Poverty & Investment in ECCD
It is hard to convince a family trapped in a cycle of poverty, and constantly facing medical costs that reduced work and extra food for mother is a priority. It is even harder to convince them that time spent nurturing a child might help that child earn more as an adolescent.

Most South Asian governments have yet to be convinced that investing in quality care of mothers as well as by mothers (Ramalingaswami, Jonsson and Rohde 1996, p.15) costs a family and society much less in the longer term than later remedial services, and there is a ‘mismatch’ between opportunity and investment (Perry 1966). Although the ability to influence the developing brain is greatest in the unborn child and during the early years, direct government support to young families is trivial, compared to later government investments in education, remedial services, hospitals, courts, prisons, and social welfare services (McCain and Mustard 1999, pp.122-123).

In the world of investment, the longer the time In the world of investment, the longer the time and the larger the distance between a decision to invest and the effect of that investment, the harder it is to get the investment (Doryan, Gautam and Foege 2002, p. 379). When it takes a long time to get a ‘return’ on an ‘investment’, other options that have a faster ‘pay-back’ are preferred. ECD is hard to ‘sell’ to governments as a good investment, partly because some of the most important effects are not observable for many years.

The Aga Khan University Symposium: September 2002
How are early childhood care and development, human capital formation and national development linked? Does it make good economic sense to invest in the care of women and children? Who should invest in ECD? Who benefits? A large number of national and international speakers and papers addressed this theme: ECCD: Best Investment for the Future in the 2002 Aga Khan University, Faculty of Health Sciences Symposium. A number of papers, posters, workshops and plenary discussions combined to reinforce their messages.

Child Mental Health
Child psychiatrist, Dr Syed Arshad Husain, from the University of Missouri, reminded us that children are the conscience and future of a nation. He reviewed the history of childhood, assessed the state of children’s health, mental health and educational opportunities in Pakistan, and argued for commitment of more resources to child mental health.

The care and attention expressed for the children become the most elegant measure of that nation’s regard for itself…Societies who neglect their children’s welfare are doomed to fail as a nation. This is why the World Summit for Children agreed that children are innocent, vulnerable and dependent. They are also curious, active and full of hope. Their time should be one of joy, and peace, of playing, learning and growing. Their future should be shaped in harmony and cooperation.

Child Nutrition
Based on a long career within government, championing improved nutritional status of children, as well as adults, Dr Mushtaq Khan, from the Centre for Research on Poverty Reduction and Income Distribution (CRPRID), Islamabad, argued:

Malnutrition is both one of the consequences of social injustice and one of the factors contributing to its maintenance. It bears hardest on small children. Contributing to the massive death toll among the young ones, and together with other adverse environmental factors, it interferes with growth and development of the survivors. It reduces their capacity to learn during childhood and learn during adulthood. Measures that will improve the nutrition of mothers before and during pregnancy, and of infants and young children, will reduce morbidity, will improve the effectiveness of expenditures on education, will reduce the cost of health care, and will increase the work productivity of adults.

The Hight Cost of Low Quality Education.
Using data from the Education for All (EFA) Year 2000 Assessment, Dr Jim Irvine from the AKU-Human Development Program, argued that lack of attention to readiness for school has its legacies in significant enrolment and completion disparities in primary schools throughout the region. Furthermore, because issues of quality have not been adequately addressed, repetition and drop-out rates remain high. It would be more efficient and cheaper to address readiness rather than remediation.

For families with limited resources, the opportunity costs and real costs of educating their adolescent children are very high. If they perceive schooling to be inefficient, irrelevant or unlikely to enhance earning opportunities, their children may be forced to drop out, without acquiring functional levels of literacy or numeracy. Conversely, increased investment in the care of women and young children, and in the quality components of basic education can enhance the prospects for many children to progress beyond the primary cycle in minimum time, with benefits to education systems of less wastage of time and resources (e.g. reduced repetition and drop-out), and a more skilled work force graduating and contributing to national development.

ECCD Program Outcomes In The Context Of UN Resolutions
Several global UN-led commitments to a stronger focus and greater investment in ECD were reviewed by Dr Femida Jalil, from King Edward Medical College, Lahore. In a World Fit for Children, leaders have pledged resources and committed support to ECD initiatives. One of the recurring weaknesses in making the case for increased investment has been the lack of internationally comparable data on the psycho-social status of infants and young children.

Over 150 countries have taken ECCD initiatives: 120 knowledgeable professionals were contacted globally to opine on effectiveness as an outcome of various ECCD programs / projects. 35 projects / programs were thought to be effective, however further analyses revealed only 10 were truly ‘effective’. Other projects need to re-evaluate their strategies and methodologies. At the same time, all countries need technical support and financial commitment for effective ECCD programs. Indicators to evaluate projects/programs and to assess psycho-social development have been developed through studies in 5 countries. These need fine tuning before they can be used as a recurring theme in the State of the World’s Children.

ECCD Leaders and Integerated Programs
Integrated approaches to ECD combine best thinking and practice from a number of perspectives, such as health, nutrition, community development, psychosocial development, environmental hygiene and sanitation, and early education. ECD advocates argue that an integrated approach is more effective together than interventions applied separately. But where are the programs to educate the new ECD leaders who must break down the traditional disciplinary, donor and ministerial boundaries or ‘silos’?

Dr Bartlett from the Aga Khan Foundation, Geneva, outlined key developments and approaches in South Asia and other regions, (e.g. the ECD Virtual University) and endorsed plans for the AKU-Human Development Program (AKU-HDP) that combine research, education and training, community ECD model building, and advocacy and constituency building as inter-dependent components of a Program to build ECD leadership capacity in Pakistan and in the wider region.

A critical gap and, indeed, a growing area of real concern for many who have been advocating for quality, effective ECD programs, research and policies is the very limited resource base of ECD ‘leaders’ across countries who are experienced and well-grounded, and who also understand the holistic and integrated nature of ECD.

Experience Based Brain Development
Keynote speaker, Dr Fraser Mustard, from the Canadian Institute for Advanced Research (Mustard 2002), argued the need for more serious attention to brain development in the critical prenatal period and the early years.

One of the least understood relationships has been how brain development in the early years influences physical and mental health in the later stages of life… coronary artery disease, type II diabetes, blood pressure, performance in the formal school system and the level of education attained. Poor early childhood development affects key aspects of brain development including the stress pathway (hypothalamus pituitary adrenal axis – HPA axis) which affects all body tissues during life including the immune system, and brain development with effects on cognition and behaviour. In the world of investment, investing in quality early childhood development and parenting programs is a ‘hard’ investment, as important to society as investments in bridges, power stations and dams.

The Economics Of ECCD
Development economist, Dr Jacques van der Gaag, University of Amsterdam, linked integrated programs of ECCD that improve the nutrition, health, cognitive development, and social interaction of children in the early years, with Human Development — education, health (including nutrition), social development, and growth — but at the scale of a nation.

Four critical “pathways” link ECD to HD: through education; health; social capital; and by the potential of ECD programs to address inequality in society… ECD programs can make a dramatic difference. They are associated with decreased morbidity and mortality among children, fewer cases of malnutrition and stunting, improved personal hygiene and health care, and fewer instances of child abuse. Well-executed and well-targeted ECD programs are initiators of HD. They stimulate improvements in education, health, social capital, and equality that have both immediate and long-term benefits for the children participating in the programs. Investments in ECD programs are in many ways investments in the future of a nation.

Foeto-Maternal Nutrition
Dr Zulfiqar Bhutta, Department of Paediatrics, AKU, linked Pakistan’s poor progress in human development indicators to the lack of investment in health, education and social development, highlighting the life-long cost of inadequate attention to the nutritional status of women and the unborn child.

The poor nutritional status of the population is specifically apparent among the most vulnerable, namely the women and children of Pakistan. Low Birth Weight (LBW) infants account for almost 30% of all births, with maternal malnutrition as a dominant risk factor. LBW may account for several long-term effects on the health and productivity that may impact on national economic performance and outcomes. Despite this information,there are very few intervention programs geared towards improving maternal malnutrition in a sustainable fashion.