In order to develop to their full potential, children need nurturing care. This means, conditions that ensure good health, adequate nutrition, safety and security, responsive caregiving and opportunities for learning. Parents, family members and caregivers – who are closest to young children in the first years of life – are the optimum providers of nurturing care. But in order to ensure they have the time and resources to do this, policies, services and community support need to be in place.

The Nurturing Care Framework for Early Childhood Development, which was launched at the World Health Assembly in Geneva on May 23rd, provides an evidence-based roadmap for action. It outlines how policies and services can support parents, families, other caregivers and communities in providing nurturing care for young children. The Framework also calls for effective national programmes that are driven by strong and sustained political commitment and a determination to reduce inequity, poverty and social injustice, drawing on best practices from across high-, middle- and low-income countries.

We spoke to Mark Tomlinson, Professor of Psychology at the University of Stellenbosch and one of the coordinating writers about the Framework for helping children not only survive, but also thrive to transform human potential in South Africa.

Q: What is the significance of the launch of the Nurturing Care Framework? Please, can you reference the 2016 ECD Lancet series in your answer?

The Nurturing Care Framework provides an important roadmap for action in the next decade. The Framework is built on the wealth of evidence accumulated in the last 30 years (culminating in and summarised in the Lancet Series on Early Child Development in 2016) about early brain development, how early childhood development unfolds across the life-course, and how it can be improved by policies and interventions.

Q: It’s important not to confuse the Framework with WHO Guidelines. Please, can you explain the difference between the two?

The World Health Organisation (WHO) produces a lot of documents – and while they are all official WHO documents each one has a different level of scrutiny – either internally or by the World Health Assembly. WHO Guidelines are a very particular form of document that contains recommendations for clinical practice or public health policy. A recommendation from a Guideline (one example would be the recommendation to have eight antenatal visits during pregnancy) tells the country, the nurse, the doctor what the best current evidence says about how to achieve the best possible health outcomes. A recommendation within a guideline has to be based on systematic reviews and a global expert group reviewing the evidence and making recommendations. These recommendations are then ratified by WHO. Many countries adopt WHO Guidelines immediately upon their being published by WHO. The Nurturing Care Framework for Early Child Development on the other hand, while based on extensive global consultation and consideration of the best current evidence, is a broad framework document that lays out the value of a particular issue (development from conception to the end of the third year in this case) for policy development, investment and country consideration. It does not make specific narrow recommendations for clinical practice or public health policy based on a systematic review like a Guideline process does. It is an important advocacy and policy tool rather than a recommendation for clinical practice.

Q: Is there a possibility that WHO Guidelines around nurturing care will be developed in the future?

More than a possibility – it is happening. Currently, there is a process underway – Guideline Development to Develop Recommendations to Improve Early Childhood Development. Systematic reviews have been initiated and the Guideline Development Expert Group met in early May 2018 to consider the evidence reviews. It is hoped that Guidelines will be published in early 2019 at the latest.

Q: What was South Africa’s contribution to the writing of Framework?

South Africa has been at the forefront of efforts to produce the Framework. Prof Linda Richter from the University of Witwatersrand led the 2016 Lancet Series on Early Child Development which has served as an important part of the development of the Framework. In addition, Prof Richter, myself (Prof Tomlinson) and Dr Bernadette Daelmans from WHO were the coordinating writers of the Framework.

Q: South Africa was one of nine countries chosen to be profiled as an example of investment in nurturing care. Why was it chosen? Why is this profile important?

South Africa has been at the forefront of global efforts towards improving early child development. Universal Grade R provision is an important component of current efforts to improve child development across the life-course and South Africa is somewhat of a pioneer in this regard. The National Department of Health is currently rolling out the new Road to Health Booklet and this was chosen as one of the case studies linked to the Framework. The five pillars of the Road to Health Booklet – nutrition, love, protection, healthcare and extra care are in many ways quite similar to the five domains of the Nurturing Care Framework.

Q: The Framework includes five strategic actions (lead and invest; focus on families and communities; strengthen services; monitor progress; use data and innovate). Which of these actions do you think will be the easiest for SA and which most difficult? Why?

In the Framework we included a quote from Sir Michael Marmot who led the Social Determinants of Health for the WHO some years ago. “If you are doing nothing, do something. If you are doing a little, do more. If you are doing a lot, do better.” Where South African is doing a little we should do more, and where we are doing a lot we should do better. I am not sure that anything is easy or more difficult – as all are essential.

Q: The Framework asks governments to commit to reaching national milestones (listed below) by 2023. Based on our performance over the past five years, do you think South Africa will be able to reach these milestones by 2023? 

  • National co-ordination mechanism
  • National communication strategy
  • Strengthening workforce capacity
  • Data
  • Local research to strengthen interventions

It will not be easy but I remain positive. In an exercise that Prof Richter and I conducted with the Frameworks Institute in the US recently we showed that national policymakers, experts and stakeholders fully understand the importance of nurturing care and the primacy of the period from pregnancy to three years of age. The National Development Plan also includes much that is good to help us work towards improving the lives of children in South Africa. Despite this, we have a long way to go. For example, there have been previous calls for a national coordination mechanism for early child development but this has not materialised. I would argue that this is utterly essential and progress will be difficult without it. South Africa is particularly strong in research and our data is of a good standard. Strengthening workforce capacity, however, requires much work. Finally, we do not have a national communication strategy that focusses on the crucial period from pregnancy to the end of the third year of life across sectors and provinces, on the role of fathers in the lives of children, on how later success is built upon what parents can do very early on. These are all a must if we are to ensure that our infants and young children not only survive, but also thrive and in so doing transform the health and human potential of South Africa.

Click here to read more about the Nurturing Care Framework for Early Childhood Development.

Image: Flickr Creative Commons License/Harsha.

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