By Carolina Freire

No quiero ir al doc

Few of us have fond memories of going to the doctor when we were young; however, if we add in a dark, cramped office lacking the proper equipment, the visit can turn into a nightmare for any child.

Panama has 152 health centers that provide early stimulation services to improve the cognitive, physical and social development of children in their first years of life. Nevertheless, an evaluation conducted in 2010 found that most of these facilities did not have adequate physical space, and more than half of them needed equipment.

Since the creation of the Network of Early Stimulation Rooms, a program that forms part of the Panamanian government’s Comprehensive Care Plan for Early Childhood (PAIPI) and receives support from the IDB, the old cubicles are gradually being transformed into spacious areas with lighting, color and equipment that meets the needs of the children. PAIPI seeks to ensure that all children between the ages of 0 and 5 have access to early stimulation, education, comprehensive preventive health care, and nutritional health care.

In accordance with standards developed by the Ministry of Health and the Panamanian Institute for Special Needs (IPHE), 47 early stimulation rooms are undergoing renovation or being built in the country’s nine provinces and in at least two indigenous districts. The rooms are spaces where stimulation activities are carried out, and they are being equipped with materials appropriate for working on three areas of child development: language, psychomotor skills and socialization.

The sessions held in these rooms reinforce the early stimulation counseling services received by the parents and caregivers of children, and they look to build skills for better child care in the home. In addition, the professionals working in these rooms play a role in the early detection of developmental delays, leading to stimulation or therapy services that provide children with the special attention they need.

According to Roberto Montecer, Head of Health Promotion for the Ngäbe Buglé Health Region, the project represents an innovation. “For the first time ever, we are allotting physical space to this activity [early stimulation]…in a geographic area where at least one third of all households are made up of children under 5, most of whom are living in poverty,” he notes.

Improving these facilities is an important step in guaranteeing the quality of the early stimulation services provided in Panamanian health centers. However, international experience and the specialized literature tell us that while infrastructure is necessary, it is insufficient for producing high-quality child development services. In other words, in order for this investment to translate into results in terms of child development, the most important thing (and the most complicated to achieve in any part of the world!) is that the people responsible for carrying out early stimulation activities have the knowledge, skills and incentives to ensure high-quality interactions with children and their families.

Carolina Freire is founder of, Panama’s first online volunteer center. She also established Voluntarios de Panamá, an NGO committed to mobilizing and connecting volunteers with national causes and organizations. Freire is a consultant for the Inter-American Development Bank, think tanks and non-profit organizations in issues related to social policy.

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