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Coordinating Investments in Children from a Policy Perspective
Many governance, finance, and accountability issues can facilitate or impede coordinated or integrated services for children and their caregivers at the national, subnational, or local levels. In a session on these issues, three speakers provided examples of programs and initiatives that have confronted these issues in productive and informative ways. The China Women’s Development Foundation has demonstrated how a single organization can provide a wide range of coordinated and integrated services for children and their mothers. In Southeast Asia, national policies to include children with special needs in mainstream schools vary from country to country, but progress is widespread. And in the Western Pacific region, the Action Plan for Healthy Newborns is reforming and coordinating policies and practices not only among—but within—countries. All of these examples demonstrate the progress that can be made through the use of early childhood development as a driver of greater cohesion in policies and programs.
THE CHINA WOMEN’S DEVELOPMENT FOUNDATION
The China Women’s Development Foundation (CWDF) was established in 1988 as a national nonprofit social welfare organization registered with the Ministry of Civil Affairs. The CWDF is dedicated to protecting women’s legal rights and is focused on the practical problems of women, including issues of children, family, health, development, education, and entrepreneurship. As foundation administrative director HaiLiang Guo
said in describing CWDF, it has received a number of awards and recognitions for its projects and for the transparency of its public reporting.
In its most recent operating year, CWDF expended about ¥900 million on public welfare, with most of those funds coming from the government, and its projects benefited more than 27 million people in need, said Guo. Its child education programs focused on the southwestern and northwestern parts of China, its disaster relief support focused on the southwestern region, and its women entrepreneurship support project has been active predominantly in the eastern and northeastern regions.
Among its projects are a poverty alleviation fund for mothers and scholarships for female students. It also provides water services for mothers and children and supports safe drinking water projects because they lack safe drinking water in many Chinese regions, Guo observed. A project known as Mother’s Health Express provides targeted medical care in poor areas. For example, in rural and remote areas, mothers receive care from pregnancy to childbirth through mobile medical units.
Because the education of children is closely linked with the financial prospects of families, CWDF has supported a business entrepreneurship project to provide mothers with training so they can gain economic independence and contribute to their children’s education. The foundation also provides postdisaster relief through reconstruction and resettlement projects, noted Guo. In disaster-struck areas, for example, it helps to arrange for volunteer teachers so children can continue to be educated.
In September 2013, CWDF and several partners launched the Guardian Childhood Program to promote a better social environment for child development and to improve children’s health. The program serves children ages 0 to 16 and provides assistance in hygiene, health, family relationships, and school conditions. This project has been integrated with the Mother’s Health Express to provide medical services wherever children live. As Guo noted, “Many children are named after this express.”
Another initiative he described is known as the Spring Buds Project, which is targeted at girls in remote and poor areas. Its goal is to help girls who have dropped out of school or are on the verge of dropping out to continue their education. Poor families tend to devote their resources to educating boys rather than girls, so financial difficulties can spell educational difficulties for girls. By the end of December 2014, the Spring Buds Project, over its 25 years in existence, had supported more than 2.5 million girls and had established 1,154 Spring Buds schools. As Guo noted, “Today’s girls are going to be mothers; therefore, we need to attach great importance to the education of girls.”
Finally, Guo briefly described a pilot project focused on children with autism between the ages of 6 and 16. The project has recruited and trained teachers with professional backgrounds in music, painting, and psychol-
ogy to work with the families of children with autism. The program integrates school resources and develops the strengths of these children to provide them with opportunities to show their talent and experience positive emotions. As Guo said in response to a question, mothers with a child who is disabled often quit their jobs to take care of the child, which has major implications for the family’s finances. Also, the All China Women’s Federation, which is one of CWDF’s partners in the project, has a representative in every village, which makes the identification of children with autism straightforward.
The foundation’s plans for the future are to continue providing family education and training for females while directing attention to the education of children. It also plans to continue its entrepreneurship training, support for families with special needs, integrated education programs for children with autism, and postdisaster reconstruction projects.
INCLUSIVE EDUCATION IN SOUTHEAST ASIA
Yasmin Hussain, director of the Regional Center for Special Education for the Southeast Asian Ministers of Education Organization, discussed inclusive education in 10 countries of Southeast Asia from Myanmar to Indonesia. Policies in these countries have been influenced by a wide variety of policy conferences and documents calling for greater inclusion of children with special needs in regular classrooms, including the Salamanca Statement, the Dakar World Education Forum, the Convention on the Rights of Persons with Disabilities, the Declaration of the Rights of Disabled Persons, the Convention on the Rights of the Child, the World Conference on Education for All, the Year of Special Needs in the Classroom, and the World Conference on Special Needs Education.
In Malaysia, the Ministry of Education has recognized the need to increase the enrollment of children with special needs into inclusive education and has made this goal a component of the Malaysia Education Blueprint 2013–2025. By 2015, Hussain said, Malaysia plans to have 30 percent of children in an inclusive setting (Bahagian Pendidikan Khas Kementerian Pendidikan Malaysia, 2014).
In Brunei, the Special Education Unit was formed in 1994 by the Ministry of Education, after which students with partial or mild to moderate disabilities started being included in ordinary schools. Brunei has succeeded in placing 70 percent of its special needs children in the schools (Special Education Unit, Ministry of Education, Negara Brunei Darussalam, 2014).
In Cambodia, Hussain continued, inclusive education is being carried out through three main strategies: equal access to education, improving educational quality and relevance (including teacher training and dropout
reduction programs), and institutional capacity development (including high-quality leadership, management, and administration) (Ministry of Education, Youth, and Sports, Cambodia, 2014a). A master plan on education for children with disabilities developed in 2008 seeks to ensure that all children with disabilities have access to schools (Ministry of Education, Youth, and Sports, Cambodia, 2014b).
In Indonesia, the government has reformed its education system to accommodate children with disabilities, said Hussain. Currently, education for children with disabilities is moving from special education toward inclusive education, with awareness that special schools for the disabled reinforce segregation and marginalization (Tsaputra, 2012). The top officials in some districts, including the governor himself, have proposed inclusive education for their school districts, making it an incentive for others to follow suit as well, Hussain stated.
In Laos, an inclusive education project started in 1993 included initiatives such as establishing inclusive kindergartens and capacity building for teachers and other educational personnel (UNICEF, 2003). Laos adopted a National Policy on Inclusive Education in 2010 and a National Strategy on Inclusive Education in 2012.
In Myanmar, only 800 students of 318,000 children with disabilities go to government schools, and 1,450 children attend special schools, Hussain reported. Half of all students with disabilities, including physical and intellectual disabilities, are not enrolled in the government’s mainstreamed schools. However, Myanmar passed a national education law in October 2014 that included a provision for education of people with disabilities, and the national education sector plan that is currently being developed will include the needs and rights of people with disabilities.
In the Philippines, the ongoing Decade of Persons with Disabilities declared by the government is orchestrating the effort to implement plans, programs, and activities for people with disabilities. The Ministry of Education in the Philippines plays a prominent role in ensuring that inclusive education takes place in mainstreamed schools and provides support systems for schools.
In Singapore, the education system embraces the concept of inclusion for students with special education needs, and the Ministry of Education of Singapore has successfully placed the majority of students with such needs in inclusive schools, said Hussain. Students with mild to moderate disabilities are supported in mainstream schools with initiatives focused on the training and deployment of special needs officers, additional funding for resourced schools, training mainstream teachers to teach students with special needs, and the provision of providers for early intervention in primary schools (Cohen, 2009).
In Thailand, inclusive education must be reflected in the national
curriculum, in expanded core curriculum activities, and in nonacademic activities that exist within a least restrictive environment. According to the country’s legislative and policy frameworks, people with disabilities must be accorded the same educational opportunities as are others.
Finally, in Vietnam, laws passed in recent years have aimed at increasing the enrollment of children with disabilities up to 70 percent in schools by 2020.
Summing up, Hussain said that every country has its own policies and its own approach to inclusive education. In addition, each leader has a particular vision and mission, which can have a powerful effect on inclusive education. However, she continued, the most important forms of support extend across countries:
- Children supporting children
- Teachers supporting teachers
- Parents becoming partners in education
- Communities supporting their local school
“An effective model of inclusive education not only benefits students with disabilities,” Hussain concluded, “it also creates an environment in which every learner has the opportunity to become a successful student.”
THE ACTION PLAN FOR HEALTHY NEWBORNS IN THE WESTERN PACIFIC REGION
The WHO recommends more than 50 “essential” interventions that cover the reproductive life course (see Figure 4-1), noted Howard Sobel, the regional coordinator for reproductive, maternal, newborn, child, and adolescent health programs in the Western Pacific Regional Office of the WHO. When Sobel asked four colleagues in the regional office, which has responsibility for 27 countries in the Western Pacific region, to come up with their one highest priority activity, they listed 42 activities spanning the life course. To prioritize, Sobel negotiated evidence-based actions capable of reducing mortality or serious morbidity at a population level.
A major product of this priority-setting process was the Action Plan for Healthy Newborns, which Sobel described at the forum. “Newborns fall into the gap between moms and children. They are often forgotten, and many harmful or unnecessary practices are still observed,” he said. Such practices include failing to check fetal heart rates, not using partographs, unnecessary induction of delivery, unnecessary cesarean deliveries, immediate cord clamping, separation from the mother, and not initiating early exclusive breastfeeding. A clinical protocol review in seven Western Pacific countries revealed that the newborn care compo-
FIGURE 4-1 Interventions target illnesses and risk across the reproductive life course.
NOTE: HIV = human immunodeficiency virus; HTN = hypertension; IUGR/ LBW = intrauterine growth restriction/low birth weight; STI = sexually transmitted infection.
SOURCE: Sobel, 2015. © WHO 2015. All rights reserved.
nent was often insufficient and outdated. As Sobel noted, “People have practices that they have been doing for 30 years.” As a result, they can resist changes in procedures. “There is a lot of work that we can do at the health facility level.” For example, in response to a question, Sobel highlighted the important link between poor intrauterine growth and disabilities. He explained that this link is often a challenging one to make clear as “most people intuitively know that the risk of death and the risk of bad outcomes with low birthweight babies is very high as compared to those who have normal weight,” but they do not understand the technical ways in which these two health markers are connected.
The action plan includes the development of supportive tools, support for countries to localize the plan, an evaluation of country progress, including steps to protect, promote, and support breastfeeding, and a
communication strategy called the First Embrace.1 Each country performed a newborn situation analysis to review the presence or absence of key policies. The regional office then worked with countries to develop and estimate the cost of localized action plans. Technical working groups or coordination groups were formed and met approximately quarterly in most countries, with a full-time person coordinating the effort. “We need to have someone paying attention to the things that are going on,” said Sobel.
Stakeholder groups engaged political leaders and champions. National workshops with all the major stakeholders represented were organized in each country to build consensus. A clinical practice protocol pocket guide was developed and widely distributed. “That is one of the biggest things that we did in countries all over the region,” said Sobel. “Many countries have adapted it into their local language and into local situations.” Mechanisms were also established to ensure that professional associations would help implement early essential newborn care, and national planning tools were developed based on a situation analysis in each country. A Health Facility Strengthening Guide and a Coaching Session Facilitator Guide provided support for training and information dissemination. A pilot monitoring and evaluation framework for the action plan is under way in the Philippines and Mongolia, along with other evaluations that will lead to modifications in the plan.
Sobel closed by citing a quotation from Margaret Chan, director-general of the WHO, who said that the development of the Action Plan for Healthy Newborns represents
a trend I wholeheartedly support, that is, the use of very simple, cost-effective interventions to save lives. It draws attention to a number of common but inappropriate and unnecessary practices, and aims to correct them. It introduces the importance of the First Embrace and shows how simply changing the sequence of steps in newborn care can save lives.
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1 More information is available at http://www.thefirstembrace.org (accessed April 20, 2015).
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