In a conversation recorded at castle Marbach, Theresa Betancourt, Aisha Khizar Yousafzai and Felicity Brown explain why healthcare workers should deliver early childhood development services; what the challenges and opportunities could be and why this is an equity issue.
Why do you think investments in early childhood development are important?
Aisha: If there were three key messages I was going to tell government leaders why they should invest more in early childhood development, it would be:
• The return on investment. The more we invest in younger children, in their brain development, the greater the return is going to be in terms of the community and the national development down the line.
• The risk factors for children’s development. We know from the neurosciences that the same risk factors that are going to threaten children’s survival also threaten children’s development. If you think about malnutrition or repeated infectious diseases they’re all going to have an impact on your cognition, on your behavior, on the relationships and the stress levels within families. By addressing those risks you’re not only ensuring that children survive but also that they thrive.
• The question of equity. I would not want to see a world where we decide that these core set of services for early childhood development is accessible for the wealthy alone and not for others. It’s not about privilege, it’s about right. If we allow these disparities to happen, the gap between advantaged and less advantaged children becomes wider and harder to tackle at the other end of the trajectory.
Theresa: We’re now in the era where advances in child rights have really transformed to a new place, where it’s not a luxury but it’s now the agenda. We have to think about how we address these massive disparities that exist globally in terms of children reaching their full developmental capacity, which has economic- and social implications. So these aren’t luxury investments they’re critical investments for advancing economies and societies in many ways.
About a third, which translates to 250 million children under five living in developing countries are not meeting their cognition- or behavioral milestones and therefore not developing well. The need to act is obvious and we also have the know-how about what we need to do in terms of content. We’re growing and nurturing expertise in a number of countries but we now need to put these pieces together with identifying how we train the appropriate lay workers as a potential avenue for delivering these services. We know what we want to deliver but we still need to experiment with who can deliver and how that will vary from country to country.
What are the challenges if lay workers are to deliver early childhood development services?
Felicity: We need to think about how to position these services within existing systems without overloading lay health workers. We also need to address the question of how to motivate lay workers and their supervisors to provide these additional services.
Theresa: We’ve seen in places like Rwanda that there’s a tipping point as to how much health workers can take on. There’s a lot of pushback at the moment that community health workers can’t do everything under the sun. But where else within systems of care can there be a workforce that can be engaged in early childhood development work with high quality sustainability and cost effectiveness?
Aisha: There are many programs within health already delivered by lay workers or community health workers, some are paid but many are volunteers. Some of the skills necessary for early childhood development are behavioral change skills. They require specific competencies and sometimes quite complex skill sets. We now need to be able to understand how we can translate this complex skill set into manageable modules for training. In the long term a challenge will be to find a way to finance this because even if people are volunteers they will need some kind of incentive.
Is there anything high-income countries can learn from low-income countries?
Theresa: It’s really an opportunity for two way learning. Lower resource settings might require a level of innovation to meet the challenges of limited budgets or lack of human resources, which brings forth new solutions or approaches we wouldn’t otherwise think of. For example, I am thinking about the emerging opportunities around cultural brokers and the role community health workers who come from that cultural background can play to contribute to early childhood development services.
Felicity: Similarly, the training and the supervision in high income countries might be provided by more specialist supervisors or trainers, whereas the resources aren’t always available in the low and middle income countries. Therefore, our research will address the urgent question of how to set up supervision and training structures in a different more cost-effective way.