By Julia Johannsen.

In a recent post in this blog, Caridad Araujo offered some reflections on the need to “keep our focus on children first.” When I first read it, I thought, “isn’t that obvious?”  When the topic is childhood development and education, how could we possibly focus on anyone other than children?

But there is one element that threatens the central focus on children in the design of governmental child development programs in the region: pressure from adults.  After all, adults have the power to vote, not children. So, if adults press their elected officials to provide childcare programs that serve mainly as babysitters, taking care of the children so the adults can work, who are those programs really serving?

Let me explain. Although disguised as a child development policy, one of the main reasons behind the creation of a public system of childcare centers was to free women to work outside the home. As Sergio Urzúa recently said in this blog, this objective may actually threaten the quality of public programs. However if instead, early childhood development programs focus first on providing optimal child development services, then freeing mothers to participate in the labor market may be a nice fringe benefit.

The latest such program, called “Crecer Bien para Vivir Bien (Grow well to Live Well)”, is in Bolivia. Ratified by the Bolivian National Congress on May 2012, it is about to be launched in two departments: Chuquisaca and Potosi. Its stated objective is to: “improve the cognitive, socio-emotional and physical development of Bolivian children in a sustainable, culturally relevant manner, through a model early childhood development program aimed at improving childcare access and quality for children under age 4.” This objective is based on current legislation in that country, which focuses on children’s rights and the concept of early childhood as a “window of strategic opportunity for providing children the right conditions to develop to their highest potential…during the first one thousand days of life,” as Patricia Jara described some time ago in this blog.

The Bolivian program aims to improve the quality of institutionalized care in ninety centers. In addition, it supports the formation of sixty mobile brigades that will visit children and their caregivers in the community or at home to provide counseling and early stimulation services, monitor children’s developmental progress, and detect potential lags.  Some developmental lags will be treated in one of sixty early stimulation rooms located in health centers.

At the event marking the program launch, Johnny Vedia, Director General of Health Services at the Ministry of Health and Sports said, “a big challenge we face is the lack of national quality standards for the provision and monitoring of integrated childcare services. Right now, each department or municipality has its own procedures (assuming any procedures even exist) for managing childcare centers. Developing national standards is a high priority of this innovative program; they must be in place before starting infrastructure projects, purchasing equipment; or training and recruiting staff.”

We know that interventions in early childhood development are among the most cost-effective public policies. They are also among the most effective in terms of breaking the inter-generational poverty cycle and promoting equal opportunity. Nevertheless, there is much that we still don’t know. How effective are urban programs, as compared to rural ones? How much do we know about the cost-effectiveness of variations in levels of intensity and intervention frequency (such as the hours of operation of childcare centers, or the frequency and duration of home visits)? How important is caregiver quality, and which aspects are most critical for their training?

These are just a few examples of the questions that remain to be answered. In a future post, we hope to discuss the impact evaluation that was proposed by the Ministry of Health and Sports, and review the country’s experiences under the new program. The evaluation will seek to answer some of the above question before scaling up the program.

Julia Johannsen is the Social Protection Specialist at the IDB’s office in Bolivia. Her work focuses on the design and supervision of conditional cash transfer programs, maternal and child health interventions, and on early childhood development programs.

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