94321 Belize   SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2013          Policy Goals Status 1. Establishing an Enabling Environment Legal frameworks in Belize provide some protection for pregnant women,  mothers, and young children. However, a comprehensive Early Childhood Development (ECD) policy does not yet exist. In addition to a multi-sectoral ECD strategy, Belize would benefit from an institutional anchor that could coordinate ECD at both the national and service delivery levels. The budget process for ECD is relatively transparent and ECD service providers are compensated by the Government. However, ECD allocation in the education sector is inadequate and ECD budget coordination could be improved. 2. Implementing Widely ECD programming exists across the health, nutrition, protection, and  education sectors. There is adequate and equitable coverage for some health and nutrition interventions, but access should be improved for other programs, such as breastfeeding promotion and anemia prevention. The gross preprimary enrollment rate in Belize is 47 percent. Early childhood care and education are not equitably provided to the poorest children. 3. Monitoring and Assuring Quality Administrative and survey data are available for ECD outcomes and  levels of coverage. Minimum operating requirements and registration and licensing processes for daycare operators exist. Quality standards for preschools also exist; however, compliance with standards is largely unknown.      BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  SystemsApproachtoBetterEducation Box1:AchecklisttoconsiderhowwellECDispromotedat thecountrylevel Results–EarlyChildhoodDevelopment Whatshouldbeinplaceatthecountryleveltopromote (SABERǦECD) coordinatedandintegratedECDinterventionsforyoung SABER – ECD collects, analyzes and disseminates childrenandtheirfamilies? comprehensive information on ECD policies around the Healthcare world. In each participating country, extensive x Standardhealthscreeningsforpregnantwomen multisectoral information is collected on ECD policies x Skilledattendantsatdelivery x Childhoodimmunizations and programs through a desk review of available x WellͲchildvisits government documents, data and literature, and Nutrition interviews with a range of ECD stakeholders, including x Breastfeedingpromotion government officials, service providers, civil society, x Saltiodization development partners and scholars. The SABERͲECD x Ironfortification framework presents a holistic and integrated EarlyLearning assessment of how the overall policy environment in a x Parenting programs (during pregnancy, after delivery and country affects young children’s development. This throughoutearlychildhood) assessment can be used to identify how countries x Childcareforworkingparents(ofhighquality) address the same policy challenges related to ECD, with x Freepreprimaryschool(preferablyatleasttwoyearswith the ultimate goal of designing effective policies for developmentally appropriate curriculum and classrooms, youngchildrenandtheirfamilies. andqualityassurancemechanisms)  SocialProtection Box 1 presents an abbreviated list of interventions and x Servicesfororphansandvulnerablechildren policies that the SABERͲECD approach looks for in x Policies to protect rights of children with special needs countries when assessing the level of ECD policy andpromotetheirparticipation/accesstoECDservices development.Thislist isnotexhaustive,but is meant to x Financial transfer mechanisms or income supports to reach the most vulnerable families (could include cash provide an initial checklist for countries to consider the transfers,socialwelfare,etc.) keypoliciesandinterventionsneededacrosssectors. ChildProtection Š”‡‡‡›‘Ž‹…› ‘ƒŽ•ˆ‘”ƒ”Ž›Š‹Ž†Š‘‘† x Mandatedbirthregistration ‡˜‡Ž‘’‡– x Jobprotectionandbreastfeedingbreaksfornewmothers x Specificprovisionsinjudicialsystemforyoungchildren SABERͲECD identifies three core policy goals that x Guaranteedpaidparentalleaveofleastsixmonths countries should address to ensure optimal ECD x Domesticviolencelawsandenforcement outcomes: Establishing an Enabling Environment, x Trackingofchildabuse(especiallyforyoungchildren) Implementing Widely and Monitoring and Assuring x Training for law enforcement officers in regards to the Quality.ImprovingECDrequiresanintegratedapproach particularneedsofyoungchildren to address all three goals. As described in Figure 1, for  each policy goal, a series of policy levers are identified, Figure1:ThreecoreECDpolicygoals throughwhichdecisionͲmakerscanstrengthenECD. Strengthening ECD policies can be viewed as a continuum; as described in Table 1 on the following page, countries can range from a latent to advanced level of development within the different policy levers andgoals.     SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  2 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Table1:ECDpolicygoalsandlevelsofdevelopment LevelofDevelopment ECDPolicyGoal   Minimallegalframework; NonͲexistentlegal Regulationsinsome Developedlegal Establishingan someprogramswith framework;adͲhoc sectors;functioninginterͲ framework;robustinterͲ Enabling sustainedfinancing;some financing;lowinterͲ sectoralcoordination; institutionalcoordination; Environment interͲsectoral sectoralcoordination. sustainedfinancing. sustainedfinancing. coordination. Coverageexpandingbut NearͲuniversalcoverage Universalcoverage; Lowcoverage;pilot gapsremain;programs insomesectors; comprehensivestrategies Implementing programsinsomesectors; establishedinafew establishedprogramsin acrosssectors;integrated Widely highinequalityinaccess sectors;inequalityin mostsectors;low servicesforall,some andoutcomes. accessandoutcomes. inequalityinaccess. tailoredandtargeted. Informationonoutcomes Informationonoutcomes Informationonoutcomes Minimalsurveydata atnational,regionaland atnationallevel; fromnationaltoindividual available;limited locallevels;standardsfor Monitoringand standardsforservices levels;standardsexistfor standardsforprovisionof servicesexistformost AssuringQuality existinsomesectors;no allsectors;systeminplace ECDservices;no sectors;systeminplaceto systemtomonitor toregularlymonitorand enforcement. regularlymonitor compliance. enforcecompliance. compliance.  Policy Goal 1: Establishing an Enabling National laws and regulations promote healthcare for Environment pregnant women. In Belize, the provision of standard ¾Policy Levers:  Legal Framework • health screenings for HIV and STDs is guaranteed for all IntersectoralCoordination•Finance pregnant women. Prenatal care guidelines include An Enabling Environment is the foundation for the standard followͲup procedures and referral to design and implementation of effective ECD policies1. appropriate services. Additionally, the policy includes An enabling environment consists of the following: the free antenatal visits for pregnant women. Skilled existence of an adequate legal and regulatory deliveryisnotaguaranteedfreeservice,but96percent framework to support ECD; coordination within sectors of births are attended by skilled attendants (UNICEF and across institutions to deliver services effectively; MICS4,2011). and, sufficient fiscal resources with transparent and National laws and regulations promote healthcare for efficientallocationmechanisms. young children. Young children are required to receive acompletecourseofchildhoodimmunizationsinBelize. Policy Lever 1.1: WellͲchild visits are also required through the LegalFramework Integrated Management of Childhood Illnesses. The legal framework comprises all of the laws and Referralsareprovidedasnecessary. regulations which can affect the development of young National laws and regulations promote appropriate children in a country. The laws and regulations which dietaryconsumptionbypregnantwomenandchildren. impact ECD are diverse due to the array of sectors which The Breastfeeding Policy (1996) encourages influence ECD and because of the different constituencies breastfeedinginBelize.Belize meetssomeprovisionsof that ECD policy can and should target, including pregnant the International Code of Marketing of Breast Milk women,youngchildren,parents,andcaregivers. Substitutes, a global health policy framework adopted  by the WHO. The Belize Bureau of Standards  encourages salt iodization and fortification of cereals  andstapleswithiron.    1 Brinkerhoff,2009;Britto,Yoshikawa&Boller,2011;VargasͲ  Baron,2005 SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  3 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Table2:ComparisonofmaternityandpaternityleavepoliciesinLatinAmericaandCaribbean Belize Barbados Chile CostaRica Jamaica 14weeksmaternityat 12weekmaternityat 18weeksmaternity, 4monthsat100%of 12weeksmaternity,at 100%ofsalary,paidby 100%ofsalary,paidby 100%,paidbystate. salary.Paidbystateand 100%for8weeks,paidby stateandemployer. state.  employer. theemployer. Nopaternityleave. Nopaternityleave. 5dayspaternityleave. Nopaternityleave. Nopaternityleave. Source:ILO,2012 sectors are trained in the appropriate identification and Policies protect pregnant women and new mothers referralproceduresforchildabuseandneglect. and promote opportunities for parents to provide care Policy frameworks in Belize ensure that orphans, tonewbornsandinfantsintheirfirstyearoflife.Belize vulnerable children, and children with disabilities are is among 23 advanced countries that have ratified the guaranteed access to a full range of ECD services. The ILO Maternity Protection Convention. Ratified by the National Plan of Action for Children and Adolescents Government of Belize in 2000, the Convention entitles (2004Ͳ2015) provides a multiͲsectoral strategy to new mothers to adequate paid maternity leave and ensure that all children 0Ͳ17 years old have lactating mothers to one or two paid breastfeeding opportunities to develop to their fullest potential breaks per working day. The Government Workers without discrimination. The Family and Children Act as Regulation (1992) guarantees women 14 weeks of 100 well as the Framework for Action for Persons with percent paid leave. The Government of Belize covers 80 Disabilitiesprovidespecificguidelinesforprotectingthe percent of maternity leave through social security and rightsofchildrenwhoarevulnerableorwithdisabilities. the employer is expected to pay the difference. Above, The Health and Family Life Education Policy and Table 2 provides a sample of leave policies from the Education Act guarantee children with special needs region. Chile is the only country of those listed below accesstoinclusiveeducation. thatalsoguaranteespaternityleave. Free preprimary education is not mandated by law. ‡›ƒ™•ƒ†‡‰—Žƒ–‹‘• ‘˜‡”‹‰‹‡Ž‹œ‡ Belizean preschools are generally managed privately x BreastfeedingPolicy(1996) and charge fees.  The mandatory school age, as x GovernmentWorkersRegulation(1992) specified in the Education Act (2003), is between 5 x VitalRegistrationofBirthsandDeathsAct(2000) years and 14 years of age. This includes Beginners x FamilyandChildrenAct(2003) (Kindergarten) for 5ͲyearͲolds and Infant 1 and Infant 2 x NationalPlanofActionforChildren(2004Ͳ2015) for6Ͳand7ͲyearͲolds. x HealthandFamilyLifeEducationPolicy  Child and social protection policies and services have been established. The Vital Registration of Births and PolicyLever1.2: Deaths Act (Revised 2000) mandates the registration of IntersectoralCoordination children at birth. The Government of Belize promotes Development in early childhood is a multiͲdimensional the reduction of family violence and provides specific process. 2 In order to meet children’s diverse needs protectioninterventionstoyoungchildren.TheFamilies during the early years, government coordination is and Children Act (1998) outlines the duties of both the essential, both horizontally across different sectors as government and parents or guardians to promote the well as vertically from the local to national levels. In welfare of children. The Act states that children are many countries, nonͲstate actors (either domestic or guaranteed the right to education, health, nutrition, international)participateinECDservicedelivery;forthis andprotection.UndertheAct,theBelizeFamilyCourtis reason,mechanismstocoordinatewithnonͲstateactors responsible for protecting children’s rights that have arealsoessential. been infringed upon and will ensure that all children have adequate care and protection. In addition, the Currently, there is no explicitlyͲstated multiͲsectoral Domestic Violence Act, Trafficking Act, Social Services ECD strategy. As of June 2013, the Government of Agency Act and Mandatory Child Abuse Reporting Belize does not have an official ECD strategy endorsed Regulations set forth specific guidelines to address by relevant sectors. However, the Government is in the family violence, reduce exploitation and enhance the  overall protection of children and women in Belize. ECD 2 Naudeauetal.,2011;UNESCOͲOREALC,2004;Neuman, serviceprovidersinboththehealthandeducation 2007 SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  4 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  process of finalizing the Early Childhood Development Box 2:RelevantlessonsfromChile:benefitsofmultisectoral Policy for children from conception to 8 years old. The policydesignandimplementation Ministry of Human Development and Social Transformation and Poverty Alleviation (MHDSTPA), the Summary: A multisectoral ECD policy should articulate the servicesprovidedtochildrenandkeystakeholdersinvolved, MinistryofHealth (MoH), andtheMinistryofEducation including responsibilities of service providers and (MOE)withtechnicalassistancefromUNICEFhavebeen policymakers. The policy should also present the legal and involved in the development of this policy. The goal of regulatoryframeworkinacountryandaddressanypossible the ECD Policy is to promote the rights of children to gaps. Typically, a policy can include a set of goals or survival, holistic development, and protection. It also is objectives and an implementation plan that outlines how designed to support parents and families in positive they will be achieved. The benefits of doing so are caregiving. Belize is encouraged to finalize a multiͲ manifold. The preparation process requires all stakeholders sector policy and implementation plan to improve to contribute, which in turn promotes a more holistic, nationalͲlevel coordination. Box 2 presents relevant synergetic approach to ECD and identifies possible lessons from the Chilean experience and the benefits of duplication of objectives by individual stakeholders. Another benefit is that the policy framework clarifies the multisectoraldesignandimplementationofECDpolicy. boundarieswithinwhichallstakeholdersaretooperateand ECD interventions are not coordinated at the national cancreateaccountabilitymechanisms. level. An early childhood education (ECE) Unit exists OnesuchexampleisChileCreceContigo(“ChileGrowsWith withinthe MOEandisonlyresponsibleforcoordination You”, CCC), an intersectoral policy introduced in 2005. The within the education sector. Currently, no measures multiͲdisciplinary approach is designed to achieve high have been taken to establish a crossͲsectoral ECD quality ECD by protecting children from conception with institutional anchor. However, in the drafted relevant and timely services that provide opportunities for implementation plan, there are plans to establish an early stimulation and development. A core element of the ECD commission that will be based in the MOE and system is that it provides differentiated support and involve the MoH and MHDSTPA. Box 3 presents guaranteeschildrenfromthepoorest40%ofhouseholdsto key services, including free access to preprimary school. effective crossͲsectoral institutional arrangements Furthermore, the CCC mandates provision of services for across ministries in Jamaica. It also discusses Jamaica’s orphans and vulnerable children and children with special strategy to include parents as stakeholders in the ECD needs. The creation and implementation of the CCC has system. been accomplished through a multisectoral, highly ECD interventions are not coordinated at the point of synergistic approach at all levels of government. At the central level, the Presidential Council is responsible for the service delivery. There are currently no regular development, planning, and budgeting of the program. At coordination meetings between different implementing each of the national, regional, provincial, and local levels actors at the subͲnational level, which could help there are institutional bodies tasked with supervision and ensure that children receive integrated services. support,operativeaction,aswellasdevelopment,planning Additionally, limited mechanisms exist for collaboration andbudgetingforeachrespectivelevel. betweenstateandnonͲstatestakeholders. KeyconsiderationsforBelize: The delivery of integrated service is an emerging 9 Highly synergetic approach to service delivery, focusing approach in Belize but an integrated service delivery onmultisectoralnatureofchildren’sneeds:giventhemultiͲ manual does not exist in Belize. The combined delivery dimensional nature of children’s development needs, a and technical integration of interventions can improve cohesive approach in ECD service delivery is highly beneficial. It is important to establish a scheme for efficiency, increasing costͲeffectiveness and impact comprehensive ECD services that should be delivered to all through synergies between interventions. Box 4 young children, leveraging the respective competencies of presents an example from Colombia, where an each sector with a focus on achieving holistic child integrated delivery scheme promotes coordination at development. thelocallevel. 9 Guaranteed support to the poorest, most in need  childrenandtheirfamilies.   SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  5 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Box3:RelevantlessonsfromJamaica:multisectoral Box4:RelevantlessonsfromColombia:RutaIntegral institutionalarrangementsforECD Summary:  The Government of Colombia has recently developed the De Cero a Siempre, or “From Zero to Summary: In 2003, the Government of Jamaica Forever” strategy to promote comprehensive ECD system established the Early Childhood Commission (ECC) as an across relevant sectors. A major component of the new official agency to govern the administration of ECD in strategy is the Ruta Integral de Atenciones, or the Jamaica (Early Childhood Commission Act). Operating “Scheme for Comprehensive Services,” which is an under the Ministry of Education (MoE), the ECC is established list of specific ECD services that should be responsibleforadvisingtheMoEonECDpolicymatters.It delivered to all young children. The Ruta Integral provides assists in the preparation as well as monitoring and an operational framework which spans from the prenatal evaluation of ECD plans and programs, acts as a periodto6yearsofageandincludesinterventionsrelated coordinatingagencytostreamlineECDactivities,manages to the health, nutrition, socioͲemotional development, the national ECD budget, and supervises and regulates cultural understanding, and protection of the child. early childhood institutions (ECIs). The ECC includes a Colombia’s new ECD strategy emphasizes implementation governance arm comprised of the officially appointed at the local level; each municipality is expected to Executive Director, a Board of Commissioners, and seven establish a municipal ECD committee. These municipal subͲcommittees representing governmental and nonͲ committeesareresponsibleforcoordinatinginterventions governmental organizations. It also has an operational at the level of service delivery to ensure that children arm that provides support to the board and receiveallessentialservicesoutlinedintheRutaIntegral. subcommittees. The ECC is designed with representation KeyconsiderationsforBelize: from all relevant sectors, including education, health, 9 Because policy decisions and interventions in ECD span local government and community development, labor, across multiple ministries in Belize is important to have a finance, protection, and planning. Each ministry or common planof action, notonly atthepolicy level, but at government agency nominates a representative to serve theservicedeliveryandlocallevel. on the Board of Commissioners. The seven subͲ committees which provide technical support to the ECC  board are comprised of 50 governmental and nonͲ  governmentalagencies. PolicyLever1.3: Furthermore, the newly established National Parenting Finance Support Commission creates links between Jamaican While legal frameworks and intersectoral coordination parentsandtheGovernmentofJamaica.In2012,theMoE are crucial to establishing an enabling environment for introduced the National Parenting Support Policy. The ECD,adequatefinancialinvestmentiskeytoensurethat Government recognized that parents should serve an resources are available to implement policies and important role to promote and coordinate organizational achieveserviceprovisiongoals.InvestmentsinECDcan efforts and resources for positive parenting practices. The National Parenting Support Commission Act further yield high public returns, but are often undersupplied established an official coordinating body to ensure without government support.  Investments during the effective streamlining of Government activities related to early years can yield greater returns than equivalent parenting. investments made later in a child’s life cycle and can lead to longͲlasting intergenerational benefits3.  Not KeyconsiderationsforBelize: 9 Established crossͲsectoral institutional anchor with onlydoinvestmentsinECDgeneratehighandpersistent representation from all relevant sectors, including returns,theycanalsoenhancetheeffectivenessofother education, health, local government and community social investments and help governments address development,labor,finance,protection,andplanning multipleprioritieswithsingleinvestments. 9 Highlysynergeticapproachtopolicydesign In Belize, the budget process for ECD is relatively 9 Improved coordination amongst relevant sectors to effectively respond to the comprehensive developmental transparent, but coordination could be improved. In needsofyoungchildren. the health and nutrition sectors, explicit criteria are  used to decide ECD spending. Criteria include: number  of children accessing services, children’s characteristics,  geographical location, usage, and historical precedent.  In the education sector, criteria are currently being  3 Valerio&Garcia,2012;WHO,2005;Hanushek&Kimko, 2000;Hanushek&Luque,2003 SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  6 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  developedtodetermineallocationofECEspending.The The MOH does not report ECDͲspecific expenditures. MOE and MHDSTPA include ECD related investments However, most health services in the public sector are within their annual budgets. However, exact overall free.Childhealthcare,includingimmunizations,growthͲ expenditures cannot be disaggregated for ECDͲaged monitoring and promotion, and well child visits are free children. On the other hand, the MOE and MHDSTPA for young children. With the exception of labor and arebothpilotministriesundertheprogramͲbased delivery, which costs 75 BZD, public health services for pregnantwomenarealsofree.Table4compareshealth budgeting project executed by the Ministry of Finance expenditure indicators in Belize with other countries in and Economic Development, which is likely to allow for theregion. more accurate reporting of specific ECD expenditure in the future. Currently ECD budgets are not coordinated Table4:Regionalcomparisonofselecthealthexpenditure across ministries. Belize is encouraged to partake in indicators joint budget planning across MOE, MHDSTPA, and MOH  Belize Barbados Chile CostaRica Jamaica and establish mechanisms to coordinate ECD Totalhealth allocations. expenditureasa 6% 7% 7% 11% 5% percentageofGDP The level of ECD finance is not adequate in the Outofpocket education sector, but it may be adequate in the health expenditure5as sector. According to UNESCO, Belize spends 0.2 percent percentageof 70% 81% 70% 91% 71% privatehealth of total government expenditures on preprimary expenditure education. While total public expenditure on education General in Belize represents 19 percent of total government government expenditures, preprimary education allocations expenditureon USD USD USD USD USD healthpercapita represent only a small portion of this. The burden of 283 998 607 932 220 (adjustedfor finance may not be equitably distributed, as fees are purchasingpower often levied for tuition (20 BZD), uniform (50Ͳ60 BZD), parity) and contribution to teacher salaries. Table 3 displays RoutineEPI the distribution of preprimary spending across other vaccinesfinanced 100% 100% Nodata 100% 100% bygovernment countries in the region. Compared to other Latin Source:WHOGlobalHealthExpenditureDatabase,2011;UNICEF,2013 Americanand theCaribbean countries, Belizefallsshort  on its level of financing for preprimary education. The Preschools are managed by state and nonͲstate OECD recommends a public investment of 1 percent of entities. The majority of nonͲstate preschools are GDP as the minimum required to ensure provision of communityͲbased. Community preschools receive 2.2 qualityearlychildhoodcareandeducationservices.4 million BZD from the Government. The salary for Table3:Publicexpendituresonpreprimaryinselected preprimary teachers ranges from 8,244 to 17,820 BZD, LatinAmericanandCaribbeancountries which is significantly less than primary teacher  Belize Barbados Chile Costa Jamaica compensation. Rica  Distributionofpublic education  1.0% 6.0% 12.0% 6.0% 9.0% expenditureon  preprimary Preprimary  expenditureas 0.1% 0.5% 0.5% 0.4% 0.6%  percentageofGDP Preprimary  expenditureas percentageoftotal 0.2% 0.8% 2.1% 1.4% 1.0%  5 government Outofpocketexpenditureisanydirectoutlayby expenditure households,includinggratuitiesandinͲkindpayments,to Source:UNESCOInstituteofStatistics,2010 healthpractitionersandsuppliersofpharmaceuticals, therapeuticappliances,andothergoodsandserviceswhose primaryintentistocontributetotherestorationor  enhancementofthehealthstatusofindividualsorpopulation 4 OECD,2011 groups. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  7 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  PolicyGoal2:ImplementingWidely Figure2:Essentialinterventionsduringdifferentperiodsof youngchildren'sdevelopment ¾PolicyLevers:ScopeofPrograms• 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) interventions in health, nutrition,education,andsocialandchildprotection,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. PolicyLever2.1: ScopeofPrograms Effective ECD systems have programs established in all essential sectors and ensure that every child and expecting mothers have guaranteed access to the Awidescopeofprogramsforpregnantwomen,young essential services and interventions they need to live children, and parents/caregivers exist in Belize. ECD healthfully. The scope of programs assesses the extent programsareestablishedincoreECDareasoffocusand to which ECD programs across key sectors reach all target all relevant beneficiary groups. Figure 3 displays beneficiaries. Figure 2 presents a summary of the key interventions that are available in Belize across sectors interventions needed to support young children and and target beneficiary groups. In the health, nutrition, theirfamiliesviadifferentsectorsatdifferentstagesina and education sectors, essential programs to target all child’slife. beneficiary groups exist. While Figure 3 displays the range of existing programs in Belize, it does not portray  the scale of these programs; this will be addressed in thenextsection. Figure3:ScopeofECDinterventionsinBelizebysectorandtargetpopulation                     SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  8 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013    PolicyLever2.2: Table 5: Regional comparison of level of access to essential health Coverage andnutritioninterventionsforpregnantwomen A robust ECD policy should establish programs in all  Belize Barbados Chile Costa Jamaica Rica essential sectors, ensure high degrees of coverage and Skilledattendantat reach the entire population equitably–especially the 96% 100% 100% 99% 98% birth most disadvantaged young children–so that every child Pregnantwomen No and expecting mother have guaranteed access to receivingantenatal 96% 100% 90% 99% data essentialECDservices. care(atleastonce) PercentageofHIV+ Less than half of children in Belize have access to pregnantwomen No 100% 96% 72% 84% preprimary education. In 2011, UNESCO reported that receivingARVsfor data the gross enrollment rate in Belize was 47 percent. This PMTCT reflects the number of children enrolled in preprimary Prevalenceofanemiain 52% 23% 28% 28% 41% pregnantwomen(2006) (regardless of age) as a percent of the total preschoolͲ Source: UNICEF MICS4, 2011;UNICEF Country Statistics, 2007Ͳ 2011; age population. Figure 4 displays the reported UNAIDS,2012;WHOGlobalDatabaseonAnemia,2006 preprimary enrollment ratios for selected countries in theregion. Thelevelofaccesstoessentialhealthforyoungchildren is inadequate. As displayed in Table 6, which presents Figure 4: Gross enrollment rate (age 3Ͳ6) in selected Latin the coverage rates for child health interventions in the AmericanandCaribbeancountries region, Belize has a nearly universal DPT immunization rate. However, young children in Belize may not receive adequate medical attention when they are sick. When children younger than five years old have an acute respiratory infection, more than one in four of them are nottakentoahealthprovider;butforthosethatdoseek medical attention, less than half are treated with antibiotics. And, when they have diarrhea, less than oneͲ third of them receive oral rehydration treatment. Belize should consider strategies to expand access to care for diarrhea and pneumonia, two of the leading causes of deathinchildrenyoungerthanfive. Table 6: Regional comparison of level of access to essential healthinterventionsforECDͲagedchildren   Belize Barbados Chile Costa Jamaica Pregnant women have adequate access to health Rica 1ͲyearͲoldchildren interventions, but not to nutritional interventions to immunizedagainstDPT prevent anemia. Table 5 presents the level of access to 74% 91% 94% 83% 99% (corresponding essential interventions for pregnant women. While vaccinesDPT3ß) there is nearly universal care across health Childrenbelow5with No interventions for pregnant women, in 2006, the WHO suspectedpneumonia 44% Nodata Nodata 52% data receiveantibiotics reported that half of pregnant women were anemic. In Childrenbelow5with addition to collecting updated data on anemia suspectedpneumonia No 71% Nodata Nodata 75% prevalence, the MoH is encouraged to expand takentohealth data nutritional interventions for anemia. IronͲfolate provider Childrenbelow5with supplements during pregnancy can prevent anemia for No No diarrheareceivingoral 43% Nodata Nodata the mother and neural tube defects for the fetus. data data rehydrationsalts Reducing anemia prevalence in pregnant women can Source: UNICEF MICS4, 2011; UNICEF Country Statistics, 2007Ͳ 2011; prevent intellectual and physical impairment in WHOGlobalDatabaseonAnemia,2006 children. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  9 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Young children have inadequate access to essential Box5:RelevantlessonsfromBrazil:breastfeedingcampaign nutrition interventions. Table 7 displays selected indicators for child nutrition regions in the region. OneͲ Summary:  Brazil’s campaign to promote breastfeeding fifth of underͲfive children in Belize are moderately or changed public perceptions and healthcare practices, severely stunted. The WHO reports that in 2006, resulting in significant increase in breastfeeding. The approximately oneͲthird of preschool aged children had campaign was initiated in 1980 by the National Food and Nutrition Institute. UNICEF and the PanͲAmerican Health iron deficiency anemia, which can significantly impede a Organization helped to develop public awareness materials young child’s development. Additionally, only 10 percent that addressed the lack of informational materials on of infants are exclusively breastfed. Exclusive breastfeeding in Portuguese. Instructional brochures were breastfeeding until 6 months can reduce infant mortality widely distributed to mothers. A media campaign featured and promote healthy development. Box 5 presents radio, television, and print media spots; and endorsements lessons from a national breastfeeding promotion by wellͲknown personalities. The WHO and UNICEF held campaigninBrazil. trainingcoursesonbreastfeedingforhealthcareworkersand managers, and the Baby Friendly Hospital Initiative was Table 7: Regional comparison of level of access to essential widely implemented to initiate early feeding. A coalition of nutritioninterventionsforECDͲagedchildren numerous actors helped make the campaign a success. The  Belize Barbados Chile Costa Jamaica Catholic Church, mothers groups, associations of medical Rica professionals, community leaders, politicians, and the media Childrenbelow5with No moderate/severestunting 22% Nodata data 6% 4% were all engaged in the effort.  The exclusive breastfeeding Infantsexclusively No raterosefrom3.6percentin1986to40percentin2006. 10% Nodata 15% Nodata KeyconsiderationsforBelize: breastfeduntil6months data Infantswithlowbirth 9 Developanddisseminateonthebenefitsofbreastfeeding 14% 12% 6% 7% 12% foravarietyofaudiences,includingtrainingmaterialsfor weight Prevalenceofanemiain 24 healthcareworkers,awarenesspamphletsforcommunity 36% 17% 21% 48% preschoolagedchildren % leadersandNGOs,andinstructionalbrochuresformothers Source:UNICEFMICS4,2011;UNICEFCountryStatistics,2007Ͳ2011; 9 Trainhealthcareworkerstoeducatemothersonthe WHOGlobalDatabaseonAnemia,2006 benefitsofbreastfeeding,andtosupportthemtoinitiate  andmaintainthepractice  9 EngagethesupportofNGOs,women’sassociations,health workers,communityleaders,etc.    There is nearly universal birth registration in Belize. In  Belize, 95 percent of children are registered at birth.  Table 8 displays the available birth registration rates in  theregion.  Table8:Regionalcomparisonofbirthregistrationrate  Belize Barbados Chile CostaRicaJamaica  Birthregistration 95% Nodata 100% Nodata 98%  2000Ͳ2010  Source:UNICEFMICS4,2011;UNICEFCountryStatistics,2007Ͳ2011               SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  10 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  PolicyLever2.3: Figure6:Earlylearningopportunitiesbywealth 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 services6. One of the fundamental goals of any ECD policy should be to provide equitable opportunities to all young children andtheirfamilies. There is equity in access to preprimary school by gender. The MOE reports that 3,611 boys and 3,505 girls attended preprimary school in 2012. Additionally, UNICEF 2011 MICS data reveal that adult caregivers  engage with both boys and girls in early learning activitiesatarelativelysimilarrate. Policy Goal 3: Monitoring and Assuring Quality There is relatively equitable access to ECD services in ¾PolicyLevers:DataAvailability•Quality rural and urban areas. Figure 5 displays selected ECD indicators divided by the rural and urban population in Standards•CompliancewithStandards Belize. Monitoring and Assuring Quality refers to the existence of information systems to monitor access to ECD Figure5:SelectedECDindicatorsbygeographiclocation services and outcomes across children, standards for ECD services and systems to monitor and enforce compliance with those standards. Ensuring the quality ofECDinterventionsisvitalbecauseevidencehasshown that unless programs are of high quality, the impact on childrencanbenegligible,orevendetrimental. PolicyLever3.1: DataAvailability Accurate, comprehensive and timely data collection can promote more effective policyͲmaking. WellͲdeveloped information systems can improve decisionͲmaking.  In particular, data can inform policy choices regarding the volume and allocation of public financing, staff  recruitmentandtraining,programquality,adherenceto standardsandeffortstotargetchildrenmostinneed. Early childhood care and education are not equitably provided by socioeconomic status. Figure 6 displays Administrative and survey data are collected on ECD UNICEF MICS data on early learning indicators. Children accessandoutcomes.Table9displaystheavailabilityof younger than five from the poorest 20 percent of the selected ECD indicators in Belize. While both population are less likely to attend preprimary school, Government and UNICEF MICS survey data contribute engagewithanadultcaregiverathomeinearlylearning to a wide scope of information about ECD in the activities, and live in a home where books or play country, some data are still missing, including materialsareavailable. enrollment of special needs children, children attending wellͲchild visits, and ECD budget information within the healthsector.Dataareavailabletodifferentiatedaccess and outcomes by urban/rural location, gender, mother tongue,andethnicbackground.  6 Engleetal,2011;Naudeauetal.,2011 SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  11 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Table9:AvailabilityofdatatomonitorECDinBelize The Government is encouraged to finalize and AdministrativeData: disseminate this document, as it will serve as a valuable Indicator Tracked tool for tracking holistic child development. ECEenrollmentratesbyregion 9 Additionally, it is advisable that the Government take SpecialneedschildrenenrolledinECE(#of) X measures to ensure that there is coordination with ChildrenattendingwellͲchildvisits(#of) X other sectors on systematically collecting and sharing Children benefitting from public nutrition the information in the profile. Box 7 presents a similar 9 interventions(#of) tool recently introduced in Jamaica that tracks child Women receiving prenatal nutrition interventions (# health and development as well as conveys messages 9 of) aboutpositivecaregivingandhealthydevelopment. AveragestudentͲtoͲteacherratioinpublicECE 9  Is ECE spending in education sector differentiated 9 Box6:RelevantlessonsfromChile:ThebioͲpsychosocial withineducationbudget? developmentsupportprogram Is ECD spending in health sector differentiated X withinhealthbudget? Individualchildren’sdevelopmentoutcomes X SurveyData Indicator Tracked Populationconsumingiodizedsalt(%) X VitaminAsuppforchildren6Ͳ59mo.(%) 9 Anemiaprevalenceamongstpregnantwomen(%) 9 Childrenbelowageof5registeredatbirth(%) 9 ChildrenimmunizedagainstDPT3at12mo.(%) 9 Pregnant women who attend at least one antenatal 9 visits(%)(notavailableforatleast4visits) ChildrenenrolledECEbysocioeconomicstatus(%) 9  Data are not systematically collected to measure child development and individual children’s development outcomes are not tracked. It is important for governments to collect data on child outcomes as this information can: i) establish a baseline and document the magnitude of gaps in development in Belize; ii) evaluate the impact of existing interventions; and iii) assess the specific types of ECD interventions that are most effective and costͲeffective  and inform policy dialogueforfutureplanning.Giventheholisticnatureof children’s development it is important for the Government to design information management systems that are capable of tracking individual children comprehensively with mechanisms to respond to their needs. Box 6 describes a component of the Chile Crece Contigo initiative, which includes a bioͲpsychosocial development support program that tracks the development path of all children who are covered by thepublichealthsystem(75percentofChile’schildren). While individual child development outcomes are not currently tracked in a systematic way, the MOH has recentlydevelopedadraftMyHealthProfile.Theprofile will collect information about a child’s developmental milestones, including ageͲspecific gross and fine motor,  language, cognitive, and social development outcomes.  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  12 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Box7:RelevantlessonsfromJamaica:thechildhealthand Clear learning standards are established for ECE. In developmentpassport Belize, the National Comprehensive Curriculum designed for 6Ͳ and 7ͲyearͲold children in Infant 1 & 2 includes standards for early numeracy and literacy, motor skills, cognitive development, and socioͲ psychological development. Annual training for teachers in Infant 1 & 2 ensures that the National Comprehensive Curriculum is taught in a coherent manner and is continuous with the primary education curriculum. For children ages 3 and 4 years old, the National Curriculum for Preschool exists, but training and adequate implementation of the curriculum is less regulated. Minimum training requirements for ECE professionals exist and opportunities for professional development are available. Preschool teachers are expected to have at least a high school education. In addition, they are required to complete a six week Basic ECE certificate program. InͲservice training exists for public preschool teachers,butisnotmandatory. The Teacher Education and Development Services are responsible for regulating preͲservice training for ECE professionals and the Early Childhood Development Center is responsible for providing the training. The Saint John’s College Junior College (SJCJC) provides an Associate’sdegreein ECE.Teacherswhogothrough the SJCJS program are required to complete a preͲservice fieldworkpracticum. Infrastructure and service delivery standards for ECE facilities are established in the draft ECD policy, but are not yet finalized. The draft ECD policy requires a maximum childͲtoͲteacher ratio of 15 children per one teacher. According to the MOE, preprimary education for3Ͳand4ͲyearͲoldsshouldbe3.5hoursforfivedaysa  week. The draft ECD policy outlines standards for the  required amount of space and specific infrastructure PolicyLever3.2: guidelines; however these standards are not yet QualityStandards mandated by law. The ECE Unit within the MoE is Ensuring quality ECD service provision is essential. A responsible for the licensing ECE facilities. ECE facilities focus on access – without a commensurate focus on are inspected immediately after construction based on ensuring quality – jeopardizes the very benefits that 16 infrastructure guidelines on a scale from 1 to 5 policymakers hope children will gain through ECD (ranging from unacceptable to very satisfactory).  The interventions.  The quality of ECD programs is directly draft ECD Policy stipulates that it will ensure the related to better cognitive and social development in provision of monitoring of available certification and children7. licensing programs and continuing education opportunities for service providers who work with youngchildren.   7 Taylor&Bennett,2008;Bryceetal,2003;Naudeauetal, 2011V;Victoriaetal,2003  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  13 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  The MHDSTPA oversees registration and licensing Box8:RelevantlessonsfromJamaica:intersectoralcommission processes for daycare centers for children 0Ͳ7 years ensuresqualityinECEprovision old. The Inspector of Social Services Institutions (ISSI) Summary: One of the key legislated functions of Jamaica’s Early within the Policy and Planning Unit of MHDSTPA is Childhood Commission (ECC) is the supervision and regulation of responsible for registration and licensing processes for all private and public early childhood institutions (ECIs). To all daycare operators. The ISSI sets clear guidelines and improve the quality of services provided by ECIs, the ECC has registration and licensing requirements. A quality developed a range of robust operational quality standards for assurance process is in place to ensure comprehensive ECIs. The Act and Regulations, which together comprise the legal inspectionsandroutinemonitoringvisits. requirements,specifytheminimumlevelsofpracticebelowwhich institutions will not be registered or allowed to operate. The Standards for health facilities exist and ECD training of standards that are not legally binding define best practices for health workers is available. The MoH Licensing and early childhood institutions and serve to encourage institutions to Accreditation Standards for Inpatient Health Facilities raise their level of practice above minimum requirements. While (2009) outline registration guidelines to ensure that ECIs are encouraged to achieve the highest possible standards to health posts, health centers, and hospitals in Belize ensure the best outcomes for children, the legally binding standardsguaranteethatminimumstandardsaremet. meet quality standards.  Additionally, doctors, nurses, extension health workers, midwives, and psychologists Inspection of ECIs is the procedure designated under the Early Childhood Act for ensuring that operators comply with the are all required to receive training in delivering ECD minimum acceptable standards of practice. The ECC is required to messages. inspect each ECI twice annually. It is a requirement of registration thattheregisteredoperatorcoͲoperateswiththeECC’sinspection PolicyLever3.3: process. The “registered operator” is defined as the person CompliancewithStandards required to apply for registration of an ECI and may be an Establishing standards is essential to providing quality individual or a group. In deciding on the suitability of an ECI for ECD services and to promoting the healthy development registration under the Early Childhood Act, the ECC will, based on of children. Once standards have been established, it is information obtained at inspection visits, determine whether or critical that mechanisms are put in place to ensure not an ECI meets and complies with the Act and Regulations. compliancewithstandards. Whereexistingprovisionfallsshortofthelegalrequirements,and the shortfall does not present a real and present danger to With the exception of average childͲtoͲteacher ratios, children, a permit to operate until full requirements are met will compliance with quality service delivery standards is be granted, with time scales for institutions to meet largely unknown. While ECE professionals are required requirements. The ECC encourages the promotion of the highest to complete a 6Ͳweek certificate program and have, at standards of practice by monitoring not only the minimum minimum, a high school education, the Government requirements at inspection visits, but also by monitoring those standardsthatarenotlegallybinding. does not collect data on whether ECE professionals Effective monitoring compliance with standards is largely comply with preͲservice training standards. attributed to the commitment and quality of efforts at the Furthermore, the Government does not rigorously groundͲlevel. Development officers, who are hired and trained by monitor compliance with infrastructure standards or the ECC, work in the field to provide technical assistance and preschoolopeninghours. support ECIs to reach minimum quality standards. Using a newly The MOE does collect data on average childͲtoͲteacher introduced national software system, the development officers can easily report groundͲlevel indicators that are linked to the ratios. In state ECE facilities, the average ratio is 17.5:1; Jamaican National Strategic Plan targets. Inspection reports are and in nonͲstate facilities, the average ratio is 13.6:1. publically available online and provide detailed information on However, it should be noted that this represents the ECIs’compliancewithstandards. overall childͲtoͲteacher ratio, rather than childͲtoͲ qualified teacher ratio. If the Government collects KeyLessonsforBelize: 9 ConsiderestablishinglegallybindingrequirementsforECE improved data on teacher qualification, it will better serviceprovisiontoguaranteethatacceptableminimumstandards understand the level of quality that children receive in aremet. state and nonͲstate preschools.  Box 8 discusses the 9 Considerassigningaspecialentitywithadelineatedroleto quality assurance mechanisms for ECE services in monitorandregulateECEserviceproviders.Animprovedquality Jamaica. monitoringsystemwillensurethatbestoutcomesareachieved. 9 Localdevelopmentofficerscanserveasaneffectivelink betweenthenationalECDcommissionandservicedeliveryatthe locallevel.  SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  14 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  ComparingOfficialPolicieswithOutcomes PreliminaryBenchmarkingandInternational The existence of laws and policies alone do not always ComparisonofECDinBelize guarantee a correlation with desired ECD outcomes. In On the following page, Table 11 presents the many countries, policies on paper and the reality of classification of ECD policy in Belize within each of the access and service delivery on the ground are not nine policy levers and three policy goals. The SABERͲ aligned. Table 10 compares ECD policies in Belize with ECD classification system does not rank countries ECD outcomes. Some policies reflect the reality for accordingtoanyoverallscoring;rather,itisintendedto some ECD interventions, such immunizations and birth share information on how different ECD systems registration. On the other hand, the low rate of addressthesamepolicychallenges. exclusive breastfeeding and access to free preprimary education do not seem to align with the respective Table 12 presents the status of ECD policy development policies. in Belize alongside a selection of OECD countries and regional comparators. Sweden is home to one of the Table10:ComparingECDpolicieswithoutcomesinBelize world’s most comprehensive and developed ECD ECDPolicies  Outcomes policies and achieves a benchmarking of “Advanced” in Exclusivebreastfeeding allninepolicylevers. BreastfeedingPolicy(1996) rate(6months):   encouragesbreastfeeding 10%  Grosspreprimary  Policyguaranteestheprovision schoolenrollment: ofpreprimaryschool 47%  Childrenarerequiredtoreceive ChildrenwithDPT(12Ͳ  completecourseof 23months): immunizations 95%   Completenessofbirth Policymandatestheregistration registration: ofchildrenatbirthinBelize 95% SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  15 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013       Table11:BenchmarkingearlychildhooddevelopmentpolicyinBelize Levelof ECDPolicyGoal LevelofDevelopment PolicyLever Development LegalFramework  EstablishinganEnabling  InterͲsectoralCoordination Environment Emerging  Finance  ScopeofPrograms  ImplementingWidely  Coverage Established  Equity  DataAvailability  MonitoringandAssuring  QualityStandards Quality Emerging  CompliancewithStandards  Latent Emerging Established Advanced Legend:         Table12:InternationalclassificationandcomparisonofECDsystems ECDPolicy LevelofDevelopment PolicyLever Goal Belize Australia Chile Colombia Jamaica Sweden Turkey LegalFramework Establishingan        Enabling Coordination        Environment Finance        ScopeofPrograms        Implementing Coverage Widely        Equity        DataAvailability Monitoringand        Assuring QualityStandards        Quality Compliancewith Standards        Latent Emerging Established Advanced Legend:         SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  16 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2013  Hanushek,E.A.andD.D.Kimko.(2000).“Schooling, Acknowledgements LaborͲForceQuality,andtheGrowthofNations."The This Country Report was prepared by the SABERͲECD team AmericanEconomicReview,Vol.90,No.5,1184Ͳ1208. at the World Bank headquarters in Washington, DC. The Naudeau,S,N.Kataoka,A.Valerio,M.J.Neuman,L.K. reportpresentscountrydatacollectedusingtheSABERͲECD Elder.2011.InvestinginYoungChildren:AnEarly policy and program data collection instruments and data ChildhoodDevelopmentGuideforPolicyDialogueand from external sources. The report was prepared in ProjectPreparation.WorldBank,Washington,DC. consultation with the World Bank Human Development LAC teamandtheGovernmentofBelize.Fortechnicalquestions Neuman,M.&Devercelli,A.2013."WhatMattersMostfor or comments about this report, please contact the SABERͲ EarlyChildhoodDevelopment:AFrameworkPaper." ECDteam(helpdeskecd@worldbank.org) SABER,WorldBank,WashingtonDC Neuman,M.J.2007.“GoodGovernanceofEarlyChildhood Acronyms CareandEducation:Lessonsfromthe2007Education BOOST BuildingOpportunitiesforOurSocial forAllGlobalMonitoringReport.”UNESCOPolicy Transformation BriefsonEarlyChildhood.UnitedNationsEducational, ScientificandCulturalOrganization,NewYork. CCC  ChileCreceContigo(Chile) OECD(OrganisationforEconomicCoͲoperationand ECC  EarlyChildhoodCommission(Jamaica) Development).2011.“StartingStrongIII:AQuality ECD  EarlyChildhoodDevelopment ToolboxforEarlyChildhoodEducationandCare.” ECE EarlyChildhoodEducation(used OECDPublications,Paris. interchangeablywithpreprimaryor UNESCOͲOREALC.2004.“IntersectoralCoͲordinationin preschool) EarlyChildhoodPoliciesandProgrammes:ASynthesis ISSI  InspectorofSocialServicesInstitutions ofExperiencesinLatinAmerica.”RegionalBureauof EducationforLatinAmericaandtheCaribbean,United MOE  MinistryofEducation NationalEducational,ScientificandCultural MoH  MinistryofHealth Organization. MHDSTPA MinistryofHumanDevelopmentandSocial VargasͲBarón,E.2005.“PlanningPoliciesforEarly TransformationandPovertyAlleviation ChildhoodDevelopment:GuidelinesforAction.”Paris: UNESCO/ADEA/UNICEF(UnitedNationsEducational, SJCJC  SaintJohn’sCollegeJuniorCollege ScientificandCulturalOrganization/Associationfor  theDevelopmentofEducationinAfrica/UnitedNations  Children’sFund). References SABERͲECDPolicyInstrument,Belize2013 Victoria,B.H.,L.Adair,C.Fall,P.C.Hallal,R.Martorell,L. Richter,andH.S.Sachdev2008.“MaternalandChild Britto,P.,Yoshikawa,H.,Boller,K.2011.“QualityofEarly Undernutrition:ConsequencesforAdultHealthand ChildhoodDevelopmentPrograms:Rationalefor HumanCapital.“TheLancet371(9609):340Ͳ57. Investment,ConceptualFrameworkandImplications forEquity.”SocialPolicyReport,25(2):1Ͳ31.   Engle,P.L.,L.C.H.Fernald,H.Alderman,J.Behrman,C.  O’Gara,A.Yousafzai,M.CabraldeMello,M.Hidrobo,  N.Ulkuer,andtheGlobalChildDevelopmentSteer  Group.“Strategiesforreducinginequalitiesand  improvingdevelopmentaloutcomesforyoungchildren  inlowͲincomeandmiddleͲincomecountries.”The  Lancet,EarlyOnlinePublication,23September2011.  Doi:10.1016/S0140Ͳ6736(11)60889Ͳ1.  Hanushek,E.(2003)."TheFailureofInputͲBasedSchooling  Policies."TheEconomicJournal113;64Ͳ98.   SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  17 BELIZEۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|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. 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 WorldBankdoesnotguaranteetheaccuracyofthedataincludedinthiswork.Theboundaries,colors,denominations,andotherinformation 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 endorsementoracceptanceofsuchboundaries. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  18