The integration and coordination of health, education, nutrition, social protection, and other services have the potential to improve the lives of children and their caregivers around the world. However, integration and coordination of policies and programs affecting early childhood development can create both risks and benefits. In different localities, these services are more or less effective in achieving their objectives. They also are more or less coordinated in delivering services to the same recipients, and in some cases services are delivered by integrated multisectoral organizations. The result is a rich arena for policy analysis and change and a complex challenge for public- and private-sector organizations that are seeking to improve the lives of children.
To examine the science and policy issues involved in coordinating investments in children and their caregivers, the Forum on Investing in Young Children Globally held a workshop in Hong Kong on March 14–15, 2015, titled “Using Existing Platforms to Integrate and Coordinate Invest-
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1 The planning committee’s role was limited to planning the workshop. The workshop summary has been prepared by the rapporteur (with the assistance of Charlee Alexander, Kimber Bogard, Maya Ramachandran, Carrie Vergel de Dios, and Mariana Zindel) as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Institute of Medicine. They should not be construed as reflecting any group consensus.
BOX 1-1
Workshop Statement of Task
An ad hoc committee will plan and conduct an interactive public workshop featuring presentations and discussions that highlight the science and economics of coordinating investments in children and their caregivers using existing platforms across areas of health, education, nutrition, and social protection. Platforms will be broadly conceived to include settings, such as schools and community-based centers, as well as other types of platforms such as community outreach, child rights, and funding streams. Public- and private-sector efforts will be included as well as data on costing and financing service integration within existing platforms. The results of the workshop will inform research, policy, and practice regionally as well as globally.
Speakers will explore questions about what it takes to set up, implement, and scale integrated or coordinated services within existing platforms. Examples will be drawn from low-, middle-, and high-income countries and focus on vulnerable populations, such as children who are indigenous, migrating, or with disabilities. Special attention will be paid to diverse cultural contexts within which children and families access and receive services. In addition, systems and governance issues that facilitate or create barriers to coordinating investments and service delivery will be explored.
The committee will identify specific topics to be addressed, develop the agenda, select and invite speakers and other participants, and moderate the discussions. An individually authored summary of the presentations and discussions at the workshop will be prepared by a designated rapporteur in accordance with institutional guidelines.
ments for Children.”2Box 1-1 provides the full statement of task for the workshop and Box 1-2 describes the forum and its objectives. Appendix A provides a list of acronyms used in this report, and Appendix B contains the workshop agenda. Held in partnership with the Centre for Health Education and Health Promotion and Wu Yee Sun College of the Chinese University of Hong Kong, the workshop brought together researchers, policy makers, program practitioners, and other experts from 22 countries for a day and a half of presentations and discussions. In his introductory remarks at the forum, the founding master of Wu Yee Sun College,
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2 Forum activities highlight the science and economics of integrated investments in young children living in low-resourced regions of the world across the areas of health, nutrition, education, and social protection. Moreover, given that caregivers of young children are key to children’s access to health, education, nutrition, and social protection, the forum takes a life course approach and addresses issues related to reproductive health, economic opportunity, and access to quality child care and education programs for caregivers.
BOX 1-2
The Forum on Investing in Young Children Globally
Launched in January 2014 after 1 year of planning, the Forum on Investing in Young Children Globally is a collaborative community of experts working to ensure that investments in children and their caregivers around the world are a top priority informed by science. The forum is seeking to create and sustain, over 3 years, a community of stakeholders across northern and southern countries who are seeking to explore existing, new, and innovative science and research from around the world and translate this evidence into sound and strategic investments in policies and practices that will make a difference in the lives of children. It is using a variety of methods to pursue this objective, including dialogue, workshops, tool development, and multimedia communications, including reports, news, videos, a website, and infographics. Sponsored by more than 20 organizations, the forum is a unique learning community that is evidence driven, international, collaborative, visionary, and practical.
Three previous workshops have focused on the cost of inaction, financing investments in young children, and scaling up those investments. Brief summaries of the workshops are available at the forum’s website, http://iom.nationalacademies.org/activities/children/investingyoungchildrenglobally.aspx, and full summaries are available from the National Academies Press (http://www.nap.edu).
Rance Lee, pointed to the parallels between the workshop objectives and the mission of the college, which is to combine “entrepreneurial spirit with social responsibility.” Said Lee: “This forum will no doubt inspire innovative ideas about how we should and could invest in our younger generations strategically.”
OVERVIEW AND PROMINENT TOPICS OF THE WORKSHOP
Physical, cognitive, social, and emotional skills are intertwined across the life course, especially during the first years of life. This creates a complicated policy challenge for governments in supporting the multiple domains of early childhood development, said Hiro Yoshikawa, Courtney Sale Ross University Professor of Globalization and Education at New York University. Typically, the services associated with these domains of development have their own disciplinary perspectives, their own organizational and institutional structures, and often their own ministries within government. Ministries of health, education, social protection, women and children’s issues, child protection, and economic issues can be arranged quite differently among nations and even among the national, subnational, and local levels.
The workshop in Hong Kong was an opportunity for the forum to explore how these sectors work together and how their activities, separately and together, could be optimized. “For all of us in the early childhood field, the words coordination and integration come up very often,” said Yoshikawa. For example, coordination and integration provide key rationales and motivations for planning across sectors and for legislation. “This is not an easy topic,” he said.
Over the course of the workshop, workshop participants called attention to several prominent topics that arose in the presentations and discussions. These topics, which have been identified by the rapporteur based on the remarks of workshop participants, are listed here not as the conclusions of the workshop or of the sponsoring organizations, but as an introduction to the variety of issues covered at the workshop:
- Coordination and integration of early childhood development programs can create both benefits and risks. Coordinated or integrated programs can result in synergy if children served by one program can also receive other kinds of services, or if such programs attract households that would not have sought out a single kind of service. But these advantages can fail to materialize in practice because of the difficulties of planning, funding, and implementing multisectoral activities.
- Coordination and integration are more common at the local than at the national level, and local experiences can provide guidance for national policies and programs. At the same time, flexibility in national policies can facilitate adaptation of programs to local conditions.
- Population-level assessment and screening can provide a basis for both coordination and integration by establishing a baseline and measures of improvement. For example, results-based budgeting, in which financing depends on improved outcomes, can spur cohesion among programs and agencies.
- The capabilities of a workforce can either limit or enhance coordination and integration. These capabilities, which include being able to communicate and work across sectors, can be enhanced through education and training with appropriate curricula and content.
- Nongovernmental organizations face many of the same challenges as governments around coordination and integration.
- Targeted programs can help reach vulnerable populations but generally involve trade-offs between equity and efficiency.
- The importance of a child’s early years for individual and population health and human development emphasizes the importance of equity.
Following this introduction to the workshop, Chapter 2 summarizes the presentations of two speakers who provided broad overviews of the issues involved in coordinating and integrating early childhood development policies and programs. Chapter 3 then uses the two keynote presentations at the workshop—on coordinated and integrated approaches in Hong Kong and Chile—to examine some of these issues in specific contexts.
Chapter 4 examines governance, finance, and accountability issues that can facilitate or impede coordinated or integrated services for children and their caregivers at the national, subnational, or local levels. Chapter 5 looks at examples of how existing platforms can be used to set up, implement, and scale integrated or coordinated services.
Chapter 6 discusses how these platforms can be used to reach and invest in vulnerable populations, again by looking at specific examples of how best to reach these populations and what kinds of services they need. Chapter 7 examines how the factors involved in developing, implementing, and sustaining programs can differ across locales, with a focus on how programs geared for local needs can be extended to serve more broadly based populations.
Finally, Chapter 8 summarizes the major points made by three breakout groups at the workshop, which discussed financing, children with disabilities, and early childhood development scales, along with the concluding remarks of the several workshop participants.
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