57076 Findings reports on ongoing operational, economic and sector work carried out by the World Bank and its member governments in the Africa Region. It is published periodically by the Knowledge Networks, Information and Technology Center on behalf of the Region. Early Childhood Development in Sub-Saharan Africa : Issues and Strategies For many children in Sub-Saharan Africa (SSA), primary school interventions are already too late to prevent irreversible disability or to allow for the development of full adult capacity. Many of the same conditions of poverty that previously placed the under-5 at risk of death later leave them at the risk of poor health, malnutrition and impaired mental, social and emotional development. The following statistics present a grim picture. · Infant mortality in the region is one-and-a-half times that of the world average of 60 per 1,000 and over 3 times that of the European and Central Asian rate of 30 per 1,000. · Under-5 mortality is twice the world average of 173 per 1,000 and 4 times that of the European and Central Asian rate of 75 per 1,000. · Approximately 30% of children under 5 suffer from chronic malnutrition. · Only 63% of the region's children have been immunized against tuberculosis and less than 50% against DPT, polio and measles. · Beyond the age of 5, an African child's chances of entering a primary school are less than 50%, of completing primary school, less than 35%, of finishing secondary school, less than 12%, and of entering university, less than 2%. · Of the nearly 5 million orphans and 20 million refugees in SSA, 80% are female. In the last decade, the number of African families who were unable to meet their basic needs doubled as average incomes fell by a third. In the same period, population grew by more than 40%. This demographic explosion has disproportionately increased the numbers of children seeking access to basic services and food security. This picture is compounded by rapid urbanization and the emerging breakdown of traditional family support structures. Early childhood care and development is often misinterpreted to mean merely an academically- oriented pre-school program. In fact, the term is used to describe a range of services that promote those conditions of care, socialization and education in the home or community that enhances a child's total development. Early childhood development (ECD) programs can happen in a variety of settings - a school site, a family home, a church, through the mass media, or even informal gatherings. The type of programs best suited to this purpose vary according to the age-group concerned and the comprehensiveness of the services provided, including health, nutrition, and developmentally appropriate learning contexts. This study, The Condition of Young Children in Sub-Saharan Africa : The Convergence of Health, Nutrition and Early Education, describes the condition of young children in Africa and begins to explore strategies to address their condition. It is the first in a series of 3 studies: the second study is a review of ECD programs in SSA and the third will synthesize lessons drawn from the preceding 2 studies as well as country case studies in Kenya, South Africa and Mauritius. Strategies A growing body of global evidence suggests that ECD programs foster language, cognitive and social development and promote the well-being of the whole child. While evidence from Africa is still scarce, research in Latin America and the USA indicates that ECD programs are especially beneficial for children from poor families not capable of providing a healthy, safe and stimulating environment for children. Increasing the efficiency of primary and secondary school investments ECD programs can increase the efficiency, reduce the cost and thus raise the returns to primary and secondary school investment by increasing access to primary education, lowering the repetition and drop-out rates and improving the quality of learning. These programs can facilitate increased primary school attendance directly by enabling older siblings ( who often drop out to look after younger children ) to go to school. Raising community awareness of the importance of education, leading to increased primary enrollment levels is yet another result. When children have a higher active learning capacity upon entry into primary school, they can make better use of the school - the efficiency of primary and secondary schools thus tends to increase. The beneficial impact of early education is particularly pronounced among girls and children from rural, indigenous and lower-level socio-economic backgrounds. Enhancing the economic contribution of the child to society Over the long term, ECD programs leading to better health and development, and improved children's physical and mental capacity, can result in higher productivity and cost savings. The positive impact of such programs on enrollment, progress and performance in schooling is associated with effectiveness of education. Reduced repetition rates improves school quality through reducing the external impact of classroom crowding. Early childhood education also helps reduce costs in other social areas by reducing deviant behavior and crimes, thus cutting the later need for social programs and lowering spending on corrective measures. Empirical evidence of the economic return to early childhood education was established by the High Scope Perry Preschool study in the USA, a program of early intervention for low-income children who were at risk of school failure. Reducing social inequity Evidence suggests that investing in human capital, especially in early development, also attacks some of the most intractable causes of poverty. ECD interventions can help reduce social inequalities rooted in poverty by helping to provide young children from disadvantaged backgrounds with a more equitable start in life and a foundation for further schooling. In South Africa, for example, the average monthly household incomes for whites was R4679 ( US$ 1,023 ) - more than 4 times that of black African households. Studies show that within the education systems for black Africans, repetition and drop-out rates contrast sharply with statistics from the education system for whites. South Africa has recognized the importance of early intervention by making a "reception year" for 5-year olds a highlight of their new education policy. One of the new priorities for Social Welfare policy is vulnerable children under 5 years of age. The "Flagship program for unemployed women with 0-5 year olds" launched in 1996 will pilot programs which may be replicable on a larger scale. The advantages of early childhood intervention are especially apparent for girls. Girls' enrollment rates are less than half those for boys in many SSA countries. Strategies to improve girls' participation include scholarships as well as attention to their readiness for primary school. Early childhood programs can be an important aid in helping to overcome discriminatory barriers and gender inequalities that already exist at the time of first entry into school. Four issues emerge which require careful consideration in balancing center-based with home- based and other alternative delivery systems, e.g. health centers, women's organizations and extension systems. They are : · the large numbers and related unit costs involved in service delivery; · the ability to pay amongst the poor and most needy; · the quality of service; and · the effects of training and certification on differentiating, and sometimes discrediting, home-based care-givers from center-based workers. What is needed is a standards policy based on performance standards negotiated by all stakeholders. Such a process acknowledges prior learning and experience while ensuring quality of care. The intersecting needs of women and children In SSA, about 50% of women are working in wage-earning sectors. Actual labor force participation is much higher if non-wage sectors are also included. Studies on women's labor force participation and child-care show that employed mothers are in greater need of, and more likely to send children to ECD programs. Recent evidence from a Latin American country shows that when child-care is not available, mothers who wish to work will conceal the child's age and enroll under-age children in the first grade, thus exacerbating the already serious overcrowding problem for other children in this grade. Due to repetition and under-age and over-age school entries, for every 100 children expected in the first year of primary school in South Africa, actual enrollments are 150 for African children and 131 for colored. This is particularly relevant to Africa's expanding urban population, where many urban poor mothers cannot afford to purchase adequate child-care, and the absence of child-care prevents mothers from seeking more stable and higher-paying jobs. The provision of ECD services can increase women's productivity not only by freeing up their time to earn wages, but also by providing direct employment in child-care for qualified women. This is especially true for the adoption of home-based day care models. Health, nutrition and early stimulation synergies ECD programs are a necessary foundation for the other programs such as primary schooling or health care to be effective. They should be seen neither as a trade-off against, nor a mere complement to, other development programs. Combined programs take advantage of the interactive effects of health, nutrition and early stimulation initiatives. A key challenge is to find effective ways to organize and finance the task. Given the limited existing resources in SSA, the means of financing ECD programs have to be either through making efficient use of the existing health, nutrition and basic education programs, by mobilizing additional community resources, or by reallocating the current budget. In addition, one might consider subsidizing private provision through tax incentives and other innovative means and by promoting more private and voluntary (NGO sector) investments. While the overall picture of the African child seems bleak, an important source for optimism is the high value placed on children in households all over SSA. Africa's future lies in ensuring that its children grow up in an environment where they can achieve their full potential. Nat J. Colletta, Jayshree Balachander and Xiaoyan Liang. 1996. The Condition of Young Children in Sub-Saharan Africa : The Convergence of Health, Nutrition and Early Education. Technical Paper no. 326. World Bank, Washington, D.C. To order copies of this paper, please either telephone (703) 661-1512 , fax (703) 661-1501 or e-mail booksint@worldnet.att.net@internet For more information on this subject, please contact Nat J. Colletta: tel. no. (202) 473-4163; e- mail address Ncolletta@worldbank.org