94323  Tuvalu   SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2014         Policy Goals Status 1. Establishing an Enabling Environment Laws are in place to promote effective early childhood development (ECD) in the  health sector, and some policies are in place in the education sector for effective early childhood care and education (ECCE) programs. Several draft laws show promise in their ability to lay solid ground for a well-functioning ECD system but need to be enacted to ensure optimal ECD service delivery. The ECD system would benefit from a multi-sectoral approach to service delivery and transparent, multi-sectoral financing. 2. Implementing Widely Tuvalu provides wide coverage of many essential ECD health services and has  reached high rates of preschool enrollment. More than 96 percent of children are immunized, and 98 percent of women give birth in the presence of a qualified attendant. However, more data is needed to capture the scope and coverage of several important ECD interventions. Equity in delivery is high where programs exist. Disparities between rich and poor and urban and rural are mainly found in the registration of newborns. 3. Monitoring and Assuring Quality More data on relevant ECD indicators is needed to obtain a more comprehensive  picture of Tuvalu’s ECD programs across sectors. While some quality standards have been established, they are not always enforced. Mechanisms to coordinate monitoring and quality across sectors and to implement a multi-sectoral budget need to be put into place.      TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014   This report presents an analysis of early childhood About 50 percent of the inhabitants live in urban areas. development (ECD) programs and policies that affect The GDP is $3,500 per capital and 26 percent of the young children in Tuvalu and recommendations to population lives below the poverty line in terms of basic move forward. This report is part of a series of reports needs.2Lifeexpectancyatbirthis67.5years.3Healthcare prepared by the World Bank using the SABERͲECD isfreeforallcitizens,buthealthexpendituresarehighas framework 1 and includes analysis of early learning, a percentage of GDP: Tuvalu ranks fourth in the world health, nutrition, and social and child protection for healthcare costs, behind only Liberia, Sierra Leone, policies and interventions in Tuvalu, along with andtheU.S.4 regionalandinternationalcomparisons.  The Tuvalu National Preschool Council coordinates TuvaluandEarlyChildhoodDevelopment preschool education across the country’s 18 ECCE centers. The Early Childhood Care and Education Policy Tuvalu is an island nation in the South Pacific Ocean (2007) guides the education component of ECD. made up of three reefs and six atolls. Formerly known Published by the Education Department’s Ministry of as the Ellice Islands, Tuvalu was granted independence Education and Sports (MoES), the ECCE policy provides in 1978, three years after splitting with the British strategies and guidelines and sets a loose curriculum. colony of Kiribati, then known as the Gilbert Islands. TheMinistryofHealth(MoH)implementsthehealthand The majority of people (96 percent) are ethnically nutrition components of ECD. There is no regulatory Polynesian, and a small minority is Micronesian (4 framework governing multiͲsectoral ECD strategy, and percent). With a population of just under 11,000, mechanisms for coordinating financing for ECD across Tuvalu is the third leastͲpopulated state in the world ministriesstillneedtobeputintoplace. and, at just 10 square miles, the fourth smallest. Because of its small size and low population, Tuvalu Table 1 gives a snapshot of key ECD indicators in Tuvalu has only one hospital, eight prenatal clinics, and 18 compared to four other countries in the South Pacific earlychildhoodcareandeducation(ECCE)centers. region. Table1:SnapshotofECDindicatorsinTuvaluwithregionalcomparison Solomon Tuvalu Fiji Tonga Vanuatu  Islands InfantMortality(deathsper1,000livebirths,2012) 25 19 26 11 15 Under5Mortality(deathsper1,000livebirths,2012) 30 22 31 13 18 Moderate&SevereStunting(Below5,2012) 10% Unavailable 32% Unavailable 26% 5 105% 18% 43% 35% 61% GrossPreprimaryEnrollmentRatio(3Ͳ6years) (asof2006) (asof2009) (asof2012) (asof2012) (asof2010) Birthregistration2000Ͳ2010 50% Unavailable 80% 98% 26% Source:UNICEFCountryStatistics,2012(Infantmortality,under5mortality,stunting,birthregistration);UNESCOInstituteforStatistics(preprimaryenrollment).  1 SABERͲECDisonedomainwithintheWorldBankinitiative,SystemsApproachforBetterEducationResults(SABER),whichisdesignedtoprovidecomparableand comprehensiveassessmentsofcountrypolicies. 2 PacificRegionalMGDTrackingReport(2012),p.9. 3 UnitedNationsDevelopmentProgram. 4 CIAFactbook. 5 LatestStatisticalDigestforTuvaluindicatesapreͲprimarynetenrollmentrateof82% SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  2 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  SystemsApproachforBetterEducation Box1:AchecklisttoconsiderhowwellECDis Results–EarlyChildhoodDevelopment promotedatthecountrylevel 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 and programs through a desk review of available x Childhoodimmunizations government documents, data, and literature, and x WellͲchildvisits interviews with a range of ECD stakeholders, including Nutrition governmentofficials,serviceproviders,civilsociety,and x Breastfeedingpromotion x Saltiodization development partners. The SABERͲECD framework x Ironfortification presents a holistic and integrated assessment of how EarlyLearning the overall policy environment in a country affects x Parenting programs (duringpregnancy, after delivery, and young children’s development. This assessment can be throughoutearlychildhood) used to identify how countries address the same policy x Highqualitychildcareforworkingparents challenges related to ECD, with the ultimate goal of x Free preͲprimary school (preferably at least two years designing effective policies for young children and their with developmentally appropriate curriculum and families. classrooms,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 provide an initial checklist for countries to consider the reach the most vulnerable families (could include cash keypoliciesandinterventionsneededacrosssectors. transfers,socialwelfare,etc.) 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 through which decisionͲmakers can strengthen ECD.  Strengthening ECD policies can be viewed as a continuum; as described in Table 2 on the following page, countries can range from a latent to advanced level of development within the different policy levers andgoals.      SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  3 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014   Table2:ECDpolicygoalsandlevelsofdevelopment LevelofDevelopment ECDPolicy Goal   Minimallegalframework; Developedlegal NonͲexistentlegal Regulationsinsome Establishing someprogramswith framework;robustinterͲ framework;adͲhoc sectors;functioninginterͲ anEnabling sustainedfinancing; institutional financing;lowinterͲ sectoralcoordination; Environment someinterͲsectoral coordination;sustained sectoralcoordination. sustainedfinancing. coordination. financing. Coverageexpandingbut NearͲuniversalcoverage Universalcoverage; Lowcoverage;pilot gapsremain;programs insomesectors; comprehensivestrategies Implementing programsinsome establishedinafew establishedprogramsin acrosssectors;integrated Widely sectors;highinequalityin sectors;inequalityin mostsectors;low servicesforall,some accessandoutcomes. accessandoutcomes. inequalityinaccess. tailoredandtargeted. Informationonoutcomes Informationonoutcomes Informationonoutcomes Minimalsurveydata atnational,regional,and fromnationalto atnationallevel; Monitoring available;limited locallevels;standardsfor individuallevels; standardsforservices andAssuring standardsforprovisionof servicesexistformost standardsexistforall existinsomesectors;no Quality ECDservices;no sectors;systeminplace sectors;systeminplace systemtomonitor enforcement. toregularlymonitor toregularlymonitorand compliance. compliance. enforcecompliance. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  4 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  and children. The government of Tuvalu is deliberating Policy Goal 1: Establishing an Enabling two draft policies—one that would encourage Environment breastfeeding and one that would set regulations for salt iodization and iron fortification of cereals and x PolicyLevers:LegalFramework• staples. Laws do not yet specifically comply with the IntersectoralCoordination•Finance International Code of Marketing of Breast Milk An Enabling Environment is the foundation for the Substitutes. However, the National Policy on design and implementation of effective ECD policies.6 Breastfeeding and Infant Feeding (1996) promotes An enabling environment consists of the following: the exclusive breastfeeding from birth to 4Ͳ6 months at existence of an adequate legal and regulatory hospitals, clinics, and on the radio. A survey found that framework to support ECD, coordination within sectors 85 percent of mothers breastfeed their infants for six andacrossinstitutionstodeliverserviceseffectively,and months, and that 35 percent breastfeed exclusively; 57 sufficient fiscal resources with transparent and efficient percent breastfeed exclusively for the first three allocationmechanisms. months.9 Policy Lever 1.1: Low birth weight is not considered a problem in Tuvalu, LegalFramework and a 1991 study found that Vitamin A deficiency is not The legal framework comprises all of the laws and a significant public health concern in the country. regulations that can affect the development of young Rather, there are concerns about overͲnutrition for childreninacountry.Thelawsandregulationsthatimpact infantsandchildhoodobesity.10 ECD are diverse due to the array of sectors that influence ECD and the different constituencies that ECD policy can Government policies mandate protections for and should target, including pregnant women, young pregnant women and new mothers. The Tuvalu children,parents,andcaregivers. Revised Employment Act (2008) mandates maternity  leave for mothers six weeks before and six weeks after National laws and regulations promote healthcare for giving birth; mothers are also entitled to two halfͲhour women and young children. The Tuvalu Health Act breastfeeding breaks a day. The law requires employers (2010)providesfreehealthcareforallcitizensofTuvalu. to pay a woman on maternity leave not less than 25 Assuch,womenreceivefreeprenatalvisitsandaskilled percent of her pay; and her employment is guaranteed attendant is present for 98 percent of deliveries. while she is on leave up to 12 weeks.11Table 3 presents Women who live on the outer islands are referred to a comparison of maternity and paternity leave policies PrincessMargaretHospital(PMH)onthemainislandfor inTuvaluandfourotherPacificIslands. care during their first pregnancy because no doctors— NationallawsdonotmandatefreepreͲprimaryschool, only nurses–are available in prenatal clinics on the but do provide free ECD health care services. outer islands. Women with complications during Preschools are not free, and parents must pay school pregnancy also receive care at PMH. Voluntary testing tuition and fees for items such as school uniforms. The for sexually transmitted diseases (STDs) and HIV are Tuvalu National PreͲSchool Council coordinates available to pregnant women, though no cases of HIV preschool education, 12 and parents and the local were found among pregnant women in 2010Ͳ2011 community manage the schools. ECCE has not yet been reporting period.7At that time, a Prevention of Mother formally incorporated into the MoES, but in 2007, the to Child Transmission policy was being drafted. 8 ministry issued an ECCE policy and a teacher salary Newborns and young children are immunized according policythatlaidoutgeneralguidelinesandstaffingrules. to an expanded national immunization schedule and The Tuvalu Education Strategic Plan 2011Ͳ2015 lays out nurses on each island monitor the well child visits of an ECCE strategy to ensure greater access to ECCE theirpatientstoensurethatvisitsaretimely. services for 3Ͳ to 5ͲyearͲolds, promote a more active  role by the PreͲSchool Council, and improve quality and National laws are not yet in place to promote key timeliness of ECCE data collection. Though the recommended dietary guidelines for pregnant women   9 TuvaluConventionontheRightsoftheChild,2011. 6 10 Brinkerhoff,2009;Britto,Yoshikawa&Boller,2011;VargasͲBaron,2005. TuvaluConventionontheRightsoftheChild,2011. 7 11 UNAIDS(2012). TuvaluEmploymentAct,revised(2008). 8 12 UNAIDS(2012). UNICEF,AchievingEducationforAllinTuvalu,p.7. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  5 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  preschoolsarenonͲprofit, thegovernmentoffersgrants on customary practices whereby extended family to help pay preschool teachers’ salaries and contributes members provide support and care for the orphans and to the construction of preschool buildings. The vulnerable children in their clans. As such, there is no government also provides resources, curriculum advice, formal policy to safeguard their wellbeing. The Tuvalu and preschool teacher training.13All ECD health care EducationStrategicPlan:2011Ͳ2015statesthatchildren servicesarefree. with special needs should have equal access to “an expanding, inclusive, safe, and quality education and Policies to protect children have not been fully care system” and has developed an inclusive education established. The judiciary and Ministry of Home Affairs policy that enables teachers to identify and support and Rural Development support child victims of students with special needs, provide an enabling exploitation and abuse, but this could be strengthened learning environment, and incorporate a regional to better protect children. 14 There is no specialized strategy on disability. A special school for children with training for judges or lawyers in cases involving the severedisabilitieshasbeenestablished. rights of children, and no specialized courts. Only law  enforcement officers are trained to respond to children Box2:LawsandRegulations in need of protection. A draft Family Protection bill is ‡› ƒ™•ǡ‡‰—Žƒ–‹‘•ǡƒ†–”ƒ–‡‰‹…Žƒ• underconsiderationthatwouldmandatehomevisitsby ‘˜‡”‹‰‹—˜ƒŽ— social workers, train health workers to identify abuse x TuvaluHealthAct(2010) and neglect, and create a taskforce on domestic x EducationLaw(1978) violence prevention. The registration of newborns is x DraftPolicyonBreastfeedingandInfantFeeding mandated by the Births, Deaths and Marriages x TuvaluEmploymentAct,revised(2008) Registration Ordinance, which states that every child x Birth, Deaths and Marriage Registration Ordinance born in Tuvalu should be registered within 10 days of (1968) birth. However, between 2005 and 2012, only half of all x Ministry of Education and Sports’ ECCE Policy newbornswereregistered.15 (2007) x Ministry of Education and Sports’ ECCE Teacher Table3:Comparisonofmaternityandpaternityleavepoliciesin SalaryPolicy(2007) PacificIslands x MinistryofHealthStrategicPlan(2009Ͳ2019) Solomon x TuvaluEducationStrategicPlan(2011Ͳ2015) Tuvalu Fiji Tonga Vanuatu  Islands  All All No Allworkers: Pregnant workers: workers: parental 14weeksat PolicyLever1.2: women 12weeks 12weeks leave minimum IntersectoralCoordination receivenot at17%of at guarantee 66%of Development in early childhood is a multiͲdimensional lessthan wage, minimum dforall wage;paid process. 16 In order to meet children’s diverse needs 25%ofpay 547days 25%of workers; by during the early years, government coordination is whileon unpaid; wage; 12weeks employer maternity paidby paidby at100% (new essential, both horizontally across different sectors as leave,which employer employer wagefor legislation well as vertically from the local to national levels. In includes6 governme will many countries, nonͲstate actors (either domestic or weeks ntworkers regulate international)participateinECDservicedelivery;forthis beforeand6 only,paid across reason,mechanismstocoordinatewithnonͲstateactors weeksafter bygovernͲ employers) arealsoessential. givingbirth ment Tuvalu has not yet developed a multiͲsectoral ECD Source:ILO(2012);TuvaluEmploymentAct,revised(2008). strategy. While there is recognition of the importance  of a multiͲsectoral approach to ECD to ensure the best Tuvalu relies on cultural traditions to protect orphans, outcomes for child development, no explicit strategy and vulnerable children and has social protection has yet been endorsed by the government. The 1978 policies for children with special needs. Tuvalu relies Education Act does not require MoES or any other  ministry to create or implement an ECD policy and the 13 TuvaluCRCReport,April2011. 14 TuvaluConventionontheRightsoftheChild,2011.  15 16 UNICEF,MultipleIndicatorClusterSurvey. Naudeauetal.,2011;UNESCOͲOREALC,2004;Neuman,2007. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  6 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  act does not formally incorporate ECCE into the ECD,adequatefinancialinvestmentiskeytoensurethat Education Act. However, the ministry issued an ECCE resources are available to implement policies and Policy in 2007 and is reviewing the Education Act with achieve service provision goals. Investments in ECD can theaimofincorporatingECCEpolicyintothelaw.Inthe yield high public returns, but are often undersupplied meantime, the ministry is responsible for implementing without government support. Investments during the the education components of ECD services only, and in early years can yield greater returns than equivalent special situations may coordinate ECD services across investments made later in a child’s life cycle and can sectorsordepartments.Forinstance,theministrymight lead to longͲlasting intergenerational benefits. 17 Not coordinate visits to ECCE centers by officials from the onlydoinvestmentsinECDgeneratehighandpersistent health or social welfare departments or by interested returns,theycanalsoenhancetheeffectivenessofother donororganizations. social investments and help governments address multipleprioritieswithsingleinvestments. The government has yet to take steps to establish a There is a limited transparent budget process. Criteria national crossͲsectoral ECD institutional anchor that to develop a budget for ECD are available only in the would be responsible for coordinating ECD policy and education sector, which gathers data on a limited implementation between sectors and departments. number of indicators to determine the amount of the Local governments in each island implement ECCE budget it devotes to ECD. Health, nutrition, and child policy and are empowered to address gaps in ECD and social protection sectors do not offer explicit delivery. The health and education sectors have criteria at the national or subͲnational level to decide separate ECD programs and schedules of ECD spending. However, the MoH’s Strategic Health implementation. Plan 2009Ͳ2019 includes plans for the National Health There is little coordination of interventions at the Account, which provides data on health indicators, to point of service delivery. ECCE providers in the link health outcomes to the budget. Though the plan educationsectormeetinfrequently.Thoseinthecapital does not mention ECD data specifically, this element of city meet semiͲannually; ECCE officers visit providers on the strategic health plan could help the government the outer islands once a year. There are no manuals or determine how best to allocate health resources to guidelines for integrated service delivery of ECD. The ECD. MoH implements separate ECD programs and visits There is no coordinated effort to determine ECD prenatalclinicsseparately. budget allocation across ministries and due to limited State and nonͲstate actors coordinate ECD provision, budget reporting, the level of ECD financing across particularly on the capital island, Funafuti. NonͲstate sectors is largely unknown. Strong evidence suggests actorshaveastrongvoiceinECDserviceprovision.They that investing early in children will bring high returns to have a guaranteed seat on the Tuvalu National PreͲ society in the future. The government falls short in School Council that is responsible for the education ensuring that adequate expenditures are allocated components of the ECD. Annual coordination meetings towards young children. There is no data on the are convened and feedback is welcomed on hotlines percentage of the MoH budget spent on routine EPI and radio programs designed to encourage nonͲstate vaccines, and other ministries involved in ECD services actors to participate in implementing ECD policy. ECCE do not provide budget breakdowns of ECD providerslocatedin Funafutimeetonceeach term. Due expenditures. The MoES is the only ministry with to far distances between the outer islands, the ECCE budget data available on ECD services. In 2012, the officialsoftheMoEShavelimitedcapacitytocoordinate MoES reported an annual recurrent ECCE budget of across all islands. ECCE officials have only one official $115,332, representing only 2 percent of its overall visit a year for meeting ECCE providers located on educationbudget.SeeTable4forasnapshotoftheECD remoteislands. budgetacrosssectorsinTuvalufor2011and2012. Without adequate funding from the education PolicyLever1.3: ministry, communities and parents of young children Finance bear much of the burden of financing ECCE services. In While legal frameworks and intersectoral coordination  are crucial to establishing an enabling environment for 17 Valerio&Garcia,2012;WHO,2005;Hanushek&Kimko,2000;Hanushek& Luque,2003. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  7 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  Tuvalu, preͲprimary education is not free and, as framework for ECCE still remains relatively weak. mentioned above, parents are responsible for paying Updating Tuvalu education policy to include ECDͲ tuition and fees. The ministry’s education budget offers agedchildrenmayleadtomoreaccountabilityofthe grants to pay for some ECCE costs, such as teachers’ MoESinapplyingtheECCEpolicyinpractice. salaries and construction of schools, but ECCE management committees or private providers are x Additionally, passing the draft laws under responsible for staff salaries, which are based on a consideration in these sectors is an essential teacher’s level of education.18Island Councils pay the component of developing a comprehensive and salaries for unqualified workers. Teachers entering the effective ECD program. These include the draft preͲprimary school field receive less than 50 percent of Breastfeeding Policy, the draft Food Safety thesalaryofaprimaryschoolteacher. regulation, and the Family Protection bill. Given that  only50percentofbirthsareregisteredinTuvalu,the The burden of finance for healthcare is equitably government should also consider devising methods distributed across society. Health care is free to all to encourage compliance with the ordinance citizens in Tuvalu, so there are no fees levied at the requiringtheregistrationofnewborns. point of delivery for services such as prenatal care, labor and delivery, or child immunizations. Tuvalu has –‡”•‡…–‘”ƒŽ‘‘”†‹ƒ–‹‘ǣ oneoftheworld’shighesthealthcareexpendituresasa x Tuvalu has made strides in recent years toward percentage of GDP (17.3 percent). The Strategic Health incorporating ECCE policy into the general education Plan 2009Ͳ2019 includes plans to review the costͲ portfolio and has developed strong coordination effectiveness of the Tuvalu Medical Treatment Scheme betweenstateandnonͲstateactorsinthedeliveryof to ensure more appropriate medical referrals. Table 4 ECD services. In that same spirit of cooperation, the displays a regional comparison of select health government could benefit from the creation of an expenditureindicators. institutional anchor designated to coordinate ECD  policy and service delivery across sectors, including Table4:Regionalcomparisonofselecthealthexpenditure education, health, nutrition, and child and social indicators protection. Such coordination would be beneficial at Solomon  Tuvalu Samoa Tonga Vanuatu the national policy level as well as the local point of Islands OutͲofͲpocketexpenditure servicedeliverylevel.Thefocusofthepresentreport asapercentageofprivate 100% 63% 57% 68% 57% is primarily in the early childhood development and healthexpenditures,2011 education subsector, and thus, emphasis is placed Governmentexpenditureon healthasapercentageofGDP, 17% 5.7% 8.0% 4.1% 4.8% primarily on strengthening coordination within the 2011 education sector. In practice, coordination among RoutineEPIvaccines concernedministriesisthemostchallengingone. Not financedbygovernment, 100% 45% 90% N/A 2010 available  Source: WHO Global Health Expenditure Database, 2011; UNICEF Country Statistics, x Creating an intersectoral framework could 2010. improve coordination of services and help to fill in gaps in service delivery that currently exist. Such a PolicyOptionstoStrengthentheEnabling collaborative process would ensure that children receive the highest level of care and attention in all EnvironmentforECDinTuvalu sectors that contribute to ECD. Box 3 displays an example from Jamaica, where a highly synergetic ‡‰ƒŽˆ”ƒ‡™‘”ǣ approach to effective intersectoral coordination has x The government has taken important steps to created an ECD system where the holistic needs of integrate preͲprimary school into the MoES portfolio childrenaremet. and is encouraged to continue moving forward with the ECCE strategy within the Tuvalu Education Strategic Plan. Given that ECCE has not yet been formally incorporated into the MoES, the legal  18 ECCEPolicy(2007);ECCEStaffingPolicy. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  8 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  Box3:RelevantlessonsfromJamaica:multisectoral implementaprocessthatmonitorseffectivebudget institutionalarrangementsforECD coordination between ECD sectors. To efficiently Summary: In 2003, the Government of Jamaica established provide comprehensive ECD services to the children the Early Childhood Commission (ECC) as an official agency of Tuvalu, the health and education sectors should to govern the administration of ECD in Jamaica (Early better coordinate budgets and develop a ChildhoodCommissionAct).OperatingundertheMinistryof methodology for quantifying ECD investments. If Education (MoE), the ECC is responsible for advising the each ministry reports disaggregated spending by MoE on ECD policy matters. It assists in the preparation as ECD age group, the government could better well as monitoring and evaluation of ECD plans and capture and monitor ECD services across sectors programs, acts as a coordinating agency to streamline ECD and identify the most costͲeffective interventions. activities,managesthenationalECDbudget,andsupervises In developing a comprehensive methodology, it and regulates early childhood institutions (ECIs). The ECC includes a governance arm comprised of the officially would also be useful to work closely with nonͲstate appointed Executive Director, a Board of Commissioners, ECD stakeholders to capture the full spectrum of and seven subͲcommittees representing governmental and ECD investment. Given that the nonͲstate sector is nonͲgovernmental organizations. It also has an operational very involved in provision of ECD services, having armthatprovidessupporttotheboardandsubcommittees. detailed information to evaluate the cost The ECC is designed with representation from all relevant effectiveness of interventions will allow sectors, including education, health, local government and policymakers to shift financial allocation to community development, labor, finance, protection, and interventions with the greatest return on planning. Each ministry or government agency nominates a investment.19 representativetoserveontheBoardofCommissioners.The  seven subͲcommittees, which provide technical support to the ECC board, are comprised of 50 governmental and nonͲ x Additionally, given that the government faces a governmentalagencies. limited budget, it should consider developing  alternative sources of funding to ensure that the Furthermore, the newly established National Parenting level of finance for ECD services is adequate to meet Support Commission creates links between Jamaican the needs of its population. Tuvalu may consider parents and the government of Jamaica. In 2012, the MoE leveraging more private funding from foundations, introduced the National Parenting Support Policy. The community groups, or private enterprises. PublicͲ government recognized that parents should serve an private partnerships with matching funds for capital important role to promote and coordinate organizational investment initiatives may also be an effective way efforts and resources for positive parenting practices. The toexpandECDservices. National Parenting Support Commission Act further establishedanofficialcoordinatingbodytoensureeffective  streamliningofgovernmentactivitiesrelatedtoparenting. PolicyGoal2:ImplementingWidely KeyconsiderationsforTuvalu: x PolicyLevers:ScopeofPrograms• 9 EstablishedcrossͲsectoralinstitutionalanchorwith Coverage•Equity representationfromallrelevantsectors,including Implementing Widely refers to the scope of ECD education,health,localgovernmentandcommunity programs available, the extent of coverage (as a share development,labor,finance,protection,andplanning. of the eligible population), and the degree of equity 9 Highlysynergeticapproachtopolicydesign. within ECD service provision. By definition, a focus on 9 Improvedcoordinationamongstrelevantsectorsto ECD involves (at a minimum) interventions in health, effectivelyrespondtothecomprehensive nutrition,education,andsocialandchildprotection,and developmentalneedsofyoungchildren. should target pregnant women, young children, and  their parents and caregivers. A robust ECD policy should ‹ƒ…‡ǣ include programs in all essential sectors, providing comparable coverage and equitable access across x To improve the efficiency of public spending on regions and socioeconomic status – especially reaching young children, the government could better track, the most disadvantaged young children and their report, and coordinate budgets across ECD sectors. families. The government may consider creating effective  mechanisms to capture data for ECDͲaged children 19 UNICEFisintheprocessofconductingacostandfinancingstudy.The across sectors to better allocate resources and to studywillhelpthegovernmentconsiderhowtobestinstitutionalizeECDand explorefinancingoptionsforECEthatmaybesupportedbytheMoES. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  9 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  PolicyLever2.1: ScopeofPrograms Effective ECD systems have programs established in all essential sectors and ensure that every child and expectant mothers have guaranteed access to the essential services and interventions they need to live healthfully. The scope of programs assesses the extent to which ECD programs across key sectors reach all beneficiaries. Figure 2 presents a summary of the key interventions needed to support young children and theirfamiliesviadifferentsectorsatdifferentstagesina child’slife. ECD programs target all beneficiaries in the health, nutrition, and education sectors, but child and social protection interventions do not exist. Tuvalu has established several essential health, nutrition, and education services necessary to promote a positive environment for ECD. While the data may be limited in scope, the programs in place target all beneficiary groups, including pregnant women, mothers, and childrenages0Ͳ83months. On the following page, Figure 3 presents the scope of ECD interventions in Tuvalu by target population and sector. Table 5 on the next page provides an overview ofECDprogramsandcoverageinTuvalu. The MoH has implemented an expanded program to provide immunizations to all children. PreͲ and postͲ natal care includes prenatal clinical visits and postͲnatal screening for maternal depression as well as births in the presence of a skilled attended. Child wellness and growth monitoring are mandated and parenting programs are available at health centers. NonͲstate actorsimplementmanyoftheprogramsincoordination withtheTuvaluAssociationofNGOs(TANGO). Countrywide programs to promote essential nutritional intake include breastfeeding for new mothers and healthy eating and exercise programs for children to fightchildhoodobesity.However,programsdonotexist to promote micronutrient or food supplements for expectant mothers, new mothers, and children. CommunityͲbased ECCE programs are offered to all children at Tuvalu’s 18 ECCE centers, and home visits provide parents with key ECD messaging. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  10 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014    Figure2:Essentialinterventionsduringdifferentperiodsof  youngchildren'sdevelopment            Figure3:ScopeofECDinterventionsinTuvaluby targetpopulationandsector              SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  11 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  Table5:ECDprogramsandcoverageinTuvalu Scale Numberof ECDIntervention Pilot Universal Regions Programs Coverage Covered Education StateͲsponsoredpreͲprimary/kindergarteneducation    StateͲsponsoredECCE    CommunityͲbasedECCE  All Yes Health Prenatalandnewborncare  All Yes Integratedmanagementofchildhoodillnessesandcarefordevelopment    Childhoodwellnessandgrowthmonitoring  All Yes Nationalimmunizationprogram  All Yes Nutrition Micronutrientsupportforpregnantwomen    Foodsupplementsforpregnantwomen    Micronutrientsupportforyoungchildren    Foodsupplementsforyoungchildren    Foodfortification    Breastfeedingpromotionprograms  All Yes AntiͲobesityprogramsencouraginghealthyeating/exercise  All Yes FeedingprogramsinpreͲprimary/kindergartenschools    Parenting Parentingintegratedintohealth/communityprograms  All Yes Homevisitingprogramstoprovideparentingmessages  All Yes SpecialNeeds ProgramsforOVCs(boardingschools&children’shomes)    Interventionsforchildrenwithspecial(emotionalandphysical)needs  All Yes AntiͲpoverty CashtransfersconditionalonECDservicesorenrollment   Comprehensive A comprehensive system that tracks individual children’s needs and All Yes intervenesasnecessary  PolicyLever2.2: Levels of access to essential ECD health interventions Coverage are high for pregnant women. Prenatal care is nearly universal in Tuvalu: skilled attendants are present at 98 A robust ECD policy should establish programs in all percent of births; 97 percent of pregnant women get at essential sectors, ensure high degrees of coverage and least once prenatal checkup; and 67 percent of women reach the entire population equitably–especially the getfourcheckupsduringtheirpregnancy.Thereareeight most disadvantaged young children–so that every child prenatal care facilities in Tuvalu—one for each island and expecting mother have guaranteed access to except Niulakita, which had a population of 41 people in essentialECDservices. 2011. As mentioned above, voluntary HIV testing for pregnant women is offered at the Princess Margaret Hospital and at prenatal clinics, but no cases of HIV SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  12 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  among pregnantwomen werereportedin the2010Ͳ2011 child’s life. Anemia is high among children under 5, at 34 reporting period.20 As of 2005, oneͲthird of pregnant percent from 2005 to 2010.24Table 7 presents a regional women had anemia; the MoH is encouraged to gather comparison of levels of access to essential health and more upͲtoͲdate data for an accurate understanding of nutritionforECDͲagedchildren. this nutritional concern. Table 6 provides a regional Table 7: Regional comparison of level of access to essential comparison of levels of access to essential health and healthandnutritioninterventionsforECDͲagedchildren nutrition for pregnant women in Tuvalu and four other Tuvalu Fiji Solomon Tonga Vanuatu PacificIslandnations. Islands 1ͲyearͲoldchildren immunizedagainstDPT Table 6: Regional comparison of level of access to essential 96% 99% 88% 99% 68% (corresponding healthandnutritioninterventionsforpregnantwomen vaccinesDPT3ß)  Tuvalu Fiji Solomon Tonga Vanuatu Childrenbelow5with Not Not Not Islands moderate/severe 10% 33% available available available Skilledattendantat stunting 98% 100% 86% 98% 74% Infantsexclusively birth Not breastfeduntil6 35% 40% 74% 40% Pregnantwomen available months receivingantenatal Not Not Not 67% 65% Infantswithlowbirth care(atleastfour available available available 6% 10% 13% 3% 10% visits) weight Pregnantwomen Prevalenceofanemia Not Not Not receivingantenatal inchildrenbelow5 34% 39% 97% 100% 74% 98% 84% available available available care(atleastone (2005Ͳ2010) visit) Source:UNICEFCountryStatistics,2007Ͳ2012;WHOGlobalDatabaseon Anemia,2005;WorldBankIndicators:Nutritionintakeandsupplements(2005Ͳ Prevalenceof 2010). anemiainpregnant 33% 56% 51% 34% 57% women(2005) Half of all newborns are registered and receive birth Source: UNICEF Country Statistics, 2007Ͳ 2012; UNAIDS, 2012; WHO Global certificates. Birth registration is an essential part of DatabaseonAnemia,2006. ensuring that young children receive adequate ECD For young children, the levels of access to some services. While Tuvalu adopted the Births, Deaths, and essentialECDhealthinterventionsarehigh,butlevelsof Marriages Registration Ordinance (1968) requiring access to essential nutrition are relatively low or registration of all newborns within 10 days of birth, unknown. Infant immunization against DPT, polio, between 2005 and 2011, only 50 percent of children hepatitis, and other childhood diseases is nearly were registered. Table 8 provides a regional comparison universal, at 97 percent or higher.21FortyͲfour percent of ofbirthregistrationrates. children under 5 with diarrhea received oral rehydration Table8:Regionalcomparisonofbirthregistrationrates from 2008Ͳ2012.22No information was available on the Tuvalu Solomon Tonga Vanuatu Fiji prevalence of pneumonia, tetanus, or malaria among Islands youngchildren.23 Birthregistration Not Not Not 50% 26% 2000Ͳ2010 available available available In terms of child nutrition, there is no data on two Source:UNICEFMICS4,2011;UNICEFCountryStatistics,2007Ͳ2011. essential indicators—the number of children aged 6Ͳ59 months who get regular supplements of Vitamin A, and Tuvalu has a high rate of preͲprimary enrollment the percentage of the population that consumes iodized compared to other Pacific Island nations. Tuvalu has the salt. Despite a drafted national breastfeeding policy that highest rate of preͲprimary enrollment among the Pacific ispromoted atTuvalu’shospitalandprenatalclinics,only Islands nations of Fiji, Samoa, the Solomon Islands, 35 percent of infants younger than 6 months were Tonga, and Vanuatu. Gross enrollment in preͲprimary exclusively breastfed between 2007 and 2011—a low school in Tuvalu has hovered around 100 percent since rate compared to other Pacific Island nations. The World 2000 and gross enrollment exceeded 100 percent in Health Organization (WHO) and UNICEF recommend 2006.25Figure 4 presents a comparison of preͲprimary exclusive breastfeeding for the first six months of a grossenrollmentratesinthePacificIslands.  20 UNAIDS(2012).  21 24 UNICEF,MISC(2012). WorldBankIndicators:Nutritionintakeandsupplements(2005Ͳ2010). 22 25 UNICEF,MICS(2012). LatestStatisticalDigestforTuvaluindicatesapreͲprimarynetenrollment 23 UNICEF,MICS(2012). rateof82%. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  13 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  Figure 4: Gross preͲprimary enrollment rates in Pacific households had registered their newborn, while 71 Islands percent of the richest had done so. Birth registration  120 Fiji rates also vary by location. More urban households  (datamissing in2002,2005, registered the birth of their children (60 percent) than  2007,2010) rural households (38 percent). The disparity did not  100 PreͲPrimaryGrossEnrollmentRate  apply to access to improved sanitation facilities: both Samoa  (datamissing urbanandruralhadnearlyequalaccess—88percentfor  80 in2002Ͳ2005) urbanand81percentforrural.    Solomon 60  Islands PolicyOptionstoImplementECDWidelyin  (datamissing 2001,2003Ͳ Tuvalu  2005) 40  Tonga …‘’‡‘ˆ”‘‰”ƒ•  (datamissing x The government has taken several steps to  2001Ͳ2003, increase the scope of ECD programs in the health, 20  2005) education, and nutrition sectors. However, data  were limited to fully ascertain the scope of existing Tuvalu 0 (datamissing programs that contribute to positive ECD services.  2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2002,2003,  2007Ͳpresent) Mapping of programs and collaboration across ECD  Year sectorswouldbeusefultoensureanadequatescope  ofprograms asavailableforpregnant women,young children, and parents. More programs to reach PolicyLever2.3: pregnant women and young children with essential Equity nutrients,forinstance,couldboosthealthoutcomes. Based on the robust evidence of the positive effects ECD The government might also consider Incorporating interventions can have for children from disadvantaged child and social protection programs into the ECD backgrounds, every government should pay special system, as this would be beneficial to increasing the attentiontoequitableprovisionofECDservices.26Oneof overall scope of programs offered. Prioritizing which the fundamental goals of any ECD policy should be to interventions to invest in will depend on the provide equitable opportunities to all young children government’s consideration of context, costs, needs, andtheirfamilies. andcapacity.Box4reviewsseveralareastoconsider Tuvalu exhibits few disparities in access to ECD health whendecidingwheretoprioritize. and education services. Boys and girls equitably attend  preͲprimary school, and the ratio of boys to girls is relatively equal at 1.2 to 1. The MoES Education Strategic Plan (2011Ͳ2015) mandates inclusive policies that cater to the needs of children with special needs enrolledinECCEcenters. Both rich and poor mothers were accompanied by skilled attendants during labor in equal measure: 99 percent of the poorest and 98 percent of the richest gave birth in the presence of a doctor or a skilled midwife. Similarly, there is almost no difference in poor and rich households when comparing underweight children. Only 1 percent of the poorest children were underweight and none of the children from the richest households was underweight. Only birth registration showed a disparity: 39 percent of the poorest  26 Engleetal,2011;Naudeauetal.,2011. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  14 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  Box4:ConsiderationsforprioritizingECDinterventions of the population that consumes iodized salt. The On the basis of the ECD diagnostic and taking into account government could ensure the universality of ECD costs and funding, countries should prioritize interventions coverage by improving the rate of birth registration. withthreeconsiderationsinmind: ECCE services would benefit from an expansion of x Startearly:Theneedsoftheveryyoungarekey,especially programstoreachchildrenages0Ͳ3. during the 1,000 days between conception and 24 months. Interventions during that period have lifelong impacts on a “—‹–› child’sabilitytogrow,learn,andriseoutofpoverty. x While most ECD services are equitably x Address risk factors for poor growth and development: provided, the government could improve equal Four main risk factors affecting at least 20Ͳ25 percent of access to services through programs targeting infants and young children in developing countries are: (1) Tuvalu’s lower income and rural residents, stunting and wasting; (2) inadequate cognitive stimulation; (3) iodine deficiency; and (4) ironͲdeficiency anemia. Other particularly to register newborns among these priority risk factors include malaria, intrauterine growth demographic groups. The government could also restriction, lead exposure, maternal depression, and target parents with messaging to increase girls’ exposuretoviolence. access to preͲprimary school to close the small x Target the most vulnerable: While a system providing gendergapinattendancerates. universal coverage for ECD interventions is ideal, under budget constraints countries should first target the most vulnerable. For example, homeͲvisiting programs could focus Policy Goal 3: Monitoring and Assuring on households with stunted children and those facing higher Quality risksofdelayedcognitivedevelopment. x PolicyLevers:DataAvailability•Quality From:InvestinginYoungChildrenforHighReturn(Denboba,etal,2014)  Standards•CompliancewithStandards Monitoring and Assuring Quality refers to the existence ‘˜‡”ƒ‰‡ ofinformationsystemstomonitoraccesstoECDservices x Parents are the primary entry point to improve and outcomes across children, standards for ECD outcomes for young children. Parenting programs servicesandsystemstomonitorandenforcecompliance already exist in Tuvalu. Reaching parents and with those standards. Ensuring the quality of ECD caregivers with messages on young children’s interventions is vital because evidence has shown that development and positive parenting can significantly unless programs are of high quality, the impact on improve outcomes for children. Stimulation for childrencanbenegligible,orevendetrimental. young children occurs through responsive and PolicyLever3.1: increasingly complex, and developmentally DataAvailability appropriate, interactions between caregivers and children. Strengthening family support in ECD could Accurate,comprehensive,andtimelydatacollectioncan beapromisingstrategytopromoteschoolreadiness. promote more effective policyͲmaking. WellͲdeveloped Efforts to promote positive parenting practices have information systems can improve decisionͲmaking. In demonstrated impacts on cognitive skills, social particular, data can inform policy choices regarding the adjustment, and academic performance once volume and allocation of public financing, staff children reach school. Encouraging parents to recruitmentandtraining,programquality,adherenceto provide learning opportunities at home can standardsandeffortstotargetchildrenmostinneed. demonstrate positive effects on children’s literacy Data are collected for only a select number of ECD andnumeracyatage5. indicators. UNICEF’s Multiple Indicator Cluster Survey x While Tuvalu’s coverage of many ECD (MICS) collects data for some health, education, and interventions is near universal, such as child nutrition indicators for Tuvalu, such as birth weight, immunizations and prenatal visits for pregnant immunizations, and access to prenatal care. The women, some other essential interventions are government also collects some administrative data. For insufficiently provided or unavailable. The example, ECCE centers in each island track and report government could improve coverage of ECD services the number of children enrolled in preͲprimary school, by increasing data collection for key coverage including urban/rural divisions. Health administrators indicators, such as the percentage of children who count and report the number of children who benefit receive vitamin A supplements and the percentage from wellͲchild visits as well as national usage of SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  15 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  nutrition interventions for children by ethnicity, location, and age. Authorities also track the percentage PolicyLever3.2: ofchildrenregisteredatbirth,thepercentageof1ͲyearͲ QualityStandards olds immunized, and the percentage of pregnant related to better cognitive and social development in motherswhoreceiveprenatalvisits.However,thereare children.27 no data collected for other essential ECD indicators, The MoES is in the process of developing learning such as the average ratio of students per teacher. Table standards. There are no clear learning standards for 9 presents an overview of the availability of data to ECCE, but educators are working with local monitorECDinTuvalu. communities, parents, and other stakeholders to  develop National Early Learning Development Somedataarecollectedtomeasurechilddevelopment Standards. For now, ECCE teachers who received outcomes. Cognitive, linguistic, physical, and socioͲ certificates from the University of the South Pacific’s emotional data are collected to support teachers in Tuvalu campus use their knowledge to develop providing holistic and appropriately individualized individual curricula according to the pupils’ interest, programs for preͲprimary school children. Individual culture, and environment. Trained ECCE teachers hold children’s development outcomes are also tracked. But workshops to learn how to align their curricula with data are not compiled to determine ECCE outcomes for primary school to bridge the transition from ECCE to various subgroups of children. ECCE access and primary. outcomes, for instance, are tracked by gender and location only. Language, ethnic, socioeconomic status, There are minimum requirements for preͲprimary andspecialneedsarenotspecificallytracked. school teachers, but ECCE training and development varies and is not regulated by the government. PreͲ Table9:AvailabilityofdatatomonitorECDinTuvalu primary school teachers must complete high school and AdministrativeData: take vocational training classes in ECD to become a Indicator Tracked teacher, but there is no specific inͲservice training ECCEenrollmentratesbyregion X requirement to develop pedagogical and teaching skills. SpecialneedschildrenenrolledinECCE(#) 9 Private teacher training institutions regulate their own ChildrenattendingwellͲchildvisits(#) 9 preͲservice training. Most ECCE teachers are trained Childrenbenefittingfromnutritioninterventions(#) 9 through distance and flexible learning programs. The Womenreceivingprenatalnutritioninterventions(#) X University of the South Pacific’s (USP) Tuvalu campus ChildrenenrolledinECCEbysubͲnationalregion(#) 9 trains the majority of preͲprimary school teachers. AveragestudentͲtoͲteacherratioinpublicECCE 9 USP’s course requires an eightͲweek practicum. The IsECCEspendingineducationsectordifferentiated Australian Pacific Training Center offers an ECCE 9 withineducationbudget? certificatethatrequiresasixͲmonthpracticumtwodays IsECDspendinginhealthsectordifferentiatedwithin X aweek. healthbudget? SurveyData Health workers are required to receive training in Indicator Tracked delivering ECD messages. Doctors, nurses, and Populationconsumingiodizedsalt(%) X midwives receive training on child developmental VitaminAsupplementationforchildren6Ͳ59mo(%) X milestones, child care, parenting, and early stimulation Anemiaprevalenceamongpregnantwomen(%) X childdevelopmenttechniques. Childrenbelowtheageof5registeredatbirth(%) 9 There areinfrastructure andservicedeliverystandards ChildrenimmunizedagainstDPT3atage12months(%) 9 for ECCE. The MoES’s ECCE Policy 2007 stipulates that Pregnantwomenattending4antenatalvisits(%) 9 the ratio of children to teachers should be 6:1 for 2Ͳ to ChildrenenrolledinECCEbysocioeconomicstatus(%) X 3ͲyearͲolds,10:1for3Ͳto4ͲyearͲolds,and15:1for4Ͳto  5ͲyearͲolds. Preschools should operate a minimum of Ensuring quality ECD service provision is essential. A 15 hours per week. There are no national standards for focus on access – without a commensurate focus on the amount of space required for a preschool and the ensuring quality – jeopardizes the very benefits that policymakers hope children will gain through ECD  27 interventions.  The quality of ECD programs is directly Taylor&Bennett,2008;Bryceetal,2003;Naudeauetal,2011V;Victoriaet al,2003. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  16 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  ECCE Policy does not mention hygiene or potable water children’s access and outcomes by socioeconomic initsguidelinesforphysicalenvironment. status, ethnic minority background, or special needs. Such a breadth of information would give a ECCE facilities must be registered and accredited. The moreinͲdepthpictureofthecoverageandequityof 2007 ECCE Policy stipulates that ECCE centers must ECDprogramsofferedinTuvalu. register with the Department of Education. Facilities must meet basic building, health, safety, and —ƒŽ‹–› –ƒ†ƒ”†• ƒ† ‘’Ž‹ƒ…‡ ™‹–Š educationalrequirementsandareinspectedannually. –ƒ†ƒ”†• There are construction standards for health and x In May 2014, regional guidelines for ECCE education facilities. Tuvalu’s eight health centers and systemswereendorsedbyMinistersofEducationat one hospital must comply with building code standards a Forum in Cook Islands. The government is set for health facilities, according to the MoH and the encouraged to incorporate these guidelines to public works division/architectural design. There are strengthen the quality of the ECCE system. also construction requirements for Tuvalu’s 18 ECCE Monitoring and enforcing compliance with centers. standards ensures that public standards of quality of ECD programs are met and maintained. To this PolicyLever3.3: end, early learning outcomes could benefit by a CompliancewithStandards concerted effort to make sure that requirements Establishing standards is essential to providing quality that preschool teachers are properly trained and ECD services and to promoting the healthy development qualifiedareenforced. of children. Once standards have been established, it is x The current effort to create National Early critical that mechanisms are put in place to ensure Learning Development Standards provides a good compliancewithstandards. starting point to ensure quality. The government is encouraged to finalize these standards and could TherearenodataavailableonwhetherECCEproviders turn to the neighboring island state of Vanuatu, comply with standards for training professional where the national preschool association has also qualifications. According to the Tuvalu Teacher developed early learning and development EducationManagementInformationSystem(TEMIS),60 standards in 2010. The government might also teachers of children aged 24Ͳ59 months had received consider establishing monitoring and evaluation inͲservice training and an additional 60 had received inͲ mechanisms to ensure that various ECD standards servicetrainingforchildrenaged60Ͳ83monthsin2012. are met across sectors. Similarly, the government The MoES’ 2007 ECCE Teachers Salary Policy could benefit from establishing mechanisms to differentiates the salary paid to qualified and ensure that ECCE centers comply with building unqualifiedteachers. codes. Box 5 provides an example from Jamaica, ECCE facilities comply with operating but not where a system of monitoring and assuring quality construction standards. All 18 of Tuvalu’s ECCE centers iswellestablished. enforce the 10:1 childͲtoͲteacher ratio requirement and operated the required 15 hours per week. However, only8of18facilitiesmeetconstructionstandards. PolicyOptionstoMonitorandAssureECD QualityinTuvalu ƒ–ƒ˜ƒ‹Žƒ„‹Ž‹–›ǣ x Tuvalu would benefit from a more robust data collectionsystemthatcouldbeusedtomakebetter informed decisions about ECD across sectors. Specifically, data to differentiate access and outcomes for special groups would help the government better assess equity issues. While data currentlycollectedaredisaggregatedbyurban/rural and gender, they are not collected to differentiated SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  17 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  Box 5: Relevant Lessons from Jamaica in Monitoring ComparingOfficialPolicieswithOutcomes andAssuringQuality The existence of laws and policies alone do not always guarantee a correlation with desired ECD outcomes. In ExamplefromJamaica:EnsuringQualityinECCEprovision many countries, policies on paper and the reality of Jamaica’s Early Childhood Commission (ECC) is responsible for the access and service delivery on the ground are not supervision and regulation of early childhood institutions (ECI) in the country. aligned. Table 10 compares ECD policies in Tuvalu with  ECD outcomes. In Tuvalu, the MoH implemented an Standards for the operation, management and administration of expanded and free immunization program available in ECIs: In Jamaican law, there are two types of standards; those all healthcare facilities that has resulted in very high transmitted by an Act or Regulations and which therefore carry legal consequences, and those that serve to improve practice voluntarily rates of immunization for children. Other policies are and are not legally binding. For practical purposes, quality standards still in draft form, such as the policy to encourage for ECIs include both sets of standards, with clear indications of those breastfeeding for infants under 6 months old. While standardsthatarelegallybinding. messaging at Tuvalu’s health facilities currently  promote the benefits of breastfeeding, less than half of Standard statements for ECI: To improve the quality of services providedbyECIs,theECChasdevelopedarangeofrobustoperational allwomenexclusivelybreastfeedforsixmonths. quality standards for ECIs. The Act and Regulations, which together Table10:ComparingECDpolicieswithoutcomesinTuvalu comprise the legal requirements, specify the minimum levels of practice below which institutions will not be registered or allowed to ECDPolicies  Outcomes operate. The standards that are not legally binding define best 1996DraftBreastfeed& Infant practices for early childhood institutions and serve to encourage Exclusivebreastfeeding FeedingPolicyencourages institutions to raise their level of practice above minimum rate(>6mo): breastfeeding  requirements. While ECIs are encouraged to achieve the highest 35% possible standards to ensure the best outcomes for children, the  legallybindingstandardsguaranteethatminimumstandardsaremet.  PreͲprimaryschool Preprimaryschoolisnotfree  enrollment: orcompulsoryinTuvalu Inspection and registration: Inspection of ECIs is the procedure 106%  designated under the Early Childhood Act for ensuring that operators complywiththeminimumacceptablestandardsofpractice.TheECCis Youngchildrenarerequiredto  ChildrenwithDPT(12Ͳ required to inspect each ECI twice annually. It is a requirement of receiveacompletecourseof 23months): registration that the registered operator cooperates with the ECC’s childhoodimmunizations 96% inspection process. The “registered operator” is defined as the person   requiredtoapplyforregistrationofanECIandmaybeanindividualor Policydoesnotmandatethe Completenessofbirth a group. In deciding on the suitability of an ECI for registration under registrationofchildrenatbirth registration: the Early Childhood Act, the ECC will, based on information obtained inTuvalu 50% at inspection visits, determine whether or not an ECI meets and   complies with the Act and Regulations. Where existing provision falls  short of the legal requirements, and the shortfall does not present a real and present danger to children, a permit to operate until full PreliminaryBenchmarkingandInternational requirements are met will be granted, with time scales for institutions ComparisonofECDinTuvalu to meet requirements. The ECC encourages the promotion of the Table 11 presents the classification of ECD policy in highest standards of practice by monitoring not only the minimum requirements at inspection visits, but also by monitoring those Tuvalu within each of the nine policy levers and three standardsthatarenotlegallybinding. policy goals. The SABERͲECD classification system does  not rank countries according to any overall scoring; KeyLessonsforTuvalu: rather, it is intended to share information on how 9 Consider establishing legally binding requirements for ECCE service provision to guarantee that acceptable minimum different ECD systems address the same policy standardsaremet. challenges. 9 Consider assigning a special entity with a delineated role to monitorandregulateECCEserviceproviders.Animprovedquality On the following page, Table 12 presents the status of monitoringsystemwillensurethatbestoutcomesareachieved. ECD policy development in Tuvalu alongside a selection ofothercountriesintheregion.      SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  18 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014   Table11:BenchmarkingEarlyChildhoodDevelopmentPolicyinTuvalu Levelof Levelof ECDPolicyGoal PolicyLever Development Development LegalFramework  EstablishinganEnabling InterͲsectoralCoordination  Environment  Finance ScopeofPrograms  ImplementingWidely  Coverage Equity  DataAvailability  MonitoringandAssuring QualityStandards  Quality  CompliancewithStandards  Latent Emerging Established Advanced Legend:      Table12:InternationalClassificationandComparisonofECDSystems LevelofDevelopment ECDPolicyGoal PolicyLever Solomon Tuvalu Australia Samoa Tonga Vanuatu Islands LegalFramework       Establishingan Enabling Coordination       Environment Finance       ScopeofPrograms       Implementing Coverage      Widely  Equity       DataAvailability       Monitoringand QualityStandards      AssuringQuality  Compliancewith      Standards  Latent Emerging Established Advanced Legend:     Conclusion compare Tuvalu’s ECD system with other countries in the region and internationally. Each of the nine policy The SABERͲECD initiative is designed to enable ECD levers are examined in detail and some policy options policymakers and development partners to identify areidentifiedtostrengthenECDareoffered. opportunities for further development of effective ECD  systems.Thiscountryreportpresentsaframeworkto This report is intended to serve as a first step for  decisionͲmaking within the government to improve the ECD system. Now that some areas in need of policy SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  19 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  attention have been identified, the government can nationͲwide curriculum and monitoring the quality of move forward in prioritizing policy options to promote teachers and the physical state of preschools. healthy and robust development during their early Additionally, because strong data collection is so years. It will be important to ensure that the definition essential to ensuring quality ECD services, the of shortͲterm policy goals align with longerͲterm policy government may consider creating a robust data options. A multiͲsectoral costed implementation plan collectionmechanismtoimproveprogramsandallocate will be essential for identifying and prioritizing resources. actionable steps for the government and other  stakeholders. A costed plan will also help ensure that Table13summarizesthekeypolicyoptionsidentifiedto adequate human talent and financial resources are inform policy dialogue and improve the provision of available to meet the goals of Tuvalu’s ECD policy. In essential ECD services in Tuvalu. It is critical that all prioritizing policy areas, the government should relevant ECD sectors mobilize their resources to ensure consider establishing a multisectoral platform and that children receive the highest quality care. This will appoint a ministry to lead ECD to ensure effective require implementing comprehensive policies and delivery of ECD services. Given that preschools are monitoring delivery of services at the national and the communityͲmanaged in Tuvalu and paid for mainly by communitylevels. parents,thegovernmentshouldalsoconsidercreatinga     Table13:SummaryofpolicyoptionstoimproveECDinTuvalu Policy PolicyOptionsandRecommendations Goal  x IncorporateECCEintotheMoESregulatoryframework x Passdraftpolicies,includingBreastfeedingPolicy,FoodSafetyRegulationsbill,andtheFamilyProtectionbill Establishingan x AppointagovernmentagencytocoordinateECDactivitiesacrosssectors Enabling x Track,report,andcoordinatebudgetallocationsforservicesforyoungchildrenacrosstheECCE,health, Environment nutrition,andchildandsocialprotectionsectors x ConsideradditionalsourcesoffundingtoensureadequatefinanceforECDservices,includingpublicͲprivate partnerships   x ConductamappingexerciseofallECDprograms x Createmessagingfocusedonincreasingtheprevalenceofbreastfeedingexclusivelyforthefirstsixmonthsof anewborn’slife Implementing x Collectdataonnutrition,includingthepercentageofthepopulationthatconsumesiodizedsaltandthe Widely percentageofchildrenwhotakevitaminAsupplements x Increaseequityinaccesstoservicesbytargetingpoorerandruralresidents,particularlytoensurethattheir childrenareregisteredatbirth   x DevelopmorerobustdatacollectionsystemtobetterassessthelevelofcoverageandequityofECDaccess andoutcomesandbettertargetservicestospecificneeds Monitoringand x DevelopstandardstomonitorqualityofECDservices,suchasthepercentageofteacherswhohold Assuring certificatesandarequalifiedtoteach Quality x RegulateECCEteachertrainingprograms x CreateanationalECCEcurriculum x EnforcebuildingcodesforpreͲprimaryschoolstoensurechildrenlearninaphysicallysafeenvironment     SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  20 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014  Acknowledgements This Country Report was prepared by the SABERͲECD team at the World Bank headquarters in Washington, DC. The report presents countrydatacollectedusingtheSABERͲECDpolicyandprogramdata collection instruments and data from external sources. The report was prepared in consultation with the World Bank Human Development East Asia and Pacific team and the Government of Tuvalu. For technical questions or comments about this report, pleasecontacttheSABERͲECDteam(helpdeskecd@worldbank.org) Acronyms ECD  EarlyChildhoodDevelopment ECCE EarlyChildhoodCare&Education(used interchangeablywithpreͲprimaryorpreschool) MoES MinistryofEducationandSports MoH MinistryofHealth References SABERͲECDPolicyInstrument,Tuvalu2013. SABERͲECDProgramInstrument,Tuvalu2013. Britto,P.,Yoshikawa,H.,Boller,K.2011.“QualityofEarlyChildhood DevelopmentPrograms:RationaleforInvestment,ConceptualFramework andImplicationsforEquity.”SocialPolicyReport,25(2):1Ͳ31. Denboba,A.,Sayre,R.,Wodon,Q.,Elder,L.,Rawlings,L.,andLombardi,J., 2014,InvestinginYoungChildrenforHighReturns.Washington,DC:The WorldBank. Engle,P.L.,L.C.H.Fernald,H.Alderman,J.Behrman,C.O’Gara,A.Yousafzai, M.CabraldeMello,M.Hidrobo,N.Ulkuer,andtheGlobalChild DevelopmentSteerGroup.“Strategiesforreducinginequalitiesandimproving developmentaloutcomesforyoungchildreninlowͲincomeandmiddleͲ incomecountries.”TheLancet,EarlyOnlinePublication,23September 2011.Doi:10.1016/S0140Ͳ6736(11)60889Ͳ1. Hanushek,E.(2003)."TheFailureofInputͲBasedSchoolingPolicies."The EconomicJournal113;64Ͳ98. Hanushek,E.A.andD.D.Kimko.(2000).“Schooling,LaborͲForceQuality,and theGrowthofNations."TheAmericanEconomicReview,Vol.90,No.5, 1184Ͳ1208. Naudeau,S,N.Kataoka,A.Valerio,M.J.Neuman,L.K.Elder.2011.Investing inYoungChildren:AnEarlyChildhoodDevelopmentGuideforPolicy DialogueandProjectPreparation.WorldBank,Washington,DC. Neuman,M.&Devercelli,A.2013."WhatMattersMostforEarlyChildhood Development:AFrameworkPaper."SABER,WorldBank,WashingtonDC Neuman,M.J.2007.“GoodGovernanceofEarlyChildhoodCareand Education:Lessonsfromthe2007EducationforAllGlobalMonitoring Report.”UNESCOPolicyBriefsonEarlyChildhood.UnitedNations Educational,ScientificandCulturalOrganization,NewYork. OECD(OrganisationforEconomicCoͲoperationandDevelopment).2011. “StartingStrongIII:AQualityToolboxforEarlyChildhoodEducationand Care.”OECDPublications,Paris. UNESCOͲOREALC.2004.“IntersectoralCoͲordinationinEarlyChildhood PoliciesandProgrammes:ASynthesisofExperiencesinLatinAmerica.” RegionalBureauofEducationforLatinAmericaandtheCaribbean,United NationalEducational,ScientificandCulturalOrganization. VargasͲBarón,E.2005.“PlanningPoliciesforEarlyChildhoodDevelopment: GuidelinesforAction.”Paris:UNESCO/ADEA/UNICEF(UnitedNations Educational,ScientificandCulturalOrganization/Associationforthe DevelopmentofEducationinAfrica/UnitedNationsChildren’sFund). Victoria,B.H.,L.Adair,C.Fall,P.C.Hallal,R.Martorell,L.Richter,andH.S. Sachdev2008.“MaternalandChildUndernutrition:ConsequencesforAdult HealthandHumanCapital.“TheLancet371(9609):340Ͳ57. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  21 TUVALUۣEARLYCHILDHOODDEVELOPMENT  SABERCOUNTRYREPORT|2014    www.worldbank.org/education/saber The Systems Approach for Better Education Results (SABER) initiative produces comparative data and knowledge on education policies and institutions,withtheaimofhelpingcountriessystematicallystrengthen their education systems. SABER evaluates the quality of education policies against evidenceͲbased 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 childrenandyouthlearn.  This report focuses specifically on policies in the area of Early ChildhoodDevelopment. ThisworkisaproductofthestaffofTheWorldBankwithexternalcontributions.Thefindings,interpretations,andconclusions 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 partofTheWorldBankconcerningthelegalstatusofanyterritoryortheendorsementoracceptanceofsuchboundaries. SYSTEMSAPPROACHFORBETTEREDUCATIONRESULTS  21