Integrated, multi-sectoral ECD programming and the Nurturing Care Framework

• In Event: Roundtable Session (Tuesday I)
  In Refereed Round-Table Session: Community-based and multi-sectoral ECE programming

Proposal

This paper will begin by highlighting the evidence that integrated multi-sectoral interventions for children in the prenatal to age three age range best support the holistic development of children, before moving to acknowledge the current barriers for integrated multi-sectoral (IMS) programming. In 2018 the author presented a series of six principles that support the achievement of integrated multi-sectoral programming: 1) Decentralize decision making to a sub-national level and provide structured guidance from a national level, 2) Understand the drivers and behaviours of the ‘end-user’, this should inform all activities from commune implementation and fund allocation, to national level content development, 3) Invest in the critical actors for service delivery, 4) Support sub-national entities to identify appropriate ‘entry points’ for IMS service delivery, 5) Provide support for working using IMS approaches at a sub-national level, 6) Collect data across multiple sectors and report it as one data set when reporting vertically. This paper will go further and explain experiences in applying these principles in the context of Cambodia.

Children, and their caregivers, live their lives holistically, not in sectoral silos (Woodhead, M. et al., 2014). That said, the importance of IMS work is broader than simple logistical efficiencies for beneficiaries, or supporting coordination in responses; it is about identifying the most appropriate response to support children’s holistic development. Ensuring that services are ‘joined up’ through an IMS approach is critical for maximum efficiency and impact for children.

Interventions that use IMS approaches and consider the interrelated nature of nurturing care result in better outcomes for children (Black, M., et al., 2015), particularly those from lower income households (Pearson, E., et al., 2017) or in emergency contexts (Sameroff, A.J., et al., 1987; UNICEF-WHO, 2012). Better outcomes for children now means that those children will grow up to be a more able and productive workforce, less likely to experience heart disease, be violent to others, or engage in risky behaviours like alcohol or drug misuse (Barth, R.P., et al., 2008). In 2015 the World Bank Systematic Review (Tanner, J., et al., 2015) considered 55 impact evaluations from child development programmes where post-early childhood outcomes were collected. The study highlighted that early years stimulation interventions were shown to have a wide impact not only on cognitive development and social-emotional development but also on physical development and nutrition (Ibid.), and studies show that early years stimulation combined with nutrition has a greater impact for children than one of these interventions alone (Rao, N, et al., 2013; Grantham-McGregor, S.M, et al., 2014; Hurley, K.M., et al., 2016). Children don’t develop in silos. This ‘multiplier effect’ of benefits for children is not isolated to nutrition and education interventions; for example, if children are not protected from harm, the impact of toxic stress can weaken or ‘stunt’ brain architecture, leading to an increased risk for children’s physical health, cognitive development, linguistic development, and social-emotional development (ISAC, 2010; Shonkoff, J.P, et al., 2012; Aboud, F.E., and Yousafzai, A.K., 2015). Likewise, if children don’t have access to safe drinking water, clean toilets or encourage hygienic practices then it will inevitably have an impact on children’s health and nutrition the negative effects of which will spill-over to the other development domains (Stewart, C.P., et al., 2018). Whilst evidence is strongest that IMS for education and nutrition results in the strongest consistent effect for children (Tanner, J., et al., 2015), the evidence is growing that the international community, national governments and implementing bodies must consider all five components of the Nurturing Care Framework to achieve the greatest impact for children.

This paper will outline the need for greater consideration of what it means to be truly ‘integrated’, what this means in the context of the Nurturing Care Framework, the evidence behind it, followed by an application of the six principles for implementing integrated multi-sectoral programming to the Cambodian context.

Author

• Holly-Jane Howell, Save the Children