These issues are discussed in the South African Child Gauge 2013, which was released earlier this week by the Children's Institute, University of Cape Town, in partnership with the United Nations Children's Fund (UNICEF) and Ilifa Labantwana. This year's annual review of South Africa's children focuses on essential services and support for young children and illustrates how these can serve as a great equaliser by breaking the intergenerational cycle of poverty.
The publication draws on the latest research evidence and coincides with the government's efforts to develop a national policy and programme for ECD which will, according to Minister Bathabile Dlamini, "define the ECD service package and make it a public good". The re-engineering of primary health care and current review of the Children's Act offer further opportunities to strengthen the delivery of essential services for young children.
Lizette Berry, senior researcher at the Children's Institute and lead editor of the South African Child Gauge 2013, said that the unequal society in which South Africa's children are growing up is "threatening their development and that of the country in the long term".
General Household Survey data from 2011 shows that 58% of children aged up to nine years old were living in households with an income of less than R604 per person per month.
Poverty impacts on children's health and nutritional status and a recent survey by the Human Sciences Research Council found that the growth of more than 25% of children under three years old is stunted due to malnutrition. The quality of nutrition in the early years affects brain development, intelligence, schooling outcomes and economic productivity in adulthood.
Educational outcomes are poor, a tell-tale sign that many young children are ill-prepared for formal schooling, and pointing to challenges in the education system.
The health and wellbeing of caregivers is the "single most important contributor" for children's health, survival and development, according to psychologist Mark Tomlinson from Stellenbosch University. Primary caregivers' ability to provide a healthy, nurturing and stimulating environment is critical. But caregivers in South Africa are facing many challenges - a combination of poverty, violence, illness and social isolation that affects their ability to care for children in a way that will ensure good developmental outcomes. Mental health conditions are common in poverty contexts, especially where caregivers face multiple burdens.
Overall, investing in young children is about social justice, explained Ilifa Labantwana programme leader, Sherri le Mottee, to "give each child the best possible start in life, regardless of their home circumstances, with the end goal of social cohesion by supporting and equipping them to be well-adjusted, caring and productive individuals in adulthood".
The negative effects of poverty can be mitigated by a continuum of services aimed at the different stages of children's development. According to co-editor Andrew Dawes: "Child development begins before birth, so what is needed is adequate support from pregnancy, through infancy, the pre-school years and into the foundation phase."
The South African Child Gauge 2013 outlines an essential package of services and support for young children and their caregivers that includes nutritional support, health and social services, support for primary caregivers, and stimulation for early learning that begins at birth, and into the early schooling years.
Poverty and associated challenges compromise the mental health of caregivers and this makes it more difficult for them to provide adequate care to young children. At least one-third of mothers living in poverty are affected. An important recommendation is better support for caregivers, such as parenting programmes that improve parenting skills and knowledge of early childhood development and help to prevent child abuse and neglect.
Other mechanisms of support for caregivers include routine mental health screening at primary health facilities and widely available psycho-social support. Caregivers also need access to affordable child care, social grants, and other social services.
"Early childhood development programmes can be centre or home-based, formal or non-formal. We therefore need interventions through various channels, such as home visits, playgroups, ECD centres, multi-purpose centres, clinics and schools that reach children and families in different contexts - especially the most vulnerable," explained UNICEF South Africa representative Aida Girma.
Health points of contact with children are important opportunities for support, said Berry. "A key opportunity is the expansion of community-based health services as part of the current re-engineering of primary health care - these can reach into the home to support the very young and their families. Other priorities are maternal and child health services and nutritional support to expectant mothers. In particular, children younger than three years old must be prioritised for nutritional support if we want to see improvements in children's health and educational outcomes."
It is also important to improve access to quality early-learning programmes, said co-editor Linda Biersteker from the organisation Early Learning Resources Unit. "Access for children in poor and rural communities is very limited. And where there are ECD centres, caregivers must pay fees to top up government subsidies, making such centres largely unaffordable for the majority of young children." Furthermore, the quality of early-learning teaching - in ECD centres, as well as in grade R to grade 3 - needs urgent attention and requires better trained practitioners and teachers.
Contributors to the South African Child Gauge 2013 recommend several important approaches to strengthen the ECD system. Local government is identified as a strong contributor in the delivery of services for young children as municipalities could target vulnerable children effectively in response to local needs. However, adequate resources and capacity are critical. This includes investment in human resources and training in multiple sectors, and adequate and appropriate funding models to support delivery of an essential package.
Girma stressed the need for "good governance and leadership that outline roles and responsibilities and provide clear lines of accountability to ensure effective delivery". This includes what Berry describes as a national co-ordinating structure with the authority to oversee activities, enable collaboration and monitor implementation: "It is recommended that the national ECD policy, which is currently being developed, should focus on these crucial elements of an effective system and facilitate the establishment of such a co-ordinating structure."
While government has specific responsibilities to support young children and families, ECD is everyone's business, said Le Mottee: "In essence, every person who comes into contact with young children has an opportunity to shape and support their development."
The publication can be accessed at www.ci.org.za.
