The Essential Package of services and support for children
Children’s early development is a function of five interrelated and integrated packages of services and support covering the period from conception to six years of age: maternal, newborn and child health; nutritional support; support for primary caregivers; social services and protection; and quality early learning programmes.
Collectively, these are the Essential Package of ECD services and support, and because they are essential, they need to be accessible to all young children and their caregivers without any barriers such as costs.
All children born in South Africa have rights to survival, health, adequate nutrition, protection, and development. These rights are protected by the highest law of our land, the Constitution, and in international law. The Essential Package is a necessary pre-condition to realise children’s constitutional rights.
The Essential Package comprises services and support not only for children but also for pregnant women and children’s caregivers. They need support so that they can provide for all aspects of their children’s development in the home.
Delivering the Essential Package requires collaboration. Because young children and their caregivers have a broad range of needs that are interdependent, multiple stakeholders should be involved in service delivery. It is important to have good collaboration and referrals between stakeholders.
Maternal, newborn and child health services
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The primary health system offers the best infrastructure to deliver most components of the Essential Package. South Africa’s vast and far-reaching network of primary health clinics and health workforce has not yet fully leveraged its potential to serve pregnant women and young children beyond health services.
Every visit by a pregnant woman or child to a health facility, as well as every visit by a Community Health Worker (CHW) to a household, is an opportunity to improve access to the Essential Package. This may include information on adequate nutrition, encouragement to stimulate children’s early learning, and referrals to social grants and services for mental health if needed.
The potential of CHW-led home visiting programmes to reach the most vulnerable households is not yet fully realised nor recognised in South Africa. CHWs can connect health, social, and caregiver support services with benefits for nutrition and early stimulation if they are sufficiently resourced and supported.
Nutritional support
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Community Health Workers (CHWs) can detect early signs of malnutrition in young children, which is a much-needed service because 27% of children under the age of two in South Africa are nutritionally stunted. Stunting has long-term individual and societal costs.
The starting point to reduce the incidence of low-birth-weight babies, which is a predictor of stunting, is support during pregnancy, in the form of micronutrient supplementation and income support through social grants. CHWs can ensure that vulnerable pregnant women are receiving these services.
Support for primary caregivers
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Community Health Workers (CHWs) can also support caregivers to provide their children with responsive and nurturing care. Caregivers in South Africa face high levels of poverty, domestic violence, and perinatal depression. Perinatal depression is often a neglected area of concern. In one rural community for instance, approximately 47% of perinatal women suffer from antenatal depression and up to 39% of women suffer from postnatal depression. CHWs provide psychosocial support and point families towards reliable sources of information on parenting and childcare.
Social services and protection
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Social services ensure children are protected from harm and neglect, are registered at birth, and receive social grants if needed. Early registration of births is important because a birth certificate is an important gateway to the Child Support Grant (CSG) – the main grant for children living in poverty. Uptake of the CSG in infancy remains below target, where only 71% of eligible children younger than one received the grant, compared to 82% of eligible children under six. Community Health Workers can ensure vulnerable babies are registered to receive the CSG early and connect caregivers to other social services.
Quality early learning programmes
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Early learning starts in the home, soon after birth, and language and cognitive development is most intense during the first three years of life. For this reason, early language and learning support through parenting and reading programmes is essential to maximise the benefit of later out-of-home early learning exposure.
From about three years of age, young children derive great cognitive, social, emotional, and physical benefits from participation in high-quality group-based Early Learning Programmes (ELPs). The government does not directly provide ELPs. ELPs are usually provided by entrepreneurial women, who charge fees that barely cover their operational costs. ELP fees are unaffordable for the poorest families, therefore more than two-thirds of the poorest children aged 0-5 in South Africa do not attend any form of ELP.
Government subsidies are available to cover some of the ELP attendance costs of poor children if the ELP meets a stringent set of compliance requirements on aspects such as physical infrastructure. ELPs in poor communities struggle to meet the requirements and don’t qualify for the subsidy as a result.