to ECD services for people practice, given the high levels of employment within the with disabilities. The Alternative Care Policy provides informal sector in Sierra Leone, many women do not ECD services to orphans and vulnerable children and benefit from paid maternity leave. According to the (extends through a child’s life until the age of 17). World Bank’s Women, Business and the Law database, Sierra Leone has not developed and implemented legislation in accordance with the ILO Maternity Policy Lever 1.2: Protection Convention. Employers are not required to Intersectoral Coordination guarantee the same position when the employee returns from maternity leave, nor is there a policy to Development in early childhood is a multi-dimensional prevent the dismissal of pregnant women. Furthermore, process 6 . In order to meet children’s diverse needs employers are not required to provide break time or during the early years, government coordination is suitable facilities for nursing mothers. Table 2 compares essential, both horizontally across different sectors as parental leave policies in Sierra Leone with Ethiopia, well as vertically from the local to national levels. In Ghana, Liberia, and Mali. many countries, non-state actors (either domestic or international) participate in ECD service delivery; for this Social and child protection policies and services are reason, mechanisms to coordinate with non-state actors established in Sierra Leone. The Ministry of Social are also essential. Welfare, Gender and Children’s Affairs (MoSWGCA) is responsible for child and social protection issues. The The draft National Policy for Intersectoral ECD Child Rights Act 2007 outlines the rights of a child, (NPIECD) in Sierra Leone has not been implemented. including the requirement for children to be registered The draft National Policy for Intersectoral ECD in Sierra at birth. Leone was developed in 2010. The numerous ministries, organizations, and agencies involved include: MoEST; The national judicial system has taken specific measures MoHS; MoSWGCA; Ministry of Finance and Economic to protect young children. Judges and lawyers are trained on matters that pertain to young children, and specific juvenile courts cover matters related to ECD aged children. Law enforcement officers receive training on the Child Rights Act, the Gender Act, and Age Assessment Guidelines, and the Family Support Unit is tasked to respond to child protection issues. Lastly, the 6 Naudeau et al., 2011; UNESCO-OREALC, 2004; Neuman, MoSWGCA created the Children’s Forum Network, an 2007 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 6 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Development; National Commission for Democracy; • Educate 90 percent of pregnant women and UNESCO; CARITAS; Sierra Leone Broadcasting Service; lactating mothers of the importance of Civil Society; The First Lady’s Initiative; Mothers Union; adequate and balanced diet; and inform them Sierra Leone Teachers Union; the Family Support Unit; about the optimal feeding practices for infants Ministry of Internal Affairs, Local Government, and and young children. Rural Development; Port Loko Teachers College; Eastern Although the NPIECD aims to achieve high intersectoral Polytechnic; Northern Polytechnic; Milton Margai synergies, it is important to note that the policy was not College of Education and Technology; National designed in a participatory manner. Reports indicate Curriculum Development and Research Centre; that some important stakeholders, such as Ministry of Agriculture, Forestry, and Food Security; development partners, have not reviewed or Ministry of Lands, Housing and Environment; Children’s contributed to the policy. Furthermore, it is unclear to Learning Services; and Standard Times newspaper. what extent some critical government stakeholders Noticeably absent from this group were international contributed and whether Government is willing to pass development partners and some local and national the draft policy. NGOs. The primary objectives of the policy are to There are currently no mechanisms to promote develop guidelines for ECD, assign responsibilities for coordination between state and non-state state and non-state actors, and establish mechanisms stakeholders. If passed, the draft NPIECD will create a for coordination, monitoring, and quality assurance of national network of non-state organizations to improve ECD services in Sierra Leone. communication and cohesion amongst stakeholders. The draft NPIECD aims to establish an institutional Currently, coordination within sectors is limited to the anchor to champion ECD and a national coordinating sector specific donor groups. committee. The institutional anchor has not yet been determined, and the national coordinating committee Policy Lever 1.3: will include representatives from each of the relevant Finance Ministries – Education, Health and Sanitation, Social Welfare, Gender and Children’s Affairs, Finance and While legal frameworks and intersectoral coordination Economic Development, Agriculture, Justice, Internal are crucial to establishing an enabling environment for Affairs, Rural Development and Local Government, ECD, adequate financial investment is key to ensure that Housing and the Environment, Nursery Schools resources are available to implement policies and Association – as well as the Family Support Unit of the achieve service provision goals. Investments in ECD can Sierra Leone Police, civil society organizations, donor yield high public returns, but are often undersupplied agencies and development partners, and the private without government support. Investments during the sector. At the subnational and local level, the policy early years can yield greater returns than equivalent envisions three bodies that focus on implementing and investments made later in a child’s life cycle and can coordinating the NPIECD mandate: District Coordinating lead to long-lasting intergenerational benefits 7. Not only Committee, Local Government Committee, and do investments in ECD generate high and persistent Community ECD Committee. returns, they can also enhance the effectiveness of other The NPIECD sets forth an ambitious set of goals social investments and help governments address pertaining to intervention coverage levels and quality. A multiple priorities with single investments. snapshot of the goals to be achieved by 2015 includes: • Ensure the provision of 70 percent of public primary schools with three preprimary classrooms; • Raise parents’ awareness with the aim to ensure all children aged 3 years have access to ECD programs; • Ensure all maternal hospitals and clinics are 7 baby friendly; and 80 percent of babies are Valerio & Garcia, 2012; WHO, 2005; Hanushek & Kimko, exclusively breastfed until six months of age; 2000; Hanushek & Luque, 2003. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 7 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 charge to all, however no timetable on when this will be There is no defined process for ECD financial achieved exists. As already mentioned in this Country allocations in any sector; no sector disaggregates Report, the Government’s proposal is quite costly and spending by ECD aged children and pregnant women. therefore infeasible. Each of the involved Ministries is tasked with financing their respective interventions. However none of the According to policy, health, nutrition, and social and Ministries have specific criteria to determine financial child protection services are provided free of charge to allocations for the provision of ECD services, nor is there ECD aged children and pregnant women. The list of coordination across sectors to ensure the timeliness health services includes: labor and delivery, and sufficiency of ECD investments. The education and immunizations, provision of insecticide-treated bed net, social and child protection sectors cannot accurately well-child visits, treatment to prevent mother-to-child report public expenditures for ECD aged children. transmission of HIV/AIDS, tuberculosis treatment, According to the MoHS report entitled “Free healthcare diarrhea treatment, malaria treatment, and for pregnant and lactating women and young children in contraceptives. Sierra Leone”, the Government spent USD 91,000,000 Presented in Table 3, data from the World Health (SLL 395,841,489,407) in 2010 on this group. Organization Global Health Expenditure Database show According to policy, financial allocation for ECD that, although policy stipulates free provision, in services is equitably distributed across various practice there is a high level of out of pocket segments of society, however high private costs are a expenditures 8. Next to Mali, Sierra Leone’s level of out barrier to access. A large portion of preprimary schools of pocket expenditure (79 percent) is the highest are privately operated and charge fees. Typically the fee amongst the regional comparison countries. covers tuition, matriculation, uniforms, and other school necessities. Under the revamped education system, which is discussed in detail in Policy Lever 2.2, the objective is to provide preprimary education free of Table 3: Regional comparison of health expenditure indicators Sierra Leone Ethiopia Kenya Liberia Mali Out of pocket expenditure as percentage 90% 80% 77% 52% 99% of all private health expenditure Out of pocket expenditure as percentage 79% 37% 43% 35% 53% of total health expenditures General government expenditure on 13% 5% 5% 12% 5% health as a percentage of GDP Percentage of routine EPI vaccines No data 5% 48% 6% 20% financed by government Source: WHO Global Health Expenditure Database, 2010; UNICEF Country Statistics, 2010 (EPI vaccines) 8 Out of pocket expenditure is any direct outlay by households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or population groups. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 8 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 4: Regional comparison of salaries for preprimary teachers compared with GNI per capita GNI per capita (adjusted for purchasing power Salary range for ECD professionals parity, 2011) Sierra Leone USD 108 to USD 200 per month USD 850 per year Liberia USD 155 to USD 485 per month USD 520 per year Tanzania USD 139 to USD 413 per month USD 1510 per year Source: Nursery schools association (Sierra Leone); Section 2 of Budget Law (Liberia); and Ministry of Education (Tanzania). Data are insufficient to evaluate the adequacy of ECD promote appropriate dietary consumption by finance to meet the needs of the population. The GoSL pregnant women and young children. The GoSL does not disaggregate spending by preprimary level, should act promptly to approve, implement, and and therefore official figures are not available for the enforce policies that pertain to salt iodization, food percentage of the annual education budget that is fortification, and the International Code of allocated towards preprimary education. However, a Marketing of Breast Milk Substitutes – all of which forthcoming UNICEF sponsored study estimates that could substantially improve children’s nutrition in recurrent spending on preprimary education is their early years and impact lifelong development equivalent to 1.5 percent of Government expenditures and potential. The GoSL should also fully examine in the education sector. the factors involved in mandating three years of preprimary school, and potentially consider a Presented in Table 3, data are not available on the phased approach to achieve universal coverage for percentage of routine EPI vaccines that are financed by 5 year olds prior to addressing younger years. GoSL. The portion of vaccines financed by government  Intersectoral Coordination – The GoSL should can indicate correlation with the program’s revive efforts to develop the NPIECD. The policy sustainability. Of the regional countries presented, should articulate the responsibilities of each Kenya finances 48 percent of routine EPI vaccines, while ministry and the services provided to children and other countries are all below 20 percent. key beneficiary groups. The policy should include a The official levels of remuneration for ECD service set of goals and objectives and associated providers are adequate compared with gross national timeframe to achieve them, as well as the income per capita, however they apply only to development of a costed implementation plan. It teachers in the public system. Table 4 presents will be important to identify an institutional anchor preprimary teacher salaries for Sierra Leone, Liberia, to develop accountability and credibility. Box 2 and Tanzania. According to policy, preprimary teachers provides insight and relevant lessons from Liberia. earn between USD 108 and USD 200 per month in Sierra Leone. However a forthcoming UNICEF studies  Finance – Financial data are not disaggregated by estimates this figure to be USD 93 per month. Although ECD provision or age of the child and therefore it is this level of payment exceeds GNI per capita, there are not possible to assess the adequacy of investment in two important points to note. First, potential earning in any of the sectors. As a first step, the GoSL could Sierra Leone is well below the upper limit in both Liberia develop a framework to capture spending by age and and Tanzania. Second, because a large portion of type of investment. Second, substantial, consistent preprimary schools are not accredited, the financing will be required in all sectors to achieve remuneration guidelines only pertain to a portion of universal, holistic coverage for all children. This is teachers. Those working in non-accredited preprimary particularly true in education. Next year UNICEF will schools and centers may be paid less. support development of a costed model for ECD. Policy Options to Strengthen the Enabling Environment for ECD in Sierra Leone  Legal framework – Significant strides have been taken to develop national laws and regulations that SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 9 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Box 2. Relevant lessons from Liberia: Designing a Multisectoral Approach to ECD Summary: Similar to Sierra Leone, historically Liberia has had a sectoral approach to ECD. Each of the respective ministries was tasked with administering services within their domain, with little coordination across sectors. In 2011, the Government of Liberia created the Bureau for Early Childhood Education, which is situated within the Ministry of Education and is the institutional anchor for ECD. In April 2012, the National Intersectoral Policy on ECD was formally launched. The policy aims to enhance coordination and cohesion amongst the ECD actors by clearly outlining the responsibilities of each sector and each level of government with respect to holistic child development. The policy also highlights the primary non-government actors and lists their responsibilities. The policy sets forth a set of goals pertaining to intervention coverage levels and quality, and the design of an integrated ECD system. Key considerations for Sierra Leone:  Selection of institutional anchor for ECD.  Identify large service delivery gaps, possible economies of scale, and opportunities for synergies between ECD stakeholders.  Incorporate non-government stakeholders into the process.  Developing a cost implementation plan to accompany draft NPIECD. Policy Goal 2: Implementing Widely Policy Lever 2.1: Scope of  Policy Levers: Scope of Programs • Programs Coverage • Equity Effective ECD systems have programs established in all Implementing Widely refers to the scope of ECD essential sectors and ensure that every child and programs available, the extent of coverage (as a share expecting mothers have guaranteed access to the of the eligible population) and the degree of equity essential services and interventions they need to live within ECD service provision. By definition, a focus on healthfully. The scope of programs assesses the extent ECD involves (at a minimum) interventions in health, to which ECD programs across key sectors reach all nutrition, education, and social and child protection, beneficiaries. Figure 2 presents a summary of the key and should target pregnant women, young children and interventions needed to support young children and their parents and caregivers. A robust ECD policy should their families via different sectors at different stages in a include programs in all essential sectors; provide child’s life. comparable coverage and equitable access across regions and socioeconomic status – especially reaching the most disadvantaged young children and their families. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 10 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Figure 2: Essential interventions during different periods of young children's development Figure 3: Scope of ECD interventions in Sierra Leone by sector and target population SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 11 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 ECD programs are established in each of the core areas While Figure 3 displays some of the interventions in of focus: education, health, nutrition, and social and Sierra Leone, it does not depict coverage levels. Table 5 child protection; coverage is inadequate overall. Sierra presents the range of interventions in Sierra Leone, Leone has programs that target the main ECD groups of number of regions in which they operate, and level of beneficiaries – children aged 0 to 83 months, pregnant coverage. Complete data are not available for some mothers, and caregivers. As presented in Figure 3, interventions. Although many interventions exist, interventions targeting social and child protection are coverage is low and data poor. limited. There are a range of health interventions that Select health and nutrition interventions have achieved target all beneficiary groups. near universal coverage. For most other interventions, The presence of war can have a devastating impact on a coverage is moderate or low. A significant challenge is country’s physical infrastructure, service delivery the lack of data collected by the GoSL. For instance, the system, and human psyche. Often children do not MoHS operates childhood wellness and growth receive the adequate nutrition and health services, monitoring through their health centers, but data are early stimulation, care and protection required to fully not available. Therefore it is not possible to compute develop. In the aftermath of war, it is essential to focus how many children are not accessing well-child visits, on ECD aged children, while also providing support nor is it possible to evaluate the effectiveness of the mechanisms for older children who did not receive investment and service delivery methods. Other adequate support and services in their early years. Box interventions that do not have data include: 3 presents the example of Angola and discusses specific interventions for children with special needs, advocacy features and approaches to support children in conflict interventions for children with special needs, as well as and post-conflict situations. select education, health and nutrition interventions. No conditional cash transfer interventions exist in Sierra Local and international agencies, NGOs, and civil society Leone and could be considered as a way to incentivize groups play an important role in ECD in Sierra Leone. families to access ECD services, such as preprimary These stakeholders, some of whom are identified in the school. draft NPIECD, engage in various activities, including: operate and deliver ECD activities, provide technical assistance to other ECD stakeholders, finance initiatives, and conduct monitoring and evaluation of ECD interventions. As discussed in Policy Lever 1.2, significant efforts are required to improve coordination between government and non-government stakeholders. Some of the organizations with a large ECD presence in Sierra Leone include UNICEF, Plan International Sierra Leone, United Kingdom’s Department for International Development, the Open Society Initiative, and the World Food Programme (WFP). UNICEF is a strong advocate for ECD and operates several interventions, including health and hygiene activities at the district level, (school sanitation and hygiene education (SSHE) and school-led total sanitation (SLTS) activities). Plan International Sierra Leone also has ECCE centers and works in child advocacy. The Open Society Initiative has the OSI for West Africa, and the World Food Progamme provides food assistance to protect mothers and children at risk of malnutrition. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 12 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Box 3: Example from Angola: Supporting young children in conflict and post-conflict situations War and the period afterwards pose enormous challenges to ECD. Children and parents are subject to armed conflict, sexual and gender-based violence, land mines, and displacement. Physical infrastructure is often destroyed, and children and parents do not have access to proper ECD facilities and interventions. Angola is a country that has experienced internal conflict and war. In 2002, at the end of the war, one-third of Angolans (3.5 million people) were displaced, and half of this population was below the age of 12. The country’s social infrastructure was destroyed, creating a lost generation of children who grew up in the most difficult situations. Furthermore, parents, who are often overwhelmed by their war experience, lack the skills and resources to be effective caregivers and guardians. To tackle these immense challenges, the Christian Children’s Fund (CFF) in Angola developed an effective program model that has four critical pillars. 1) Ecological approach: to support young children, it is necessary to support their caregivers. Ecological approaches highlight social influences, such as family, friends, and community as important factors for achieving holistic child development. CCF Angola conducts community workshops for adults, offering space for reflection about the past, present, and future. 2) Community mobilization: often in a conflict or post-conflict environment the initial response is to adopt a service delivery model so that materials can be distributed as quickly as possible. Although the deliverables are important, the approach can undermine parents’ role as caregivers and create dependency. Well- planned, participatory approaches engage the community and establishes a framework for sustainable ECD programming. 3) Program integration: as discussed in Policy Lever 1.2, holistic ECD requires effective coordination across all sectors. CCF Angola uses an integrative strategy of building psychosocial and protection supports for children in each sector. As a result, the program does not target specific beneficiary groups, but rather aims to address the entire eligible population, which makes the support of young children one element in a wider system of supports for all children. 4) Culturally grounded approach: the CCF Angola incorporates local beliefs and practices with international best practices to ensure programming is relevant and acceptable to the population. Key Lessons for Sierra Leone:  Integrated framework that engages all sectors and stakeholders and incorporates cultural and local practices.  Supports parents with a particular emphasis on emotional healing is post-crisis period. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 13 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 5: ECD programs and coverage in Sierra Leone Scale Number of ECD Intervention Pilot Regions Level of programs covered coverage (out of 4) EDUCATION (stimulation and early learning) Government-provided early childhood care and education 4 Low Privately-provided for profit early childhood care and education 4 Low Privately-provided not-for-profit early childhood care and education 4 Low Community-based early childhood care and education 4 Low Capacity building for early childhood care and education No data HEALTH Prenatal healthcare 4 Moderate Labor and delivery 4 Moderate Comprehensive immunizations for infants 4 Universal Childhood wellness and growth monitoring No data Capacity building intervention on quality of child health services No data Maternal depression screening or services No data NUTRITION Micronutrient support for pregnant women 4 Universal Food supplements for pregnant women No data Micronutrient support for young children 4 Universal Food supplements for young children No data Food fortification No data Breastfeeding promotion programs 4 Low Anti-obesity programs encouraging healthy eating/exercise No intervention Feeding programs in preprimary schools 4 Low PARENTING Parenting integrated into health/community programs No data Home visiting programs to provide parenting messages No data ANTI-POVERTY Cash transfers conditional on ECD services or enrollment No intervention SOCIAL AND CHILD PROTECTION Programs for OVCs 4 Low Interventions for children with special needs No data Advocacy and capacity building intervention for provision of care to No data children with special needs MULTISECTORAL OR COMPREHENSIVE A comprehensive system that tracks individual children’s needs and No intervention intervenes, as necessary Source: SABER-ECD Policy Data Collection Instrument and SABER-ECD Program Data Collection Instrument *Note: Nearly universal coverage signifies coverage rates above 95 percent SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 14 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 13 percent of schools, and only 7 percent of schools are Policy Lever 2.2: Coverage publicly operated. The discussion in Policy Lever 3.3 details that many schools are not approved by the GoSL. A robust ECD policy should establish programs in all essential sectors, ensure high degrees of coverage and The draft National Education Policy 2010 mandates a reach the entire population equitably – especially the new structure for the education sector. The main most disadvantaged young children – so that every child changes to the existing system entail: the inclusion of and expecting mother have guaranteed access to compulsory preprimary school (also referred to as essential ECD services. preschool) for children aged 3 to 5 and the extension by one year of secondary level education. The motivating Currently, only 14 percent of children aged 3 to 5 years factor behind these changes is to improve the learning attend preprimary programs in Sierra Leone. The Early outcomes of children and youth, starting at a young Childhood Care and Education system is embarking age. Under the new format, the proposal is to establish upon a period of transformation. The current system preprimary school for a duration of 3 years and would largely consists of private provision. Presented in Table be situated on the same location as primary schools. 6, as of the 2010/2011 academic school year, there were a total of 644 preprimary schools reported. Of these, 40 percent operate privately, and 39 percent are mission schools. Community based centers account for Table 6: Number of preprimary schools by region and proprietor / owner (2010/2011) Region GOSL Private Community Missions Other Agencies All East 11 26 20 51 2 110 North 17 16 11 44 2 90 South 6 30 7 54 3 100 West 9 185 43 105 2 344 National 43 257 81 254 9 644 (% of national) 7% 40% 13% 39% 1% Source: MoEST 2010/2011 School Census Report SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 15 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 The new framework set forth in the draft National Education other avenues to increase coverage and quality of Policy 2010 is very ambitious and lists a set of key areas to preprimary school. achieve universal, high quality preprimary school for 3 Presented in Table 7, enrollment in preprimary school in years for all children. These include the following: Sierra Leone varies significantly by region. The West • prioritize access for children from region has the highest coverage, with 36.5 percent of disadvantaged backgrounds and children with eligible children attending preprimary school – 53.4 special needs; percent of all preprimary schools are located in this • support and articulate training for preprimary region. Data that depict average number of students teachers; per school and distribution of schools within each • establish minimum operating standards for all region are not available. providers of preprimary education; • monitor preprimary schools for adherence to Access to health interventions for pregnant women in the standards; Sierra Leone is low. Table 8 presents three indicators • support feeding programs for preprimary that depict the level of access to ECD health schools; interventions for pregnant women in Sierra Leone and • ensure newly constructed primary schools make regional comparison. Sixty-two percent of HIV+ accommodation for a preprimary wing; and, pregnant women receive antiretroviral drugs to prevent mother-to-child transmission. Compared with other • support the National Institute of Education, countries in the region, this level is high and Training, and Research (NIETAR) to develop demonstrates the success of the MoHS intervention, appropriate preprimary curricula. though room for improvement remains. A second Despite the intentions of the new policy, it does not indicator is the percentage of pregnant women accurately reflect the current state of preprimary receiving antenatal care at least four times. Although education in Sierra Leone. A recent cost analysis the rate in Sierra Leone (56 percent) is higher than most demonstrates that the cost of expanding preprimary other countries presented in Table 8, it is very low by school is prohibitive and that the GoSL should consider international standards. Table 7: Enrollment by region Enrollment % of preprimary schools located in Region (age 36-59 months) the region East 19% 17% North 7% 14% South 11% 16% West 37% 53% National Enrollment 14% Source: MoEST 2010/2011 School Census Report Table 8: Level of access to programs for pregnant women in Sierra Leone and comparison countries Sierra Leone Ghana Kenya Liberia Mali Births attended by skilled attendant 42% 57% 44% 46% 49% Pregnant women receiving antenatal care (at 56% 78% 47% 66% 35% least four times) HIV+ pregnant women/exposed infants receive 62% No data 43% 38% 34% ARVs for PMTCT Source: UNICEF Country Statistics, 2010, UNAIDS database (2010) SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 16 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 9: Level of access to essential health services for young children in Sierra Leone and regional countries Sierra Leone Ghana Kenya Liberia Mali 1-year-old children immunized against DPT 90% 94% 93% 64% 90% (corresponding vaccines: DPT3ß) Children below 5 with diarrhea receive oral 57% 45% 43% 47% 38% rehydration/ continued feeding Children below 5 with suspected pneumonia 27% 51% 50% 62% 38% receive antibiotics Children below 5 sleeping under ITN 26% 28% 47% 26% 70% Children below 5 with fever, receive anti- 30% 43% 23% 67% No data malarial Source: UNICEF Country Statistics, 2010 The level of access to essential health interventions for international standards and indicates that children are young children in Sierra Leone is low. Access to health not receiving the nutrients and balanced diet required interventions is low in each of the five countries to optimize development. The impact of stunting on a presented in Table 9. This is particularly true for Sierra child’s development is immense. The period between Leone. Of the population below the age of 5, only 26 conception and the age of 2 is a window of opportunity percent sleep under an insecticide-treated bed net, and to address and prevent the damage caused by just 30 percent who have a fever receive anti-malarial malnutrition. If not addressed, a child that suffers from drugs. Both of these rates are extremely low, especially malnutrition will not fully develop physically, which in in a country with high susceptibility to malaria. turn hinders linguistic, cognitive, and socio-emotional Compared with other African countries, the percentage development. This can result in diminished human of children below age 5 with diarrhea who receive oral capital and lower lifetime earnings. The proportion of rehydration and continued feeding (57 percent) is high. children that are exclusively breastfed in Sierra Leone is However, this is a product of low coverage levels in the extremely low (currently 11 percent); efforts to increase comparison countries rather than high coverage in exclusive breastfeeding until the age of six months Sierra Leone. Viewed through a different lens, 43 could help address the prevalence of stunting. percent of children with diarrhea do not receive oral Another concern is the prevalence of anemia in rehydration. A noteworthy achievement is that 90 pregnant women (60 percent) and young children (83 percent of 1 year old children are immunized against percent). This is an issue across the region. A DPT. noteworthy success is the universal Vitamin A The level of access to essential nutrition interventions supplementation for children aged 5 to 59 months. for young children and pregnant women is relatively low in Sierra Leone. Presented in Table 10, the level of moderate and severe stunting amongst children 5 years of age or younger is 36 percent. Although this rate is lower than Liberia and Mali, it is extremely high by SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 17 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 10: Level of access to essential nutrition interventions for young children and pregnant women in Sierra Leone and comparison countries Sierra Leone Ghana Kenya Liberia Mali Children below 5 with moderate/severe 36% 28% 35% 42% 38% stunting Vitamin A supplementation coverage (6-59 100% 93% 62% 53% 59% months) Infants exclusively breastfed until 6 months 11% 63% 32% 34% 38% Infants with low birth weight 14% 13% 8% 14% 19% Prevalence of anemia in pregnant women 60% 65% 55% 62% 73% Children below 5 with anemia 83% 76% 69% 88% 83% Population that consumes iodized salt 58% 32% 98% No data 79% Source: UNICEF Country Statistics 2010, WHO Worldwide Prevelence of anaemia, 1993-2005 Figure 4: Level of access to essential ECD interventions by socioeconomic status 100 80 60 40 20 0 Underweight prevalence in Birth registration (%) 2000- Skilled attendant at birth (%) children under five (%) 2006- 2010 2006-2010 2010 Poorest 20% 43 28 22 Richest 20% 62 71 12 Source: UNICEF Country Statistics 2010 location. Figure 4 compares birth registration, skilled Policy Lever 2.3: Equity attendant at birth, and underweight prevalence in children below 5 for the poorest 20 percent of children Based on the robust evidence of the positive effects ECD with the richest 20 percent. The results indicate that interventions can have for children from disadvantaged there is high inequity in access. Skilled attendants assist backgrounds, every government should pay special with more than 70 percent of births for the richest attention to equitable provision of ECD services 9. One of quintile, whereas the figure is only 28 percent for the the fundamental goals of any ECD policy should be to poorest quintile. Furthermore, 62 percent of children in provide equitable opportunities to all young children the highest quintile are registered at birth, compared to and their families. only 43 percent of the poorest children. Figure 5 Access to essential ECD services in the health, nutrition, illustrates inequity in access by rural/urban location. and social and child protection sectors is highly The four indicators analyzed are: birth inequitable by location and socioeconomic status. The following section presents data from the UNICEF Country Statistics on access to several interventions and ECD outcomes by socioeconomic status and rural/urban 9 Nadeau et al., 2011; UNESCO-OREALC, 2004; Neuman, 2007 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 18 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Figure 5: Level of access to essential ECD interventions by urban/rural location 100 80 60 40 20 0 Percentage of children % of population using Birth registration (%) 2000- Skilled attendant at birth aged 36-59 months improved sanitation 2010 (%) 2006-2010 enrolled in preprimary facilities, 2008 school Urban 59 67 24 23 Rural 48 33 6 11 Source: UNICEF Country Statistics 2010 registration, skilled attendant at birth, percentage of preprimary school. Current capacity and resource population using improved sanitation facilities, and limitations are prohibitive, at least in the short- percentage of children aged 36 to 59 months enrolled in term. The Government could evaluate the different preprimary school. For each of these indicators the level service delivery modalities and develop more of access is much higher in urban locations than in rural flexible arrangements to support the non-State areas. This disparity is most pronounced for skilled providers of preprimary education. attendant at birth: births are attended by a skilled  Coverage – Coverage is inadequate for numerous attendant 67 percent of the time in urban areas, essential ECD interventions. This is particularly true compared with 33 percent in rural areas. The in education, health, and nutrition. One possible percentage of population using improved sanitation explanation is that, despite policy stating otherwise, facilities is only 24 percent in urban locations and a the significant private costs associated with health meager 6 percent in rural locations. In respect to access services are preventing access. The GoSL should to preprimary school, 23 percent of children aged 36 to consider strengthening efforts to reduce the 59 months attend preprimary schools in urban financial burden on pregnant women and young locations, whereas the rate is only 11 percent in rural children as a way to increase access and achieve locations. Of the total 37,351 children age 3 to 5 years better health outcomes. who attend preprimary school, 51 percent (19,104) are female, indicating no gender disparity in preprimary  Equity – Data clearly illustrates that the poorest, enrollment. most marginalized populations have less access to ECD interventions. These are the children that Policy Options to Implement ECD Widely in benefit the most from investment in ECD. The GoSL Sierra Leone could better identify the underserved populations  Scope of Programs – Due to the sectoral and consider alternative methods to service structure of ECD provision and absence of a uniting provision. One option to consider is a Conditional policy, there is a gap in knowledge of what Cash Transfer (CCT) program, which provides interventions exist and where they operate. This financial support to parents conditional upon contributes to low access in some areas of the specific requirements being met (i.e. child enrolled country and for specific populations. The GoSL and attends one (or multiple) intervention, such as should consider undertaking a mapping exercise to preprimary school). Box 4 provides relevant lessons develop a database of ECD interventions. This could from the Mauritian example on the use of CCTs to be completed in conjunction with the revised ECD promote ECCE enrollment. policy. It is also important to recognize and evaluate the feasibility of introducing three years of universal SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 19 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Box 4: Example from Mauritius: Conditional Cash Transfers (CCTs) to Promote ECCE Enrollment Summary: The Government of Mauritius has focused policy efforts on increasing preprimary school enrollment in the last decade. In order to encourage parents to enroll their children, the Government provides all families with financial support contingent upon the child attending the final year of preprimary school (age 4 in Mauritius). The transfer amounts to USD 6 per month and has helped achieve an 85% enrollment rate in preprimary school for children age 3-5 in Mauritius. Provision is largely through non-State centers (17% of all preschools are State-managed), but the design and enforcement of quality control mechanisms has remained central to Government policy efforts. Key considerations for Sierra Leone:  Incentivizing on-time enrollment in the last year of preprimary school could be a first step to scale-up ECCE provision school.  CCTs could be considered either for the entire population or targeted to the most underserved areas or segments of society (i.e. poorest families, families in rural areas, etc).  It will be important to determine the appropriate funding level to maximize effectiveness of policy. Policy Goal 3: Monitoring and Assuring Both administrative and survey data are collected, however administrative data are not robust in Sierra Quality Leone. Table 11 presents a series of key indicators that  Policy Levers: Data Availability • a country can collect to track the provision of services Quality Standards • Compliance with to promote young children’s development. These data Standards include both administrative and survey data. Monitoring and Assuring Quality refers to the existence Administrative data refer to data formally collected of information systems to monitor access to ECD through GoSL information systems and report actual services and outcomes across children, standards for figures (i.e. enrollment, expenditures, etc.). ECD services and systems to monitor and enforce Administrative data collection systems exist in compliance with those standards. Ensuring the quality education, health, and child and social protection, but of ECD interventions is vital because evidence has do not collect robust, comprehensive data. Within the shown that unless programs are of high quality, the education sector, data are more complete for primary impact on children can be negligible, or even and secondary school, but are poor for the preprimary detrimental. level. Access data are captured by region, but are not Policy Lever 3.1: detailed to include age of the child, special needs, or Data Availability socioeconomic status, for example. Survey data, which are based on sampling of a specific population, are more thorough. The fourth and most recent version of Accurate, comprehensive and timely data collection can UNICEF Multiple Indicators Cluster Survey was promote more effective policy-making. Well-developed conducted in 2010. Administrative and survey data in information systems can improve decision-making. In Sierra Leone disaggregate by gender, rural/urban particular, data can inform policy choices regarding the location, and socioeconomic status for select volume and allocation of public financing, staff indicators. recruitment and training, program quality, adherence to standards and efforts to target children most in need. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 20 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 11: Availability of data to monitor ECD in Sierra Leone Administrative Data Indicator Tracked Special needs children enrolled in ECCE (number of) X Children attending well-child visits (number of) X Children benefitting from public nutrition interventions (number of) X Women receiving prenatal nutrition interventions (number of) X Children enrolled in ECCE by sub-national region (number of)  Average per student-to-teacher ratio in public ECCE X Is ECCE spending in education sector differentiated within education budget? X Is ECD spending in health sector differentiated within health budget? X Survey Data Indicator Tracked Population consuming iodized salt (%)  Vitamin A Supplementation rate for children 6 -59 months (%)  Anemia prevalence amongst pregnant women (%)  Children below the age of 5 registered at birth (%)  Children immunized against DPT3 at age 12 months (%)  Pregnant women who attend four antenatal visits (%)  Children enrolled in ECCE by socioeconomic status (%)  X refers to indicators that are not tracked. Source: UNICEF Country Statistics 2010, MoEST, MoHS Table 12: Early learning and stimulation at the household level Region Children aged 36-59 months Books in the home Child plays with With whom adult With whom household the father 3 or more 10 or more Manufactured Household members engaged in Homemade children’s children’s /store objects/toys engaged in four one or more toys books books bought toys found outside or more activities activities over over 3 day period 3 day period East 53% 48% 1% 0% 20% 28% 53% North 48% 31% 1% 0% 31% 22% 62% South 56% 56% 1% 0% 26% 26% 58% West 80% 31% 12% 2% 30% 70% 53% Total 54% 42% 2% 0% 27% 30% 57% Source: UNICEF MICS Country Report, 2010 immense impact on reading and language development Child development outcomes are captured in MICS. and is important for later school performance and IQ Sierra Leone does not have a system to track child scores. Although the prevalence and use of books is development on a regular basis in the four interrelated low, it is important to note that families in Sierra Leone domains of child development: physical, cognitive, have a rich history of oral story telling which contributes linguistic, and social and emotional development. to children’s early learning and stimulation. A snapshot of the home environment and the Slightly more than 54 percent of children aged 36 to 59 promotion of child development are captured in the months benefit from adult engagement in four or more MICS-4 data. Table 12 presents select indicators for activities over a three day period. This percentage is early learning and stimulation at the household level. In lower when isolated for fathers. Only 42 percent of total, only 2 percent of households have 3 or more fathers engaged in one or more activities with their children’s books, and only 0.3 percent have more than child, and in the North and West regions of the country 10 children’s books. Exposure to books can have an this rate is 31 percent and 30 percent, respectively. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS ` 21 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Though the number of families engaged in early Primary school infrastructure standards apply to learning activities with children is low overall, the preprimary schools; service delivery standards are not national and regional averages are significantly higher specific to preprimary school. According to the MoEST, than preschool enrollment levels – in many countries preprimary facilities must adhere to the same this type of discrepancy indicates that parents recognize infrastructure standards as primary schools. The the value of early learning opportunities for children but standards aim to provide a safe environment for face constraints to enrolling children in formal students, and include all aspects of the building (i.e. preschool or early learning opportunities such as cost or roof, floor, windows, etc.). Schools are supposed to be location. built with concrete and are required to have access to electricity, potable water, and functional hygiene Policy Lever 3.2: facilities. Quality Standards In respect to service delivery, most schools operate at Ensuring quality ECD service provision is essential. A their discretion. Specified child to teacher ratio do not focus on access – without a commensurate focus on exist, nor are there specific space requirements or ensuring quality – jeopardizes the very benefits that operating environments for children. policymakers hope children will gain through ECD Registration and accreditation procedures exist, but interventions. The quality of ECD programs is directly details are not available to assess the procedures. The related to better cognitive and social development in MoEST reports that registration and accreditation children10. procedures exist for preprimary schools, however no The MoEST has drafted a national preprimary school details on the exact procedures were provided for the curriculum. The drafted national preprimary school preparation of this Country Report. curriculum aims to lay the foundation for the holistic development of the child, including preparation for Policy Lever 3.3: primary school. The curriculum has eight development Compliance with Standards domains – social/emotional, psychosocial, physical and well-being, cognitive, technology, spiritual/moral, Establishing standards is essential to providing quality literacy, and language – and presents a framework to ECD services and to promoting the healthy development evaluate each area at specific periods throughout a of children. Once standards have been established, it is child’s development. No details are available regarding critical that mechanisms are put in place to ensure the timeframe or process for implementation. compliance with standards. Data are not collected to assess the level of pre-service Requirements for ECCE professionals are not clear. training amongst ECCE professionals. The MoEST states Pre-service requirements for ECCE professionals are not that ECCE professionals must have a teacher certificate well depicted in Sierra Leone. According to the MoEST, but no data exist to verify in public or private ECCE preprimary teachers should have at a minimum a centers. teacher certificate (TC), yet it is preferred if they have a higher teacher certificate (HTC) or a bachelor degree in Public and non-public schools do not adhere to ECCE. Early childhood education was introduced in the infrastructure, accreditation, or service delivery Institute of Education and Extra-Mural Studies standards. Of the 644 preprimary schools operating, 50 (INSEEMS) at Fourah Bay College in 2009 to target percent are not formally approved by the MoEST. preschool education. Programmes include Certificate in Furthermore, it is likely that many other schools Early Childhood Care and Education (ECCE) offered for operate outside jurisdiction of the GoSL. This is an one year, Diploma in ECCE offered for two years and exceptionally high number and illustrates that the B.Ed in ECCE offered for four years. Yet very few MoEST, due to inadequate financial resources, institutions do offer such training. The draft National infrastructure, and technical capacity, cannot currently Education Policy 2010 highlights this as a priority area. adequately oversee the provision of preprimary school in Sierra Leone. 10 Taylor & Bennett, 2008; Bryce et al, 2003; Naudeau et al, 2011V; Victoria et al, 2003 In respect to infrastructure, as presented in Table 13, 48 percent of all preprimary classrooms are in need of SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 22 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 repair. Data on schools that have access to potable  Quality Standards – As outlined in the draft water and functional hygienic facilities are not NPIECD, the GoSL recognizes that substantive disaggregated by school type. Out of all eligible schools, efforts are required to improve service delivery approximately 38 percent do not have access to and infrastructure standards. Particular attention functional facilities. All schools have access to water; should be paid to developing attainable service however the water source in many instances is not delivery standards, including duration and intensity potable. of ECCE, and number of children per qualified Table 13: Percentage of preprimary classrooms in teacher. It will be important to include a time need of repairs period and outline adequate resources to achieve desired outcomes. Percentage of Number of Region preschools preschools in need  Compliance with Standards – In parallel with of repair improved standards, the GoSL should consider East 110 61% expanding the technical capacity and financial North 90 52% resources to enforce standards. This includes South 100 68% frequent site visits and potentially mandating West 344 42% retrofitting where necessary. It is also paramount National 644 48% to monitor the compliance of teachers with pre- Source: MoEST 2010/2011 School Census Report service requirements to ensure quality service provision. Policy Options to Monitor and Assure ECD Comparing Official Policies with Outcomes The existence of laws and policies alone does not Quality in Sierra Leone always guarantee a correlation with desired ECD  Data Availability – Participating in MICS-4 is an outcomes. In many countries, policies on paper and the excellent step to improve the availability of data reality of access and service delivery on the ground are regarding children’s development. In conjunction, not aligned. Table 14 compares policy intent with ECD the GoSL should assist each relevant ministry to outcomes in Sierra Leone. Three of the policies improve management information systems to presented – breastfeeding promotion, compulsory improve and capture access and quality indicators preprimary school and salt iodization – are in draft across interventions to better understand the form. For each of these, the outcome is very poor, status of ECD. In the future the Government indicating the need for effective policy development should consider developing and monitoring child and implementation. The Child Rights Act 2007 development indicators (in addition to MICS) to mandates birth registration, yet only 51 percent of ensure the child’s full development and identify children are registered. areas for intervention early on. Table 14: Comparing ECD policies with outcomes in Sierra Leone Policy Outcomes No policy that complies with the International Rate of exclusive breastfeeding Code of Marketing of Breast milk Substitutes until 6 months: 11% Child Health Program mandates a complete Children with DPT course of childhood immunizations (12-23 months): 90% Child Right Act mandates birth registration Birth registration rate: 51% Draft education strategy will mandate compulsory Net preprimary school preprimary for 3-5 year olds by 2015 enrollment (3-5 years): 14% SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 23 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 15: Comparing policy intent with ECD outcomes in Sierra Leone and comparison countries Sierra Leone Kenya Liberia Uganda Salt Iodization Salt Iodization Policy Draft policy Mandatory No policy No policy Population Consuming Iodized 58% 90+% 20% 96% Salt Appropriate Infant Feeding and Breastfeeding Promotion Compliance, Code of Marketing Some provisions Draft policy Voluntary Law of Breast Milk Substitutes law Exclusive Breastfeeding until 6 11% 32% 34% 60% Months Preprimary Education Not compulsory; Government Not compulsory; Not compulsory; finances some Not compulsory; all Preprimary School Policy largely non- State and non-state recurrent costs but provision non-state state provision provision user fees are common Preprimary School Enrollment 14% 42% 47% 7% Rate Birth Registration Mandatory within 3 Birth Registration Policy Mandatory Mandatory Mandatory months of birth Birth Registration Rate 51% 60% 4% 21% Table 15 compares key policy provisions and associated each of the nine policy levers and three policy goals. For outcomes in Sierra Leone with countries in the region. The each of the three policy goals, Sierra Leone’s level of table shows a wide range of policy development and ECD development is classified as “latent.” In the legal outcomes. Only Kenya has a policy mandating salt framework policy lever, Sierra Leone performs at the iodization, and shows that the policy is effective by having “emerging” level, which reflects the adoption of the Child 90 percent coverage rates. Uganda is the only country with Rights Act 2007, and will continue to improve with further a law that adheres to the International Code of Marketing legislation being considered for preprimary education and of Breast Milk Substitutes, and also has nearly twice the rate for health and nutrition interventions. Both intersectoral of exclusive breastfeeding as Kenya and Liberia. None of the coordination and finance are “latent” and can be countries mandate compulsory preprimary education, yet improved by revisiting the draft NPIECD and increasing coverage varies from as low as 7 percent in Uganda to 42 financial commitment to ECD. Sierra Leone is classified as percent in Kenya and 47 percent in Liberia (although there is “established” for scope of programs because interventions concern over the validity of the statistic in Liberia). Lastly, all are available for each beneficiary group – parents and countries mandate birth registration, and Kenya has caregivers, pregnant women, and ECD aged children – but achieved the highest level of birth registration (60 percent). coverage and equity are “latent” due to low access, These findings underscore the importance of especially in rural locations and by children in lower implementation and enforcement mechanisms to socioeconomic households. Each of the data availability, accompany well-designed policy. In isolation, stated policy quality standards, and compliance with standards policy bears little weight, however when paired with strong levers is classified as “latent.” To ensure positive ECD political will and effective systems, the likelihood of success outcomes, it is vital to design and implement quality is much greater. standards that are founded in strong data. The policy options outlined in this report present avenues to improve Preliminary Benchmarking and International Comparison the level of development for each of the policy levers. of ECD in Sierra Leone. Table 16 presents the classification of the level of development in ECD in Sierra Leone within SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 24 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 16: Benchmarking Early Childhood Development Policy in Sierra Leone Level of Level of ECD Policy Goal Policy Lever Development Development Legal Framework Establishing an Enabling Inter-sectoral Coordination Environment Finance Scope of Programs Implementing Widely Coverage Equity Data Availability Monitoring and Assuring Quality Standards Quality Compliance with Standards Latent Emerging Established Advanced Legend: Table 17: International Classification and Comparison of ECD Systems Level of Development ECD Policy Goal Policy Lever Sierra Ethiopia Kenya Liberia Mali Tanzania Leone Legal Framework Establishing an Enabling Coordination Environment Finance N  Scope of Programs Implementing Coverage Widely Equity N  N  Data Availability Monitoring and Quality Standards Assuring Quality Compliance with Standards Latent Emerging Established Advanced Legend: Table 17 presents the status of ECD policy development on ensuring these standards are enforced. Tanzania in Sierra Leone alongside a selection of countries in East recently developed an intersectoral strategy to and West Africa. The level of development in Sierra coordinate ECD which could serve as a model for Sierra Leone is comparable to the level of development in Leone. Both of these ECD systems have substantial Liberia and Mali, while Kenya and Tanzania have room for improvement, too. achieved higher levels of development. Both Kenya and Tanzania have ECD systems with effective elements that are relevant to Sierra Leone. In particular, Kenya has developed strong quality standards and now must focus SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 25 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2013 Table 18: Summary of policy options to improve ECD in Sierra Leone Policy Policy Options and Recommendations Dimension • Finalize, approve, and enforce the national policy on iodized salt consumption, policy on iron fortification, and law on breastfeeding to promote appropriate dietary consumption. • Revisit the National Policy on Intersectoral Early Childhood Development (NPIECD) by engaging Establishing an all stakeholders and articulating responsibilities, institutional design, and sharing service Enabling Environment delivery models. • Develop an achievable, costed implementation plan to accompany the NPIECD. • Develop methodology to measure and track financial investments in ECD in all sectors. • Identify funding sources to increase investment to meet scale-up of preprimary school. • Increase awareness and cohesion amongst ECD stakeholders by undertaking a mapping exercise of ECD interventions. • Evaluate various non-state preprimary modalities to expand access and quality of service Implementing delivery. Widely • Identify primary gaps in service delivery system, with particular focus on marginalized children. • Consider alternative means to increase coverage and deliver ECD interventions to needy children, such as a conditional cash transfer programs. • Further advance information management systems in each of the respective line ministries to better capture access and quality data. • As presented in the draft NPIECD, develop effective service delivery and infrastructure Monitoring and standards to ensure the well-being and safety of young children and provide effective Assuring Quality environment for ECD. • Develop teacher training standards specific to ECD. • Establish technical capacity with sufficient financial resources to enforce standards. Conclusion overstretched. In light of these challenges, the GoSL enacted the Child Rights Act and is on the verge of The SABER-ECD initiative is designed to enable ECD further advancing the legislative and regulatory policy makers and development partners to identify framework. It is critical that this momentum is seized opportunities for further development of effective ECD and acted upon. The draft NPIECD has the potential to systems. The SABER-ECD classification system does not raise awareness of the importance of ECD and increase rank countries according to any overall scoring; rather, coordination within Government and between all it is intended to share information on how different ECD stakeholders. Coverage is low in all sectors, especially systems address the same policy challenges. This education. One avenue being considered to address this Country Report presents a framework to compare Sierra issue is compulsory preprimary school. The current Leone’s ECD system with other countries in the region system has weak capacity. Implementing three years of and internationally. Each of the nine policy levers are preprimary school is not financially realistic. Rather, the examined in detail and some policy options are Government should focus on improving access for all identified to strengthen ECD are offered. while achieving high quality standards and compliance. The lasting impact of the civil war cannot be Table 18 summarizes possible policy options presented understated. Much of the country’s infrastructure was in this Country Report to improve ECD in Sierra Leone. destroyed, and the social security system remains SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 26 SIERRA LEONE ǀ EARLY CHILDHOOD DEVELOPMENTSABER COUNTRY REPORT |2013 www.worldbank.org/education/saber The Systems Approach for Better Education Results (SABER) initiative produces comparative data and knowledge on education policies and institutions, with the aim of helping countries systematically strengthen their education systems. SABER evaluates the quality of education policies against evidence-based global standards, using new diagnostic tools and detailed policy data. The SABER country reports give all parties with a stake in educational results—from administrators, teachers, and parents to 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. For technical questions or comments about this report, please contact the SABER-ECD team (helpdeskecd@worldbank.org). This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. THE WORLD BANK 26 SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS