In Sri Lanka, Priyanthi, a 28-year-old mother in the Matale District, remembers the evening that she carried her daughter, Madushika, 7 kilometres to the closest medical facility. It was about five in the late afternoon and almost dark when the small woman began her frightful journey with the 18-month-old toddler in her arms struggling for air. Stumbling over the fallen branches and underbrush cluttering the narrow dirt paths, she heard her daughter’s laborious gasps growing weaker. By 6 p.m., she and the baby reached the clinic. The doctor’s words still haunt this woman with tired eyes and underscore her race against the clock. Had she delayed the trip by a mere 15 minutes, she remembers him saying, her baby, whose chest cold had turned into pneumonia, would have been dead. Had Madushika, now a healthy five-year-old, been born just a decade earlier, without the availability of life-saving drugs, the pneumonia would have likely won the race.

Priyanthi’s children, Madushika and her younger brother Madusha have benefited from Sri Lanka’s system of health services and early childcare programs. Both children were born in the relative safety of a hospital, like nearly 90 per cent of Sri Lankan live births today. When the young mother was pregnant with her two-year-old son, she received regular health check-ups in the village clinic and pregnancy advice from the village midwife. She learned how talking to her infant during breastfeeding would improve his mind and body. She learned that cooing and babbling to her child in response to his sounds, commonly called ‘motherese’, would help the baby boy learn to talk.

Once released from the hospital, Priyanthi and her newborn participated in a program in which trained volunteers visited them in their home. Madusha’s height and weight continued to be monitored. Priyanthi also continued to get support and advice on the importance of touching, talking and singing, as well as on bathing and feeding her baby. Priyanthi’s family is 1 of 22 families from Ambanganga, a small village about 25 kilometers from Matale, involved in a home-based program

carried out by a local NGO called Sithuwama, with UNICEF support. Sithuwama, which means ‘raising a child with enjoyment’, promotes early childhood care, including healthy childcare practices and cognitive stimulation. Its services are provided through home-visiting programs for infants up to three-year-olds and for pre-schoolers from age three to five. Through Sri Lanka’s home-based service, Priyanthi learns that good nutrition, home hygiene and sanitation practices and cognitive stimulation are all necessary ingredients for her children to grow and develop. Now, she is investing the focused time, care and attention that are vital for improving her children’s lives. She collects extra firewood to boil water for her children to drink. She finds legumes that add to the nutritional value of their meals. She makes certain that they use the latrine and wash their hands afterwards. She asks her children their thoughts about the birds chattering overhead during their baths in the stream. She takes them to village health days.

Priyanthi, her husband and children live in a small, four-room, cement house without electricity or running water. They sleep together on a dirt floor on woven straw mats. The family survives on a little over 2,000 rupees (about $27) a month that Priyanthi’s husband earns on a tea plantation.

Sithuwama’s volunteer home visitors helped Priyanthi figure out how to promote her children’s psychosocial and cognitive development without spending much money. The NGO’s volunteers teach her the importance of play for her children’s physical and mental well being. She and her husband constructed a playhouse for the children. The airy structure is made from twigs and branches tied together with pieces of cloth and covered with a tarp. Little wooden shelves are filled with colorful boxes, gourds, coconut shells, ceramic bowls, metal cans and flowers they have picked. Through play, Madushika and Madusha are learning about colors, shapes, sizes, labeling and sorting. They are also learning to dream and imagine.

Priyanthi meets weekly with a program volunteer and once a month with a group of other parents in support sessions. Learning from each other, the parents compare notes about their babies’ height, weight and other milestones.

Community-based services that meet the needs of infants and young children are vital to Early Childhood Development and they should include attention to health, nutrition, education, water and environmental sanitation in homes and communities. The approach promotes and protects the rights of the young child to survival, growth and development. The ECD approach remained unfortunately a lost out opportunity vis-à-vis the policies and programs of Government of Pakistan until recently. At present there are many ECD initiatives under-way, both by the Government and donors, to promote ECD approaches for education and development of young children in Pakistan. (For more details please refer to the section on RCC Program)

Most brain development occurs before a child turns three. In the first moments, months and years of life, every touch, movement and emotion in a young child’s life translates into an explosion of electrical and chemical activity in the brain, as billions of cells are organizing themselves into networks requiring trillions of synapses between them. Long before many adults even realize what is happening, the brain cells of a new infant proliferate, synapses crackle and the patterns of a lifetime are established. In a short period of 36 months, children develop their abilities to think and speak, learn and reason and foundation are laid for their values and social behavior as adults.

These early childhood years are when experiences and interactions with parents, family members and other adults influence the way a child’s brain develops, with as much impact as such factors as adequate nutrition, good health and clean water. And how the child develops during this period sets the stage for later success in school and the character of adolescence and adulthood.

When infants are held and touched in soothing ways, they tend to thrive. Warm, responsive care seems to have a protective function, to some extent immunizing an infant against the effects of stress experienced later in life. But the brain’s malleability during these early years also means that when children do not get the care they need, or if they experience starvation, abuse or neglect, their brain development may be compromised.

The effects of what happens during the prenatal period and during the earliest months and years of a child’s life can last a lifetime. All the key ingredients of emotional intelligence – confidence, curiosity, self- control, relatedness, capacity to communicate and cooperativeness – that determine how a child learns and relates in school and in life in general, depend on the kind of early care he or she receives from parents, pre-school teachers and caregivers. Emphasizing the care of babies and toddlers means focusing on women whose physical and emotional conditions influences their pregnancies and their babies development

Educating families about the importance of proper diet and health care for pregnant women is also the part of ECD, as is educating men about their important role in caring for their pregnant wives and nurturing their children. When fathers as well as mothers are convinced about the support required for healthy pregnancies and child development, harmful health practices `can be eliminated.

ECD requires integration of different departments especially health, education and community development. Health department should focus on integrated, holistic early childhood development. All children have the right to be delivered safely. It is possible only in the presence of well-trained community based midwives. Luckily, in Pakistan we have a strong network of 50,000 Lady Health Workers covering nearly 50% of the country’s population under the National Program of Primary Health Care. Many have the potential to be up- graded to do more specialized jobs.

Each child, under 03 years, should have the facility of regular health checkup, immunization, growth promotion and supplementary feeding and referral services. Additionally, the age group of 3 to 6 requires nutrition, health education, early child care and pre-school education. The job can easily be accomplished by lady health workers and preschool teachers. A comprehensive ECD based Primary Health Care Program should also cater to the needs of adolescents, pregnant women, breastfeeding mothers and all women between 15 to 45 years of age.

The time of early childhood should merit the highest-priority attention when responsible governments are making decisions about laws, policies, programs and money. Yet, tragically both for children and for nations, these are the years that receive the least.

Timely and appropriate early childhood care saves lives. Wherever it is found, whether in war-ravaged countries or industrialized societies, programs that focus on health, education and social well-being of the youngest citizens have made a profound difference in children's survival, growth and development.

What is a fair price to pay for saving children? India's Integrated Child Development Services was estimated in 1994 to cost 27 cents a day for each child. During the same year, the Hogares Comunitarios de Bienestar program in Colombia, operating in 55,000 sites and offering full day care including food, was estimated to cost 38 cents a day. Many countries spend considerably more, with governments absorbing much of the cost.

Far-sighted leaders understand that money spent now on early childhood care will pay off in the form of healthier, more productive children and in stable families that are able to sustain themselves and contribute to society. Indeed, choosing not to provide early care for all children is the costliest mistake. For every $1 invested in the physical and cognitive development of babies and toddlers, there is an estimated $7 return, mainly from cost savings in the future.

By championing the rights of the youngest children, we are taking the first step to breaking the bonds of poverty, violence, disease and discrimination and to building a world of hope and change. As Priyanthi has discovered by seeing her own small treasure thrive, the true wealth of a nation is measured in the health and strength of its youngest citizens.

Early childhood care for survival, growth and development is just an empty phrase unless governments in developing countries allocate sufficient resources (UNICEF recommend 20%) from their national budget to the basic social services and donors also do the same.

(Excerpted from: State of the World’s Children 2001 - UNICEF).
Compiled by: Dr. Shaikh Tanveer Ahmed
Executive Coordinator, Health and Nutrition Development Society (HANDS)

Dr. Shaikh Tanveer Ahmed is the Executive Coordinator of Health and Nutrition Development Society (HANDS). He has been working in the field of social development, especially health, for more than fifteen years. Dr. Ahmed has also authored and presented many papers in national and international conferences.