Armenia SABER Country Report EARLY CHILDHOOD DEVELOPMENT 2012
Policy Goals Status 1. Establishing an Enabling Environment The Republic of Armenia (RoA) has established strong national laws and regulations to promote the provision of ECD services. The National Program on the Protection of Children's Rights for 2004-2015 is a multi-sectoral ECD policy that comprises the education, health, and social protection sectors, and serves as an overarching umbrella to guarantee access to essential ECD services through national laws and regulations. 2. Implementing Widely The RoA has established national programs in all essential sectors of ECD. These efforts have resulted in increased equitable access to ECD services provided to young children and mothers, particularly in the area of health, but access to nutrition remains inequitable as reflected in the high stunting rate. In the education sector, the preprimary enrolment rate remains low. The net enrolment rate in preprimary school for children 3-6 years of age is only 33.9% countrywide, with significantly lower levels in some regions and particularly in rural areas. 3. Monitoring and Assuring Quality Child outcome indicators are collected in the health sector, but not in other relevant sectors. Armenia has well established minimum quality standards and requirements in health and education sectors. Compliance should, however, be enforced. There is a need to develop a comprehensive child development tracking system across sectors.
THE WORLD BANK ARMENIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012
Armenia: Assessment of the Early exclusively breastfed from 35 percent to 60 Childhood Development Policies and percent by 2018. Develop a plan to provide regular antenatal care Programs for an increased percentage of pregnant women; Summary of Policy Recommendations reduce the percentage of pregnant women with The National Program on the Protection of Children’s Rights anemia from 39 percent to 20 percent by 2018. 1 for 2004‐2015 is a multi‐sectoral Early Childhood Identify causes for a high percentage of stunting Development (ECD) policy in Armenia that comprises the among children under five‐year old and develop a education, health, and social protection sectors, and serves strategy to reduce stunting from 19 percent to as an overarching umbrella to guarantee access to essential below 10 percent by 2018. ECD services. As the program period will soon end, it would Ensure young children an access to health care be timely for the government to review and assess the and increase the percentage of children below results of this program together with other sectoral ECD five‐year old with suspected pneumonia taken to programs and develop new, comprehensive multi‐sectoral an appropriate health care provider from 57 ECD policies and programs. percent to above 80 percent by 2018. Ensure access to key health and nutrition Based on the multi‐sectoral analysis of ECD policies and interventions focused and targeted towards low‐ programs in Armenia, this report proposes the following income and vulnerable children. Overall, out‐of‐pocket priority reform areas for the government’s consideration. expenditure (formal or informal) as percentage of total health expenditures is very high in Armenia. For Multi‐sectoral issues – monitoring and evaluation instance, there have been some reported instances of out‐of‐pocket informal payments for hospital care, Review the existing ECD data collected by line mainly for drugs because reimbursements from the ministries and develop a comprehensive ECD database government are insufficient to fully cover the cost of to be managed collectively among the relevant the drugs. This applies to ECD services as well. ministries, or consolidated by the National Statistical Fortunately, it appears that the introduction of the Service or any other suitable body. Ensure that a Child Health State Certification Program has improved comprehensive ECD database include essential child access to pediatric inpatient care for children under outcome indicators in all ECD sectors. seven‐year old, which needs to continue being Establish an improved Monitoring and Evaluation monitored. system that would help guarantee that eligible beneficiaries receive the appropriate services Education Wherever possible, develop an impact evaluation of interventions on cognitive, linguistic, physical, and Continue on the expansion of the coverage of the socio‐emotional development of children to one year National School Readiness Program to measure the effectiveness of interventions. achieve a 90‐percent enrollment rate by 2017. In addition to the lower requirements of community Health and nutrition contribution for poor communities that the government is currently considering, analyze the financial capacity of Review and improve the existing prenatal communities without a single preschool and develop a healthcare, infant immunization, and childhood subsidy mechanism, if needed, to support the wellness and growth monitoring programs as some establishment of a preschool for the most disadvantaged key ECD indicators suggest weaknesses in those communities. programs. In particular: Promote exclusive breastfeeding and increase the percentage of children under six‐month old
1 Since this report was prepared, the government adopted a new National Programme on the Protection of Children’s Rights for 2013‐2016 dated December 28, 2012.
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Child protection Almost one‐third of the population lives below the poverty line; rural poverty is higher, where an Strengthen interventions to provide care for estimated 40 percent of the population lives below the children with special needs. While this report did not poverty line and 28 percent of the labor force is discuss this topic in detail, it is advisable that the unemployed. government collaborate with other development partners where they have strong advantages in supporting in this area. SABER – Early Childhood Development
This report presents an analysis of the ECD programs SABER – ECD collects, analyzes and disseminates and policies that affect young children in Armenia and comprehensive information on ECD policies around the recommendations to move forward. This report is part world. In each participating country, extensive of a series of reports prepared by the World Bank using multisectoral information is collected on ECD policies and the SABER‐ECD framework and includes analysis of early programs through a desk review of available government learning, health, nutrition and social and child documents, data and literature, and interviews with a protection policies and interventions in Armenia, along range of ECD stakeholders, including government officials, with regional and international comparisons. service providers, civil society, development partners and scholars. The SABER‐ECD framework presents a holistic Armenia and Early Childhood Development and integrated assessment of how the overall policy environment in a country affects young children’s The Republic of Armenia (RoA) is a landlocked development. This assessment can be used to identify how mountainous country in the South Caucasus region of countries address the same policy challenges related to Eurasia, bordered by Turkey to the west, Azerbaijan to ECD, with the ultimate goal of designing effective policies the east, Georgia to the north and Iran to the South. for young children and their families. Armenia is a lower middle‐income country with a Box 1 presents an abbreviated list of interventions and population of 2.9 million people, ranked 86th in the policies that the SABER‐ECD approach looks for in UNDP Human Development Index table and, a GDP per countries when assessing the level of ECD policy capita (PPP) of 5,829 USD (2011). Despite a severe development. This list is not exhaustive, but is meant to economic recession in 2009, when GDP declined by provide an initial checklist for countries to consider the more than 14 percent, the economy is quickly key policies and interventions needed across sectors. recovering, registering 4.6 percent growth in 2011.
Snapshot of ECD Indicators in Armenia with Regional Comparison
Armenia Georgia Kyrgyzstan Russia Federation Ukraine
Infant Mortality (deaths per 1,000 live births) 18 20 33 9 11
Under‐5 Mortality (deaths per 1,000 live births) 20 22 38 12 13
Moderate and Severe Stunting (under‐5) 19% 11% 18% No data No data
Net Preprimary/kindergarten Enrollment Rate 38.7% 33.9% 17.2% 72.9% 75.1% (36 to 59 months of age) (2006)
Birth registration 2000‐2010 96% 92% 94% No data 100%
Source: UNICEF Country Statistics and TransMONEE Data Set, 2010
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Box 1: A checklist to consider how well ECD is promoted at the country level. Three Key Policy Goals for Early Childhood What should be in place at the country level to promote Development coordinated and integrated ECD interventions for young children and their families? SABER‐ECD identifies three core policy goals that Healthcare countries should address to ensure optimal ECD Standard health screenings for pregnant women outcomes: Establishing an Enabling Environment, Skilled attendants at delivery Implementing Widely and Monitoring and Assuring Childhood immunizations Quality. Improving ECD requires an integrated approach Well‐child visits to address all three goals. As described in Figure 1, for Nutrition Breastfeeding promotion each policy goal, a series of policy levers are identified, 2 Salt iodization through which decision‐makers can strengthen ECD. Iron fortification Early Learning Strengthening ECD policies can be viewed as a Parenting programs (during pregnancy, after delivery continuum; as described in Table 1, countries can range and throughout early childhood) from a latent to advanced level of development within High quality childcare, especially for working parents Free preprimary school (preferably at least two years the different policy levers and goals. with developmentally appropriate curriculum and classrooms, and quality assurance mechanisms) Social Protection Figure 1: Three core ECD policy goals Services for orphans and vulnerable children Policies to protect rights of children with special needs and promote their participation and access to ECD services Financial transfer mechanisms or income supports to reach the most vulnerable families (could include cash transfers, social welfare, etc.) Child Protection Mandated birth registration Job protection and breastfeeding breaks for new mothers Specific provisions in judicial system for young children Guaranteed paid parental leave of least six months Domestic violence laws and enforcement Tracking of child abuse (especially for young children) Training for law enforcement officers in regards to the particular needs of young children
2 SABER‐ECD is one domain within the World Bank initiative, Systems Approach to Better Education Results (SABER), which is designed to provide comparable and comprehensive assessments of country policies.
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Table 1: ECD policy goals and levels of development Level of Development ECD Policy Goal Latent Emerging Established Advanced Non‐existent legal Minimal legal framework; Developed legal Regulations in some Establishing an framework; ad‐hoc some programs with framework; robust inter‐ sectors; functioning Enabling financing; low sustained financing; some institutional intersectoral coordination; intersectoral intersectoral coordination; sustained Environment sustained financing. coordination. coordination. financing. Universal coverage; Low coverage; pilot Coverage expanding but Near‐universal coverage in comprehensive programs in some gaps remain; programs Implementing some sectors; established strategies across sectors; sectors; high inequality established in a few programs in most sectors; integrated services for Widely in access and sectors; inequality in low inequality in access. all, some tailored and outcomes. access and outcomes. targeted. Information on outcomes Information on Information on outcomes Minimal survey data at national, regional and outcomes from national at national level; available; limited local levels; standards for to individual levels; Monitoring and standards for services standards for provision services exist for most standards exist for all exist in some sectors; no Assuring Quality of ECD services; no sectors; system in place to sectors; system in place system to monitor enforcement. regularly monitor to regularly monitor and compliance. compliance. enforce compliance.
Policy Goal 1: Establishing an Enabling In Armenia, the National Program on the Protection of Environment Children's Rights for 2004‐2015 was developed and endorsed in 2003; it is a multisectoral ECD policy that Policy Levers: Legal Framework • comprises the education, health, and social protection Intersectoral Coordination • Finance sectors. This National Program, closely linked to Armenia’s An Enabling Environment is the foundation for the Poverty Reduction Strategy Paper (PRSP),3 serves as an design and implementation of effective ECD policies. An overarching umbrella to guarantee access to essential ECD enabling environment consists of the following: the services through national laws and regulations. existence of an adequate legal and regulatory framework to support ECD; coordination within sectors National laws and regulations in Armenia promote and across institutions to deliver services effectively; preschool education. According to the Law on Preschool and, sufficient fiscal resources with transparent and Education, adopted in 2005, children have an equal right efficient allocation mechanisms. to receive preprimary education which can be implemented in a preschool institution, in the family, or through private pedagogical activity (Article 23). The scope Policy Lever 1.1: of this law includes early learning and health and Legal Framework protection of children. The Law commits to: preserve and improve the child’s physical and mental health; provide The legal framework comprises all of the laws and regulations which can affect the development of young 3 children in a country. The laws and regulations which The Sustainable Development Program (SDP), approved by the government in October 2008,is Armenia’s second Poverty Reduction impact ECD are diverse due to the array of sectors which Strategy Paper (PRSP‐2). The SDP has three key goals covering the influence ECD and because of the different constituencies period 2009–2021 (with specific medium term targets indicated in that ECD policy can and should target, including pregnant 2009–2015): reducing poverty, including the elimination of extreme women, young children and parents and caregivers. poverty; ensuring human development; and deepening economic growth and accelerating development of lagging regions (Source: The World Bank, 2009, Country Partnership Strategy for the Republic of Armenia for the Period of FY09‐FY12). SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 5 ARMENIA ǀ EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2012
harmonious development and education for preschool women who gave birth to more than one child children; and prepare children for formal schooling. The are entitled to 180 calendar days (70 days law led to the creation of the Strategic Program for before delivery and 110 after childbirth). Reforms in Preschool Education of the Republic of Unpaid parental leave to take care of children younger Armenia (2008‐2015). The objective of this strategic than three years old is also granted to parents, program is to promote equal opportunity upon entry to grandparents or other relatives or a guardian who are school, promote adaptability of children and ensure that actively raising a child. During the period of this leave, all children have strong foundations for the development employees’ jobs are guaranteed to be maintained. of their personal and social skills. In 2012, the Government 4 approved the RoA Activity Program 2012‐2017 , in which National laws and regulations promote appropriate an expansion of access to preschool education is one of dietary consumption for pregnant women and young the government’s priority directions. The government children. In 2004, the Government of Armenia (GoA) envisions achieving expected results by creating more passed a decree that required mandatory iodization of preschool institutions through the implementation of salt for human consumption. As a result, 97 percent of micro‐projects, training preschool personnel, and Armenian households consumed adequately iodized salt improving facilities and teaching and learning resources by 2005. In efforts to encourage iron fortification of necessary for preschool services. wheat flour, by the decree of the Prime Minister, a task force team has been formed to develop a national Preschool education in Armenia caters to children aged action plan for flour fortification. The Concept and 1‐6 and is not compulsory. Preschool establishments action plan on flour fortification were approved by the include daycare nurseries for children of 1 to 3 years of Government in February 2011. The flour fortification, as age and kindergartens for children aged 3 to 6. As part well as the Salt Iodization program, is implemented with of the strategic program the Ministry of Education and UNICEF’s support. Science has set the following specific goal in the effort to improve access to preschool education: increase the In 1993, the Ministry of Health endorsed a national number of children enrolled in a one‐year school program, Ten Steps to Successful Breastfeeding, based readiness program, especially those from vulnerable 5 on the UNICEF/WHO Baby‐Friendly Hospital Initiative families, to 90 percent by 2017 . (BFHI). The International Code of Marketing of Breast Milk Substitutes – an international health policy National laws and regulations promote opportunities framework for breast feeding promotion adopted by for parents and caregivers to provide care to newborns the World Health Organization – serves as a minimum and infants during their first year of life. The Labor requirement for all countries to protect infants and Code of Armenia (Article 172 Pregnancy and Maternity young children by ensuring that parents receive Leave) mandates that women receive maternity leave evidence‐based information and regulating the before and after giving birth at their full gross tax marketing of breast milk substitutes and feeding exempt salary. The exact number of days depends upon supplies. On the basis of this International Code, the the woman’s particular situation: GoA has developed a draft law on breastfeeding most women are entitled to 140 calendar days promotion and regulation of infant food marketing (split evenly before and after childbirth); currently under circulation in Parliament for adoption. women who had complicated deliveries are While 89 percent of children below the age of six entitled to 155 calendar days (70 days before months are breastfed and 23 percent of children are childbirth and 85 days after childbirth); and, breastfed until the age of two or beyond in Armenia, only 35 percent of 0‐6 month old children are exclusively breastfed.
4 Per decree N730‐A of June 18, 2012. 5 The Government initially targeted to achieve 90 percent enrollment in the school readiness program by 2015, but primarily due to the economic crisis in 2009, the target has been postponed to 2017.
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National laws and regulations mandate a wide range education, free medical care and services, provision of of healthcare services for pregnant women and young nutritious food, psycho‐social rehabilitation, the right children. The Law on Medical Services for the to housing, and provision of free legal assistance. This Population (Article 10) stipulates the right of each child law applies to children deprived of parental care, and to receive free medical care and services within public covers all children and adolescents from birth up to health programs. The Ministry of Health has established the age of 23. specific goals to ensure the well‐being of young children and pregnant women in Armenia. These include: (i) to In Armenia there are a number of state allowances for reduce infant mortality and child mortality respectively childbearing and young children, including a one‐time by two‐thirds by 2015; (ii) to improve maternal health maternity/child birth allowance, childcare allowance for and reduce maternal mortality ratio by three‐fourths by children of up to 2 years old, family allowance for 0‐83 2015; and (iii) to increase the number of measles months old children as well as allowances in case of the loss vaccinations to 96 percent. By law, all health services to of caretaker (parents or other guardians) and disability. young children and pregnant women are provided free of charge in polyclinics within the scope of the state Moreover, within the framework of the National programs targeted to mother and child health Program on the Protection of Children's Rights for 2004‐ protection (as stated in the Strategy Paper for 2003‐ 2015, the GoA has been implementing the following 2015 on Mother and Child Health Protection, targeted interventions: ‘State Support to the Graduates Government decree No 1000, August 2003; and the of Orphanages; ‘Organization of Child Care in National Strategy on Child and Adolescent Orphanages’; ‘Introduction of Foster Care Institution’; Development, 2009). Additionally, all hospital services and, ‘Creation of a Databank of Foster families’. are free of charge for children up to 7 years old. The national immune‐preventive program of Armenia provides a full package of mandatory vaccination (Tuberculosis, hepatitis B, diphtheria, whooping cough, Box 2: Key Laws and Regulations Governing ECD tetanus, hemofilus influenza type B infection, measles, in Armenia roseola, and mumps) for all children. The UN Convention). Other key health services provided include: labor and The UN Protocol on the Sale of Children and Child delivery; well‐child visits; growth monitoring and Prostitution and on Involvement of Children in promotion; antenatal checkups for pregnant women; Armed Conflict (ratified in 2005). diarrhea treatment; malaria treatment; treatment for The ILO 182nd Convention on Child Labor (ratified in upper respiratory tract infection; antibiotic treatment 2005). for pneumonia; treatment to prevent mother‐to‐child The Hague Convention on Inter‐Country Adoption transmission of HIV/AIDS; anti‐retroviral treatment for (ratified in 2006). HIV/AIDS; and, tuberculosis treatment. Adopted National Laws including: the Law on Child’s National laws and regulations promote child Rights, the Law on Preschool Education, the Law on protection and care for disadvantaged children. The Medical Services for the Population, the Law on Law of the Republic of Armenia on Social Protection of Social Protection of Children Deprived of Parental Children Deprived of Parental Care mandates the Care, the Family Code, Labor Code and Criminal provision of social guarantees for the main indicators Code. of quality of life for children including: mainstream
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Protection of Children's Rights for 2004‐2015. The Policy Lever 1.2: Committee is comprised of the MoES, MSS, MoH, MoA, Intersectoral Ministry of Sport and Youth Affairs, Ministry of Justice,
Ministry of Foreign Affairs, and international Development in early childhood is a multi‐dimensional organizations' members (Figure 2). This committee has process. In order to meet children’s diverse needs the sole function to set and coordinate ECD‐related during the early years, government coordination is policies. Recognizing the multisectoral nature of ECD, essential, both horizontally across different sectors as the government has delineated clear responsibilities for well as vertically from the local to national levels. In individual line Ministries. For example, the MoES has many countries, non‐state actors (either domestic or the lead in Early Childhood Education (ECE) policy international) participate in ECD service delivery; for design and implementation. The MoH is responsible for this reason, mechanisms to coordinate with non‐state healthcare and nutrition of children, and determine and actors are also essential. monitor quantitative standards of food. The MoA is Armenia has an explicitly‐stated multisectoral ECD responsible for nutritional intake of children, and the strategy. Armenia’s National Strategy for Child and State Service of Food Safety under the MoA is Adolescent Health and Development (2009) is a responsible for the safety of the food provided to multisectoral ECD strategy. Taking into account the children. The MSS plays its role in combating poverty main child health determinants, the development of and creating favorable conditions for children’s growth this strategy was based on an intersectoral approach and development and, hence, is responsible for child involving health care providers, representatives of local and social protection. and international non‐governmental organizations, as The country has established a three‐layer child well as representatives from key ECD stakeholder protection system which provides an integrated agencies. Special emphasis was laid on the interagency approach to the protection of children’s rights at the cooperation between the Ministry of Health (MoH), the national, marz (province), and community levels. At the Ministry of Education and Science (MoES), the Ministry national level, the National Committee comprised of of Labor and Social Affairs (MSS), and the Ministry of representatives of various ministries is responsible for Agriculture (MoA). child development issues. At the marz (province) and Recognizing the fact that child’s first five years of life Yerevan municipality level, child protection units called are the most vulnerable and crucial for a child’s Divisions on Family, Women and Child Rights Protection wellbeing, this strategy considers early childhood as a implement the child protection policy developed by the key stage for physical and mental development of the Government and rights protection of children in difficult child, as well as for shaping of social and motor skills. circumstances. At the community level, Guardianship The priorities of the strategy are set as follows, putting and Trusteeship Commissions aim to secure protection equal emphasis on ECD and adolescent health and of rights of people with no and/or limited employability, development: (i) Neonatal health; (ii) Health and children without parental care and in difficult development of young children, including nutrition and circumstances, juveniles, and the right of children to immunization; (iii) Developmental disorders and child grow up in a family. disability; (iv) Health and development of school‐aged children and adolescents; (v) Mental health; (vi) Chronic However, there is an evident lack of collaboration conditions; (vii) Injuries and abuse; and (vii) between the line Ministries in coordinating the activities Environmental health. aimed at improving the provision of services to children. Additionally, there is no annual action plan of activities Armenia has established an institutional anchor to for the National Committee to guide responsible lead ECD policy and coordinate across sectors. agencies and partners to implement the National Child According to the government decree N588 of June 21, Protection Program. Neither is there a monitoring 2001, a cross‐sectoral national committee was formed mechanism for the implementation of the three‐layer for the development of the National Program on the child protection system in the country.
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Figure 2: Key ministries involved and cross‐sectoral collaboration
Box 3: The Chilean experience: benefits of multisectoral policy design and implementation
Summary: A multisectoral ECD policy is a comprehensive document that articulates the services provided to children and key stakeholders involved, including responsibilities of service providers and policy makers. The policy should also present the legal and regulatory framework in a country and address any possible gaps. Typically, a policy can include a set of goals or objectives and an implementation plan that outlines how they will be achieved. The benefits of doing so are manifold. The preparation process requires all stakeholders to contribute, which in turn promotes a more holistic, synergetic approach to ECD and identifies possible duplication of objectives by individual stakeholders. Another benefit is that the policy framework clarifies the boundaries within which all stakeholders are to operate and can create accountability mechanisms. One such example is Chile Crece Contigo (“Chile Grows With You”, CCC), an intersectoral policy introduced in 2005. The multi‐ disciplinary approach is designed to achieve high quality ECD by protecting children from conception with relevant and timely services that provide opportunities for early stimulation and development. A core element of the system is that it provides differentiated support and guarantees children from the poorest 40% of households key services, including free access to preprimary school. Furthermore, the CCC mandates provision of services for orphans and vulnerable children and children with special needs. The creation and implementation of the CCC has been accomplished through a multisectoral, highly synergistic approach at all levels of government. At the central level, the Presidential Council is responsible for the development, planning, and budgeting of the program. At each of the national, regional, provincial, and local levels there are institutional bodies tasked with supervision and support, operative action, as well as development, planning and budgeting for each respective level. The Chile Crece Contigo Law (No. 20.379) was created in 2009. Key considerations for Armenia: Highly synergetic approach to service delivery, focusing on multisectoral nature of children’s needs: given the multi‐ dimensional nature of children’s development needs, a cohesive approach in ECD service delivery is highly beneficial. It is important to establish a scheme for comprehensive ECD services that should be delivered to all young children, leveraging the respective competencies of each sector with a focus on achieving holistic child development. Guaranteed support to the poorest, most in need children and their families.
Policy Lever 1.3: yield high public returns, but are often undersupplied Finance without government support. Investments during the early years can yield greater returns than equivalent While legal frameworks and intersectoral coordination investments made later in a child’s life cycle and can are crucial to establishing an enabling environment for lead to long‐lasting intergenerational benefits. Not only ECD, adequate financial investment is key to ensure do investments in ECD generate high and persistent that resources are available to implement policies and returns, they can also enhance the effectiveness of achieve service provision goals. Investments in ECD can other social investments and help governments address multiple priorities with single investments.
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Public sector ECD funding is allocated in Armenia based for health financing have been made through annual on clear criteria. In the education sector, kindergartens targeted health programs which set the scope and are the responsibility of local communities and funded by extent of the state‐guaranteed free health care and the community budget. For instance, Yerevan services. Beyond this scope, health care is provided on a Municipality has its own budget for Yerevan‐based public fee‐for‐service basis. The World Health Organization preschool institutions which became free since 2010. Global Health Expenditure Database (2011) reports However, many communities have not been able to that, at the household level, out of pocket provide kindergarten services primarily due to lack of expenditures 7 account for 93 percent of all private funding. In order to increase preschool enrollments in health expenditure in Armenia. The share of rural areas, the Government introduced a one‐year government spending on healthcare is low (6 percent) School Readiness Program for 5‐6 year old children, with only 2 percent of GDP allocated for government mainly targeting rural communities where no preschool expenditure on health. As a percentage of the total facilities are available. The government, through the health expenditures, out of pocket expenditures are 55 World Bank‐funded Education Quality and Relevance percent in Armenia. This rate is significantly higher than Project, finances initial investment to establish a in neighboring countries. Even though data are not preschool program in the existing educational institutions specific to the ECD aged population, this figure (i.e., schools and kindergartens). Due to the co‐financing illustrates that despite the well‐established health care requirement for the introduction of a program, the policy guaranteeing free access to health services, poorest communities have not been able to participate in beneficiaries continue to bear major costs to receive the program to date. In addition to the initial investment, these services. For instance, there have been some under the decree signed by the Minister of Finance and reported instances of out‐of‐pocket informal payments Minister of Education in December 2011, the central for hospital care, mainly for drugs because government finances recurrent costs for the program reimbursements from the government are insufficient offered in school facilities as part of per capita school to fully cover the cost of the drugs. However, a most financing. Every year, the Government allocates state recent study8 suggests that since the Child Health State budget to preschools based on the number of students Certificate Program was introduced in 2011, which and newly opened groups. significantly increased salaries of service providers for pediatric inpatient care for children 0‐7 years of age, Similarly, in the health and social/child protection incidents of informal out‐of‐pocket payments have sectors, ECD funding allocation is measured based on dropped dramatically; as a result, access to the care has explicit criteria including, number of beneficiary considerably increased among the poor. According to the children covered, number of caregiver positions, study, the number of informal payments has decreased to characteristics of children covered and by geographical one third in Yerevan and one fifth in regions. location. The mountainous and highly mountainous areas of Armenia receive a higher allocation given the Further information is required, including the level of difficulty to reach targeted beneficiaries in such areas6. government spending on ECD interventions in all essential sectors, in order to fully assess the public In the health sector, it is estimated that a total amount sector financial commitment to ECD as a whole. of more than 10 billion AMD (approximately USD 25.6 million) is spent on health programs for young children aged 0‐83 months. Health sector policies define the rights of every child to free‐of‐charge health services. 7 Children with disabilities are also fully entitled to Out of pocket expenditure is any direct outlay by households, receive free care by specialized medical and including gratuities and in‐kind payments, to health practitioners and suppliers of pharmaceuticals, therapeutic appliances, and psychological services. Since 1997, budget allocations other goods and services whose primary intent is to contribute to the restoration or enhancement of the health status of individuals or 6 In the health sector, the formula funding multiplies the number of population groups. 8 beneficiary children by 1,000 AMD (USD 2.5) and gives geographical Crape, B. et. al., 2011, Evaluation of the Child Health State coefficients of 1.1 and 1.2 for mountainous and highly‐mountainous Certificate Program, USAID, the Ministry of Health, and American areas, respectively. University of Armenia: Yerevan.
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Table 3: Select health expenditure indicators Russian Armenia Georgia Kyrgyzstan Ukraine Federation Out of pocket expenditure as a percent of all private 93% 89% 86% 83% 93% health expenditure (PvtHE) Out of pocket expenditure as % of total health expenditures 55% 68% 38% 31% 41% General government expenditure on health as a 2% 2% 3.5% 3.5% 4% percentage of GDP % of routine EPI vaccines financed by government, 2010 66%1/ 80% 85 % No data No data Source: WHO Global Health Expenditure Database, 2011; TransMonEE, 2010; UNICEF Country Statistics, 2010. 1/ A notable portion of the remaining costs are covered by other donors, particularly.
Box 4: Relevant lessons from Australia: sustainable financial investments
Example from Australia: The National Partnership Agreement on Early Childhood Education Education is the responsibility of the State and Territory governments in Australia. In the 2007/2008 academic year, nearly 70% of preschool eligible children attended, and six out of the eight jurisdictions had enrolment rates above 85%. However, enrollment was low for specific sub‐groups within the population, especially Aboriginal children. To address this issue and increase enrollment across the country, in 2008, through the Council of Australian Governments, all state and territory
governments in Australia jointly agreed to the National Partnership Agreement on Early Childhood Education. The National Partnership aims to provide all children with access to a quality early childhood education program by 2013, delivered by a four‐year university‐trained early childhood teacher, for 15 hours a week, 40 weeks a year, in the year before formal schooling. Prior to the National Partnership, Australia’s investment in ECD was only 0.1% of GDP, which ranked 30th out of the 32 OECD countries, and well below the 0.45% of GDP average. To achieve quality, universal coverage, all parties agreed to increased, sustained financial investment, which was partially aided through additional funding of $970 million (AUD) by the Commonwealth of Australia over a five‐year period.
The Australian strategy calls for streamlined mechanism for management and finance at the national, state, and local levels. It requires effective accountability mechanisms, with clearly defined roles and responsibilities at each respective level. The Best Start Program in the State of Victoria is an example of a comprehensive ECD program with sustainable financing mechanisms. The program uses a decentralized approach and is co‐financed by municipal and local governments, with contributions from regional stakeholders. The program’s multi‐pronged funding approach is effective largely due to strategic mapping, constant monitoring, and extensive evaluation methods at the local level.
Key lessons for Armenia: In order to expand coverage and effectively implement services, commitment from the national, provincial (marz) and community levels to maintain financial support to ECD will be essential. Similar to the Australian context, Armenia’s decentralized system requires coordinated financing efforts at the national, provincial and community governments, which has already been placed through the School Readiness Program. It is essential to further define the roles and accountability measures for each level of the governments to expand the coverage both horizontally (universal coverage) and vertically (longer preschool years) in a sustainable manner.
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Policy Options to Strengthen the Enabling economic status to provide co‐investment in Environment for ECD in Armenia sustaining ECD services. Overall, out‐of‐pocket expenditure (formal or informal) as percentage of Legal framework – National laws and regulations in total health expenditures is very high in Armenia. Armenia promote the provision of ECD services for This applies to ECD services, including the most children, but without mechanisms to enforce the essential services such as childhood vaccines. It provision of comprehensive services. The general should be the first priority for the government to policies do not create mechanisms to promote provide sufficient funding for the basic services, adequate access to ECD services for all young children. particularly targeting the poor and most vulnerable. A policy that requires, for example, that children attend well‐child visits on a regular basis could better ensure that all children in Armenia receive Policy Goal 2: Implementing Widely appropriate health interventions in early childhood. Policy Levers: Scope of Programs • Universal provision of health services in Coverage • Equity early childhood can ensure the prevention and Implementing Widely refers to the scope of ECD treatment of leading causes of death for children programs available, the extent of coverage (as a share below 5 years, including diarrhea and pneumonia. of the eligible population) and the degree of equity Intersectoral Coordination – Armenia has a well‐ within ECD service provision. By definition, a focus on defined ECD policy and has established an institutional ECD involves (at a minimum) interventions in health, anchor. Yet, there is a lack of coordinated efforts nutrition, education, and social and child protection, and between the Armenian Ministries dealing with ECD should target pregnant women, young children and matters: the MoES is responsible for ECD policy their parents and caregivers. A robust ECD policy should implementation in Education; the MoH is responsible include programs in all essential sectors; provide for ECD policy implementation in Health; the MoA is comparable coverage and equitable access across responsible for the nutritional intake of children; and, regions and socioeconomic status – especially reaching the MSS is responsible for Child/Social Protection. The the most disadvantaged young children and their established cross‐sectoral committee has currently families. the sole responsibility of developing ECD related policies and programs. As part of updating the multi‐ sectoral National Program on the Protection of Policy Lever 2.1: Children’s Rights for 2004‐2015, it would be good to Scope of Programs enhance coordination functions between the line ministries and between the national and sub‐national Effective ECD systems have programs established in levels. all essential sectors and ensure that every child Finance – The multisectoral nature of ECD makes it and expecting mothers have guaranteed access to difficult to clearly identify and aggregate public the essential services and interventions they need financing of ECD, though it is clear that the GoA is to live healthfully. The scope of programs assesses allocating funding for ECD related sectoral the extent to which ECD programs across key interventions. Communities have been given sectors reach all beneficiaries. Figure 3 presents a responsibility for preschool education but have summary of the key interventions needed to limited financial levers. Limited budgets create support young children and their families via different difficulties for communities with low socio‐ sectors at different stages in a child’s life.
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Figure 3: Essential interventions during different periods of young children's development
Armenia has programs established in each of the and the Global Alliance for Vaccines and Immunization essential ECD sectors: education, health, nutrition, and (GAVI) to list a few, are active in the area of ECD, child and social protection. Within these, there are implementing complementary capacity building programs that focus on the three main ECD target activities in the effort to improve ECD in Armenia. groups – children aged 0 to 83 months, pregnant mothers and caregivers. Figure 4 shows a selection of For each sector, a series of specific interventions some of the existing ECD interventions in Armenia, are essential to support young children. While Figure including sectoral, multisectoral, and comprehensive 4 illustrates some of the most important ECD programs interventions. Government interventions such as the in Armenia, it does not illustrate the level of coverage of Expanded Programme on Immunizations, Prenatal the interventions. Table 4 illustrates that ECD Health Programme, and Breastfeeding Promotion interventions exist across sectors, ranging from Programs operate country‐wide. Alongside the education, health, nutrition, parenting, and special Government, many development partner, such as needs. While it is commendable that nearly all of the Children of Armenia Fund, Save the Children, UNICEF, essential interventions exist in the multiple sectors of the World Food Programme (WFP), the World Bank, Armenia, the scale of coverage of selected ECD programs World Vision, the World Health Organization (WHO), in Armenia demonstrates that levels of access vary.
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Figure 4: Selected ECD programs in Armenia
Snapshot of ECD interventions supported by non‐state agencies in Armenia In line with the Government’s preschool education reform strategy, the ‘School Readiness Program’ aims to improve the school readiness of children entering primary school. It was first piloted under the first World Bank‐funded Education Quality and Relevance Project (EQRP) in 2004‐2009, and the second EQRP continues supporting the implementation of the fully‐adopted national program. UNICEF continues to work with the GoA to ensure that all children are protected from vaccine‐preventable diseases, as well as to improve primary health care services and child nutrition. UNICEF trains health workers on immunization and social mobilization to improve coverage. UNICEF also works to introduce new approaches of mother and child healthcare, including knowledge and skills development on how to prevent and manage common childhood illnesses and monitor child growth and development. Since 2000, World Vision Armenia has been implementing the community‐based ‘Maternal and Child Health and Nutrition Program’ (MCHN) which addresses the issues of healthy lifestyle, healthy and sick child care & nutrition, food safety, personal and environmental hygiene, access to safe drinking water, reproductive health, safe motherhood and essential newborn care. Since 2007, the Children of Armenia Fund (COAF) has worked towards improving health services provided to young children through its ‘Healthy Child Development Program.’ This program includes key ECD health interventions, including pregnancy care, breastfeeding, malnutrition, anemia, immunization, child development monitoring, and parental counseling. Save the Children’s Action for Child Health and Education (ACHE) Program works to enable children’s participation in quality ECD programs through increasing availability of ECD services, improving quality of ECD services and service providers, increasing community capacity to children’s development, as well as improving parenting knowledge and practices. The US Department of State‐ funded Livelihood Recovery and Social Support Program for Refugees and Vulnerable Residents in Armenia (LRSSP) aims to improve the well‐being, livelihoods and socio‐economic services available to refugees and former refugees in Armenia. This program targets preschool aged children from 4‐6 years old. The World Health Organization supports the quality improvement of immunization services for children in the country, and the Global Alliance for Vaccines and Immunization supports efforts of reducing infectious diseases among children of Armenia through the introduction of vaccines.
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Table 4: ECD programs and coverage in Armenia
ECD Programs and Coverage in Armenia Scale At scale in ECD Intervention Pilot Scaling Universal some programs Nationally coverage regions Education Publicly‐provided early childhood care and education Publicly‐subsidized early childhood care and education X Privately‐provided early childhood care and education X Community‐based early childhood care and education X 1/ Capacity building intervention for ECCE X Health Prenatal healthcare X Labor and delivery X Comprehensive immunizations for infants X Childhood wellness and growth monitoring X Advocacy for universal access to maternal and child health care X Capacity building intervention on quality of child health services X Nutrition Micronutrient support for pregnant women Food supplements for pregnant women Micronutrient support for young children Food supplements for young children Food fortification X2/ Breastfeeding promotion programs X Anti‐obesity programs encouraging healthy eating/exercise Feeding programs in preprimary schools X Parenting Parenting integrated into health/community programs X Home visiting programs to provide parenting messages Special Needs Programs for OVCs X Interventions for children with special needs Advocacy and capacity building intervention for provision of care to children X with special needs3/ Comprehensive A comprehensive system that tracks individual children’s needs and intervenes, as necessary Source: SABER‐ECD Policy and Program Data Collection Instruments. 1/ The National “School Readiness Program” includes capacity building services such as training to preschool directors and teacher mentoring and monitoring in preschools set up within the framework of Education Quality and Relevance Programme (ALP II of World Bank). 2/ National Salt Iodization Programme. 3/ World Vision Armenia’s program “Disabled People Organizations (DPO) Outreach for Greater Inclusiveness” supported activities related to building organizational and networking skills of DPOs for a collaborative decision‐making process with local authorities and donor organizations to support children with special needs. The trained DPOs conducted disability mainstreaming trainings in 30 preschools. The project supported the website of the Disability National Commission (www.disabilityarmenia.am) to bring together NGOs/DPOs. This program is over.
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Policy Lever 2.2: young children and pregnant women in Armenia. For Coverage some interventions, Armenia performs quite well in A robust ECD policy should establish programs in all comparison to other neighboring countries, however essential sectors, ensure high degrees of coverage and in others coverage levels remain relatively low: while reach the entire population equitably–especially the data show that 100 percent of child births are most disadvantaged young children–so that every child attended by skilled attendants, only 71 percent of and expecting mother have guaranteed access to pregnant women receive regular antenatal care based essential ECD services. on international standard (at least four times). Similarly, Table 5 shows that Armenia has the lowest Armenian children and mothers have adequate rate (57 percent) of children under 5 with suspected access to some ECD health interventions. Table 5 pneumonia benefiting from medical consultation. shows the level of access to a selection of essential These figures illustrate that despite remarkable ECD health interventions for young children and coverage levels in certain interventions, young pregnant women in Armenia and other countries in children and pregnant women are not yet receiving a the region. As illustrated in Table 5, there is a relatively comprehensive set of child and maternal health high level of access to essential ECD health services for services.
Table 5: Level of access to essential health interventions Level of Access to Essential Health Interventions for Young Children and Pregnant Women Armenia Belarus Georgia Kyrgyzstan Ukraine
Percentage of 1‐year‐old children immunized 94%1/ 98% 91% 96% 90% against DPT (corresponding vaccines: DPT3ß)
Percentage of children below five years of age Data not with suspected pneumonia taken to an 57% 90% 74% 62% Available appropriate health care provider
Rate of births attended by skilled attendants2/ 100% 100% 100% 99% 99%
Percentage of pregnant women receiving Data not Data not 71% 90% 75% antenatal care (at least four times) available available Data not Birth registration rate 96% 92% 94% 100% available
Source: UNICEF Country Statistics 1/ In Armenia, this index has been evaluated based on the immunizations involvement index of the Hib component which was introduced in the country in 2009 and based on the results of the first year’s implementation, it nearly corresponds to the WHO requirements. 2/ Data refers to the percentage of births attended by skilled health personnel (doctors, nurses or midwives) and refers to the most recent year available during the specified period: 2006‐2010.
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Access to essential ECD nutrition interventions is Preprimary education coverage in Armenia is low, but inadequate in Armenia National legislation necessitates gradually increasing. Despite the fact that, by law, salt iodization,9 resulting in notable increases at the children are entitled to receive preprimary education, household consumption level. According to a survey the level of access to preprimary education in Armenia conducted in 2005, more than 97 percent of Armenian remains far beyond the targeted goal. As shown in household use iodized salt. On the other hand, while Figure 5, since 2000, preprimary school enrollment flour fortification10 is highly encouraged, it remains a rates for 3‐6 year olds are increasing in most countries voluntary undertaking, and yet to be implemented of the Europe and Central Asia (ECA) region. Yet, the more thoroughly. Table 6 shows the level of access to a region is characterized by a large disparity: while selection of essential ECD nutrition interventions for countries such as Belarus have achieved coverage levels young children and pregnant women in Armenia. Breast as high as 93 percent, countries such as Tajikistan and milk is considered to be the best method to ensure an Kyrgyzstan have coverage levels in the lowest echelon. infant’s intake of all the nutrients and calories for In Armenia, between 2000 and 2010, the enrollment proper growth and development. Following the change level has significantly increased from 16.3 percent to in WHO recommendations, the Armenian Ministry of 33.9 percent. More recently, preschool education Health Department of Mother and Child changed its enrollments (ages 1 to 6) increased from 55,711 in 2009 breastfeeding policy in 2005, urging mothers to to 65, 982 in 2012, mostly due to a growth of private exclusively breastfeed for the first six months of life. kindergartens. Yet, by regional comparison, the level of Since 2005, among children under age 6 months, access remains low. breastfeeding has increased slightly (84 and 89 percent, respectively, in 2005 and 2010). However, exclusive Viewed from another perspective, Figure 6 shows breastfeeding shows only a slight improvement (35 the percentage of children aged 3 to 6 who are percent in 2010 compared with 33 percent in not enrolled in kindergarten. Based on this regional 2005).While Armenia performs well in specific nutrition comparison, Armenia is placed in the highest tier interventions such as salt iodization, data show that and is one of the six countries in the region which malnutrition remains a serious public health concern. As have a significant number of the eligible young illustrated in Table 6, 19 percent of children below 5 population non‐enrolled (more than 65 percent). years of age suffer from moderate and severe stunting, indicating that children are not receiving the required diet to maximize their growth and development. This figure underlines the need for targeted interventions to ensure that all young children receive appropriate dietary consumption at this highly critical early age.
9 The National Program on Struggling Against and Preventing Consequences of Iodine Insufficiency of the Republic of Armenia Population, 12 February, 2004, N 353‐N. 10 The National Flour Fortification Program by the Ministry of Health in collaboration with UNICEF, February 2011.
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Table 6: Level of access to essential nutrition interventions
Level of Access to Essential Nutrition Interventions for Armenia Belarus Georgia Kyrgyzstan Ukraine Young Children and Pregnant Women
Percentage of children exclusively breastfed until 6 Data not 35% 9% 32% 18% months of age available
Percentage of infants with low birth weight 7% 4% 5% 5% 4%
Percentage of households consuming iodized salt 97% 94% 100% 76% 18%
Data not Data not Data not Percentage of pregnant women with anemia 38.6% 25.8% available available available Percentage of under‐fives suffering from moderate Data not 19% 4% 11% 18% and severe stunting available Source: Demographic Health Services, UNICEF Country Statistics, WHO Global Database on Anemia.
Figure 5 – Net preprimary (kindergarten) enrollment rate (as % of children aged 3‐6 years)
Source: UNICEF’s TransMONEE data set, 2011
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Figure 6: Regional comparison of 3‐6 year olds not in kindergarten (2009/10)
Source: UNICEF’s TransMONEE data set, 2011
Figure 7: Preprimary enrolment rate in relation to GDP per capita, 2010/2011
Source: TransMONEE 2012 Database, UNICEF Regional Office for CEECIS
As an illustration, Figure 7 presents preprimary higher preprimary enrolment rate in comparison with enrolment rate in relation to GDP per capita in Central Armenia with a relatively similar level of GDP. This and Eastern Europe and The Commonwealth of shows that alongside countries such as Tajikistan, Independent States (CEECIS) region. This figure Kyrgyzstan, Uzbekistan and Turkey, Armenia needs to illustrates that despite having a low GDP per capita, pay increased attention to preprimary coverage with a countries such as Moldova and Ukraine have a much focus on disparities.
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(MICS)11, Figure 8 and Figure 9 illustrate the level of Policy Lever 2.3: Equity access to a selection of ECD services based of socioeconomic status and geographical location
respectively. Figure 8 compares access to essential ECD Based on the robust evidence of the positive effects interventions for the poorest 20 percent of the ECD interventions can have for children from population with the wealthiest 20 percent of the disadvantaged backgrounds, every government should population, including birth registration rates, skilled pay special attention to equitable provision of ECD attendants at birth, and the number of children under services. One of the fundamental goals of any ECD five years of age with diarrhea who receive oral policy should be to provide equitable opportunities to rehydration and continued feeding. This figure clearly all young children and their families. illustrates relatively small gaps in coverage for birth
registration and skilled attendance at birth, but a much Preliminary analysis of information on access to a greater difference for diarrhea treatment. In addition, selection of ECD interventions shows that Armenia is according to ILCS data, the level of enrollment in yet to provide more equitable opportunities to young preschool (children of 0‐6 year age) varies widely children and pregnant women, irrespective of their depending on the poverty status. Enrollment among socioeconomic situation or geographical location. Using non‐poor households was equal to 45.9 percent, poor data from the UNICEF Multiple Indicator Cluster Survey 26.7 percent and extremely poor 19.1 percent. 12
Figure 8: Access to ECD services and ECD outcomes for poor and rich in Armenia
11 http://www.unicef.org/infobycountry/armenia_statistics.html. 12 National Statistical Service, 2011, Social Snapshot and Poverty in Armenia 2011, (http://www.armstat.am/file/ article/ poverty_2011e_4.pdf).
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Figure 9: Access to ECD services by rural/urban location in Armenia
Similarly, Figure 9 compares access to essential ECD Policy Options to Implement ECD Widely in interventions in the urban area with the rural area, Armenia including preschool enrollment rate, birth registration rates, skilled attendants at birth, the number of Scope of Programs and Coverage – A robust ECD children under five years of age with diarrhea who policy should include all important sectors and reach all receive oral rehydration and continued feeding, and critical stakeholders. In Armenia, ECD interventions are the percentage of population using improved established in most essential ECD sectors and a range sanitation facilities. This figure illustrates a generally of development partners are also implementing equitable access to ECD services for beneficiaries complementary capacity‐building interventions. located in urban and rural locations, with a greater Despite a wide range of existing ECD sectoral difference in access to diarrhea treatment and interventions, the majority of them are not operating at improved sanitation facilities. As for education, the scale. The GoA could consider developing mechanisms administrative statistical data illustrate a wide gap to ensure that all essential interventions are available between urban and rural areas: in 2010 enrolment in throughout the country. A mapping exercise to develop preschool education was 25.3 percent, including 32.7 13 a database of ECD related interventions could be useful percent in urban and 12.4 percent in rural areas. to foster in‐country collaboration and identify potential There is a lack of alternative child care centers in the gaps and possible synergies amongst the different country which is an obstacle for early identification and stakeholders. proper care and development for children, especially Coverage for essential ECD interventions is those under 6 years old. Creation of similar centers will expanding in Armenia. This study supports the undoubtedly contribute to a more successful government in continuing expanding the coverage of implementation of the School Readiness Project, the one year National School Readiness Program to particularly for children with special needs. achieve a 90‐percent enrollment rate by 2017. Once the horizontal expansion is achieved, the government should also consider extending the duration up to 2 to 3 years as the next step.
Access to health and nutrition interventions, such as 13 Ditto programs to promote breastfeeding and parenting
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education about healthy eating, could be more Annual data collection on service provision is required available for families. Providing access to nutritional at all levels in the key sectors, however, there is a need services, particularly improved access or knowledge to develop a comprehensive system to track about the consumption of foods with iron could lower integrated ECD outcomes and children’s progress. In anemia prevalence. Reducing anemia prevalence in the key sectors of health and education, national pregnant women could also prevent intellectual policies require annual data collection on service impairment and mental retardation of children. provision (e.g., enrolment in ECCE centers and usage of Equity – Disparities exist in access to select health and child health centers) at the national, sub‐national, and nutrition services as well as access to preprimary local levels, as well as service provision by education between those in urban and rural areas, and socioeconomic status, broken down by a child’s specific between the rich and poor. The GoA may need to age and collected on an urban/rural basis. However, consider expanding access focused and targeted there is no functional and scaled comprehensive system towards low‐income and vulnerable children as well as to track integrated ECD outcomes and a child’s progress those hard to reach. For instance, in addition to the in the four interrelated domains of child development: lower requirements of community contribution for physical, linguistic, cognitive, and socio‐emotional. poor communities that the government is currently considering, it is advisable that the government Data indicating access to ECD services for special analyzes the financial capacity of communities without groups are available in Armenia. The Government a single preschool and develops a subsidy mechanism, collects data on young children in ECD centers by if needed, to support the establishment of a preschool gender and by type of special needs related to physical for the most disadvantaged communities. and intellectual disabilities (hearing, eyesight, emotional defect, cancer or other disease).
Policy Goal 3: Monitoring and Assuring Child outcome indicators are not collected in all essential sectors. There is a large disparity between sectors in terms Quality of data collection on child outcomes. While the health Policy Levers: Data Availability • Quality sector collects child outcome indicators, education, Standards • Compliance with Standards nutrition, and child and social protection sectors’ data collection efforts are limited to service provision and Monitoring and Assuring Quality refers to the existence of service provider levels. Recognizing that comprehensive information systems to monitor access to ECD services and data collection promotes rational and effective policy outcomes across children, standards for ECD services and making, there is a need to develop an individual child systems to monitor and enforce compliance with those development tracking system across the different sectors standards. Ensuring the quality of ECD interventions is vital in order to measure a child’s comprehensive early because evidence has shown that unless programs are of childhood development. high quality, the impact on children can be negligible, or even detrimental. Table 7 displays a series of key indicators that a country could track to monitor young children’s development. Policy Lever 3.1: Data These indicators are divided into both administrative Availability and survey data: ‐ Both administrative and survey data are important Accurate, comprehensive and timely data collection can to inform an effective data collection system; promote more effective policy‐making. Well‐developed ‐ Administrative data are more accurate, costly, and information systems can improve decision‐making. In tend to focus on specific programs; and particular, data can inform policy choices regarding the ‐ Survey data are cost‐effective and representative. volume and allocation of public financing, staff recruitment and training, program quality, adherence to Ideally, a system that consolidates all these series of standards and efforts to target children most in need. indicators could be developed.
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Table 7: Availability of data to monitor ECD in Armenia Administrative Data: Indicator Tracked ECCE enrollment rates by region Special needs children enrolled in ECCE (number of) X Children attending well‐child visits (number of) X Children benefitting from public nutrition interventions (number of) X Women receiving prenatal nutrition interventions (number of) X Children enrolled in ECCE by sub‐national region (number of) Average per student‐to‐teacher ratio in public ECCE Is ECCE spending in education sector differentiated within education budget? X Is ECD spending in health sector differentiated within health budget? X Survey Data Indicator Tracked Population consuming iodized salt (%) Vitamin A Supplementation rate for children 6 ‐59 months (%) X Anemia prevalence amongst pregnant women (%) Children below the age of 5 registered at birth (%) Children immunized against DPT3 at age 12 months (%) Pregnant women who attend four antenatal visits (%) Children enrolled in ECCE by socioeconomic status (%) X
Box 5: Relevant lessons from international experience in ECD tracking system
Example from Chile: Online Registration, Monitoring, and Referral System The “Chile Grows with You” initiative‐CCC‐(Chile Crece Contigo) is a comprehensive child protection system to prove intersectoral support to children from 0 to 4 years. One innovative component of CCC is an online monitoring system that follows each child through the CCC system. The system tracks child’s eligibility for and receipt of services, as well as his or her developmental outcomes. It allows service providers and policymakers to monitor the delivery of benefits as well as evaluate program impact.
Key Lessons for Armenia: This system could support better monitoring of compliance with standards, as it tracks which children receive specific benefits and services. This tracking system is particularly beneficial for improved intersectoral coordination at the point of delivery, as it provides an accessible platform for health, education, and child protection service providers to be on the same page about child’s needs and receipt of services. An improved online system could improve targeting and triggers for at‐risk children.
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Policy Lever 3.2: Quality The average caregiver‐child ratio in ECCE centers in Standards Armenia varies. According to the international standard for best practice, optimal learning environment is achieved with an average caregiver‐child ratio not Ensuring quality ECD service provision is essential. A exceeding 1:15 in preschool education. In Armenia, a focus on access – without a commensurate focus on significant disparity exists in preprimary education ensuring quality – jeopardizes the very benefits that provision between urban and rural areas. The urban policymakers hope children will gain through ECD areas have a higher ratio with 28 children per teacher, interventions. The quality of ECD programs is directly while the rural areas have a lower ratio with 11 children related to better cognitive and social development in per teacher. children. Access to sanitary and hygienic facilities is guaranteed Standards for service delivery and infrastructure are in Armenia. National policy is in place to ensure that all established for ECD service providers in Armenia. In public ECCE institutions have access to potable water the education sector, the Licensing Department of source and functional hygienic facilities. The Sanitary‐ MoES has established minimum requirements for ECCE Hygiene Agency of the Ministry of Health has services which mainly include: (i) availability of established specific sanitary rules for preschools by appropriate space; (ii) teaching methodical basis; and decree, followed by implementation enforcement (iii) availability of teachers with appropriate education. mechanisms. The MoES has equally established minimum qualification for ECCE teachers – ISCED 4A/5A/5B. Policy Lever 3.3: Although in‐service training of ECCE teachers is not Compliance with Standards mandatory, the National Institute of Education and
Step‐by‐Step Benevolent Foundation conduct trainings of teachers. A minimum of three and half hours Establishing standards is essential to providing quality teaching per day is required in ECCE institutions in ECD services and to promoting the healthy Armenia. Both public and private ECCE centers are development of children. Once standards have been constructed according to the well‐established Ministry established, it is critical that mechanisms are put in of Urban Development (MoUD) standards. place to ensure compliance with standards.
In the health sector, the MoH has established standards Registration and inspection processes exist for centers to govern the provision of ECD services to young providing ECD services. The MoES mandates that all children (0‐83 months). Healthcare providers are public and private ECE institutions must be registered required to complete training in early childhood service and accredited. ECE centers of Yerevan are inspected in delivery. Furthermore, the MoUD is in charge of Yerevan Municipality on an annual basis, however, ensuring health facilities’ compliance with construction there are no regular inspections in the regions where standards – health posts, centers, and hospitals. ECCE institutions (i.e. kindergartens) belong to communities. While the MoUD has the mandate to ECD learning standards have been established in ensure that both public and private ECCE institutions Armenia. The MoES of Armenia, with technical are in compliance with construction standards, these assistance of UNICEF, developed state standards of standards are irregularly inspected and site visits are preschool education which define the main directions of rarely conducted, and mainly in Yerevan Municipality. educational content of preschool children. They are part of comprehensive ECD standards which cover motor A formal registration process is also in place to monitor skills, speech, emotional, interpersonal, social the compliance of public and private health facilities development, cognitive, self‐service and security, and with required service delivery standards. Yet, health attitude to learning. By law, mother‐tongue preschool facilities are irregularly inspected, mostly based on instruction is mandated in Armenia. arising needs. Similarly, construction standards in place are irregularly monitored through site visits.
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Policy Options to Monitor and Assure ECD early years, new capacities emerge continuously and Quality in Armenia development in one domain often affects development in another. For example, children who Data Availability – Comprehensive data collection are slow in one domain (i.e. language development) can promote effective policy‐making, allowing for may have limited capacity to show the skills that they improved decision‐making. The GoA could consider possess in other domains (i.e. for instance cognitive the need to establish an improved Monitoring and tasks that require language skills). Therefore, Evaluation system that would help guarantee that development in young children should be assessed as eligible beneficiaries receive the appropriate comprehensively as possible. When measuring a services. Child outcome indicators are essential in the child’s development, it is also important to closely policy‐making and decision‐making process. In look at which indicators are expected to change as a Armenia, child outcome indicators are only collected result of a specific intervention. in the health sector. It is highly recommended that child outcome indicators are collected in all essential Quality Standards & Compliance with ECD sectors to better inform comprehensive ECD Standards – Armenia has well‐established implementation moving forward. Measuring minimum standards and requirements for quality cognitive, linguistic, physical, and socio‐emotional assurance in health and education sectors. development can help policymakers evaluate the However, it is highly recommended that monitoring impact of existing interventions and decide which and compliance mechanisms be strengthened. interventions are most effective. During a child’s
Box 6: Relevant Lessons from International Experiences in Monitoring and Assuring Quality
Example from Jamaica: Ensuring Quality in ECCE provision The Early Childhood Commission (ECC) was established by an Act of Parliament, the Early Childhood Commission Act, in 2003. The Commission has the responsibility to ensure the integrated and coordinated delivery of early childhood programmes and services. Through its varying activities, the ECC will guide the holistic development of children, including physical, cognitive, social and emotional development. The Commission has a range of legislated functions, one of which indicates direct responsibility to supervise and regulate early childhood institutions (ECI).
Standards for the operation, management and administration of ECIs: In Jamaican law, there are two types of Standards; those transmitted by an Act or Regulations and which therefore carry legal consequences and those that serve to improve practice voluntarily and are not legally binding. For practical purposes, quality standards for ECIs include both sets of standards, with clear indications of those standards that are legally binding.
Standard statements for ECI: to improve the quality of services provided by ECIs, the ECC has developed a range of robust operational quality standards for ECIs. The Act and Regulations, which together comprise the legal requirements, specify the minimum levels of practice below which institutions will not be registered or allowed to operate. The standards that are not legally binding define best practices for early childhood institutions and serve to encourage institutions to raise their level of practice above minimum requirements. While ECIs are encouraged to achieve the highest possible standards to ensure the best outcomes for children, the legally binding standards guarantee that minimum standards are met.
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Box 7: Relevant Lessons from International Experiences in Monitoring and Assuring Quality
Inspection and registration: inspection of ECIs is the procedure designated under the Early Childhood Act for ensuring that operators comply with the minimum acceptable standards of practice. The ECC is required to inspect each ECI twice annually. It is a requirement of registration that the registered operator co‐operates with the ECC’s inspection process. The “registered operator” is defined as the person required to apply for registration of an ECI and may be an individual or a group. In deciding on the suitability of an ECI for registration under the Early Childhood Act, the ECC will, based on information obtained at inspection visits, determine whether or not an ECI meets and complies with the Act and Regulations. Where existing provision falls short of the legal requirements, and the shortfall does not present a real and present danger to children, a permit to operate until full requirements are met will be granted, with time scales for institutions to meet requirements. The ECC encourages the promotion of the highest standards of practice by monitoring not only the minimum requirements at inspection visits, but also by monitoring those standards that are not legally binding. Key Lessons for Armenia: Consider establishing legally binding requirements for ECCE service provision to guarantee that acceptable minimum standards are met. Consider assigning a special entity with a delineated role to monitor and regulate ECCE service providers. An improved quality monitoring system will ensure that best outcomes are achieved.
Comparing Official Policies with Outcomes correlation between policies/national programs and The existence of laws and policies alone do not always implementation is reflected in a selection of ECD focus guarantee a correlation with desired ECD outcomes. areas. However, despite the recognition and desire to In many countries, policies on paper and the reality increase access to preprimary education, the outcome of access and service delivery on the ground are remains limited. Table 8 shows the status of these not aligned. In the case of Armenia, a strong comparisons in a selection of ECD activities.
Table 8: Comparing ECD policies with outcomes in Armenia ECD Policies Outcomes Nutrition Armenia’s policies comply with the International Code of Marketing of Breast Milk Substitutes, but the Rate of exclusive breastfeeding until the relevant law is yet to be adopted age of six months: 35% Health Young children are required to receive a Children immunized with DPT complete course of childhood immunizations (1 year old): 94% National policy mandates the iodization of salt for Percentage of households human consumption consuming iodized salt: 97% Child Protection National policy mandates the registration of children Birth registration rate: 96% at birth Education Preschool/kindergarten is not mandatory for any Preschool/kindergarten enrollment Rate child age (children aged 3‐6): 33.9%
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Preliminary Benchmarking and International intended to share information on how different ECD Comparison of ECD in Armenia systems address the same policy challenges. Table 10 presents the status of ECD policy development in Armenia alongside a selection of OECD countries. Table 9 presents the classification of ECD policy in Armenia Sweden is home to one of the world’s most within each of the nine policy levers and three policy goals. comprehensive and developed ECD policies and achieves a The SABER‐ECD classification system does not rank benchmarking of “Advanced” in all nine policy levers. countries according to any overall scoring; rather, it is
Table 9: Benchmarking Early Childhood Development Policy in Armenia Level of ECD Policy Goal Level of Development Policy Lever Development Legal Framework Establishing an Enabling Intersectoral Environment Coordination Finance Scope of Programs Implementing Widely Coverage Equity Data Availability Monitoring and Assuring Quality Standards Quality Compliance with Standards
Table 10: International Classification and Comparison of ECD Systems Level of Development ECD Policy Goal Policy Lever Armenia Australia Chile Colombia Sweden Uzbekistan
Legal Framework Establishing an Intersectoral Enabling Environment Coordination Finance Scope of Implementing Programs Widely Coverage Equity Data Availability Monitoring and Quality Standards Assuring Quality Compliance with Standards
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Conclusion high level of coverage in sectors such as health and nutrition, universal coverage and equitable access for The SABER‐ECD initiative is designed to enable ECD the eligible population in all essential sectors is yet to policy makers and development partners to identify be achieved. ‘Monitoring and Assuring Quality’ is also opportunities for further development of effective ECD emerging, with a need to improve monitoring and systems. The SABER‐ECD classification system does not evaluation system. While key quality standards are rank countries according to any overall scoring; rather, being effectively established, further compliance it is intended to share information on how different ECD reinforcement mechanisms are required. systems address the same policy challenges. This Country Report presents a framework to benchmark Resources and technical support must be directed Armenia’s ECD system; each of the nine policy levers towards strengthening the development of a are examined in detail and some policy options are comprehensive ECD system in Armenia, including the recommended. expansion of coverage in some sectors as well as the development of an effective individual child Armenia has an emerging ‘Enabling Environment’ with development tracking system. Many development strong national laws and regulations guaranteeing the partners are active in the field of ECD in Armenia. provision of essential ECD services and a framework for Building the capacity of the national ECD committee is a multisectoral collaboration. Further data collection and crucial step in this effort, with the aim to form a analysis is required to clearly identify the level of public national level ECD implementation coordinating body to sector commitment to ECD finance. ‘Implementing ensure that well‐coordinated and integrated essential Widely’ is at an emerging stage in Armenia. Although ECD services are provided to young children and programs are established in all essential sectors with pregnant women.
Table 11: Summary of policy options to improve ECD in Armenia Policy Policy Options and Recommendations Dimension Develop strategies to deliver all services that national laws and regulations promote Create mechanisms to enforce the provision of ECD services, such as establishing requirements for regular well‐child visits mechanisms Establishing an Strengthen coordination mechanisms to ensure service delivery is coordinated at the sub‐national level. Enabling Building the capacity of the National ECD Committee could be considered with the idea of forming a Environment national level and sub‐national level ECD implementation coordinating bodies Assess the level of ECD spending within the different sectors to fully evaluate the strengths and areas for improvement and to plan targeted ECD investment Accelerate the expansion of the coverage and duration of the National School Readiness Program which targets 90% enrollment rate for the one year school readiness program by 2017. Implementing Improve nutrition interventions, such as breastfeeding promotion, parental education about the Widely consumption of foods with iron could lower anemia prevalence Expand access to key health and nutrition interventions focused and targeted towards low‐income and vulnerable children as well as those hard to reach Collect child outcome indicators in all essential ECD sectors to better inform comprehensive ECD implementation. Measuring cognitive, linguistic, physical, and socio‐emotional development can help Monitoring and policymakers evaluate the impact of existing interventions and decide which interventions are most Assuring Quality effective. Establish an improved Monitoring and Evaluation system that would help guarantee that eligible beneficiaries receive the appropriate services
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www.worldbank.org/education/saber
The Systems Approach for Better Education Results (SABER) initiative produces comparative data and knowledge on education policies and institutions, with the aim of helping countries systematically strengthen their education systems. SABER evaluates the quality of education policies against evidence-based global standards, using new diagnostic tools and detailed policy data. The SABER country reports give all parties with a stake in educational results—from administrators, teachers, and parents to policymakers and business people—an accessible, objective snapshot showing how well the policies of their country's education system are oriented toward ensuring that all children and youth learn.
This report focuses specifically on policies in the area of Early Childhood Development.
This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.
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SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 27