The Progress of Nations 2000

COMMENTARY: EARLY CHILDHOOD CARE

care that the chil(dren in their
(comm unities andmI nations receive.
When children's rights are realized, both the imlnediate and
longer-term rewardls in human
(levelopment are great. Supported
from the moment of birth and
b)efore, chil(dren are likely to survive and to )e healthier and happier, to l)e better able to learn
throughout life and to become
1)rod(uctive citizens.
The results are also visible on
spreadsheets, in lower costs for
remedial education and curative
health expelnditures. And in a
delayed reaction well worth waiting for, effective care leads to better grounded, better nourished,
healthier and more stable and
lproductive societies.
All over the world, millions
upon millions of families do provi(le excellent care fbr their chil(dren. Many millions of others,
however, are unable to (do so, usually because they are among the
1.2 billion people in developing
countries who live below the
p)overty line of $1 per (lay.
They wage a vast but largely
unnoticed struggle against disease, unsafe water, poor sanitation, ignorance, malnutrition,
gender discrimination and often
war and violence. How can we
continue to be surprise(d that
11 million chil(dren below age
five die each year in this unequal
contest and that millions more
lose physical and intellectual
potential?
It is dlilTficult to grasp the physical and cognitive effects of malnutrition alone: Half the children
of South Asia atid one third of
those in sub-Saharan Africa are
mnalmourished, their motivation,
attention, curiosity and cognitive
abilities dulle(l. Malnutrition and
the repeated infections thataccompany it l)roduce a lethal lethargy
that can prevent a young child
from enjoying the care he or she
(leserves. Implicate(l in nearly half
of all chil(l (leat hs and countless

failures to thrive, malnutrition has

been estimated to cost the world -
in one year alone- the e(luivalent of 46 million years of pro(luctive, disability-free life.
During a child's early years,
low birthweight, recurrent illnesses, a lack of psychosocial
stimulation, poor nutrition an(l
the stresses of poverty can lead
to poor health and a general lowering of intellectual, behavioural
and social abilities.
Creating and
revitalizing basic
social services and
building strong
partnerships with
poor communities
are crucial aspects
of ensuring a
good start to life
for children.
These are preventable losses,
for which the solutions are known,
available, fairly inexpensive and
highly cost effective. The answer
is to invest in children- time,
energy, care and resources - and
to (do this from the earliest possible time, from birth and even
before, when the investments will
have the greatest impact on later
human development. Creating
and revitalizing hasic social services and building strong partnerships with poor conmmunities
are crucial aspects of ensuring a
good start to life, for children.
Investing in children
A child whose mother has access
to the care and services she needs
(luring pregnancy and chilll)irth,
a child born into a conunity with
a competently staffed and ade(quately stocked primary health care
centre, where information about
nutrition an(l help for common
ailments and infections are avail
ablde, is a child off to a good start.

When there is time for the stimulation and early learning that lead
to better formal school achievement later, where there is access
to clean water andi a(le(luate sanitation systems and( 'chil(d-friendly'
primary schools- these too are
vital factors in a good start in life.
An additional globl)al expenditure of approximately $70 billion to $80 billion each year
would help extelndl basic services
that provide this kind of vital
foundation to all. This is by no
means an exorbitant amount,
particularly in light of the benefits that would accrue, but it is
one that developing countries oil
their own could not uster.
However, if developing countries devoted about 20 per cent
of national budgets andi donor
nations a similar proportion of
official developmenilt assistance
(O)A) to basic social services,
then the resources, fo)r tile most
p)art, would be available. Such
allocations are the basis of the
20/20 Initiative, a(ldvocated by
UNICEF and other partners and
endorsed by many nations at the
World Sununmmit for Social Development inl 1995.
There are many reasons why
countries do not honour the
most basic rights of ('children. In
some, war has destroyed infrastructure, econonmies and communities; AIDS is rampant,
particularly in Africa, and it is
very (langerously ero( Iing already
fragile social structures andi thle
abilities of commlunities a(nd nations to respond. Corruption
drains the coffers in iiiaiy otilers.
Ant ii far too many, Ibe spiral of
increasing and self-perpetuating
debt strains already threadbare
budgets and translates into disaster for children.
It is an enormous blot on the
conscience of the worl(l that in
the 41 heavily in(lel)te(l poor
countries (HIPCs) where human (levelopment ini(licators are
tile worst in the world.. (lelt ser
vice consumes three to five times

the amount of resources spent on
l)asic services. In almost half of
those same countries, nearly 50
per cent of people lack access to
adequate sanitation and( ('clean
drinking water; 26 oft le 31
counitries with the highest niumh)ers of child deaths in the world
are in the HIPC group.
Not only is debt relief still
stymie(l, l)ut development assistance has also fallen from an
average of 0.33 per ((cent of gross
national p)roduct (GNP) in 1990
to an average of 0.24 per ('cenlit in
1998. This is lhappening in tihe
conltext of a global economly that
has grown to more than $30 trillion tod(ay and in l(dono(r ('countries where average GNP )er
person increased fronm $20,900
to $27,000 over the course of the
last (deca(de.
There is no question lithat the
resoutrces exist, but too little
monmey is allotted for children's
survival, growth andi (development, and too few people tilnd(lerstand(l the implications for all
societies (of missed opport unities in early childhood.
When (care in early chil(ldhood
is ma(le a priority, much can lbe
achieved. iThe accomp()l)lishmetits
of the lpast 10 years are signifi(cant. Inmmnunization alone saves
the lives of 2.5 lmillion chil(lren
each year. The conditions for
unleasihing these children's full
human p)otential, however, remain largely unchange(d i n poor
conmuunities.
Simnple transforming steps
We no longer have the excuise
of ignorance. We know of good
working exaniples of the iimtegrate(l approach that eiisures
children's siirvival and brings (it
their potential. Programues i
Ini(lia, Jamaica, Kenya, Peru alitt
Turkey, for example, offer impomrtant lessonts aid hold ()tp1romtis(e
fomr similar gains elsewhere.
So too (loes aii evolving iiitegrate(l early childhoo(l (are an(l

develolpment approach iti the

12')