Chile grows along with you
Francisca Infante and Helia Molina
Early childhood provides a unique opportunity for achieving neurological, biological and social milestones that are critical for future development. Achieving these milestones require a fostering environment that promotes development. Where children are born, live and learn directly affects the life chances and health they will have in the future, the skills they will develop, the education they will access, and the occupational opportunities they will have. Francisca Infante and Helia Molina share some experiences from Chile.
A child born in a poor neighborhood in Chile is more likely to have developmental delays, less years of education, do poorly in school, and subsequently as an adult is likely have a low income, high fertility at an earlier age, and provide poor health care, nutrition, and stimulation to his/her own children, contributing to the intergenerational transmission of disadvantage. Thus early childhood is considered a social determinant on its own, providing developmental opportunities that are not repeated in later moments of the life cycle, which will allow girls and boys to have access to better opportunities later on. At the same time it is affected by other social determinants of health. Evidence shows that assuring equal opportunities for the development of children and families allows social and economic development, as well as reducing inequity.
Based on the large body of evidence showing the importance of early childhood development as a social determinant of health and its impact in national social and economic development, Chile has created an early childhood social protection system named Chile Crece Contigo (Chile Grows Along with you) with the objective of making equal opportunities for the development for both girls and boys, from conception to school entrance (0-4 years old), independent of social origin, sex, home structure or any other potential factor of inequality. The four main principles that govern Chile Crece Contigo are a Human Rights framework where all children have the right to develop to their maximum individual potential; Social Participation, with children and families participating from the inital design phase of various Government programmes, in order to include their needs and wants; and Equity, including universal actions for all children of a similar age, some actions targeting only children who participate in the public health sector, and other actions especially targeting vulnerable children who belong to the 40 per cent of the poorest households – which encompasses around 60 per cent of children from 0-4 years old in the country. Intersectoral work presents a network of interventions to the child, the family and the environment that goes beyond the “service provision” model to a more comprehensive approach to assure efficiency and coordination among the different Government stakeholders at the local, regional and national level.
Comprehensive network of services:
The social protection system set up simultaneous government interventions for the child, the family and the environment, and created new programmes in order to offer different levels of support depending on a girl or boy’s needs. The different components include:
- Educational programme for all citizens, ensuring that independent of income, or the area where the child is born, parents, care givers, and the whole community have access to information regarding the relevance of ECD, and skills for its promotion.
- Strengthen legislation and standards of protection for maternity and paternity such as:
o Automatic transfer of days to the postnatal period, if they have not been used in the prenatal period;
o Right to transfer up to three weeks of prenatal benefits to the postnatal period;
o Right of working mothers to nurse their children independently of a nursery in the workplace, if it exists.
o Extension of prenatal leave to one year when a child is born with a disability, and
o Improved legislation giving equal rights to adoptive parents in regard to adoption time, leave entitlement and postnatal subsidies. - Care for all children from the first prenatal control until school enrollment:
- Reinforcement of prenatal care through learning materials and education, to prepare more vulnerable families for delivery, nursing and home visits; o Friendly services at childbirth;
- Parental skills workshops and home visits for vulnerable families and children with developmental delays, and
- Friendly hospital paediatric services.
- Differentiated support and guarantees for children from the 40per cent of homes with low income or in special situations of vulnerability:
- Free childcare of accredited quality, for all children of working mothers, mothers who are looking for work, are studying, or who have special needs;
- Free playgroup services of accredited quality, either full or part-time, for all children between two and three years of age;
- Childcare and playschool facilities that accommodate different realities; e.g. rural zones, seasonal work, and nightshift work;
- Guaranteed access to technical help for the home, along with technical support for health and education establishments to enable to the provision adequate quality of care to children with special needs, and
- Specific support is also to be provided directly to families through preferential access to the programmes and public services they need for their children’s development such as scholarship to maintain school enrollment for adolescent mothers, livelihood training for unemployed parents, and economic subsidies for housing.
How Chile Crece Contigo was created:
Chile Crece Contigo was created through a participatory process that included a “Consejo Asesor Presidencial,” an expert commission on early childhood development policy reform and civil consultations with children and families throughout the country from which a series of recommendations was created. These recommendations were presented to the President, who used them as the basis on which tocreate a Social Protection Ministry Committee formed by Ministers of Housing, Education, Labour, Health and Social Planning, Arts and Culture and the National Women´s Service. This committee translated the recommendations from the expert commission into the Social Protection System on Early Childhood, to provide a guaranteed set of basic services and programmes tailored to the needs and wants of children’s different developmental stages, in a coordinated way at municipal level, to assure policy coherence, commitment, and leadership at national and local level.
How is it managed?
The systemic approach required by Chile Crece Contigo has required public management capacity to coordinate and involve different sectors and actors with sometimes incompatible interests. This has been achieved by creating a management secretariat, a shared budget for the programme that is independent of different sector budget, and a shared branding or image that serves as an umbrella for all sectors that provide the different benefits. There is also an evaluation system to help identify child and family needs so that the network of benefits, subsidies and services targeted towards children and their families is received in a timely manner and of a suitable quality.
Achievements and Challenges
The implementation of the social protection system for early childhood is relatively recent, therefore it is too early to evaluate its impact. However, we carried out a situation analysis prior to implementation. All interventions are evidence-based, therefore, we can expect a positive impact in the lives of children, their families and the future of our nation. Based on the views of different professionals who work in the system we know that Chile Crece Contigo has created a new working environment in the public system calling for collaboration among different stakeholders at every level. It moves beyond the curative model towards a more comprehensive and inter-sector model of work with high political and civil support; creating important and consistent evidence for interventions on early childhood as a determinant of health.
Francisca Infante is Psychologist, M.Ed. Technical Advisor for Vice Minister of Public Health.
Helia Molina M. is M.D., M.P.H. Public Policy and Health Promotion Chief, Ministry of Health.
Filed under: social determinants of health
