The first rule of any self-respecting target is that it should remain static. In this, the millennium development goals (MDGs) have performed admirably since their inception in 2000. But what happens if our understanding of how to meet a target changes? Should we shift the goalposts accordingly?
The publication in Friday's Lancet of a series on early child development (ECD) raises just that question in relation to the MDGs. The two-part series draws on new science and evidence to transform our understanding of the tremendous benefits of programming for under-fives, and the risks of inaction.
The findings are unambiguous: poor nutrition, maternal and family stress, and poverty affect brain development from the prenatal period or earlier. If children are denied relatively simple interventions in their early years, their academic aptitude, cognitive development and ability to generate income as adults will suffer. Conversely, the evidence on the biology, the psychology, the economics, all points to the value of early stimulation and early investment in childhood.
According to a Nobel laureate in economics, the new evidence around early childhood development does indeed require the MDGs to be revised. Programmes must be integrated. And, yes, more money is needed.
That's a tricky trifecta against a backdrop of global financial uncertainty, yet the research is forthright - governments and donors simply can't afford not to invest in ECD and in parents across the developing world. The report finds that the economic benefit of ECD could give a seventeenfold return on investment if a developing country increased pre-school enrolment to 50%. So investing in ECD now will quite literally yield billions of dollars in later years.
According to the report, the most successful and cost-efficient time to prevent inequalities is prenatally and in the first years of life. Equity in life chances means starting early, very early.
The crux is a home focus, with parenting as the linchpin. Exclusive breastfeeding and early parent-to-child stimulation are key protective factors, along with maternal nutrition and education of mothers. Outside the home environment, good quality pre-schooling, conditional cash transfer schemes and educational media are also important tools in the battle for child development.
Integrating early child development priorities into health programmes can have a dramatic impact too, the research finds. For this critical process to happen, changes are required in the way governments and development agencies go about business. Vertical programming - of health, education, nutrition - has to give way to combining interventions for children. The answer may well be to look at the lifecycle of a child, and ECD appears to be the perfect vehicle to make the change.
This is a point accentuated by Nobel laureate Professor James Heckman. "The key new concept reported in The Lancet series - that I don't think was present in the millennium development goals - was a sense of how the outcomes at one age were linked to the outcomes of an earlier age," he says in a debate to be aired next week on unicef-irc.org.
"We've got to get children, all children, on to the right trajectory, so that they can take advantage of all the opportunities that they will have as they downstream, and they go into life and they become adults. And the millennium development goals simply didn't recognise this dynamic. Now I think we do, and so [the MDGs] should be amended."
However, many governments appear reluctant to make the initial investment in under-five schooling. The Organisation for Co-operation Development (OECD) estimates a minimum of 1% of GNP needs to be spent to ensure quality early child development services; OECD governments spend an average of 2.36%. Some central and eastern European and South American countries budget 0.4% for pre-school education, while the figure is as low as 0.1% in Kenya, Nepal and Tajikistan. Nicaragua and Senegal spend less than 0.02%.
"Unless governments allocate more resources to quality early child development programmes for the poorest segment of the population, economic disparities will continue to exist and to widen," warns the paper.
Unicef, Save the Children, the Agha Khan Foundation, Step by Step and the World Bank are among those backing ECD initiatives, but many bilateral donors show signs of retreat, and the poorest governments are not spending enough.
This latest report, however, brings with it an injection of new science to support policies and funding. We cannot afford to wait until 2016 to act on the evidence in support of early childhood development.
-reprinted from The Guardian