Nurturing care is the key to a brighter future for South Africa’s children
Just over a month ago, the country was euphoric with victory – having just become Rugby World Cup winners for the third time. Mainstream media were filled with heartwarming stories of how national heroes, Springbok Captain Siya Kolisi and Makazole Mapimpi, the first try scorer for South Africa in a Rugby World Cup final, overcame incredible odds to make rugby history. These were inspirational stories of two men who had succeeded beyond expectation, despite facing numerous structural and personal challenges starting very early in their lives.
When we reflect about these two stories, a few things stand out. Firstly, that your future is not predetermined by the circumstances that you are born into. Second, that there are certain key ingredients, usually involving safe proximal caregiving environments (such as home and school) and significant people (adults) in your life who care about your health and well-being and that help and support you on the path to success.
Lastly, that it should not only be exceptional individuals who break the mould of poverty and go onto succeed in life. This should be the attainable reality of all children in South Africa, including the 60% who live in income poverty.
South Africa has committed to creating this future for all children through our National Development Plan 2030 and the commitment to achieving the 17 Sustainable Development Goals (SDGs). Further, our 2015 National Integrated Early Childhood Development (ECD) Policy recognises the importance of investing in early childhood.
This investment is required to uphold children’s right to survive and thrive and to optimise their human potential; and, at a population-level, it is required to boost economic growth and reduce poverty and inequality.
The key to optimising developmental potential is to start early. The period from conception to age 2-3 is a critical time for brain and physical growth, for better or for worse. The ECD Policy assigns responsibility for the provision of a comprehensive package of ECD services during this period to the National Department of Health. This has led to the start of a fundamental paradigm shift from the historical focus on vertical, child survival-focused services to a more comprehensive approach to providing integrated services that promote survival as well as nurturing care of young children through the health system.
Nurturing care embodies the provisions outlined in the ECD Policy and comprises five essential elements, i.e. health, nutrition, early learning, safety and security and responsive caregiving. These should be provided to all children, particularly in the earliest years, with a recognition that there are children and families who require additional, targeted support and care in order to survive and thrive.
The first step in this process, was the redesign of the South African Road to Health Booklet (RtHB), which is given to every child at birth and is at the centre of the national under-5 child health campaign, known as the Side-by-Side campaign. Child health consultations (in facilities and households) should be structured around the five pillars (as reflected in the RtHB) and health workers are expected to address each of these pillars at every contact. Ongoing efforts, over the forthcoming years, will ensure that the RtHB and Side-by-Side campaign provide a platform for
implementing nurturing care, and for expanding and strengthening the package of services provided to young children through the health system.
Despite these strides, there is still much we need to do. Most of the work to date, has focused on strengthening nurturing care through child health services. However, there is much that can be done before and during pregnancy to ensure a strong foundation for child and parental health and well-being.
South Africa has adopted the World Health Organization recommendations of eight antenatal care visits and one routine early ultrasound scan for all pregnant women. These provide well-timed opportunities to feasibly and cost-effectively integrate nurturing care interventions into existing
health platforms early in the life course.
We have to ensure that all children have equal opportunities to attain their developmental potential. We live in a society where poverty, inequity, violence and a multitude of other social and economic stressors place our children at risk of not attaining their full potential. Without adequate
care and support, and intervention for those who need it, there will be significant short-term, long-term and intergenerational impacts on health, education and adult earnings.
Children with disabilities or long-term health conditions require supportive, responsive, family-centred services that are tailored to their individual needs. A system of care that is provided at home and in facilities or environments closest to home are essential, with equitable availability and access to quality routine and specialist care and support. All children have the right to opportunities to achieve in life and our approaches to promoting this must be inclusive.
Despite the many challenges, this is a time of hope for South African children. There is strong political will and national commitment to work towards a society where all children are cared for in safe, secure environments with caring, responsive adults who support them to be healthy, grow and develop and allow them to optimise learning opportunities from birth. This will prepare them for a future where they can maximise their health, educational and economic potential.
It may even help us to discover more rugby (and other) champions in our impoverished communities - but without the added pressure of having to be extraordinary on all fronts to succeed. And it all starts with nurturing care...
* Wiedaad Slemming and Lesley Bamford are contributors to the South African Child Gauge 2019 which is published by the Children’s Institute, University of Cape Town. For more information see: http://www.ci.uct.ac.za/cg-2019-child-and-adolescent-health
** The views expressed here are not necessarily those of Independent Media.