Meeting the Special Needs of Young Children: The Way Forward
ECD HIV/AIDS Workshop
Dar es Salaam, Tanzania, April 12-16, 2004
Workshop Report
Government representatives and NGOs from five African countries, Ghana, Malawi, Rwanda , Tanzania, and Zambia declared their commitment to accelerate action in support of the special needs of young children in HIV/AIDS programs. The commitment was the final act of a workshop on Early Child Development and HIV/AIDS that was held in Dar Es Salaam , Tanzania, April 14 – 16th, 2004.
Participants had responded to an invitation of the World Bank, UNICEF and UNAIDS to join a pioneering initiative that focuses on developing effective early child development (ECD) programs for children between the ages of 0 to 8, the period of most rapid development and most vulnerability. This age group has often been neglected in HIV/AIDS action programs.
Tanzanian Director of policy and planning and national response of the National AIDS Council, Dr, Joseph Temba, set the tone for action: “We have been overlooking the most important years, the years in which governments invest the least.” This workshop, the first of its kind, challenges us to lay a strong foundation to respond to the unmet needs of our young children. Per Engebak, UNICEF’s Regional Director for Eastern and Southern Africa, speaking for the sponsoring agencies, the World Bank, UNICEF and UNAIDS pointed to the impact of HIV/AIDS: in the region: ”… more than seven million orphans and vulnerable children… and the number will more than double by the year 20010.” It is the time, he said, to intensify our investments and programs for early childhood. “No special investment can give a better positive return than early child development.” A common holistic vision within a human rights framework, one that gives equal importance to survival, growth and development will ensure success. “The challenge is to move faster than ever before and scale up our efforts to reach every affected community.” To achieve this objective, partnerships are essential – agencies, governments, institutions, churches, civil society, the communities themselves. “The partnership between UNICEF and the World Bank is an important one for both agencies but we recognize that we cannot do it alone. Only with the broad strategic alliance represented in this workshop and in the individual countries can our common objective for young children be achieved.”
Each participating country had its own team with members drawn from a cross-section of government ministries and committees including National AIDS Councils and secretariats, Ministries of Health, Social Welfare, Education, Gender and Women’s Affairs, Community Development and Local Government and representatives of non-governmental organizations (NGOs).
Country teams had embarked on extensive preparations for the workshop: gathering data, setting ECD priorities, and identifying constraints and opportunities, among them. Videoconferences and exchanges between the sponsors and country team members supported national efforts.
Country Presentations
The first day of the workshop was devoted to team presentations. Each country shared its experience in early child development activities, pointed out actions that needed to be taken to accelerate ECD in the context of HIV/AIDS; and the challenges and gaps holding them back
A supportive policy environment exists in most countries with policies in place or in line for adoption or a strong government commitment having been made for a multi-sectoral partnership for ECD support. The linkage of early childhood to the broader frame of orphans and vulnerable children in policy and planning was made clear and reinforced. Turning policy into action was an overriding concern in country presentations. Participants were keenly aware that without an appropriate and strong coordinating mechanism their efforts to accelerate action and reach the most vulnerable children in their countries would fail.
Growing recognition of the importance of early childhood as the critical period of human development is influencing government priorities. Country efforts are more often directed towards a multi-sectoral approach, utilizing existing services and local resources, with actions aimed at reaching the most vulnerable. While all countries could point to interventions addressing ECD needs; the quality and scale of interventions varied widely. In Ghana, for example, non-formal ECD activities are widely available but unstructured. Pre-school services are being expanded and are viewed as an entry point. ECD services are a strong feature in Malawi’s country program but community childcare centers are small in number when compared to children’s needs and among them, only a relative handful receives additional support. Tanzania could point to strong health and nutrition inputs but limited opportunities for comprehensive ECD programs. All countries attested to the strong presence of NGOs, FBOs, and CBOs. An active ECD network of NGOs and government partners was cited as a positive and important factor.
Training is the area of greatest need. From simple awareness of the importance of ECD and a common understanding of its elements to the essentials of care and support, countries lacked the capacity to adequately respond to the need for information, knowledge and skills for stimulation, and early learning. Another missing and important element is psychosocial support. Counseling skills are in demand. Only Malawi had incorporated psychosocial support and counseling in its program intervention. In all countries the limitations of financial and human resources prevented the scaling up of successful interventions. The lack of support for families who provide the bulk of care was underscored in each presentation.
Infrastructure weaknesses are also a major stumbling block. The coordination/convergence of services continues to be a major challenge in all countries. A hindrance also, in some countries, was traditional beliefs and practices. The importance of community mobilization for ECD engagement and advocacy in support of the young child and against discrimination in furthering the ECD agenda was recognized but remained unfulfilled priorities because of the lack of funds and expertise.
Among the needs and challenges presented, participants chose five overriding themes: partnership and coordination; capacity building; situation analysis, monitoring and evaluation and policy development; advocacy and community engagement; and interventions. The crosscutting issues, partnership and coordination, and capacity building were prominent features in draft work plans.
Funding Channels
Participants sought guidance on funding country action plans. One ready but not exclusive source of funds is the World Bank’s Multi-country HIV/AIDS Program for Africa (MAP). MAP projects exist in all countries involved in the ECD accelerated effort. Each country project differs considerably in specifics, from the timing of national planning and submission of proposals to the kinds of funding that are available, direct, for example, through the local response window for activities or indirect through public sector ministries. Members of National AIDS Councils who were part of country teams contributed to the discussion. The host country provided details on the proposal process in Tanzania. The discussion was enlightening. Richard Seifman, World Bank Senior Adviser, AIDS Campaign Team for Africa, encouraged country teams to arrange consultations with their National AIDS secretariats to explore the broad range of funding channels available, including the MAP in their countries. The workshop, in a sense, is the “end of the beginning,” the first phase of a continuing process. “It was important now to keep the focus on ECD actions.”
Good Practices
A session was devoted to ”Good Practices,” practices that support a young child’s holistic development in HIV/AIDS affected communities. Among them was an initiative rooted in traditional care practices. The Queen Mothers, women selected from royal families in Ghana, are viewed as the custodians of local customs, traditions and values. In the region of the country that has the highest prevalence of HIV/AIDS, Queen Mothers reach out to orphans in their own communities with the aim of providing the basic needs of life, education, and the feel of family attachment. Children are assigned to caregivers, usually a relative. Assistance from the Queen’s association contributes towards the costs of food, clothing and education. The project has the strong support of the Paramount Chief and community members.
The mushrooming of institutions for orphan children in Zambia led to a program that sought an alternative form of care and support that conformed to the standards of the Convention on the Rights of the Child and the country’s Children’s Act. The Child Care Upgrading Program has established minimum standards for residential care of children and a system of childcare inspectorates. Standards have been set for child-care providers and training is provided.
Malawi presented an approach to community dialogue. Steps to move from dialogue to problem identification and analysis to possible solutions through joint planning, adoption and commitment were outlined. Community home based care for chronically ill adults and children and community based child care centers (CBCCs), key interventions, were described and illustrated. A CBCC provides parent/child care that encompasses all elements of early child development support.
Tanzania closed the session with its presentation of a young drama troupe that worked with communities to help them overcome the stigma and discrimination associated with HIV/AIDS. The impact of HIV/AIDS on young children is often the theme of the drama. Performances are keyed to community experience. The audience, community members, becomes involved in post-performance discussion on the play and resolution of the issue that divides the community.
Action Plans – First Phase
The remaining two days of the workshop were devoted to the preparation of work plans. Advisers from the World Bank and UNICEF were assigned to each country team. While the intent was to develop a plan to cover 18 to 24 months it became apparent that the first three months phase was priority. This time was considered critical for broadening the support base for accelerated action and determining responsibilities, steps considered essential for laying the groundwork and moving the process forward.
Country action plans focused on the kinds of briefings and consultations that would take place after the teams return home. Included among them were: debriefing sessions with UNICEF, the World Bank and other team members; consultation with the National Aids Council with the aim of gaining information and guidance in preparing a funding proposal; a larger meeting with potential stakeholders to enlist interest/support for developing an action plan that addresses ECD and HIV/AIDS. Stakeholders meetings would also be held in regions and districts. The first action item for most countries was establishing a National Steering Committee with sufficient authority to move the national ECD HIV/AIDS agenda forward. Such a committee, it was suggested, would report to the National AIDS Council or the President’s Office. Developing a Monitoring and Evaluation mechanism and identifying specific actions to fill data gaps to support the planning process, setting an advocacy agenda, reviewing existing policies and sensitizing government officials of the importance of early childhood programs were preferred action choices. Start-up activities might require additional funds and countries were advised that some resources were available for follow up activities. Participants agreed to forward their revised work plans and resource needs within the two weeks following the workshop.