Inclusive early childhood development in the Pacific

Fleur Smith1 and Kirsty Teague1

This ‘Disability equity and rights: Challenges, opportunities, and ways forward for inclusive development’ publication was prepared under the DFAT – CBM Inclusion Advisory Group Disability Inclusion Technical Partnership, an Australian aid initiative implemented by CBM Inclusion Advisory Group and the Nossal Institute for Global Health at the University of Melbourne.This publication has been funded by the Australian Government through the Department of Foreign Affairs and Trade. The views expressed in this publication are the author's alone and are not necessarily the views of the Australian Government.

Background

Optimal early childhood development (ECD) is widely accepted as critical not only for the outcomes of children, but for their families and society more broadly. Providing enabling environments for nurturing care and development in the first years of life, when children’s brains are undergoing their most rapid change, ensures they can achieve their best possible physical, social, emotional, and cognitive outcomes. This applies equally to children with and without disabilities. The evidence shows that investing in ECD has intergenerational benefits for productivity and wellbeing that in turn promote societal economic growth, stability, and equality.2 To this end, Sustainable Development Goal (SDG) target 4.2 seeks to ensure that ‘by 2030 all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education’.3 While action on ECD has gained global support, with just 7 years left to achieve target 4.2 there is still much to be done and children with disabilities are being left behind.

The Pacific region is home to approximately 1.7 million children under 5.4 Considering recent estimates that 16% of the global population has a disability this translates to approximately 272,000 children with disabilities under 5 in the Pacific region who can benefit from inclusive ECD programming.5 Safety, health care, adequate nutrition, responsive caregiving, and opportunities for early learning are all necessary for optimal ECD yet data indicates that young children with disabilities are far less likely to have access to these than children without disabilities. 6,7

With the recent establishment of the Pacific Regional Council for Early Childhood Development (PRC4ECD), a multi-sector, multi-government body, to guide and strengthen approaches to ECD across the Pacific now is the time to ensure ECD activities across the region are disability-inclusive.8

Challenges and opportunities

Inclusive ECD for school ‘readiness’

The focus on development investment for children with disabilities to date has been on inclusive education for school-aged children. However, as illustrated in Figure 1, inclusive ECD starting from birth is needed to build the foundation for successful inclusive education.

Figure 1. Pathway to inclusive child health, education and development.9  

A flow chart diagram with 4 boxes and arrows linking one box to the next. The first box has the heading Early Childhood Intervention and contains 2 dot points - Early Detection: Newborn screening, developmental screening and surveillance. The second box has the heading Early Childhood Development and says 'Developmentally on track in health, learning and psychosocial wellbeing.' The third box has the heading School Readiness and 3 dot points - Child's readiness, family and community supports, and School's readiness. The fourth box has the heading Inclusive Education and 3 dot points - full inclusion. Partial inclusion, mainstreaming
While the growing global action on ECD is pleasing, much of it has excluded children with disabilities. Moving forward, achieving SDG target 4.2 of access to quality ECD for all requires mainstream ECD services and programs to be inclusive of children with disabilities, including health and nutrition programs, early childhood education and parenting support. But these need to be accompanied by programming to address the specific needs of children with disabilities, such as early detection, early intervention, and provision of assistive technology. Inclusive ECD programming from birth to school age promotes not only ‘child readiness’ for education, but also ‘family and community readiness’ to support and facilitate children with disabilities to access and meaningfully participate in education.

Until now, the focus of development programming on inclusive education has been on the readiness of education systems to include children with disabilities, not on the readiness of children and their families to access and utilise education. Investing in inclusive ECD will enable greater readiness of children and their families to attend school and benefit from inclusive education.

‘Child readiness’ in this context refers to children with disabilities having access to opportunities for physical, social, and cognitive development and participation with peers that ‘prepares’ them for school.10  This requires effective systems for early detection of developmental disability and access to early intervention services (see Figure 1). Early intervention services support young children with disabilities to develop their independence and functioning across developmental domains (for example: communication, mobility, self-care) through advocating for the rights of children with disabilities, therapeutic interventions and parent education and support. Access to inclusive playgroups, preschool, or early childhood education programs, play and early learning further support the readiness of children with disabilities for school, while also facilitating ‘community readiness’ by setting a precedent and expectation for inclusion from the earliest stages of education.

‘Family readiness’ for inclusive education is facilitated by supporting parents or caregivers of young children with disabilities through social supports and protection. There is a growing evidence base of the feasibility and acceptability of peer-facilitated parent and caregiver support programs as a model of early intervention for children with developmental disabilities and their caregivers, including the pilot of such a program in Fiji.11,12 Such programs have been found to increase parent and caregiver awareness of their child’s rights and support needs, and in turn empower them to advocate for their child’s inclusion and participation.13 Family ‘readiness’ is further supported through provision of social protection or other forms of livelihood support for parents and caregivers of children with disabilities. The links between poverty and disability are well-established, and such financial support measures enable families to meet the direct and indirect costs associated with their child’s disability, protecting the family unit from the economic, health, and social impacts of the disability-poverty cycle.14

Despite the evidence of what is needed to achieve inclusive ECD, including child and family readiness for inclusive education, many of these inclusive mainstream and disability-specific supports are lacking throughout the Pacific region. As the Pacific Regional Council for Early Childhood Development works to implement the ‘Pasifika call to action on ECD’ and ensure that every child in the region has access to the services and opportunities needed to reach their potential, there is an opportunity to change this.

In addition to inclusive ECD being vital for successful inclusive education and continuing Australia’s positive track record in disability-inclusive development, inclusive ECD intersects with other key development priorities of gender and climate change responsiveness.

Inclusive ECD and women’s empowerment

Women continue to assume the primary caregiving role for young children, impacting their ability to participate in the workforce and contribute to household income generation. This is compounded for female caregivers of children with disabilities by a lack of alternative childcare options that are willing and able to appropriately care for children with disabilities.

While early childhood education or preschool services are becoming more common in many low- and middle-income countries, there is little evidence these are disability-inclusive. Support for inclusive early childhood education and care services is key to enabling women to have equal opportunities for workforce participation. This support also contributes to ‘family readiness’ as described above. Further, female primary caregivers are more likely to face stigma, discrimination, and partner abandonment.15 Inclusive services for young children with disabilities can alter such social norms and build both gender and disability equity.

Inclusive ECD and climate change

There is increasing evidence of the significant impacts of climate change on young children with disabilities. Climate change disproportionately impacts both people with disabilities and children under 6 years of age.16 The impacts of climate and other emergencies on young children include disruption and toxic stress impacting on brain development during a crucial period and thus their physical and mental wellbeing, while also impacting access to mainstream and specialist services. This serves to further increase risks of exclusion, violence, discrimination, institutionalisation, and risk of injury and death.17

As Pacific Island countries develop their multi-sector approaches to ECD, it is necessary that these systems and services are climate and disaster resilient. This includes mainstream and disability specific ECD programming and consideration of how these measures can contribute to reducing disaster risk and mitigating the effects of climate change on young children’s development. Also required is contingency planning for service disruption during disasters, to ensure young children’s development does not suffer.

Looking ahead to 2030

The following recommendations are made with a view to supporting governments in achieving SDG target 4.2 and ensuring children with disabilities are considered front and centre among all children.

Given the recent establishment of the Pacific Regional Council for Early Childhood Development and the opportunity this presents, the following recommendations are focused on the Pacific Island countries but are equally applicable to other countries beyond the Pacific.

  • Provide support and advocacy to the Pacific Regional Council for Early Childhood Development to ensure children with disabilities are included in strategies and actions.
  • Support the establishment of Organisations of People with Disabilities (OPDs) that specifically represent and advocate for children with disabilities and their families. For example, a specific branch of the Pacific Disability Forum (PDF) or a similar regional OPD for children who could support national level child focused OPDs.
  • Support countries to evaluate current ECD programming for barriers to disability inclusion, and enablers of disability inclusion.
  • Enable existing services to increase capacity and coverage including through supporting trials of service models such as telehealth and community-based peer-facilitated caregiver support programs. Also, by supporting workforce development initiatives, particularly in Pacific Island countries where the workforce is extremely limited.
  • Support strengthening of routine developmental monitoring and referral systems in existing health systems to identify children with developmental delays and disabilities early, linking them into available services.
  • Promote access to affordable inclusive early childhood education and care services (childcare) to support caregiver wellbeing and workforce participation for women.
  • Consider how mechanisms for social protection and livelihood support for parents and caregivers of children with disabilities can be strengthened in the Pacific.
  • Ensure inclusive ECD is considered in actions to respond to the impacts of climate change in the Pacific.

About the Authors

Fleur Smith, Nossal Institute, is an occupational therapist and a senior technical advisor in disability inclusion and rehabilitation. She has particular expertise in developmental disability and early childhood intervention, and works to change systems to enable equity for children with disabilities and their families.

Kirsty Teague, Nossal Institute, is a technical advisor focusing on health system strengthening in the Asia-Pacific area. She has a paediatric occupational therapy background specialising in child development, early intervention, and disability.

References

[1] Nossal Institute, University of Melbourne. Lead/corresponding author: Fleur Smith, smith.f@unimelb.edu.au

[2] World Health Organisation, United Nations Children’s Fund, and World Bank Group. 2018. Nurturing Care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. World Health Organization, Geneva. https://nurturing-care.org/ncf-for-ecd

[3] United Nations. 2015. Sustainable Development Goal – Goal 4. https://sdgs.un.org/goals/goal4

[4] Pacific Regional Council for Early Childhood Development (PRC4ECD). N.d. [Accessed 13 July 2023] https://pacific-child.org

[5] World Health Organization. 2022. Global report on health equity for persons with disabiltiies. World Health Organization, Geneva. https://www.who.int/publications/i/item/9789240063600

[6] World Health Organisation, United Nations Children’s Fund, and World Bank Group. 2018. Nurturing Care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. World Health Organization, Geneva. https://nurturing-care.org/ncf-for-ecd

[7] United Nations Children’s Fund. 2021. Seen, Counted, Included: Using data to shed light on the wellbeing of children with disabilities. United Nations Children’s Fund, New York. https://data.unicef.org/resources/children-with-disabilities-report-2021/

[8] United Nations. 2015. Sustainable Development Goal – Goal 4. https://sdgs.un.org/goals/goal4

[9] Olusanya B O, Yun Boo N, de Camargo O K, Hadders-Algra M, Wertlieb D, and Davis A C. 2022. Child health, inclusive education and development. Bulletin of the World Health Organization; 100(7), pp.459-461. http://dx.doi.org/10.2471/BLT.22.288103

[10] Nair M K C, Radhakrishnan R, and Olusanya B O. 2023. Promoting school readiness in children with developmental disabilities in LMICs. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.993642

[11] Nanyunja C, Sadoo S, Kohli-Lynch M, Nalugya R, Nyonyintono J, Muhumuza A, et al. 2022. Early care and support for young children with developmental disabilities and their caregivers in Uganda: The Baby Ubuntu feasibility trial. Frontiers in Pediatrics, 10. https://doi.org/10.3389/fped.2022.981976

[12] Woolfenden S, Milner K M, Tora K, Naulumatua K, Mataika R, Smith F, et al. 2020. Strengthening Health Systems to Support Children with Neurodevelopmental Disabilities in Fiji–A Commentary. International Journal of Environmental Research and Public Health; 17(3). https://doi.org/10.3390/ijerph17030972

[13] Smith F, Perera S, and Marella, M. 2023. The journey to early identification and intervention for children with disabilities in Fiji. Int J Environ Res Public Health; 20(18). https://doi.org/10.3390/ijerph20186732

[14] Loucaides E M, Zuurmond M, Nemerimana M, Kirk C M, Lassman R, Ndayisaba A, et al. 2022. Livelihood support for caregivers of children with developmental disabilities: findings from a scoping review and stakeholder survey. Disability and Rehabilitation. 46(2), pp.293-308. https://doi.org/10.1080/09638288.2022.2160018

[15] Nair M K C, Radhakrishnan R, and Olusanya B O. 2023. Promoting school readiness in children with developmental disabilities in LMICs. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.993642

[16] United Nations Children’s Fund. 2023. Over the tipping point. United Nations Children’s Fund, East Asia Pacific Regional Office, Bangkok. https://www.unicef.org/eap/reports/over-tipping-point

[17] United Nations Children’s Fund. 2017. Situation Analysis of Children in the Pacific Island Countries. United Nations Children’s Fund Pacific Office, Suva. https://www.unicef.org/pacificislands/reports/situation-analysis-children-pacific-island-countries

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