1. Comparative & International Education Society: Gaining Educational Equity Around the World Teachers College, Columbia University Edwin Philip J. Horca Ph.D. March 17 – 21, 2008 Integrating Health and Nutrition in ECD

2. Outline of Presentation The Face of the Filipino Children Today Working within the Child 21 Framework Integrating Health & Nutrition in ECD Programming Building from What We Have Crafting Effective ECD Programs Enhancing the Transition Process

3. The Face of the Filipino Children Today 88.7 M Filipinos (2007 projection, NSO) 14 th rank in world population 108.5 M by 2015 3.6 fertility rate 2.36 population growth rate The Philippines very own symbolic six billionth baby of the world,baby Lorrize marks a milestone in history and serves to remind one and all about the intricate interrelationship between population, development, resources and the quality of human life on earth.

4. The Face of the Filipino Children Today Children comprise a big percentage of the population: 34.6 M are children below 18 years old 0-6 years of age account for 17.5% of the total population An estimated 13.5 M 0-6 years old in the country 6.5 M 3-5 years old in the country CWC, 2007

5. The Face of the Filipino Children Today Out of 100 Children born each year in the Philippines, 8 will likely die before their 5 th birthday, 30 will suffer from malnutrition in their first five years of life, 26 will not be immunized against the basic childhood diseases, 19 will lack access to safe drinking water, 10 suffer from physical and mental disability or developmental delay 67 of the 3-4 year olds are not able to experience early childhood stimulation, 40 five year olds are not able to enter preschool and 17 will never go to school. CWC, 2007

6. The Face of the Filipino Children Today 4 Core Threats to the Filipino Children: Health Nutrition Education Protection The problems are closely linked and indicate an urgent need for an intensive and integrated effort to ensure the optimum development of the child.

7. Working within the Child 21 Framework Our vision is that by 2025, every Filipino child will be, Born healthy and well, with an inherent right to life, endowed with human dignity; Happy, loved, and nurtured by a strong, stable and god-loving family; Living in a peaceful, progressive, gender-fair, and child- friendly society; Growing safe in a healthy environment and ecology; Free and protected by a responsive and enabling government; Reaching her (his) full potential with the right opportunities and accessible resources; Imbued with Filipino values steeped in her (his) indigenous cultural heritage. Assertive of her (his) rights as well as those of others; Actively participating in decision-making and governance, in harmony and in solidarity with others, in sustaining the Filipino nation. The Philippine National Strategic Framework for Plan Development for Children or CHILD 21 is a strategic framework for planning programs and interventions that promote and safeguard the rights of Filipino children. It paints in broad strokes a vision for the quality of life of Filipino children in 2025 and a roadmap to achieve the vision.

8. Working within the Child 21 Framework Legal Basis for ECCD RA 8980: Early Childhood Care & Development Act An Act Promulgating a Comprehensive Policy and a National System for ECCD

9. Integrating Health & Nutrition in ECD A. The Compelling Case for ECCE Early childhood sets the foundations for life. Early childhood programs are important, –first, to guarantee the rights of young children, enshrined in the Convention on the Rights of the Child now ratified by 192 countries. –Second, early childhood is a highly sensitive period marked by rapid transformations in physical, cognitive, social and emotional development. Strong Foundations, 2007

10. Under nutrition, deprivation of care and poor treatment are particularly damaging to young children, with repercussions often felt into the adult years. Accessibility to key environmental factors and nurturing experiences during early years have been shown to be significantly correlated to psychological and biomedical outcomes in later life (Hayden, 2006) Integrating Health & Nutrition in ECD A. The Compelling Case for ECCE

11. Addressing health and nutrition problems in pre- school children is important for two reasons: –First, these children account for more than 50% of the global gap in mortality between the poorest and richest quintiles of the worlds population –Second, they bear 30% of the total burden of disease in poor countries. Of the 10.5 million children that died in 1999, 99% were from developing countries and of these 36% were in Asia and 33% in Africa. Integrating Health & Nutrition in ECD B. Impact of Health & Nutrition

12. Health & Nutrition in Pre-school Children Eminently treatable and preventable conditions, such as pneumonia, diarrhea, malaria, measles and malnutrition are leading killers of children. (Jukes, 2006)

13. Health & Nutrition in Pre-school Children

14. Common condition of poor health and nutrition can affect education in a number of ways: –First, childrens health and nutrition has an impact on their access to school. –Second, childrens school readiness can be affected by their health and nutrition. Integrating Health & Nutrition in ECD C. Impact on Access & School Readiness

15. In the Philippines, education indicators reveal: 33% GER in ECCD 12.5% drop out by Grade One 3.2% drop out by Grade Two 7.36% drop out rate for Elementary level Integrating Health & Nutrition in ECD C. Impact on Access & School Readiness EFA, 2006 ; Dep Ed BEIS, 2007

16. ECCD and the Childs Staying Power Children who experience early child care and development are most likely to complete ten years of schooling.

17. …the main problem the child encounters is in the move from grade 1 to grade 2: only about 86% of grade 1 entrants are able to move on to grade two the following year... Meeting the Basic Learning Needs of Young Filipino Children. A Study on Public Investment in Early Childhood Education by Ruperto P.Alonzo and Feny de los Angeles-Bautista in collaboration with Dr. Robert Myers Integrating Health & Nutrition in ECD C. Impact on Access & School Readiness

18. Brgy. BF 77,567 (Total Population) ECCD and the Childs Staying Power

19. The strong determinants of school readiness are as follows: type of place- whether rural or urban ; marginalization status; sex of child; exposure to early childhood education; health status; parents knowledge, attitude and practice on childrens cognitive development; parents practices in stimulating childrens school readiness; and access to learning materials. School Readiness Study, 2003 Integrating Health & Nutrition in ECD C. Impact on Access & School Readiness

20. Childrens health status figured out as an important determinant of school readiness too as it was positively correlated specifically with cognitive and social-emotional domains of school readiness as well as with the standard score. This implies that an integrated approach to nurturing childrens growth and development has to be a sine qua non in any intervention for the young. The childs biological disposition interacts with all his/her environmental forces to shape the nature of his/her development. School Readiness Study, 2003 Integrating Health & Nutrition in ECD C. Impact on Access & School Readiness

21. Building from What We Have Learning from our SHN Program 50% of school-age children are anemic; two out of ten school children are iodine deficient; four out of 100 preschoolers have night blindness and 17 school children go blind every day due to vitamin A deficiency; majority of the school children suffer from dental caries (84.3%); intestinal parasitism (75%); malnutrition (44.9%); and various kinds of infections of the ear (17.2%) and skin (53%)

22. Building from What We Have Learning from our SHN Program School Health and Nutrition Improved health and nutrition status of school aged children leading to improved school performance Program Components Health & Nutrition Services – mass deworming, Iron supplementation, vitamin A, vision & hearing screening Health & Nutrition Education – health talks, film/video showing School Environment Improvements – Sanitary toilets, water supply, hand washing facilities Community Support Systems – PTCA, Barangay Council, SHN fairs, LCPC

23. A Case for SHN After three years of implementing school-based deworming what results did we achieve?

24. Pampalusog Bata Project

25. School-based deworming is not THE only answer to control parasitism infection among school-aged children!

26. Pampalusog Bata Project Aksyon 2: Tamang Pangangalaga sa Kalusugan Aksyon 3: Malinis at Masustansyang Pagkain Aksyon 4: Gawaing Pamayanan para sa Kontrol ng Worm Infection Aksyon 1: Gawaing kalusugan sa eskwelahan

27. Pampalusog Bata Project Aksyon 5: Malinis na Tubig Aksyon 6: Malinis na Kapaligiran Aksyon 7: Responsableng Pagmamagulang

28. Did it improve School Performance? Masville Elementary School marked a 72.78 (Nearing Mastery) score in the National Reading Test.

29. Did it improve School Performance? The National Achievement Test Mean Percentage Score for the National Capital Region is 60.18. For the Parañaque Division the NAT mean percentage score is 53.02.

30. Lessons Learned School-Community as one locus for learning and action. Multi-pronged programming approach works - Health services - Behavior centered communication - Facilities improvement - Social and political environment Community ownership & participation is key to sustainability

31. Only 19% of children aged 4-6 years old are able to go to private or public pre-schools There are 32,787 day care centers accounting for 41,924 of all barangays in the country Only 3 out of 10 schools/NGOs offer training or any form of parenting education Average teacher/caregiver : child ratio from is 1:45 in government assisted centers/ pre schools Crafting Effective Programs

32. ECD Increased proportion of 6 year olds entering elementary school and succeeding to Grade 2 Support to Day Care Services Supervised Neighborhood Services/KapitBahay-Aralan Summer Learning Program Parent Education ESSS Programming Crafting Effective Programs

33. Stepping Up to School Success (36 to 60 months) Expand ECD access by supporting alternatives to center-based programs (e.g., KapitBahay Aralan or neighborhood learning model) Build capacity of day care workers/preschool teachers and support public day care centers/public preschools in meeting quality ECD standards Integrate health content and services into early learning opportunities Sustain parent education on positive care & development of young children

34. Stepping Forward in School (6 to 8 years old) Summer learning program for prospective first grade entrants with no prior ECD exposure School welcome days and parent education initiatives School health & nutrition interventions Teacher training and promotion of developmentally appropriate teaching-learning approaches for early grades Basa para sa Bata (Reading for Children) program

35. Moving Forward: Enhancing the Transition Process Health promoting early childhood programs and settings : –Facilitate protective factors against the development of psychosocial, mental and biomedical health problems. –Sustained through participatory, multi- sectoral and community based processes Early Childhood Services as Health Promoting Settings, Hayden 2006

36. Moving Forward: Enhancing the Transition Process Learning from the Health Sector: Systematically measuring Survival of Year One in Primary School – The health sector has long measured child survival using two key points in time: year one (Infant mortality rate) and year five (child mortality rate).

37. Moving Forward: Enhancing the Transition Process Track rate of survival within basic education cycles – In addition to having data on completion & achievement rates at the end of primary, there would be an intermediary indicator of early primary survival.

38. Moving Forward: Improving the Transition Process Brgy. BF 77,567 (Total Population)

39. Moving Forward: Enhancing the Transition Process Continuity of Developmentally Appropriate Practice –Using a Transition framework deliberately links ECD and early primary school –Child-friendly schools promote holistic approaches that address the childs overall development and learning as well as their health and safety.