Did you know that a single deposit of $2000 into a newborn baby’s retirement investment account could grow to over $220,000 on their 65th birthday, but if you wait to invest until they turn twenty, those $2000 become only about $50,000? That’s a $170,000 difference. These numbers show the magic of investing in Early Childhood Development (ECD), which can have a compounding impact over a person’s lifetime.
Studies have shown that investment at this early age has the highest rate of return than at any other stage. This is because of “dynamic complementarity”, a concept developed by Nobel Prize Winner James Heckman, where the generation of capacity in children creates more capacity for the individual and society as a whole. Therefore, high-quality ECD interventions that generate human capital at early stages enhance the impact of investments in education, training, and other areas, achieving greater development outcomes.
Applying this concept to Paraguay
Within the framework of the National Plan for Comprehensive Early Childhood Development (2011-2020), the Ministry of Health in Paraguay, with support from the Inter-American Development Bank, developed one of the first ECD programs in the country designed to benefit vulnerable populations. The model, known as MAIDIT for its Spanish acronym, takes advantage of the fact that in Paraguay the greatest contact with young children is through the health services network. Therefore, most of the program’s resources are dedicated to strengthening primary health care services, ensuring they include ECD components.
The loan promotes the cognitive, emotional and physical development of vulnerable children under 5, as well as the timely detection and treatment of delays in their development. It also finances infrastructure improvements for Family Health Units, as well as the training of health teams working with families to promote ECD. This includes promoting positive parenting practices and stimulation of children’s development through community workshops and home visits.
Three years ago, I first visited the Family Health Unit of Miraflores in San Lorenzo, which is less than an hour away from Asunción, the capital, to explore how this model could be implemented there. I was surprised to find the Family Health Unit dilapidated, without the necessary human resources, and with barely enough space to operate its existing portfolio of services.
More field visits confirmed that this was an all too common problem for the Family Health Units in Paraguay. They typically lack sufficient human resources (especially Community Agents), physical infrastructure and medical and administrative equipment. Although these health units have been considered since 2008 a cornerstone for the reform of the hospital-based health model in Paraguay, actual coverage remains low at around 33%.
Rethinking the Strategy
This diagnosis prompted a shift in the project’s implementation strategy to not only advance the formulation of the MAIDIT, but also to take structural measures to improve the quality of the Family Health Units. This approach would provide a solid platform to implement the MAIDIT and improve the quality of family primary care across the nation. The project is strongly aligned with current national priorities of expanding primary care and investing in early childhood.
Fast forward to 2019, and the Family Health Unit in Miraflores that I visited in 2016 has now been reconstructed and was recently inaugurated. It is one of the first Family Health Units, of the existing 804, to be certified by the Ministry of Health for meeting all quality standards, including full medical equipment and a complete team of health professionals, as required by the model.
The Time for Investing is Now
This progress is really encouraging for two reasons. First, the presence of Family Health Units in Paraguay is correlated with reduced maternal and child mortality. Nonetheless, the Units are often under resourced and in precarious conditions. Second, application of development tests (Batelle) in the first group of Family Health Units participating in the ECD project shows that more than a quarter of the children under 5 years of age present some degree of developmental delays, with the lag increasing with age.
This shows the importance of not only continuing to expand and improve primary care through the Family Health Units, but also to implement the MAIDIT and identify and treat delays in a timely manner. Failure to do so prejudices children’s development throughout their life, weakening their academic performance, employment outcomes, and health, while exacerbating disadvantages for people living in poverty.
The Bank’s motto is “Improving Lives.” Evidence shows that we need to start doing this at an early age. Early childhood investments generate positive health and education outcomes, making future investment in capacity-building more productive. Like that hypothetical $2000 deposit I mentioned at the beginning, investment in this stage of life compounds children’s well-being and, at a cumulative level, promotes the development of Paraguay.
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