Recently, several countries in the region – Colombia, Ecuador, Nicaragua and Peru, among others – are working on broad, cross-cutting early childhood development strategies and programs. They tend to include a wide range of services, such as pre and post-natal healthcare, lactation support, complementary nutrition, child growth and development monitoring, early stimulation and guidance on child rearing for parents.
The success of these strategies and programs depends on the governments’ ability to align the objectives of the various public and private institutions involved in financing and providing the services that make up the early childhood development “combo” package. What have we learned in the past few decades about implementing inter-sectoral interventions in the region?
To answer that question, I want to share my reflections on the lessons that have come out of conditional cash transfer programs (CCTs), since their success also depends on sectoral synergies. As many of you know, these programs are among the most revolutionary for social policy in Latin America and the Caribbean. They provide direct cash transfers to poor families—aimed at helping them make ends meet—on the condition that the children in those families be taken for preventive health check-ups and enrolled in school in order to increase their human capital. Oportunidades in Mexico, Familias en Acción in Colombia, Solidaridad in the Dominican Republic, Juntos in Peru, Bolsa Familia in Brazil, Bono 10,000 in Honduras, and Bono de Desarrollo Humano in Ecuador, are examples of such programs.
Without a doubt, these programs have had a significant impact on poverty and they have reduced inequalities in income and consumption in several countries in the world’s most unequal region. In addition, CCTs have improved the utilization of health and education services among poor families. However, their impact on education and health outcomes has been lower than expected. For example, although doctors have reported an increase in numbers of health check-ups, improvements in children’s nutritional status have not been observed in most countries.
The complex and still unresolved challenge is to find ways to achieve synergies between the CCTs and quality service provision. The basic premise behind the effectiveness of CCTs is good coordination between the various sectors (health, nutrition and education) to improve access to quality services for the poorest families. However for a number of reasons, some countries in the region have been more successful than others in achieving this coordination.
So, getting back to the question -which lessons from the CCT programs can be applied to the implementation of inter-sectoral child development programs and strategies? Here’s a summary of my thoughts:
- Aligning the objectives of each sector won’t happen by itself.
- It will require clear mandates and political support at the highest levels.
- It will require huge efforts in terms of coordination and budgetary and operational planning, both centrally and in the subnational level.
- To ensure accountability, mechanisms must be put in place to monitor resource allocation, program coverage, and the quality of the services provided.
- It may also be beneficial to offer service providers performance-based incentives to encourage high coverage and quality.
Implementing public policy initiatives in early childhood development reminds us how challenging inter-sectoral coordination can be. However, when sector objectives and activities are in alignment, it’s apparent that the whole is much greater than the sum of its parts. Early childhood development programs and strategies can extend their synergies with CCTs, themselves. Doing so would certainly refocus CCT programs on one of their primary objectives: promoting human capital development from the first years of life.