79934 Uganda SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2012 Policy Goals Status 1. Establishing an Enabling Environment The Government of Uganda (GoU) has established national laws and regulations to promote the provision of Early Childhood Development (ECD) services. The Draft National Integrated Early Childhood Development Policy (NIECDP) under development is a crucial step towards establishing an effective enabling environment and comprehensive ECD system. Once approved, the NIECDP should be followed by a costed implementation plan and clearly defined coordination mechanisms should be in place to ensure the provision of integrated ECD services. 2. Implementing Widely Despite the Government’s efforts to ensure access to essential ECD services for all children, coverage levels remain low, particularly for children from disadvantaged families and those living in marginalized areas. ECD service delivery should be expanded in all sectors to ensure that children have the opportunity to reach their full potential in life. 3. Monitoring and Assuring Quality Uganda has developed minimum quality standards and requirements in the health and education sectors. Compliance mechanisms should, however, be enforced and regulated. Child development outcome indicators are collected in the health and nutrition sectors, but not in the education sector. A comprehensive child development tracking system should be established across sectors in order to expansively measure a child’s early childhood development. THE WORLD BANK UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 This report presents an analysis of the Early Childhood documents, data and literature, and interviews with a Development (ECD) programs and policies that affect young range of ECD stakeholders, including government officials, children in Uganda and recommendations to move forward. service providers, civil society, development partners and This report is part of a series of reports prepared by the scholars. The SABER-ECD framework presents a holistic World Bank using the SABER-ECD framework 1 and includes and integrated assessment of how the overall policy analysis of early learning, health, nutrition and social and environment in a country affects young children’s child protection policies and interventions in Uganda, along development. This assessment can be used to identify how with regional and international comparisons. countries address the same policy challenges related to ECD, with the ultimate goal of designing effective policies Uganda and Early Childhood Development for young children and their families. The Republic of Uganda is a landlocked low-income Box 1 presents an abbreviated list of interventions and country with a GDP per capita of USD 487 and ranks 161st policies that the SABER-ECD approach looks for in in the UNDP Human Development Index. Uganda’s countries when assessing the level of ECD policy population is estimated at 35.8 million people, of which development. This list is not exhaustive, but is meant to almost half (49.9 percent) is below 14 years of age. Over provide an initial checklist for countries to consider the key the last decade, child mortality has significantly declined in policies and interventions needed across sectors. Uganda from 175 per 1000 births in 1990 to 99 per 1000 births in 2010. Yet, this rate remains remarkably high. Three Key Policy Goals for Early Childhood Malnutrition is a significant public health problem in Development Uganda, particularly for young children; 38 percent of children below the age of 5 are stunted and 16 percent are SABER-ECD identifies three core policy goals that under weight. Children enter the primary cycle countries should address to ensure optimal ECD unprepared: preprimary enrollment rates are very low and outcomes: Establishing an Enabling Environment, too many children lack the necessary services to reach Implementing Widely and Monitoring and Assuring their potential in life. Quality. Improving ECD requires an integrated approach to address all three goals. As described in Figure 1, for SABER – Early Childhood Development each policy goal, a series of policy levers are identified, through which decision-makers can strengthen ECD 2. SABER – ECD collects, analyzes and disseminates Strengthening ECD policies can be viewed as a comprehensive information on ECD policies around the continuum; as described in Table 1, countries can range world. In each participating country, extensive from a latent to advanced level of development multisectoral information is collected on ECD policies and within the different policy levers and goals. programs through a desk review of available government Snapshot of ECD indicators in Uganda with regional comparison Uganda Ethiopia Kenya Tanzania Infant Mortality (deaths per 1,000 live births) 63 68 55 50 Under-5 Mortality (deaths per 1,000 live births) 99 106 85 76 Children below 5 with moderate/severe stunting (2006-10) 38% 51% 35% 42% Gross Preprimary Enrollment Rate (36-59 months, 2007-2010) 12% 4% 51% 33% Births attended by a skilled attendant 42% 6% 44% 49% Birth registration 2000-2010 21% 7% 60% 16% Source: UNICEF MICS Country Statistics, 2010 2 1 These policy goals were identified based on evidence from SABER-ECD is one domain within the World Bank initiative, impact evaluations, institutional analyses and a Systems Approach for Better Education Results (SABER), benchmarking exercise of top-performing systems. For which is designed to provide comparable and comprehensive further information see “Investing Early: What Policies assessments of country policies. Matter� (World Bank, forthcoming). SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 2 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Box 1: A checklist to consider how well ECD is promoted at the country level What should be in place at the country level to promote coordinated and integrated ECD interventions for young children and their families? Healthcare • Standard health screenings for pregnant women • Skilled attendants at delivery • Childhood immunizations • Well-child visits Nutrition • Breastfeeding promotion • Salt iodization • Iron fortification Early Learning • Parenting programs (during pregnancy, after delivery and throughout early childhood) • Childcare for working parents (of high quality) • Free preprimary school (preferably at least two years with developmentally appropriate curriculum and classrooms, and quality assurance mechanisms) Social Protection • Services for orphans and vulnerable children • Policies to protect rights of children with special needs and promote their participation and access to ECD services • Financial transfer mechanisms or income supports to reach the most vulnerable families (could include cash transfers, social welfare, etc) Child Protection • Mandated birth registration • Job protection and breastfeeding breaks for new mothers • Specific provisions in judicial system for young children • Guaranteed paid parental leave of least six months • Domestic violence laws and enforcement • Tracking of child abuse (especially for young children) • Training for law enforcement officers in regards to the particular needs of young children Policy Goal 1: Establishing an Enabling Policy Lever 1.1: Environment Legal Framework  Policy Levers: Legal Framework • The legal framework comprises all of the laws and Intersectoral Coordination • Finance regulations which can affect the development of young children in a country. The laws and regulations which An Enabling Environment is the foundation for the impact ECD are diverse due to the array of sectors design and implementation of effective ECD policies. which influence ECD and because of the different An enabling environment consists of the following: the constituencies that ECD policy can and should target, existence of an adequate legal and regulatory including pregnant women, young children, parents, framework to support ECD; coordination within sectors and caregivers. and across institutions to deliver services effectively; and, sufficient fiscal resources with transparent and efficient allocation mechanisms. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 3 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Figure 1: Three core ECD policy goals Table 1: ECD policy goals and levels of development Level of Development ECD Policy Goal Developed legal Establishing Non-existent legal Minimal legal framework; some Regulations in some framework; robust inter- framework; ad-hoc programs with sustained sectors; functioning inter- an Enabling financing; low inter- financing; some inter-sectoral sectoral coordination; institutional Environment coordination; sustained sectoral coordination. coordination. sustained financing. financing. Universal coverage; Low coverage; pilot Coverage expanding but gaps Near-universal coverage in comprehensive Implementin programs in some sectors; remain; programs established in some sectors; established strategies across sectors; g Widely high inequality in access a few sectors; inequality in programs in most sectors; integrated services for and outcomes. access and outcomes. low inequality in access. all, some tailored and targeted. Information on outcomes Information on Information on outcomes at at national, regional and outcomes from national Monitoring Minimal survey data national level; standards for local levels; standards for to individual levels; available; limited standards and Assuring for provision of ECD services exist in some sectors; services exist for most standards exist for all Quality no system to monitor sectors; system in place to sectors; system in place services; no enforcement. compliance. regularly monitor to regularly monitor and compliance. enforce compliance. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 4 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 National laws and regulations promote appropriate Centre has further developed the learning framework for dietary consumption by pregnant women and young ECCE in Uganda. children. In accordance with WHO recommendations3, the Uganda Food and Nutrition Policy mandates the National laws and regulations promote opportunities for iodization of salt and iron fortification of food staples. In parents and caregivers to provide care to newborns and 2009, the Nutrition Section of the Ministry of Health infants in their first year of life. The Employment Act of (MoH) developed the Operational Framework for 2006 mandates the provision of parental leave in Uganda. Nutrition following the publication of the 2008 Lancet Women are entitled to 60 working days of maternity leave Series on Maternal and Child Under-nutrition. In paid at full salary and job guarantee upon return to work. collaboration with development partners and key nutrition Men are entitled to 4 working days of paternity leave paid stakeholders, the MoH identified a defined package of at full salary immediately after the delivery or miscarriage nutrition interventions, which will be scaled up through of a child and job guarantee. This leave policy applies to family-based and community-based service delivery employees of both the public and private sectors. Table 2 channels. This package includes a range of nutrition provides a sample of leave policies from the East and interventions: Iron and Folic acid (IFA) for pregnant Southern Africa sub- region. women; promotion and support for exclusive It is important to note that given the high proportion of breastfeeding and for continued breastfeeding at least to people employed in the informal sector in Uganda 24 months; Vitamin A supplementation for lactating (estimated at around 90 percent), the vast majority of mothers and for children 6 to 59 months; counseling to parents do not, in reality, benefit from paid parental leave. encourage increased food intake and day time rest during pregnancy; deworming of children aged 1 to 14 years; National laws and regulations mandate healthcare for control of iodine deficiency disorders; and food pregnant women and young children. In 2009, the MoH fortification especially of complementary foods. The developed its new Health Sector Strategic Plan (HSSP) International Code of Marketing of Breast Milk Substitutes 2010/2011-2014/2015 which includes Maternal and – an international health policy framework for Child Health (MCH) as a major component of the plan. breastfeeding promotion adopted by the World Health In accordance with WHO recommendations, the Organization – is enshrined in law in Uganda. Adherence Ugandan National Expanded Program for to the provisions suggested in the Code is mandatory. Immunizations (UNEPI) requires that all children receive a complete course of immunizations 4. Young children National laws and regulations do not adequately are required to attend periodic well-child visits. promote early learning. The Education Act 2008 registers Additionally, referral systems are in place to direct preprimary education as the first level of education. young children and parents to additional services, as Building upon the Dakar Framework for Action (2000), to necessary. Pregnant women are required to have health which Uganda is signatory and which underscores the screenings for sexually-transmitted diseases (STDs) and importance of Early Childhood Care and Education (ECCE) to be tested for HIV/AIDS. Other key health services as part of a comprehensive approach to achieving provided free of charge include: labor and delivery; Education For All (EFA), the Ministry of Education and insecticide treated bed net provision for pregnant Sports (MoES) of Uganda developed the education women; growth monitoring and promotion; antennal focused ECD Policy (2007) to govern the provision of ECCE check-up for pregnant women; diarrhea treatment; services. This Policy targets all children below 8 years of malaria treatment; upper respiratory tract infection age – with the government being responsible for providing treatment; antibiotic treatment for pneumonia; services for children between 6 to 8 years and the private treatment to prevent mother-to-child transmission of sector taking on the function of providing ECD services for HIV/AIDS; anti-retroviral treatment for HIV/AIDS; and children 0 to 5 years. The GoU-Curriculum Development Tuberculosis treatment. 3 4 The WHO Recommendations on Wheat and Maize Flour EPI complete course of immunizations targets nine vaccine Fortification includes fortification with iron, folic acid, zinc, preventable diseases: tuberculosis; diphtheria; pertussis; vitamin B12, and Vitamin A. tetanus; poliomyelitis; measles; hepatitis B; Haemophilus influenza type b; and yellow fever. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 5 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Table 2: Regional comparison of parental leave policies Uganda Ethiopia Kenya Tanzania 60 days of maternity leave at A minimum of 90 days paid 60 days of maternity leave at A minimum of 90 days paid 100% of salary; 4 days of maternity leave at 100% salary 100% of salary; 10 days of maternity leave at 100% parental leave at 100% of for women; no paternity leave for paternity leave at partial pay. salary; no paternity leave for salary. fathers. fathers. National laws and regulations promote child protection According to Children’s Act (chapter 59), the and care for disadvantaged children in Uganda (Box 2). Government operates “Approved Homes�, which The Births and Deaths Registration Act (Chapter 309) provide alternative family care until parents are able to mandates the registration of the birth and the death of provide basic needs and enough care to a child or until each child. The birth of a child must be registered within the child becomes 18 years of age. 3 months from the date of birth, failure of which is considered as an offense. The registration period could The National Judicial System has established specialized be exceptionally extended to 6 months depending on courts to ensure the protection of young children in the reason for late registration. The GoU gives particular Uganda. The Family and Children Court (FCC) has attention to children with special needs: the MoES has jurisdiction to handle child matters. Every child has the developed and approved the draft policy on special right to have a specialized lawyer represent them and needs and inclusive education, which is currently proceedings can be conducted informally to accommodate waiting for approval by the Parliament. Once approved, the child’s needs. Social Welfare Officers and the Police this policy will govern the provision of targeted ECD can intervene as needed to ensure the protection of young services to young children with special needs. children in Uganda. The judicial system further developed the protection of children by mandating the right to a fair trial, and requiring that personnel involved in the Box 2: Key Laws and Regulations Governing administration of juvenile justice receive appropriate ECD in Uganda training. At the local level, the Local Governments Act • The Children Act (Chapter 59 of the Ugandan (Chapter 243) stipulates that, “each local government council has the responsibility to safeguard the welfare and Constitution) protection of all children in their area.� Local government • The United Nations (UN) Convention on the Rights councils are also entitled to re-unite children who are of the Child separated from their parents and guardians. • The UN Optional Protocol on the Sale of Children and Child Prostitution and on Involvement of Policy Lever 1.2: Children in Armed Conflict Intersectoral Coordination • The Hague Convention on the Civil Aspects of International Child Abduction Development in early childhood is a multi-dimensional • The Convention on the Protection of Children in process. In order to meet children’s diverse needs during the early years, government coordination is Respect of Inter-Country Adoption essential, both horizontally across different sectors as • The African Charter on the Rights and Welfare of well as vertically from the local to national levels. In the African Child many countries, non-state actors (either domestic or • Adopted National Laws including: the Education international) participate in ECD service delivery; for Act 2008, the Employment Act, the Births and this reason, mechanisms to coordinate with non-state Deaths Registration Act (Chapter 309), the actors are also essential. National Council for Children Act (Chapter 60), Uganda has a multi-sectoral ECD policy that is still in draft Local Governments Act (Chapter 243), the Prisons form and awaiting finalization and approval. The National Integrated Early Childhood Development Policy SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 6 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 (NIECDP) is the first of its kind in Uganda and signals the Uganda. Presently, it is leading and coordinating the country’s increased commitment to its youngest development of the NIECDP. A multi-sectoral ECD citizens. It is a holistic policy that includes the sectors of Taskforce has been established to develop this holistic education, health, nutrition, childcare and protection, ECD policy. This Taskforce is comprised of and water and sanitation. Its primary objective is to representatives from relevant government Ministries, ensure an integrated approach to the implementation including: Ministries of Health, Education, Justice, and delivery of quality ECD services and to enhance Gender, Agriculture, Internal Affairs and Kampala coordination and cohesion amongst the many ECD Capital City Authority. Non-government ECD stakeholders to create a unified ECD system in Uganda. stakeholders also take part, including representatives The policy development process started in 2011, and from UNICEF, Plan International, National Council for the NIECDP is awaiting finalization and official approval. Children, and Uganda Children’s Rights Network. The The central government is responsible for the design of Taskforce meets on a quarterly basis and reports to the ECD policy in Uganda, however, the responsibility of MoGLSD. No ECD-specific budget has been allocated – implementation and ECD service provision falls to the however, the MoGLSD has been using funds from its local governments. policy development budget to finance the ECD Taskforce’s work. Figure 2 displays the structure of the Uganda has established an institutional anchor to lead national ECD Taskforce. Uganda’s ECD system currently ECD policy and coordinate across sectors. The Ministry operates in silos with limited service delivery of Gender, Labor and Social Development (MoGLSD) is coordination and low coverage. Box 3 provides insight mandated to lead all activities that affect children in and lessons from the Tanzania experience. Figure 2: Structure of the national ECD Taskforce SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 7 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Box 3: Lessons from Tanzania: Achieving effective multi-sectoral coordination In the early 2000s, Tanzania’s level of inter-sectoral coordination for ECD service provision was similar to Uganda. Sectors operated in silos, and little coordination was observed amongst the main ECD service providers. To remedy this, three national committees on ECD were established in 2006: the National Steering Committee, the National Technical Committee, and the National ECD Secretariat. Officially, these committees are tasked with: setting policies for ECD; establishing standards for service delivery; monitoring quality of ECD services; and coordinating across different entities and agencies. The Steering Committee meets semi-annually and the Technical Committee and ECD Secretariat meet quarterly. In addition, an engaged group of development partners has formed the ECD Working Group and regularly interacts with government officials. The Ministry of Community Development, Gender and Children (MCDGC) is the coordinating Ministry for ECD in Tanzania. In addition, focal points have been established in key ministries. Clear structures at the district and ward level are established to coordinate ECD service provision through PMO-RALG. Specific spending levels for ECD health and nutrition Policy Lever 1.3: activities in Uganda are difficult to ascertain. Each of Finance the relevant ministries involved in ECD are responsible for financing their respective interventions. Information While legal frameworks and intersectoral coordination is not available on any explicit criteria used for the are crucial to establishing an enabling environment for allocation of ECD funding. In addition, no national policy ECD, adequate financial investment is key to ensure has established a minimum level of public funding for that resources are available to implement policies and ECD and no mechanisms have been put in place to achieve service provision goals. Investments in ECD can coordinate budgeting across ministries. yield high public returns, but are often undersupplied without government support. Investments during the Data from the Government are not available for health early years can yield greater returns than equivalent and nutrition expenditures. However, as shown in Table investments made later in a child’s life cycle and can 3, the World Health Organization Global Health lead to long-lasting intergenerational benefits 1. Not Expenditure Database reports that, at the household only do investments in ECD generate high and level, out of pocket expenditures 5 account for 50 persistent returns, they can also enhance the percent of the total expenditure on health in Uganda, effectiveness of other social investments and help which is significantly higher than in neighboring governments address multiple priorities with single countries such as Ethiopia (37 percent), Kenya (43 investments. percent), and Tanzania (14 percent). The share of government spending on healthcare in Uganda is 9 Early Childhood Care and Education (ECCE) centers in percent of GDP, which is a relatively high rate when Uganda are privately managed and no public funding is compared with those in neighboring countries such as allocated to increase access to early learning. According to the ECD Policy 2007, nursery schools/kindergartens are provided through the private sector. The MoES plays a monitoring and regulatory role, in addition to developing the learning framework and producing and disseminating instructional materials. All ECCE centers in Uganda are non-State. The GoU contributes to ECCE through its formal primary 5 education system through which children of “official Out of pocket expenditure is any direct outlay by school age� (6 years) are provided with free basic households, including gratuities and in-kind payments, to health practitioners and suppliers of pharmaceuticals, education in public primary schools. Although the GoU therapeutic appliances, and other goods and services whose recognizes the importance of early learning, no public primary intent is to contribute to the restoration or funding is allocated to increase access to ECE. enhancement of the health status of individuals or population groups. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 8 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Ugandan Shillings UGX (approximately USD 41). The study further underlines some variations observed Table 3: Regional comparison of select health between districts. While districts such as Kiruhura and expenditure indicators Iganga registered the highest monthly pay of UGX 117,778 and UGX 101,000 respectively (approximately Uganda Ethiopia Kenya Tanzania USD 47 and USD 40), Gulu and Luweero districts paid Out of pocket the lowest monthly income 87,857 and 95,500 expenditure as respectively (approximately USD 35 and USD 38). a percentage of all private 64% 80% 77% 42% health Health care professionals are not well compensated in expenditure Uganda. Health sector administration staffs are (PvtHE) compensated with a minimum monthly salary of UGX Out of pocket 496,400 (approximately USD 200) and nurses earn UGX expenditure as 372,300 (approximately USD 150) per month, while % of total 50% 37% 43% 14% health doctor salaries tend to start at UGX 744,600 (USD 300). expenditures Further information is required, including the level of General government government spending on ECD related interventions in expenditure on all essential sectors, in order to fully assess the public 9% 5% 5% 6% health as a sector financial commitment to ECD as a whole. percentage of GDP Policy Options to Strengthen Uganda’s Routine EPI vaccines Enabling Environment financed by 36% 5% 48% 18% government, Legal framework – The GoU has made progress in 2010 adopting national laws and regulations and in ratifying Source: WHO Global Health Expenditure Database, 2010; UNICEF international conventions and protocols to promote ECD. Country Statistics, 2011 The crucial next steps will be the finalization and approval Ethiopia (5 percent), Kenya (5 percent), and Tanzania (6 of the NIECDP and the development of a costed percent). As a percentage of the total private health implementation plan. The current ECD policy delegates expenditures, out of pocket expenditures are 64 the responsibility of ECCE service provision to the private percent in Uganda. Even though data are not specific to sector. The GoU should consider playing its role to the ECD aged population, this figure illustrates that increase access to preprimary school by providing despite the well-established health care policy that incentives and targeted services to the most guarantees free access to health services, beneficiaries disadvantaged children, particularly in the rural areas. It is continue to bear major costs to receive these services. also noteworthy that Uganda has established a strong Only 36 percent of routine EPI vaccines are financed by public-private partnership (PPP) for the provision of the GoU. primary and more intensively lower secondary education. Thus, learning from the ongoing secondary education Early childhood educators are not well compensated in reform program and in cognition of the Universal Basic Uganda. A standardized pay scale has not been Education framework to extend to ECE, the GoU should established to govern the compensation of early further consider forging a viable and sustainable PPP for childhood educators. Because ECCE centers are the provision of ECE. privately managed, each institution decides its own pay scale. According to a recent study undertaken by the Inter-sectoral Coordination – Although Uganda has MoES on the role of ECD in Universal Primary Education established an institutional anchor, it is unclear whether (UPE) Performance (April 2012), an early childhood the MGLSD has adequate resources to effectively play educator earns an average monthly salary of 101,111 its leading role. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 9 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Box 4: Relevant lessons from Mauritius: Financing ECD through conditional cash transfers (CCTs) Summary: The Government of Mauritius has focused policy efforts on increasing preprimary school enrollment in the last decade. In order to encourage parents to enroll their children, the Government provides all families with financial support contingent upon the child attending the final year of preprimary school (age 4 in Mauritius). The transfer amounts to USD 6 per month and has helped achieve an 85 percent enrollment rate in preprimary school for children aged 3 to 5 in Mauritius. Provision is largely through non- State centers (17 percent of all preschools are State-managed), but the design and enforcement of quality control mechanisms has remained central to Government policy efforts. Key considerations for Uganda:  Incentivizing on-time enrollment in preprimary school could help address the significant problem of early enrollment in primary school.  It will be important to determine the appropriate funding level to maximize effectiveness of policy. The established special ECD Taskforce has currently the ECD investment country-wide from all sources. This sole responsibility of developing the NIECDP. Improving exercise will provide policy makers with detailed coordination mechanisms and synergies amongst information to evaluate and monitor the existing relevant government entities and ECD service providers sectoral ECD interventions and identify the most cost is at the heart of this policy. Building the capacity of the effective interventions. MGLSD and the ECD Taskforce could be considered with the idea of forming a national level ECD implementation coordinating body to monitor progress. Policy Goal 2: Implementing Widely Policy Levers: Scope of Programs • Coverage Finance – In education, the current policy which • Equity delegates the responsibility of provision of preprimary education to the private sector limits access, Implementing Widely refers to the scope of ECD programs particularly for disadvantaged children, and quality. The available, the extent of coverage (as a share of the eligible Government should consider revising its current policy population) and the degree of equity within ECD service to increase financial allocation for preprimary education provision. By definition, a focus on ECD involves (at a and providing targeted services to disadvantaged minimum) interventions in health, nutrition, education, children who currently do not benefit from preprimary and social and child protection, and should target education. Options may include capitation grants to pregnant women, young children and their parents and schools specifically for preprimary expenditures and caregivers. A robust ECD policy should include programs in cash transfers or vouchers for disadvantaged families all essential sectors; provide comparable coverage and contingent upon enrolling a child in preprimary school equitable access across regions and socioeconomic status or accessing other ECD services. Furthermore, the multi- – especially reaching the most disadvantaged young sectoral nature of ECD makes it difficult to clearly children and their families. identify and aggregate public financing of ECD, though it is clear that the GoU is allocating funding for ECD related sectoral interventions. The GoU should consider developing a comprehensive methodology for measuring ECD investment. This requires efforts from the different line ministries to disaggregate spending by ECD age group, and potentially include separate budget line item to better capture and monitor ECD spending. It could also be useful to work closely with non-state ECD service providers to capture the scale of SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 10 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 support young children and their families via Policy Lever 2.1: different sectors at different stages in a child’s life. Scope of Programs ECD programs are established in each of the core ECD Effective ECD systems have programs established in areas of focus: education, health, nutrition, and social all essential sectors and ensure that every child and child protection. Within these, there are programs and expecting mothers have guaranteed access to that target the main ECD beneficiaries – young children, the essential services and interventions they need to pregnant mothers, and parents. Interventions targeting live healthfully. The scope of programs assesses caregivers and educators are limited. Figure 4 presents the extent to which ECD programs across key a selection of ECD interventions in Uganda, including sectors reach all beneficiaries. Figure 3 presents sectoral and multi-sectoral interventions. a summary of the key interventions needed to Figure 3: Essential interventions during different periods of young children's development . SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 11 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Figure 4: Snapshot of ECD programs in Uganda Snapshot of Non-State ECD interventions in Uganda Since 2000, UNICEF has been working with the Uganda Registration Bureau (URSB) and local governments to improve the birth registration system in Uganda by introducing the Mobile Vital Registration System (Mobile VRS). Mobile VRS uses mobile technology to facilitate communication between institutions located in different parts of the country and is currently being integrated into the present manual and paper-based registration system. UNICEF continues to work with the GoU to improve the nutritional status of children through targeted Vitamin A supplementation and deworming activities in select regions with the highest prevalence of child poverty rates. Since 1992, Plan Uganda has been working to help marginalized children access health and education services. Plan Uganda continues to work with more than 39,700 young children in five targeted districts (Tororo, Kamuli, Luweero, Kampala, and Lira) and is currently implementing the HIV/AIDs Mother to Child Transmission Prevention Programme in select districts. Child Fund Uganda works to improve education and health services provided to young children and their parents through its Disease Prevention and Healthcare and Early Childhood Development programs. Child Fund continues to support 50 community-based organizations to provide immunization, diarrhea and malaria prevention services and access to clean water and proper sanitation. Child Fund also has built more than 70 ECD centers in 40 communities which provide regular child and maternal health services including, immunization, growth monitoring, training on the prevention and control of infectious disease and hygiene education. Since 1992, the Aga Khan Foundation has been implementing its Madrasa Resource Center Uganda (MRCU) program which works directly with disadvantaged rural, urban and peri-urban communities to support the establishment of community-owned and managed preschools. Through MRCU, 57 community-owned and managed preschools have been established in 10 districts and registered with the Government. Cure Uganda, a faith-based non-profit children’s and specialty teaching hospital, provides health services to children with disabilities in Uganda. CURE Uganda works to 6 eliminate untreated infant hydrocephalus and its preventable causes through treatment and training. Since 2000, Cure Uganda has saved more than 5,000 lives and trained 10 surgeons from nine different countries. 6 Infant hydrocephalus, sometimes referred to as "water on the brain," is one of the most common abnormalities affecting the nervous system of children around the globe. Infant hydrocephalus can exist at birth or be acquired. Hydrocephalus is an abnormal medical condition that develops when the normal flow and absorption of cerebrospinal fluid (CSF) in the brain is hindered or blocked resulting in excessive accumulation of fluid in the ventricles of the brain. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 12 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 While Figure 4 displays some of the major ECD and Child Fund Uganda, to list a few, are active in the programs in Uganda, it does not portray the scale of area of ECD, implementing complementary capacity programs. Table 4 shows that a range of ECD programs building activities in the effort to improve ECD in in Uganda are established in education, health, Uganda. For each sector, a series of specific nutrition, and child and social protection. Many of these interventions are essential to support young children. programs are provided by non-state actors, with Table 4 illustrates that ECD interventions exist across coverage in a limited number of regions in the country. sectors, ranging from education, health, nutrition, Government interventions including, for example, the parenting, special needs, and anti-poverty Expanded Programme on Immunizations, Prenatal programming. While it is commendable that nearly Health Programme, and Breastfeeding Promotion all of the essential interventions exist in the multiple Programs operate country-wide. Yet, the geographical sectors of Uganda, the scale of service delivery is complexities and inadequate infrastructure system also an important consideration. Table 4 also displays makes it difficult to reach children in the most isolated the scale of coverage of selected ECD programs in parts of the country. Alongside the Government, many Uganda, demonstrating that levels of access can vary. development partners, such as UNICEF, Plan Uganda, This will be discussed further in Section 2.2. Table 4: ECD programs and coverage in Uganda Scale ECD Intervention Pilot At scale in Scaling Universal programs some regions Nationally coverage Health Prenatal healthcare X Comprehensive immunizations for infants X Childhood wellness and growth monitoring X Mosquito bed net distribution programs for young children and X pregnant women Education Publicly-provided early childhood care and education Publicly-subsidized early childhood care and education Privately-provided early childhood education X Community-based early childhood care and education X Nutrition Micronutrient support for pregnant women Food supplements for pregnant women X Micronutrient support for young children Food supplements for young children X Food fortification X Breastfeeding promotion programs X Feeding programs in preprimary schools Parenting Parenting integrated into health/community programs Home visiting programs to provide parenting messages X Anti-poverty Cash transfers conditional on ECD services or enrollment Special Needs Programs for OVCs X Comprehensive A comprehensive system that tracks individual children’s needs Source: SABER-ECD Policy and Program Data Collection Instruments . SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 13 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Policy Lever 2.2: The level of access to essential ECD health interventions Coverage for pregnant women is low in Uganda. As displayed in Table 5, 42 percent of births are attended by skilled A robust ECD policy should establish programs in all attendants, and 42 percent of HIV+ pregnant women essential sectors, ensure high degrees of coverage and receive antiretroviral (ARVs) to prevent mother-to-child reach the entire population equitably–especially the transmission (PMTCT). These rates remain low by most disadvantaged young children–so that every child international standards and underscore the necessity of and expecting mother have guaranteed access to enhanced coverage and targeting mechanisms to essential ECD services. ensure that young children and pregnant women The level of access to essential ECD health receive the appropriate services. interventions is low for young children and pregnant The level of access to essential nutrition interventions women. Table 5 presents the level of access to a for young children and pregnant women is low in selection of essential ECD health interventions for Uganda. The level of moderate and severe stunting young children in Uganda and select neighboring amongst children 5 years of age or younger is 38 countries. Currently, 47 percent of young children percent. The impact of stunting on a child’s suspected to have pneumonia receive antibiotics and 39 development is immense. The period between percent of young children suffering from diarrhea conception and the age of two is a window of receive oral rehydration and continued feeding. opportunity to address and prevent the damage caused Although the level of access to these health services in by malnutrition. If not addressed, a child that suffers Uganda is similar to neighboring countries, coverage from malnutrition will not fully develop physically, levels remain very low. For example, just 60 percent of which in turn hinders linguistic, cognitive, and socio- 1 year olds are immunized against DPT. Uganda has the emotional development. In comparison with lowest coverage level among the countries in the region neighboring countries presented in Table 6, the presented here, with Ethiopia, Kenya, and Tanzania prevalence of moderate and severe stunting is higher in having 90 percent coverage or higher. Only 33 percent Uganda than in Kenya. By international standards, the of children below 5 years of age sleep under an level of moderate and severe stunting is extremely high insecticide-treated bed net (ITN) and 60 percent of in all four countries and indicates children are not children with fevers receive anti-malarial medication in receiving the nutrients and balanced diet required to Uganda. maximize physical development. Table 5 : Level of access to essential ECD health interventions for young children and pregnant women Uganda Ethiopia Kenya Tanzania Children below 5 years of age with diarrhea who receive 39% 15% 43% 50% oral rehydration and continued feeding (2006-2010) 1 year olds immunized against DPT 60% 90% 93% 91% Children below five years of age suspected of pneumonia 47% 5% 50% No data who receive antibiotics (2006-2010) Children below five years of age who sleep under an 33% 33% 47% 64% insecticide-treated bed net (2006-2010) Children below five years of age with fever receiving anti- 60% 10% 23% 59% malarial drugs (2006-2010) Births attended by skilled attendants (2006-2010) 42% 6% 44% 49% HIV+ pregnant women and HIV exposed infants who No data No data 43% 59% receive ARVs for PMTCT Source: UNICEF MICS Country Statistics, UNAIDS Country Fact Sheets SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 14 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Table 6 : Level of access to essential ECD nutrition interventions for young children and pregnant women Uganda Ethiopia Kenya Tanzania Children below five years of age suffering from moderate 38% 51% 35% 42% & severe under nutrition (2006-2010) Vitamin A supplementation coverage (6-59 months) (2010) No data 84% 62% 99% Infants with low birth weight (2006-2010) 14% 20% 8% 10% Infants exclusively breastfed until 6 months of age (2006- 60% 49% 32% 50% 2010) Population that consumes iodized salt (2006-2010) 96% 20% 98% 59% Prevalence anemia in pregnant women 41% 63% 55% 58% Source: UNICEF MICS Country Statistics; WHO Global Database on Anemia, Vitamin A. Table 6 illustrates the nutritional status of young send children below the official primary school entry children and pregnant women in Uganda and some age to public primary schools as many of them could neighboring countries. Breast milk is considered to be not afford to pay for private preschools. As a result of the best method to feed an infant during the first six this, the MoES advised public primary schools that had months of life, giving the child all the nutrients and extra classrooms available to provide preprimary calories needed for proper growth and development. education services and to charge fees to cover the Uganda has the highest performance with 60 percent of salary of the educators and other school needs. Yet, as children being exclusively breastfed until 6 months of many primary schools do not have sufficient age. Yet, approximately 14 percent of infants are of low classrooms, many young children are enrolled in highly birth weight, and 41 percent of pregnant women have crowded classrooms. As an illustration, in a Nursery anemia. School in Kampala, 183 preschoolers are housed in four classrooms and further expansion is a concern given the The level of access to early childhood care and increasing high demand for preprimary education from education services is limited in Uganda. Preprimary the surrounding communities. education in Uganda caters to children aged 0 to 6 and is not compulsory. Preschool establishments include: ECCE is included in the Education Act of Uganda as the daycare, home-based or community-based centers first level of education. While the GoU recognizes the providing fully institutionalized care for half or full day importance of ECCE and officially children aged 3 to 5 for children below 3 years; nursery years old are expected to be enrolled in preprimary schools/kindergartens providing preprimary education institutions, the MoES is only responsible for the to children 3 to 6 years; and lower primary school provision of the education services to children starting classes (P1-P3) providing formal basic primary from the official school entry age of 6 years old, as part education to children of school going age of 6+ years. of the formal primary education system. Thus, all ECCE The official entry age to this cycle of primary school is 6 centers are owned and managed by the non-State years and the Government focuses on the 6-8 year olds sector. According to a recent study undertaken by the that attend the lower primary education cycle through MoES 7 (based on data from the Education Management the universal education program. Yet, all ECD centers Information System 2011), a total number of 7,368 and kindergartens that provide ECCE services are ECCE centers exist in the entire country. Figure 5 shows managed by the private sector and many are profit the percentage share of ECCE Centers by type. motivated, which has negatively impacted Uganda’s level of access to preschool. It is also noteworthy that, following the free universal primary education declaration in Uganda in 1997, some parents tended to 7 The role of Early Childhood Development in Universal Primary Education Performance: Improvement in Uganda (April 2012). SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 15 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Figure 5: Percentage share of ECCE centers by type 2010/11 Community- Home-based based 1.30% 16.70% Daycare centers 0.70% Nursery 81.30% Source: MoES, EMIS 2011 Figure 6: Preprimary school enrollment and school going population (3 to 5years) Source: MoES, EMIS 2011 As presented in Figure 5, nursery constitutes the percentage of the population aged 3 to 5 is 9 percent majority with a percentage share of 81.3 (5,990), (2011) which translates into a gap of 91 percent. The followed by community based centers with a share of Study further examined preschool enrollment gap with 16.7 percent (1,230). Home based centers accounted respect to age through a study of the Net Enrollment for 1.3 percent (96 centers) while day care centers Rate 8 (NER). If all children aged 3 to 5 years are enrolled comprised the least share of only 0.7 percent (52 in preschool, the NER will be 100 percent. Since 2003, centers). The majority of the Centers are located in there has been a gradual increase of NER. Yet, in 2011, urban and peri-urban areas putting the rural children at only 6.6 percent of preschool going age children a disadvantage. attended preprimary school. The Study further shows a consistent gap between Apart from the development of the learning framework preschool enrollment levels and the population of and development of the ECD Policy, the GoU’s efforts to eligible children aged 3 to 5 during the last ten years. promote early learning are not adequate to meet existing Figure 6 illustrates the gap between enrollment in gaps and increasing needs. The private preschools are preprimary schools and the preprimary school going concentrated in urban areas where the income levels are population (3 to 5 years) in Uganda. higher which disfavors young children in rural area Since 2007, a slight increase is observed in the proportion of children attending preschool. Yet, the 8 The number of children of official preprimary school age (3 to 5 proportion of children enrolled in preschool as a years) who are enrolled in preprimary education as a percentage of the total children of the official preprimary school age population. SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 16 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 from the UNICEF Multiple Indicator Cluster Survey Policy Lever 2.3: (MICS), Figure 7 and Figure 8 illustrate the level of Equity access to a selection of ECD services based of socioeconomic status and geographical location, Based on the robust evidence of the positive effects respectively. Figure 7 compares access to essential ECD ECD interventions can have for children from interventions for the poorest 20 percent of the disadvantaged backgrounds, every government should population with the wealthiest 20 percent of the pay special attention to equitable provision of ECD population, including birth registration rates, skilled services. One of the fundamental goals of any ECD attendants at birth, and the number of children below 5 policy should be to provide equitable opportunities to years of age with diarrhea who receive oral rehydration all young children and their families and continued feeding. Significant discrepancies in The level of access to ECD services is not equitable in coverage exist. The differences in access to skilled Uganda. Preliminary analysis of information on access attendants at birth are particularly remarkable – only to a selection of ECD interventions shows that, overall, 28 percent of poor children have a skilled attendant provision of opportunities to young children and at birth, whereas 76 percent of the wealthiest pregnant women is not equitable in Uganda. Using data children have a skilled attendant at birth. Figure 7: Disparities in access to ECD services and ECD outcomes in Uganda Under-fives with diarrhea Birth registration (%) 2000- Skilled attendant at birth (%) receiving oral rehydration 2010 2006-2010 and continued feeding (%) 2006-2010 Richest 20% 26 76 44 Poorest 20% 17 28 39 Source: UNICEF MICS Country Data SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 17 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Figure 8: Disparities in access to health and child protection services and outcomes by rural/urban location Under-fives with diarrhea Underweight Skilled Birth receiving oral prevalence in attendant at registration (%) rehydration children under birth (%) 2006- 2000-2010 and continued five (%) 2006- 2010 feeding (%) 2010 2006-2010 Urban 24 80 48 11 Rural 21 37 39 17 Source: UNICEF MICS Country Data Figure 8 presents the same three indicators plus by government entities and a range of development prevalence of underweight in children below 5 to partners are also implementing complementary capacity- compare the level of equity by rural and urban building interventions. Once approved, the draft NIECDP locations. As clearly illustrated, inequity exists for all aims to foster coordination amongst the different ECD indicators by urban and rural location. The level of stakeholders in the country. In line with this policy, a inequity is particularly significant in relation to the mapping exercise could be considered to develop a percentage of skilled attendants at birth and percentage database of ECD related interventions to identify of the children below 5 with diarrhea receiving oral potential gaps and possible synergies amongst the rehydration and continued feeding. This highlights the different stakeholders. Interventions targeting parents fact that young children and pregnant women who live are also limited in Uganda: the GoU should consider in rural areas are even more challenged to access the increasing parenting programs in the country. required services to ensure their well-being than the Coverage – Coverage for essential ECD interventions is rest of the population in better equipped urban areas generally low in Uganda. In the education sector, the GoU should consider increasing access to preprimary In the northern part of Uganda, young children and education in line with the Universal Basic Education women continue to suffer from war instability and often framework. Service providers also should ensure that require specialized interventions and targeting only ECD aged children attend primary schools to mechanisms. Investments in ECD can be highly guarantee the provision of age-appropriate education. effective ways to reach marginalized populations and Increasing preprimary coverage could remedy this ensure integration into society from an early age. problem. Despite the Government’s efforts, the level of Particularly given the potential benefits, the needs of access to essential health and nutrition services is not young children suffering from war instability should be adequate. The Government should therefore consider taken into account in policy planning. developing a strategy to improve coverage of health and nutrition services for young children and pregnant women. Policy Options to Implement ECD Widely in Uganda Equity – Currently, young children and pregnant women living in isolated rural areas are not receiving equitable access to essential ECD services. Targeting Scope of Programs – A robust ECD policy should mechanisms should be put in place to ensure that the include all important sectors and reach all ECD most marginalized and those living in isolated areas are stakeholders. In Uganda, ECD interventions are provided guaranteed access to existing ECD interventions. The SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 18 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 provision of preprimary education through private Uganda’s Education Management Information System providers disproportionately disfavors children from (EMIS) collects data on young children’s access to ECE. disadvantaged families. The majority of the ECCE Uganda’s EMIS collects data on ECE enrollment at the centers are located in urban and peri-urban areas national, regional and district levels through an annual putting the rural children at a disadvantage. The GoU school census. EMIS data differentiate children’s access should consider providing preprimary education to ECE by age, gender, and special needs. Results targeted to the most disadvantaged children. CCTs generated by this system are being effectively used in could potentially be considered to remedy this problem. monitoring progress and improving education services Policy planning should further take into consideration in the country. Yet, the current system does not the special needs of young children and mothers in the currently collect data on access by geographical location northern part of Uganda, who are still suffering from (urban/rural), socio-economic background, and mother post-war instability tongue. Drawing comparisons in access for different levels of socioeconomic status and by geographical Policy Goal 3: Monitoring and Assuring location will better inform targeted service provision to disadvantaged and hard to reach population. Thus, the Quality well-established Ugandan EMIS could be developed to  Policy Levers: Data Availability • integrate these parameters. Quality Standards • Compliance with Standards Administrative and survey data are collected on access to health, nutrition, and child and social protection Monitoring and Assuring Quality refers to the existence interventions in Uganda. Uganda’s Health Management of information systems to monitor access to ECD Information System (HMIS) collects data on usage of services and outcomes across children, standards for health facilities at the national, regional and district ECD services and systems to monitor and enforce levels on an annual basis. HMIS data differentiate usage compliance with those standards. Ensuring the quality by child age and by socio-economic status. Uganda of ECD interventions is vital because evidence has participated in UNICEF’s Multiple Indicator Cluster shown that unless programs are of high quality, the Survey (MICS-3). MICS collects and provides a range of impact on children can be negligible, or even household data on access and outcomes related to detrimental. interventions in health, nutrition, education, child protection, and water and sanitation. Table 8 presents a Policy Lever 3.1: series of key indicators that a country could track to Data Availability monitor young children’s development. These Accurate, comprehensive and timely data collection can indicators are divided into both administrative (census promote more effective policy-making. Well-developed data) and survey data (based on sampling of a specific information systems can improve decision-making. In population group). MICS is the primary source for the particular, data can inform policy choices regarding the majority of the health and nutrition indicators discussed volume and allocation of public financing, staff under Policy Levers 2.2 and 2.3. recruitment and training, program quality, adherence to standards and efforts to target children most in need. Table 8: Administrative and survey data collected in Uganda Administrative Data SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 19 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Indicator Collected Special needs children enrolled in ECCE (number of) Yes Children attending well-child visits (number of) Yes Children benefitting from public nutrition interventions (number of) No Women receiving prenatal nutrition interventions (number of) Yes Children enrolled in ECCE by sub-national region (number of) Yes Average per student-to-teacher ratio in non-State ECCE No Is ECCE spending in education sector differentiated within education budget? No Is ECD spending in health sector differentiated within health budget? No Survey Data Indicator Collected Population consuming iodized salt (%) Yes Vitamin A Supplementation rate for children 6 to 59 months (%) Yes Anemia prevalence amongst pregnant women (%) Yes Children below the age of 5 registered at birth (%) Yes Children immunized against DPT3 at age 12 months (%) Yes Pregnant women who attend four antenatal visits (%) Yes Children enrolled in ECCE by socioeconomic status (%) No Child development outcome indicators are not developed the Early Learning and Development collected in all essential sectors. While the health and standards for children aged 0 to 6 years. The document nutrition sectors in Uganda collect child development outlines developmental areas including cognitive outcome indicators, data collection within the development, knowledge, skills and understanding; education, child and social protection sectors are physical development, health and safety; language, limited to service provision and service provider levels. communication, and literacy; social and emotional Uganda does not have a comprehensive system in place development; and, approaches to learning. Based on the to track individual children’s needs and development. identified developmental needs of young children (i.e. Given that comprehensive data collection can promote cognitive, motor, social, emotional, and linguistic rational and effective policy making, it is necessary to development), the National Curriculum Development measure child development outcomes in order to Center (NCDC) further developed the ECD learning monitor children’s development in the four interrelated framework to govern the provision of preprimary domains of physical, cognitive, linguistic, and socio- education for children aged 3 to 6 years. Mother-tongue emotional development. In Uganda, establishing an preschool instruction is mandated in Uganda. According individual child development tracking system across the to the MoES, the ECD learning framework has been different sectors could enable comprehensive and translated into different local languages to ensure responsive monitoring of children’s development. effective use, which include: Luganda, Lusoga, Runyoro/Rutooro, Runyankole/Rukiga, Lubwisi, Policy Lever 3.2: Lhukonzo, alur, Lugbara, Langi, Acholi, Leb-thur, Quality Standards Dakirimjong, Polkot, Ateso, Kumam and Dhapadhola. The NCDC further established the Care Giver’s Guide to the Ensuring quality ECD service provision is essential. A ECD learning framework to ensure effective use of the focus on access – without a commensurate focus on preprimary curriculum. Yet, the framework and the ensuring quality – jeopardizes the very benefits that guide have not been widely distributed and nursery policymakers hope children will gain through ECD schools continue to use materials developed by interventions. The quality of ECD programs is directly individuals, some of which tend to cover work more related to better cognitive and social development in similar to primary level education. The MoES should, children. therefore, work to ensure that the ECD learning Early learning standards and preprimary curriculum framework is coherent and continuous with the primary have been established in Uganda. In 2011, the MoES education curriculum. The MoES should also provide the SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 20 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 learning framework in all the 65 local languages as trainees and certificates offered are not accredited by provided for in the constitution for effective promotion any recognized body. and use of the ‘mother-tongue’ instruction approach. The average caregiver-child ratio in ECCE centers in Infrastructure and service delivery standards for ECCE Uganda varies across the regions. According to are well established in Uganda. In July 2010, the MoES international standards for best practice, an optimal introduced “The Guidelines for ECCE Centers� with the learning environment is achieved with an average aim to: i) provide procedures, standards, and caregiver-child ratio not exceeding 1:15 in preschool regulations for operating ECD centers; and ii) build education. As shown in Table 9, a significant disparity coordination and quality control mechanisms that exists in preprimary education provision between the involve different stakeholders at the local council, different regions in the country. The North East region district and national levels. has the highest ratio with 79 children per teacher, while the Central and East regions have a lower ratio with 23 The MoES has established a range of detailed minimum children per teacher. Similarly, the North East region requirements for setting up ECCE facilities to ensure has an extremely high ratio for daycare service that children learn in safe and child-friendly provision with 489 children per caregiver. environments. To list a few, these requirements include: availability of appropriate space; availability of Infrastructure and service delivery standards for health appropriate sanitation and hygiene facilities; teaching facilities are established in Uganda. The MoH has methodical basis; and, availability of teachers with established standards to govern the provision of ECD appropriate education. In addition, the Construction services to young children. Healthcare providers are Management Unit (CMU) of the MoES has established required to complete training in early childhood service specific safety related construction standards for early delivery. The MoH is in charge of ensuring health childhood centers. The MoES further states that facilities’ compliance with construction standards – preschools should operate for 4 to 8 hours daily health posts, centers, and hospitals. depending on parents’ needs. The licensing and registration of ECD centers is the responsibility of local Table 9: Pupil-teacher ratio in preprimary schools governments. In order for a school to obtain a license, in Uganda (2012) the proprietors work closely with the Preschool Region Nursery Daycare Management Committee, District Inspector of Schools Central 23:1 5:1 and the District Education Officer from initial inspection, East 23:1 7:1 to evaluation of infrastructure standards and teacher North East 79:1 489:1 qualifications, to registration. The whole registration North 25:1 14:1 process is free of charge and takes up to two years. South West 27:1 5:1 West 25:1 9:1 Minimum requirements for ECCE professionals are established, yet the MoES does not regulate in-service training program to improve quality of early learning services. The MoES requires that ECCE teachers have a Policy Lever 3.3: minimum level of tertiary education. Preschool teachers Compliance with Standards Establishing standards is essential to providing quality are also required to have a certificate in specialized ECD ECD services and to promoting the healthy course. Although in-service training of ECCE teachers is development of children. Once standards have been not mandatory, under the ECD policy the pre-service established, it is critical that mechanisms are put in training of preschool teachers is the mandate of place to ensure compliance with standards. Kyambogo University. Yet, more than 40 private institutions presently train nursery teachers; courses Registration and accreditation processes exist for offered differ as each institution follows its own centers providing ECD services, but compliance curriculum, has different entry requirements for mechanisms should be reinforced. The MoES mandates that all ECCE institutions must be registered and SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 21 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 accredited. The first step in the registration process to Quality Standards – While the MoES indicates that seek permission to operate an ECCE center is to call for Kyambogo University has the mandate to govern the inspection. Once approved, a provisional license is given provision of preschool teacher training, in practice, a for service provision for up to two years. After two range of private institutions are involved in teacher years of service, inspectors should inform the training. It is therefore highly recommended that the Permanent Secretary that the center is satisfactorily MoES streamline training as well as standardize the operating according to the established requirements – remuneration of preschool teachers to promote the only then the Center is given a Certificate of registration status of the early learning profession in the country. and classification. Despite the well-established registration and accreditation processed, no regular Compliance with Standards – While minimum inspections are conducted. standards and requirements for quality assurance in health and education sectors are established, Similarly, preschool educators are only qualified to monitoring and compliance mechanisms should be teach for a period of two years before they are fully strengthened. Great efforts have been made in the certified. Teachers’ performance is required to be development of the early learning framework, teaching assessed through regular inspections and mentoring. materials and guides; yet, the effective use of these Yet, this process has not been effectively applied as materials could be facilitated through incentives and ECCE educators are directly managed by private enforcement mechanisms, where appropriate. institutions. Comparing Official Policies with Outcomes Policy Options to Monitor and Assure ECD The existence of laws and policies alone do not always guarantee a correlation with desired outcomes. In Quality in Uganda many countries, a disconnect exists between policy Data availability – Comprehensive data collection can intent and the reality of implementation and service promote effective policy-making, allowing for improved delivery on the ground. In the case of Uganda, a strong decision-making. Child outcome indicators are essential correlation between policies/national programs and in the policy-making and decision-making process. It is implementation is reflected in a selection of ECD focus highly recommended that child outcome indicators are areas such as infant breastfeeding and iodized salt collected in all essential ECD sectors to better inform consumption. However, despite the recognition and comprehensive ECD implementation moving forward. desire to ensure the registration of birth, only 21 Both EMIS and HMIS collect data and differentiate data percent of children are registered. While it is a legal by a select number of indicators such as child age and requirement that children receive a complete course of gender. It is recommended that both data collection childhood immunizations, yet only 60 percent of 1 year systems be improved to comprehensively collect data to old children are immunized. Table 10 shows the status enable Government and ECD stakeholders to identify of these comparisons in a selection of ECD activities. coverage gaps and particular development needs of These discrepancies between policy intent and outcome marginalized populations. indicate a need to examine the policies and their implementation. Table 10: Comparing policy intent with ECD outcomes in Uganda Policy Outcomes Ugandan policy complies with the International Rate of exclusive breastfeeding until six months: Code of Marketing of Breastmilk Substitutes 60% SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 22 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Uganda has a national policy to mandate the Household consumption of iodized salt: iodization of salt 96% Preschool/kindergarten is not mandatory for any Preprimary school enrollment: child age 6.6% Young children are required to receive a complete Children with DPT (1 year old): course of childhood immunizations 60% National policy mandates the registration of children Completeness of birth registration: at birth 21% Table 11: Comparing policy intent with ECD outcomes in East Africa Comparing Policies with Outcomes in East Africa Uganda Ethiopia Kenya Tanzania Salt Iodization Salt Iodization Policy Mandatory Mandatory Mandatory Mandatory Population Consuming Iodized Salt 96% 20% 90+% 59% Appropriate Infant Feeding and Breastfeeding Promotion Compliance, Code of Marketing of Law Some provisions Law Breast Milk Substitutes law Exclusive Breastfeeding until 6 Months 60% 49% 32% 50% Pre-Primary Education Not Compulsory; Not compulsory; Government Government Not compulsory; Not compulsory; Preprimary School Policy non-State provision finances recurrent finances recurrent free 2 years State costs; user fees cost; user fees provision common common Preprimary School Enrollment Rate 6.6% 4.8 or 11% 42% 33% Birth Registration Birth Registration Policy Mandatory Mandatory Mandatory Birth Registration Rate 21% 7% 22% Table 11 summarizes key policy provisions in East Africa, Preliminary Benchmarking and International along with related outcomes. Despite mandatory salt Comparison of ECD in Uganda iodization policies in all four countries, household consumption of iodized salt varies from a low of 20 Table 12 presents the findings from the SABER - Early percent in Ethiopia to a high of 96 percent in Uganda. Childhood Development assessment of ECD policy in Birth registration seems to be a challenge throughout the Uganda. Uganda has an emerging Enabling region; all four countries have mandatory registration Environment with a range of national laws and policies – these policies, however are currently yielding regulations guaranteeing the provision of essential registration rates of less than a quarter of the population ECD services. Implementing Widely is deemed in each country. emerging in Uganda. Although programs are established in all essential sectors, coverage levels remains low and universal coverage for the eligible beneficiary population in all essential sectors is yet to be achieved. Monitoring and Assuring Quality is also SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 23 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Table 12: Classifying the level of ECD policy development in Uganda Table 13: International classification and comparison of ECD systems emerging, with key quality standards being developed, Table 13 presents the status of ECD policy development but requiring further regulation and compliance in Uganda alongside a selection of OECD reinforcement mechanisms. and neighboring countries. Sweden is home to SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 24 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 one of the world’s most comprehensive and Table 14 summarizes the key policy options identified to developed ECD policies and achieves a benchmarking inform policy dialogue to improve the provision of of “Advanced� in all nine policy levers. essential ECD services in Uganda. The finalization and approval of the draft NIECDP is a critical step in Conclusion the establishment of well-functioning ECD system. The SABER-ECD initiative is designed to enable ECD Resources and technical support must be directed policy makers and development partners to identify towards strengthening the development of a opportunities for further development of effective ECD comprehensive ECD system in Uganda, including systems. The SABER-ECD classification system does not the expansion of coverage in some sectors as rank countries according to any overall scoring; rather, well as the development of an effective individual it is intended to share information on how different ECD child development tracking system. Many systems address the same policy challenges. This development partners are active in the field of Country Report presents a framework to benchmark ECD in Uganda and could provide support to these Uganda’s ECD system; each of the nine policy levers are efforts. Building the capacity of the special examined in detail and some policy options are ECD Taskforce and the Lead Ministry is a crucial step recommended. in this effort to provide integrated essential ECD services to young children and pregnant women. Table 14: Summary of policy options to strengthen the ECD system in Uganda Policy Policy Options Dimension • Approve the draft NIECDP as a matter of priority • Develop and approve a costed implementation plan for NIECDP • Build the capacity of the MGLSD to lead ECD activities • Build the capacity of the special ECD Taskforce • Increase financial allocation to the preprimary sub-sector to provide targeted Establishing an services to disadvantaged children: options may include capitation grants to Enabling schools specifically for preprimary expenditures and cash transfers or Environment vouchers for disadvantaged families contingent upon enrolling a child in preprimary school • Consider creating separate line items to disaggregate ECD spending • Consider some form of public provision or subsidization of preprimary education • Undertake a mapping exercise to identify existing ECD interventions • Increase access to preprimary education services Implementing • Improve coverage of health and nutrition services for young children and Widely pregnant women • Target programs to reach marginalized children and pregnant women • Ensure that child development outcome indicators are collected in all essential sectors • Enforce monitoring and compliance mechanisms to ensure that established Monitoring and standards are met Assuring Quality • Streamline teacher training and standardize preschool educators’ remuneration system • Address the high disparities between regions in terms of teacher to pupil ratios SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 25 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 Acknowledgements instruments and data from external sources. The report This Country Report was prepared by the SABER-ECD was prepared in consultation with the Uganda team and team at World Bank headquarters in Washington, DC. the Government of Uganda. For technical questions or The report presents country data collected using the comments about this report, please contact the SABER- SABER-ECD policy and program data collection ECD team (helpdeskecd@worldbank.org). SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 26 UGANDA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012 www.worldbank.org/education/saber The Systems Approach for Better Education Results (SABER) initiative produces comparative data and knowledge on education policies and institutions, with the aim of helping countries systematically strengthen their education systems. SABER evaluates the quality of education policies against evidence-based global standards, using new diagnostic tools and detailed policy data. The SABER country reports give all parties with a stake in educational results—from administrators, teachers, and parents to policymakers and business people—an accessible, objective snapshot showing how well the policies of their country's education system are oriented toward ensuring that all children and youth learn. This report focuses specifically on policies in the area of Early Childhood Development. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. THE WORLD BANK SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 2