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Abstract
The early years are critical and inform the developmental trajectory of children. This is justifiably attracting growing policy attention. Much of this attention is focused on interventions and policies directed at parents, especially mothers. Yet emerging evidence suggests that increasing numbers of children in rapidly urbanizing low- and middle-income countries are now spending much of their day with other formal and informal childcare providers, including largely unregulated paid childcare providers. This paper summarizes the limited literature about the use of such paid childcare in low- and middle-income countries in sub-Saharan Africa, before considering possible reasons behind the lack of research evidence. Finally, key research gaps and their implications for public health practice are explored, with reference to the ongoing British Academy funded Nairobi Early Childcare in Slums research programme in Nairobi, Kenya. We argue that improving childcare may be an under-explored strategy to help some of the world's most disadvantaged children in the most important period of their lives, and that interventions in this largely informal market should be built on a rigorous research base.This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.
Highlights
The early years—especially the period leading up to a child’s third birthday— matter profoundly for the rest of that child’s life
Especially in the context of the resource constraints described above, for any intervention strategy to attract attention and funding, research will need to explore the cost-effectiveness of childcare interventions [3]. These analyses should explore not just the short- and long-term benefits to child health, wellbeing, learning and—eventually—earning, and the co-benefits that access to childcare can bring for parents, especially mothers, and for employers and economies, including if and how improving access to childcare in slums can contribute to female economic empowerment [15,26,45,46]
Linked advocacy, we hope that policy makers and funders will better understand and engage with childcare systems in urbanizing sub-Saharan Africa
Summary
The early years—especially the period leading up to a child’s third birthday— matter profoundly for the rest of that child’s life This is increasingly well-appreciated, and early childhood development (ECD) is beginning to attract welcome global health policy attention and funding [1]. It emphasizes the universal fundamentals to what constitutes a strong and healthy start to life: security and safety; good health and nutrition; responsive caregiving; and support for early learning (figure 1) While this recognition of the importance of the early years is welcome, from a practical and policy perspective it is critical to determine what policies, programmes and interventions can best support babies and toddlers and those who care for them. We go on to consider how through better research and engaging with complex, often informal, childcare systems we might be able to develop a promising holistic early childhood intervention platform
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