Priority-setting in the roll out of South Africa’s National Integrated ECD Policy

Abstract

ABSTRACTThe South African National Integrated Early Childhood Development Policy was approved by the South African Cabinet in 2015. Given capacity and financial constraints, all services outlined cannot be implemented in a single step. Priorities must be set. We examine the budget implications (total cost and cost per child) and benefits of the four largest components of the Policy: interventions to improve pregnancy outcomes; home visits for at-risk mothers of children under 2 years of age; community-based playgroups for mothers and children, and center-based early childhood development services. Further, we identify which services are based on the strongest evidence, the value-based trade-offs that characterise the prioritising decisions, and which logistical factors favour alternative orderings of services. The interventions to improve pregnancy outcomes are low cost, based on sound evidence and would make use of the established healthcare infrastructure. Home visits for at-risk mothers are associated with improved development for targeted children and consequential benefits for caregivers and broader society. Playgroups are a promising low-cost intervention, but further evidence is required to determine their effectiveness. Centre-based services are expensive and generate smaller developmental returns, but provide childcare. The results highlight the value judgements required to determine the appropriate sequencing of interventions.