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Breakout Group Reports and Closing Remarks
In addition to the panel presentations, the workshop featured a session in which the participants separated into groups to discuss three key issues: financing early childhood development programs, children with disabilities, and the development of scales to monitor early childhood development. The reports of the breakout group leaders and the final remarks of workshop participants are summarized here, in this final chapter of the workshop summary, as a way of revisiting several key concepts and looking toward the future.
FINANCING EARLY CHILDHOOD DEVELOPMENT
Even if the case is made successfully that investments in early childhood development are cost-effective, the financing of such services can remain uncertain. Four major challenges exist in funding and financing early childhood development, observed several participants in the breakout session. The first is the fragmentation of public responsibility for these services. The second is inadequate public subsidies for privately provided services; public services are not considered a major source of financing for early childhood development. The third is the diversity and lack of coordination among stakeholders in both the public and private sectors, including the ministry of finance, the line ministries, the private sector, parents, donors, and foundations. The fourth is what one participant called the introversion of the early childhood development community,
or the tendency of stakeholders not to reach out to other groups that are experimenting with innovative financing mechanisms.
Approaches to financing that were discussed during the breakout group included earmarked taxes or dedicated funds reserved for early childhood development, regulatory reform to allow more public–private partnerships, results-based financing tied to beneficial outcomes, social impact bonds, and affinity credit cards, where the credit card bonuses go to early childhood development projects. Earmarked taxes were used in the Philippines, but they are not very common, said Burnett, who led the breakout session on financing. More often, different kinds of taxes are used, such as sin taxes and payroll taxes in Colombia. Each of these approaches has both potential and problems, several breakout group participants observed. For example, with results-based financing, different levels of consensus exist on the proper sets of both inputs and outcomes. Nutritional outcomes may be easy to establish, but outcomes related to cognitive skills or learning would be more difficult, they pointed out. Similarly, social impact bonds—where a third party pays back investors with interest once results are achieved—could be expected to raise questions about defining outcomes.
Dedicated funds have been successful in more targeted areas, such as vaccinations or disease, participants in the breakout group said. Such funds have not yet been established for broad service domains such as early childhood development. Funds distributed through such education mechanisms might tend to flow to particular needs and not others. Even within a particular domain, such as education, particular areas may receive disproportionate attention and funding. For example, the use of education mechanisms risks the movement of funds to preprimary education, one participant observed, while failing to fund different early childhood development programs like health and nutrition. Broader mechanisms are preferable, the participant continued, but a general program may be difficult to implement.
Breakout group participants also discussed how to respond to policy makers who ask why additional funding for early childhood development is needed when a portion of public funding is already going to poverty reduction. Additional funding is necessary if young children are viewed as a specific segment of the poor population, but participants also discussed the proper allocation of existing funds. The needs of poor children and the importance of their health and well-being for the future of society are often overlooked, several participants pointed out. Better measures of their status and the convergence of innovative finance mechanisms from different fields would help make the case for early childhood development.
The Universal Declaration of Human Rights and other international agreements enshrine the concepts of equality and dignity for all. In addition, the Convention on the Rights of Children and the Convention on the Rights of People with Disabilities both address the rights of children with disabilities. Governments are aware of their responsibilities and obligations to the Convention on the Rights of Children, but not as much to the Convention on the Rights of People with Disabilities, stated breakout participants. This convention advances the level of discourse surrounding people with disabilities, viewing children as “subjects of human rights rather than burdens to be fixed.” However, as several breakout participants observed, children with disabilities are often neglected and are overrepresented among the poorest sections of society, which makes this group a particular concern in considerations of early childhood development.
A breakout group participant noted that disabilities are not fixed and that a biopsychosocial approach can greatly enhance capabilities. The group discussed the definition of disability, contrasting constraints with substantive freedoms. Rather than looking at difficulties in functioning, the group emphasized disabilities as a general continuum of experience. The paradigm of capability, rather than disability, has especially strong connections to early childhood development, several participants observed. When children have low birthweight, are malnourished, lack stimulation, or are institutionalized, their functioning is affected. Stunting, diseases, and delayed development are all related to the conditions of early life. As one breakout group participant pointed out, surveys indicate that 23 percent of 2- to 9-year-olds in developing countries have disabilities. A focus on early childhood development could serve as a powerful platform to address this issue.
The discussion centered on three approaches. One, discussed by several participants, is to reduce disparities to lower the risks to children. Another is to enhance capabilities—for example, by empowering children and their families to chart their own pathways through school, which would reduce the emphasis on special education. A third mentioned by a few participants is to embrace diversity by framing the issue around a range of abilities rather than mean performance, which could further recent movements toward greater inclusion.
Research was presented on transformative powers worldwide, including the immediate benefits of cognitive measures, the likelihood for special education to be reduced later, and the movement of children out of risk statuses so that transitioning to mainstream can be supported. This can build momentum to create communities of inclusion over time, noted one participant.
Two additional concepts that could make a difference to children with disabilities, a breakout participant said, are the principles of universal design, where environments are designed to accommodate people with a range of abilities, and the principle of reasonable accommodations, which individualizes environments for people with particular needs.
Finally, the breakout group participants discussed the intertwined concepts of reversibility, plasticity, and resilience. Several observed that an emphasis on irreversibility can increase the danger that governments and communities will absolve themselves of responsibility for children with disabilities by claiming that early investments in those children have fixed their problems. Children are resilient, but not all needs can be addressed permanently through early interventions.
EARLY CHILDHOOD DEVELOPMENT SCALES
As presented by Nirmala Rao of the University of Hong Kong, the Southeast Asia and Pacific region has been working on a set of early childhood development scales to monitor child development in the context of poor school readiness and learning outcomes, track the development of vulnerable and at-risk children, and analyze the effect of early childhood policies and programs on children. In deliberations involving eight countries, more than 1,700 different items were boiled down to 85 that have been in a pilot phase of testing, she said. The items are focused on the 3- through 5-year-old age range.
Initial analyses have shown strong validity and sensitivity with such measures as maternal education, early childhood education, exposure to home assets, and gender. The data collected during the pilot testing suggest that such measures could be linked with outcomes such as academic achievement. The data show signs of being used to correlate queries such as dissenting versus academic achievement or the influence of quality early childhood education with these scales, noted one participant.
Even 85 items will be challenging to implement in many cases, so work is ongoing to reduce the number to about 30. The challenge also exists to get the number down to about 10, which would make the measures easier to use in global frameworks. Reducing the number down to 10 is associated with other challenges, including the definition of the degree of effort needed to keep the quality and scalability of the scale moving forward.
Breakout group participants discussed ways to motivate children to participate in the measuring process—for example, through game-based applications or play. They also discussed the reliability of the data and the resistance some governments exhibit to adopting and using such measures. A bottom-up approach, where individual countries demonstrate
the value of early childhood development scales, can help overcome this resistance, one participant observed.
Some of the participants talked about extending the measures to young children below age 3. Some countries, including China, have been advocating for such an extension, and measures of younger children would have many applications on a global scale.
At the conclusion of the workshop, Albert Lee, clinical professor in public health and primary care at the Chinese University of Hong Kong, remarked that the workshop represented “the beginning rather than the end” of the forum’s discussion of how existing platforms can be used to invest in children and their caregivers. The workshop provided many excellent examples of coordination and integration, with speakers sharing the “wonderful work they’ve done in different parts of the world,” Lee said. But he also pointed out that an emphasis on coordination and integration should not detract from the responsibility of each sector for early childhood development. “We need to be cautious in integrating different sectors so we don’t make one sector disintegrate.”
Lee also emphasized the importance of leadership, education, and training in early childhood development. How to build the necessary workforce is an emerging issue at all levels of organization, he said. In terms of engagement apart from the workforce, Lee mentioned the importance of the engagement of civic societies, including the family, the parents, the private sector, large businesses, small business, and nongovernmental organizations. He also emphasized the importance of considering the multiple roles of young girls and women, including their role as future caretakers of children. The multiple roles of women play an important role in early childhood development for many reasons, not just because of their vulnerability or the income status of their country. Lee underlined the concept of universal equity and described how targeting populations with certain risk factors, including populations with disabilities, immigrant, and nonmainstream families, is a separate approach from the concept of universal health coverage. Lee ended his remarks with a comment on the importance of establishing a committee of incentivized health workers with some form of recognition, either formal or legal.
Andy Shih, senior vice president for scientific affairs at Autism Speaks, also pointed to the importance of leadership. He mentioned that the main challenges, from an advocacy perspective, were questions like, “Who are these leaders, and how do you identify and support them so they can move the agenda forward? There may be opportunities beyond the traditional platforms of health, education, and social protection to
meet the needs of children,” he said. “That’s an opportunity for us—to look for nontraditional channels to advocate and help build a better agenda for children.”
Finally, Ann Masten, Distinguished McKnight University Professor in the Institute of Child Development at the University of Minnesota, pointed to a convergence in the thinking of those involved in the health and well-being of children and their caregivers. At the same time, exciting new science on how early childhood is linked to lifelong positive outcomes can channel this growing consensus into more effective programs and policies.
“It’s time to raise the bar for global child well-being,” Masten said. “Children need more than being able to survive. They need to thrive.”
