By Patricia Jara.
Significant advances in research and evaluation have exponentially expanded our understanding of child development. Using this knowledge to improve resource management and service provision is still a huge challenge. It should be used to help restructure services so as to reduce coverage gaps in maternal and child healthcare as well as improve coordination among the various interventions. Achieving comprehensive development seems to require coordinating numerous activities, which implies that social services in the field need to be integrated.
We know that intervening in early childhood, especially during gestation and the first one thousand days of life, is a strategic window of opportunity for setting children on a course toward achieving their highest developmental potential. It’is the first phase of learning in the life cycle. But what implications does this have for services?
When we think about the conditions that have to be in place to promote optimal development in the initial stages of life, a number of factors come to mind: prenatal healthcare and medical care during childbirth, preventive and curative healthcare, nutritional and growth monitoring, addressing developmental delays, and early education. The direct implication for service managers is the need to ensure that resources are adequately distributed to provide support in all of these areas.
During gestation, families need prenatal care, maternal and child healthcare and access to resources that support early stimulation and parent-child bonding. In the first five years of life, children need neonatal care services, conditions that support exclusive breastfeeding, early stimulation and bonding experiences, as well as monitoring of nutritional status, growth, and physical and cognitive development. Subsequently, they continue to need services related to their physical and cognitive development, including early education and exposure to new environments that encourage social development and learning.
Even when reasonable levels of resources are available, there’s no guarantee that families and children, in particular, will have access to all the services they need. Thus, the second major management task is to develop organized, straight-forward service routes or pathways. Having predictable service routes in place accomplishes two goals: it creates a pathway that allows clients to flow seamlessly from service to service; and it improves service usage by the most vulnerable populations, who typically need them the most.
However, with so many services involved in supporting child development, how do we go about integrating them? Just taking a multi-dimensional approach isn’t enough. True integration requires: (1) identifying all the relevant sites and stakeholders involved in child development; (2) covering all aspects of development from conception through age six; (3) operating a coordinated, specialized network of services; and (4) ensuring accessibility, inclusiveness and responsive to various client contexts and needs.
This simple formula hides a world of possibilities. Its main benefit is that it forces all the sectors involved in child development to collaborate, while simultaneously recognizing the contributions of each to the development process, which ultimately improves children’s well-being. This breaks the old “one-time benefit” service delivery logic and instead, focuses on serving people in a coordinated way, using a delivery model set up with pre-established service routes.
Given the short window of opportunity for child development, service networks must have rapid response mechanisms and early warning systems in place that trigger action at the managerial level, when appropriate. Of course we understand this, so what is the challenge? It’s transforming the uncoordinated, unorganized, and uni-dimensional programs and services in the field, into a truly coordinated network of service providers. It’s letting go of the old, fragmented service structure and replacing it with concerted action that encourages collaboration among programs and helps them become more effective. It’s abandoning exclusive service delivery practices and making services accessible to all children who need them, as well as increasing responsiveness to the most vulnerable among them. And above all, the challenge is to establish efficient mechanisms for sharing information among all the services that support children along their pathway of development.
Patricia Jara is a sociologist in the Social Protection and Health Division of the Inter-American Development Bank. Her work at the IDB has focused on policies and programs aimed at helping vulnerable groups.
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