South Africa’s youngest children are exposed to significant variation in the delivery of critical services, including health care and social security, based on where in the country they reside.
These variations can have lifelong consequences on their health, learning ability, and earning potential.
This is according to the South African Early Childhood Review 2017, an annual measure of progress in early childhood development (ECD) service delivery.
The 2017 review reveals stark inequalities across the country and within provinces. Children aged 6 years and younger, who live in the rural districts, are receiving disproportionately poorer services.
Almost half of SA’s children under six are rural
“This is serious when you consider that 43% of our young children are living in rural areas,” says Colin Almeleh, executive director of Ilifa Labantwana and co-author of the South African Early Childhood Review 2017.
The provinces with the highest share of rural children under 6 are the Eastern Cape, 60%; Limpopo, 83%; KwaZulu-Natal, 61%, and Mpumalanga, 65%.
The 2017 review found that young children in rural areas live far from clinics and are, therefore, less likely to be fully immunised or screened for developmental delays.
Rural children are less likely to receive micro-nutrient supplementation if they are malnourished. They are also far less likely to be exposed to an early learning programme and therefore start school on a back foot.
Early childhood: a once-in-a-lifetime opportunity
“Early childhood is a very sensitive period of development, with the brain and body growing very quickly. The development that takes place at this time will affect all future health, behaviour, and learning,” says Almeleh.
“Children require certain essential services during this time to develop. If they don’t receive them, it is very difficult to help them catch up later,” he said.
“We know that two thirds of South Africa’s young children are living in poverty and their development may be compromised if they don’t receive quality early childhood services. Plans to deliver these services should differentiate between the needs of rural and urban populations.”
Improvement in health care, but provincial averages mask district inequalities
Health care is a service area showing improvement. The review finds that 61% of women are now accessing antenatal care before the 20th week of pregnancy, versus just 31% in 2005. Similarly, 89% of children are now fully immunised before their first birthday.
“These provincial and national averages can mask vast differences between districts,” says Almeleh. For example, 85% of babies in South Africa are delivered in health facilities under trained personnel - an increase from 66% in 2001, which is encouraging.
However, there are districts where the in-facility delivery rate is as low as 45%, which calls for a targeted service delivery response.
Children are not getting sufficient nutrition
The review reports 77% of children aged 6-23 are not fed a minimum acceptable diet, thus compromising their growth and increasing their risk of infections.
It also reports that over a fifth of children under 5 are stunted - a result of chronic malnutrition which has lifelong adverse consequences on health, learning and participation in the economy.
Under-nutrition is also evident in increasing obesity and overweight rates among children under five (13% are overweight nationally), which increases their risk of heart disease and diabetes into adulthood.
Vitamin A supplementation is a widespread nutritional intervention but coverage rates reveal striking variation across districts.
Nationally, over 57% of children aged 12-59 months received vitamin A supplementation. However, in some districts this number is lower than 40%, while in others it is over 90%.
Early learning characterised by widespread inequality
“Young children need quality early learning programmes from the time they turn 3. Without it, they are not prepared for school,” says Sonja Giese, executive director of Innovation Edge and co-author of the report.
“Our poorest children aren’t accessing quality early learning. This is consistent across all provinces.
A 4-year-old from a low-income household has only a 50% chance of being enrolled in an early learning programme, compared to a wealthier child who has a 90% chance. As a result, South Africa’s poorest children are starting school on the back foot,” said Giese.
The 2017 review analysed recent data from South Africa’s first population level preschool assessment tool, Early Learning Outcomes Measure, and found that children in the bottom income quintiles performed considerably worse than wealthier children, across all developmental areas - but, especially, in emergent literacy and language, as well as cognitive and executive functioning.
Persistent gaps in child support grant access
Urban districts under-perform their rural counterparts in the roll-out of the child support grant, which is available to children whose caregivers have a monthly income of less than R3 800 if they are unmarried.
“Early access to the child support grant is associated with improved nutritional, health and education outcomes for children,” says Katharine Hall, senior researcher at the Children’s Institute and co-author of the review.
“That means children should start receiving the grant from as early as possible. But only two-thirds of babies under a year receive the grant, and the share is even lower in the urban provinces.”
Only 55% of poor infants in the Western Cape are receiving the grant, and an even lower 49% in Gauteng.
“This is of great concern because it is the most needy and vulnerable children who are excluded.”
She said the government will need to find a way to resolve a few million exclusions if it is to meet its goal of covering 95% of people eligible for social security benefits by 2019, as set out in the Medium Term Strategic Framework.
Translating the national ECD policy into practice: still much work to do
Multiple government departments are responsible for service delivery for ECD - the three key departments being Health, Social Development and Basic Education.
They are guided by the National Integrated Early Childhood Development Policy, which was approved by the cabinet in December 2015.
“This year, we have seen the development of a draft national implementation plan and some provinces working on ECD strategies aligned to the policy,” says Lizette Berry, one of the co-authors of the SA Early Childhood Review 2017.
“This is encouraging, but to reach the policy’s goal of providing all children with essential services much more work needs to be done. The plan still needs to be circulated among civil society stakeholders.
“We will also need to see amendments to the existing legislation, new leadership structures, accountability mechanisms, and sufficient budget being allocated to ECD services,” Berry said.
Doneva is the Communications Manager for Ilifa Labantwana