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Part II Analytic Section

3. Progress Toward Goals and Targets

3.1. Early Childhood Care and Development (ECCD)

In the government’s social strategy ECCD is considered to include health and sanitation, nutrition, education and social welfare and is intended to provide the healthy growth and development of children. It includes formal and non-formal means of purposeful and organized efforts to promote children’s development. These involve family and community interventions too. The early childhood care and development thorough non-formal means and through community and extended family practices has not been studied and thus no data exists for analysis. In addition it could also be asserted that the overall capability and awareness is very low and greater sensitization and mobilization of the family and community is required. While the government shoulders great responsibility in the promotion and development of social service, the main strategy is the assurance of responsible participation of the community in the development of social service. In general, the all-round intervention on children after independence has been based on the low living condition and status.

Promotion of Early Health and Nutrition Interventions in Children

One of the areas, which demanded the particular focus and intervention of the government is the accessibility of children to basic care and development. Hence prenatal care, delivery services, immunization and growth monitoring programmes have been directed to minimizing the problems which adversely affect the health growth and development of children. The general assessment is that there have been major interventions to improve the health and nutritional status of children from early days and the promotion of mother care has been an important dimension of this. The government has thus invested in health education, family planning education for women, in antenatal services, provision of delivery services for women, immunization services and various growth monitoring services for children made.

Table 4: Percentage of Health Service population Coverage by Year and type of service

 

 

Year

 

Health Ed -Tot Pop in %

 

Family Planning Women 15-45 years in %

 

Antenatal Service in %

 

Delivery Services in %

 

Immunization in %

Growth Monitoring –

< 5 years in %

Children

Women

15-49 years

<1 year

1-2 years

1992

9

0.7

24.4

9.7

19.3

6.3

3.9

-

1993

15.5

6.9

68.0

15.7

27.7

10.8

4.8

33.9

1994

24.7

4.0

56.0

17.5

36.0

13.6

5.0

39.8

1995

29.4

3.9

56.1

21.9

42.0

19.5

19.3

43.5

1996

39.3

4.3

41.7

23.7

53.6

19.0

7.5

21.5

1997

34.4

4.9

42.7

23.8

55.5

9.4

17.1

21.8

1998

41.1

5.2

44.2

18.6

59.1

10.1

22.7

37.1

The government’s effort in introducing a primary health network system has been successful throughout the country with the establishment of health clinics and centers especially in rural and periphery areas. At present it is estimated that about half of the children under the age of 3 live within 5 km distance from a facility providing child health services including immunization. This has markedly facilitated efforts at introducing basic health care for children. The assessments made at various levels and times shows that diarrhea, respiratory infections and malaria are the common diseases affecting children in Eritrea. Assessments show (MOH 1998, p 3-5) that ARI accounts for 44% of admission to hospitals (3% of them die), malaria for 20% (of which 7% die), diarrhea for 11% (13% of them die) and the remaining 25% are from other various diseases. TB accounts for 4% (9% of them die). Among the top ten causes of death in children less than five years of age, malaria ranks the third.

Various measures have been taken to reduce acute respiratory infection (ARI), low birth weight, diarrhea related illness, malaria, eye and ear diseases. To a great extent introducing better sanitation has been a major concern in terms of health care for children. Health reports (MOE 1998, p 3) show that the immediate causes of illness in children are inadequate dietary intake and high prevalence of infections. A great deal of correlation has been ascertained between the two causes, which justifies the development of a strategy based on food security, health security and environmental security. The 1993 Micro Nutrient Survey conducted by the Ministry of Health revealed that 7% of children had vitamin A deficiency, 55% iron deficiency, 66% were stunted, 41% under weight for their age and 10.4% were wasting. The EDHS survey conducted by the State of Eritrea in 1995 also showed similar trends.

Immunization has been one of the largest preventive programmes and concerted efforts are going on for a universalization of immunization against the basic diseases related to healthy growth. In general, EDHS results show that in 1995 about 41% of children age 12-37 months were fully vaccinated and 38% have not received any vaccinations. The main problem is disparity across cultures especially between urban and rural areas where less than 1/3 of children in rural areas are vaccinated against 4/5 in urban areas. Children under the age of one are the main targets in immunization though children of age 1-2 have also been included. Among the vaccine preventable diseases, measles accounts the highest rate for the deaths of children. The immunization status of children for some programmes has increased from 10% in 1991 to 70% in 1998 while it is about 90% for polio and immunization has been successful in all high-risk areas. No polio has been reported in the last 2 years and Eritrea has the plan to make the society free of polio by the year 2000. Ministry of Health assessment shows that about 8000 children are saved every year as a result of the immunization efforts made in the last 4 years. This is a great benefit to the children and to the society socially and economically. In relation to the promotion of mother care, women 15-49 years old are also targeted for Tetanus Toxic immunization.

Nutrition and Effects

Nutrition is known to affect the cognitive development of Eritrean children directly and indirectly. The mismatch between early opportunity and investment together with malnutrition could lead to irreversible conditions, improving nutritional status and introduction of feeding programmes has been one of the highest successful interventions. The national Micro Nutrient Survey conducted by the Ministry of Health in 1993 showed that micro nutrient deficiencies are also common in children in Eritrea. Here Vitamin A deficiency, iodine deficiency disorders and nutritional anemia were the major problems. The above indicated nutritional situation showed that children are inadequately prepared for school with the basic conditions in stunting, wasting and underweight slightly lower than the Sub-Saharan standard in the 1995 findings. The above survey showed that 6.7% of children below one year of age had Vitamin A deficiency, another 6.7% were at high risk and about 21.7% were with moderate risk. The incidence in general could be taken as low but this low rate is however related to the breast feeding practices in the society where about 98% of children are breastfed. The general policy and mobilization is to maintain this practice. To address the problem in the deficiency of Vitamin A, however, the government introduced a capsule supplementation programme, which started as part of the national immunization campaign in 1998. About 90% of the children between the ages of six months and five years and have been provided with appropriate doses of Vitamin A. In general, children under five and pregnant women have been the main targets for nutrition growth and development assessment.

Another major intervention was preventing iodine deficiency through iodized salt. Iodine deficiency is also a major problem that affects the intellectual development of children. The 1993 micro nutrient survey mentioned earlier showed that about 83% had varying degree of deficiency (36% severe, 25% moderate, and 22% mild). With the implementation of the Universal Salt Iodization (USI), the problem dropped to 17% (3.6% severe, 8.5% moderate and 13.2% mild) which is a remarkable progress in terms of assuring the healthy growth and development of children (MOH 1998, p 8-9). A survey made in 1998 especially on school children also showed similar drop in iodine deficiency. There is now a great need to consolidate these gains and iodine deficiency monitoring system will be established in schools in the future.

Access to safe water has been taken as a major target in the last five years to alleviate the chronic shortage of drinking water in many parts of the countries. EDHS survey shows that only about one third of Eritrean population have access to safe water. While 90% in urban population have access to safe water, only about 10% of the rural population have access to safe water. The grave problem that affects children, women and girls in particular is the distance of the water source. Surveys show that only 10% in rural areas and about 70% in urban areas have source of water below 11.5 minutes distance from their homes. Provision of safe and potable water for children in schools becomes an urgent priority and data shows that more than 46% of schools do not have any type of water provision (MOE 1997).

Due to the efforts made during the last eight years significant changes have been made in the living condition of children. EDHS shows that the infant mortality rate has decreased from 165 deaths per 1000 live births in 1960 to about 72 in 1995. The under-five morality has also dropped to 136 deaths per 1000 live births (163/1000 for male and 141/1000 for female). Thus enormous improvements have been made. There is, however, regional disparity in mortality rates. It is very high in South Red Sea (1 in 5 die), followed by Gash-Barka and North Red Sea (20% die). Mortality is low in the other regions (is less than 150 deaths per 1000 lives) (MOH 198, p 1). The UNDP Human development Report of 1997 shows that that infant mortality rate has dropped to 73/1000 and under-five mortality rate to 116/1000.

Children’s Welfare and Disadvantaged Groups

Assuring the Social Welfare of children is also another important area of the strategy based on the objectives underlined in the Macro Policy. The Ministry of Labor and Human Welfare has developed a social welfare policy on protecting children. Based on the overall principles laid in the social policy of the government and the Convention on the Right of the Child (CRC), some of the interventions given focus include safeguarding equal opportunity to disabled children, giving girls equal right and services as boys and safeguarding the interest of disadvantaged children. The Eritrean government ratified the CRC on August 3, 1994. National and regional conferences were convened where policy makers, religious leaders, community elders, children under 18 years of age, the civic society, representatives of various ministries and NGOs participated. The main aim of these conferences was to create a context for the implementation of the convention in the Eritrean reality. The CRC guideline was translated into six local languages and distributed to the population. Various sensitization programmes have also been broadcasted in the radio and television in various local languages.

The long war and the colonial policy of disrupting the fabrics of the Eritrean society had its deep effect on children. The increasing number of children who live on the streets of urban areas, abandoned children, children who became orphans due to the war has been major concern of the government. One of the main social concerns was safeguarding the interest and development of orphan children and street children. At present there are at least 90,000 Eritrean orphans. Since 1995, 14,000 children have been unified with extended families. Another 2500 will be unified in the year 2000 with the financial support of UNICEF. Community based solutions have been taken as the main strategy and efforts have been made to establish arrangements and mechanisms for establishing the involvement of the communities. Two group homes have been established at pilot level mainly for ages between 5 and 14 (14 boys and 10 girls). Each home accommodates 12 children of mixed ages. The group homes were intended to test the efficacy of such placement for orphans who can not be reunified. The construction of three additional group homes is under way, with external financial support.

There are also orphan children accommodated in an orphan center run by the MLHW. Most of these are made to attend schools at BE level with about 19 at elementary school level (11 boys and 8 girls). Under special circumstances there are also children put in orphan centers (a total of about 241 of which 149 are boys). While 39 of these are under the age of 5, twenty-five are between 5-9, forty-three between 10-14 and the rest were above 15 years of age. About 112 of the total attend basic education level while 21 attend KG and 38 in nursery programmes. The MLHW has also tried to address the problem of street children in the last 5-6 years.

Educational Equity through ECE

Promotion of the educational right of children has also been an important cornerstone of the Macro Policy of the government. Early education is considered a necessary investment in economic development on top of being seen as a major right for children. It is estimated that there are about 200,100 children between the ages of 5-6 in Eritrea. In Eritrea, ECE has been regarded as the first component of the Basic Education strategy and is organized at two levels (Nursery programmers and KG). The government has taken the UPE as the main strategy and priority. Still many bottlenecks and great challenges lie ahead in this respect. The investment in formal pre-school education, despite its importance, has not been addressed properly. Thus, government intervention in the establishment of formal centers has been very limited. Its functional roles in terms of developing policies, guidelines, programmes, teacher training and monitoring has however been very significant. It has also been encouraging NGOs, private establishments and individuals to set up ECE centers.

There are about 82 KG centers throughout the country and the number has not changed much in the last eight years. Enrolment has increased from 7,747 in 1993 to 11,581 in 1998 at an average of about 10% yearly. GER could be taken as 6.51% in 1998 and GER in 1993-94 was 5.05 and NER about 3.97. In general GER for ECE was continuously decreasing until 1996 but improving there after. Though assessments have not been made, the general indication for the slightly higher decrease in enrollment in 1996 could be the fact that many of the kindergartens run by the Municipalities were transferred to private institutions and community control and thus some were closed immediately due to lack funds.

Table 5: GER and NER Trends in ECE by Gender and Year: 1993-1998

 

1993/94

1994/95

1995/96

1996/97

1997/98

1998/99

 

T

F

M

T

F

M

T

F

M

T

F

M

T

F

M

T

F

M

GER

5.1

4.9

5.2

5.1

4.8

5.3

5.0

4.7

5.2

4.5

4.3

4.6

5.4

5.2

5.6

6.5

6.0

7.1

NER

4.0

3.8

4.1

3.8

3.6

4.0

3.7

3.5

3.9

3.3

3.2

3.5

4.2

4.1

4.3

5.3

4.9

5.6

KG accessibility and coverage is very limited. Most are situated in urban areas, in the capital city in particular. 66% of the students and 67% of the teachers and 69% of the workers are in the Central region (including the capital city). The fact that more than 94% of the official age are not enrolled (about 170,000 children of the age 5-6) signifies that a great deal of challenge exists in terms of providing center based pre-school preparation. But in general, the accessibility and coverage of the system is very low. GPI is also 0.877 and that is a good indication but has decreased over the years from 0.982 in 1993-94. The percentage of girls needs to be improved to reach the 1.0 level on the average, as the equal participation of girls needs to be addressed starting from ECE. It must be noted that ECE is a good strategy for improving girls’ enrolment at the elementary school level.

Most of the KGs are controlled by religious institutions. The percentage by ownership in each region shows that more than 92% are run by institutions other than the government which is a good indication of a greater community participation (See Table 6). More effort is needed in general to sensitize the community to consider the importance of ECE institutions. This is in particularly true and essential especially in terms of the effort going on to consolidate the participation of women in economic, social and political activities of the country and the establishment of day care centers has become important as well. In adult literacy programmes one of the interventions made to ensure greater participation and optimum literacy result was to open day care centers in some pilot schemes.

Table 6: Percentage Comparison of Kindergarten Ownership and Control by Region: 1998/99

Region

Government

Public

Community

Private

Mission

Others

Total

Anseba

-

-

2.4

-

6.1

-

8.5

Debub

-

-

-

3.7

15.9

-

19.6

Gash-Barka

-

-

-

1.2

6.1

2.4

9.7

Maekel

7.3

11.0

4.9

8.5

15.9

4.9

 

SK Bahri

-

-

1.2

-

8.5

-

9.7

Total

7.3

11.0

8.5

       

School organizational indicators show that the overall situation in kindergartens is relatively very low in terms of learning environment. About 23% of the pre-schools work in double shifts and this is regarded as a means of maximizing the utilization of resources in terms of space allocation and cost effectiveness. The overall average class size is 42.6 a little more than the maximum standard set in the pre-school regulation, which is 40. The ratio of a teacher to a child is 1: 39 but this becomes more unbalanced when the ratio of the assistants and workers is considered (64.9 children per assistant unlike the standard 1 for every 40 children). The overall learning environment in most centers is very inadequate with most lacking basic resources and materials used for play. A good social advantage is that 99.3% of the teachers are female and 64% of the workers are female. More than 50% were untrained, and in the last three years a three summer training programme for certifying KG teachers has been going on. So far about 90 have successfully completed the training. It is expected that this would radically change the quality of learning in the future. In general, there seems to be a great necessity to invest more on the quality of ECE and greater monitoring is needed to maximize the outputs of the centers.

There is no data available on how many of children enrolled at the kindergartens are accepted in the primary schools and what advantage that gives in primary education. A survey made on this gives a general indication though no conclusive generalization could be made from the survey (MOE 1999). The survey conducted in about 3% of the elementary schools shows the following results: -

In general, the effect and impact of Early Childhood education on primary schools has to be assessed and clear strategies need to be formulated so as to assure school readiness, enrollment at the right age, lower drop-out and repetition rates and improved health and social behavior.

To improve the quality of the kindergartens a new pre-school programme has been developed and tested in many centers. It has been assessed that the main advantage of the programme is the cultural relevance of the content. A practical organization of the programme in thematic approach has also been introduced. This is based on activities and needs of children which promote creative thinking and participatory approach. A resource center was established at national level to orient teachers and directors to the programme. Mini-resource centers were also established in three regions to facilitate the implementation of the programme and improve the professional capacity of teachers.


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