Implementation of ECD policies

This section provides a brief analysis of significant aspects related to ECD policy implementation that include:

• the importance of shared value and conceptual frameworks

• structures for intersectoral collaboration

• who assumes the leadership process

• importance of participatory mechanisms

• incremental processes

• targeted versus universal policies

• human rights and international legislation to support national policy-making

• monitoring and evaluation tools.

Governments can develop new venues of action through the creation of an interministerial policy framework for ECD that clearly articulates the roles and responsibilities of each sector and their methods of collaboration. It is recommended that governments should also integrate ECD policy elements within the agendas of each sector to ensure that they are considered routinely in sectoral decision-making.

Many countries have ambitious ECD policies with a high-flown conceptual framework and well-defined objectives that are only rhetorical, never leading to action or endlessly at the early stage of the implementation process. The main factor in this is political will.

Public policy implementation is always contested, with many priorities competing for attention, so the strength of the advocacy coalition for children is crucial. Thus, the intersectorality of childhood policies is not only an opportunity to build a broad coalition but also a problem as the constituency for action for children tends to be diffuse in society, not concentrated and

(usually) lacking in resources. Furthermore, intersectoral effectiveness in child policies requires sharing of conceptual, ethical and value frameworks. There are no recipes for implementation, there are as many ways of doing it as there are child policies: dependent on culture-specific, resource and sociopolitical contexts, and the initial situation of every context, among many other elements.

Notwithstanding, a rights and equity framework has a globally cross-cutting character that gives coherence to ECD policies and also has the capacity to facilitate mainstreaming for action.

We propose a roadmap to implement child policies that allows analysis of different scenarios and strengthens operationalization of the concept of ECD-HiAP. However, there is a need to recognize that very often the policy process is uneven, complex and even erratic in terms of the factors that affect this process (see Kingdon’s framework (16) and Chapter 1).

Box 6.1 Implementation of ECD policies

Implementation of ECD policies is complex in proportion to its comprehensiveness.

In other words, many strategies and actions need to work simultaneously and complementarily in order to achieve objectives involving the child in his/her family and community environments. Some necessary (but sometimes insufficient) conditions should be considered in the implementation process.

1. Clear goals and objectives that are feasible to perform.

2. Defined target population such as specific age groups, socioeconomic strata, geographical locations, policy type to be implemented (universal or focalized), implementation strategy (progressive coverage), scaling-up time.

3. Map of identified sectors and participants involved in policy development in order to seek agreements on sectoral and cross-cutting responsibilities.

4. Existence of law and legislative and regulatory frameworks that facilitate resource mobilization give shape to management models and contribute to the sustainability of what is implemented.

5. Policy relevance of strategies to be implemented in order to minimize resistance that often exists and to increase the support of interest groups and communities.

6. Social acceptability – it is critical to communicate throughout the territory and the population.

7. Consistent ethical and value frameworks within the policy proposal in order to prevent double standards and the lack of priority setting.

8. Implementation costing – cost-effectiveness studies if possible.

9. Feasibility analysis – considering items 1–8.

10. No false starts – may undermine credibility and community confidence.

Among other activities, implementation requires systematization of the information available in a country on: health and development in childhood;

socioeconomic conditions; and health- and education-related determinants.

This requires knowledge of the current supply and demands of services, gap analysis, quantification of existing resources and potential mobilization of feasible resources during the implementation process.

6.2.1 Who assumes leadership of the implementation process?

It is important to define who will assume the leadership role (whether a ministry or an institutional representative or a high-ranking official): acting as group coordinator and holding an official mandate with clearly defined roles and relations with others. Prevention of competitive scenarios on technical leadership, double standards and power struggles is recommended. Ministries of planning (or their counterparts) are often neutral and offer greater management capabilities for these types of processes. Planning of such an implementation has a national scope, its importance depending on the characteristics of the country (centralized or decentralized). In both cases, integrating ECD-HiAP and forging strategic partnerships is crucial for the process.

The formation of a cross-cutting group is recommended, whether intersectoral, interinstitutional, multidisciplinary or any other variable of interest appropriate for the country (e.g. ethnic minorities’ representation, unions, political groupings). This group would be responsible for providing national authorities with the technical guidelines, management model and distribution of resources;

as well as the assessment, monitoring and accountability mechanisms. Other important functions include planning the implementation that defines the general plan and specific programmes that must be executed, the times and structures needed and the resources involved.

Horizontal and vertical coordination are key issues in the policy-making process. Hence, although intersectoral policies at state level are needed, intersectoral governance at community level is equally important as this is where real transformations take place. Many programmes are still designed from the top down, without the involvement of user groups, and are likely to be ineffective, of insufficient scope and potentially unsustainable. There is enough evidence to recommend community-building initia tives that increase cohesion, cooperation and interpersonal trust among children and adolescents, especially in communities with low social capital for levelling up the social gradient in children’s health (17).

National guidelines are generally implemented after being locally adapted. At this level, apart from providing services, the participants and executing agencies

are close to children, their families and communities. This place is privileged as all sectors provide natural instances of meeting: regional governments or boards, community councils or others.

Governments, policy-makers and practitioners must ensure that children, young people and families across the socioeconomic gradient participa te in the design and implementation of policies and interven tions in order to ensure that their needs are addressed and they are reached. Many countries all over the world have implemented consultation mechanisms (mostly at municipal level) that bring children and young people into the policy-making process (including Brazil, Chile, Ireland, United Kingdom).

Health is the sector closest to families and children in their early years, making it a natural entry point for health-related and early biopsychosocial development interventions. As the life course progresses, other participants and sectors (such as education) gain more access and responsibility through different forms of child-care, early childhood and pre-school education. It is important that the implementation process acknowledges what already exists, building upon experience to improve what is susceptible of change to conserve effective actions and eliminate those that are ineffective or potentially harmful to children and families (see Case study 6.2).

6.2.2 Proportionate universal policies

The most effective approach for improving the well-being of chil dren and young people is to ensure their family or caretakers’ ability to nurture them.

This is best achieved through universal policies that redistribute societal resources but universal policies do not entail policies applied uniformly. To ensure that universal measures effectively level up the socioeconomic gradient, governments should first assess and address the specific pathways that lead to bad health in different socioeconomic groups and across their life courses.

For example, the effects of multiple disadvantages may inhibit the ability of disadvantaged families, children and young people to benefit equally from certain universal measures. Universal policies should therefore be designed to address proportionally greater need with greater intensity and/or link service fees or taxes to ability to pay. In addition and where necessary, universal measures should be complemented by targeted measures such as well-designed programmes to prevent early school exits, in order to ensure that children and young people and families in most need get the necessary support (17).

Case study 6.2 Chilean child protection policy “Chile Crece Contigo” (Chile Grows With You)

One of (former) President Michelle Bachelet’s first commitments during her presidency was to create a social protection system for early childhood.

This aimed to ensure equal opportunities for all children, thus assuring their right to develop as a way of enabling the socioeconomic development of the country. In 2006, a Presidential Resolution created a technical advisory committee. Three months of work, with the participation of stakeholders from different sectors (representing ministries and technical experts), resulted in the development of The Future of Children is Always Today. This document represents the foundation for the design of the national child protection system known as Chile Crece Contigo (Chile Grows With You, CGWY).

The Ministry of Planning and Cooperation was designed to coordinate all the ministries involved in this process (health, education, finance, culture, justice, labour, housing and women).

Key point of departure: One image, one budget with many actors and sectors working together. Based on a comprehensive set of health social services (Fig. 6.2), CGWY was implemented at municipal level ensuring universal care for pregnant women and children aged from 0 to 4 years (represents almost 80% of the population covered by the public sector).

Each municipality created a local team to coordinate the interventions.

In the health sector, a manager was responsible for follow-up in terms of coverage and quality. Culture and contextual adaptation of policies demands the understanding that this environment was conditioned by the personal history and commitment of President Bachelet who opened a window of opportunity which made ECDs a high priority in the policy agenda.

Social services provided by CGWY Services for all Chilean children aged 0 to 4 years (100%) 1. Educational programmes for each citizen

2. Information available through the Internet

3. Legislative improvements to protect maternal and paternal rights Services for children and their families using public health services (80%

of the population)

4. Psychosocial support programme – a longitudinal intervention (ECD promotion, parenting education and support, maternal depression screening and treatment)

6.3 The need for a socially accountable approach to