System for Comprehensive Child

Protection Chile Crece Contigo- ChCC(Chile Grows with You)

June 2012

CONTEXT

Poverty Levels

Data: CASEN 2009

There are 889.247 children under 4 years of

age

There are 889.247 children under 4 years of

age

Evolution of Poverty, Children Under 4 Years of Age

2000 to 2009(percentage)

• Professional care during child birth = 99.8%

• 90% of women use the public health system for prenatal care.

• 79% promptly initiate their pregnancy care (before 20 weeks of pregnancy).

Health Rates : Coverage

Source: CASEN, 2009

(*) The “Other” category includes the: “Other” and “FFAA y del orden” alternatives

(**) The “None” category represents private care.

81,8% of children under four are attended to by

the public health system.

Percentage of Children Younger than Four, according to the Provisional Health System,

2009(percentage)

Health Rates: Infant Mortality

2008 rate: 7,8 x 1.000 live

births

Health Rates: Infant Mortality

Even though we have vanquished malnutrition and death, the full development of children remains a challenge.

Source: Final Report II NATIONAL SURVEY ON THE QUALITY OF LIFE AND HEALTH 2006 Division for Health Planning. Ministry of Health.

Nursery and Kindergarten Attendance, 2000 a 2009 (percentage)

Source: CASEN, respective years

Variation in percentages 2,6% 33,8% 15,3%

18,5% 87,5% 30,7%

Early Childhood Education Rates: Coverage

Nursery Attendance by Income Quintile, 2006 - 2009 (percentage)

Source: CASEN, respective years

3,0

5,94,8

7,8

13,1

6,6

8,3

7,1

9,0

10,5

0

2

4

6

8

10

12

14

I II III IV V

2006 2009

Variation in percentages 120,0% 41,4% 49,6% 14,9% -20,2%

Kindergarten Attendance by Income Quintile

2006 - 2009 (percentage)

Source: CASEN, respective years

Variation in percentages 12,9% 30,2% 4,8% -4,1% 33,4%

24,120,2

29,4 29,3

38,2

27,2 26,331,0

28,0

50,8

0

10

20

30

40

50

60

I II III IV V

2006 2009

Reasons for Lack of Nursery Attendance in Children Younger than Two, 2009 (percentage)

Source: CASEN, 2009

ReasonsAutonomous Income Quintile

I II III IV V

There is no need as they are taken care of at home. 75,7 76,0 75,1 78,7 82,2

No use for them to go at this age 10,8 11,7 12,6 8,8 10,9

Distrust in the care they would receive 3,0 2,6 1,2 3,7 1,3They would get sick too often 1,8 1,5 4,0 1,1 2,0

There is no nursery nearby 2,3 1,1 1,1 0,4 0,5

Other reasons 6,5 7,0 6,0 7,3 3,2

Total 100,0 100,0 100,0 100,0 100,0

The “other reasons” category includes reasons such as “the schedule is not right for me”, “there are no vacancies” “access is difficult”, “economic difficulties, “”the child is disabled”, “a special facility is required” and “the child is not accepted”.

Reasons for Lack of Kindergarten Attendance in Children Between Two and Three Years of Age, 2009 (percentage)

Source: CASEN, 2009

Reasons

Autonomous Income Quintile

I II III IV V

There is no need as they are taken care of at home. 70,5 70,0 68,7 72,9 74,8

No use for them to go at this age 8,8 7,0 13,1 9,0 10,5

Distrust in the care they would receive 2,8 5,3 2,7 3,3 2,6

They would get sick too often 2,3 1,7 2,6 3,2 5,3

There is no nursery nearby 5,3 3,7 1,7 1,1 0,1

Other reasons 10,2 12,2 11,1 10,5 6,8

Total 100,0 100,0 100,0 100,0 100,0

The “other reasons” category includes reasons such as “the schedule is not right for me”, “there are no vacancies” “access is difficult”, “economic difficulties, “”the child is disabled”, “a special facility is required” and “the child is not accepted”.

The origin of Chile Crece Contigo

Presidential Advisory Council for the Reform of Childhood Policies (2006)

Committee of Childhood Ministers

Inter-ministerial Technical Group

Committee of Childhood Ministers

Inter-ministerial Technical Group

Public Policy Proposal

2006

Analysis and activities for the implementation

2006

System for the Comprehensive Childhood

Protection

2007

• Extensive participation Hearings with both national and international experts on the

subject. Regional hearings with organizations and people linked to the

issue. Inputs of thousands of children and adults through the Website.

1

Law 20.379

Institutionalize ChCC

2009

2 3 4

Its design is based on

• Scientific evidence:• Consolidation and universalization of successful services and

experiences (national and international evidence). • Window of opportunities (Large impact of working with early

childhood).• Rate of return (very cost effective investment).

• Broad consensus• Unanimous approval in Congress of Law 20.379 which

institutionalizes the Subsystem for Comprehensive Childhood Protection, Chile Crece Contigo

• In accordance with emerging paradigms • Social health determinants.• Focus on child rights.• Systemic Ecological Focus.

Principles and Basics

Crucial Periods of Development

Strategic Investment

For each dollar invested in Early Childhood the State saves up to eight dollars.

Multidimensionality and Intersectoriality• Childhood development is multidimensional.

• Assistance must be given in a timely manner that pertains to the particular necessities of each child.

• Intersectional policies allow for the accompaniment of people’s lifecycle, strengthening of resources, and a simultaneously impact related factors.

• Chile Crece Contigo allows for the junction of integral services that follow the path of child development during early childhood which strengthens the impact of the actions taken.

Early Stimulation

Adequate

Nutrition

Health and Hygiene

Positive Environment

What is Chile Crece Contigo?

• A programme that allows for the equality of opportunities for childhood development, preventing the structural causes of poverty and supporting social mobility.

• Allows for synergy among institutions : Provides, organises, integrates, and generates early childhood support benefits (from pregnancy until the child is four years old). These are provided by various public services which allows for a follow up of the development path of each child during their early childhood.

• Falls within the framework of the Social Protection System.

How does it work?

Committe of Ministers for Early Childhood

MIDEPLANMINSAL MINEDUC

SEREMISerplac

SEREMIHealth

SEREMIEducation

Health Services

ChCC Managers

GovernmentsJUNJIINTEGRA

Coord.Prov. P.S.

Municipality

Health Education

Enc. RegionalChCC

National Level

Communal Level

Provincial Level

Regional Level

Support Structure

ChCC Communal

Network

Central/National Design with local

expressions.

Inadequate living

conditions

Personalized Accompaniment of development

Bio-psychosocial Development Support Program

Identification of bio-psychosocial risks according to protocol

Health vulnerability

Health

Social vulnerability Municipality

The System is entered after the 1st prenatal check-up, no matter the week of the pregnancy

birth

Any of the child’s contact points must activate the programe in situations of vulnerability (Health, Municipality, Education)

Differentiated Support

Ex: Household Visit Program

Need for daycare

Ej: FPS implementation and derivation from Chile Solidario

Ex: Prioritized access to housing improvement program

EducationLag in

development

Health control

Chile Crece Contigo is a network of integrated services

Chile Crece Contigo communal network

Unit for familial intervention

Public health

network

Public education

system

Stratification Office (FPS)

FAMILY

Other social

services

What does it offer?

All children in Chile(100%)

• Bulk Educational Program with informative and interactive spaces.

• Legislative improvements

• Bio-psychosocial Development Support Program (PADBS)

• Support Program for the New-born (PARN)

Support and Benefits offered by Chile Crece Contigo

Vulnerable children

(74%)Children in the Public Health

System

(81,6%)

• Free and quality nurseries and kindergartens.

• Household visits from health teams. • Family allowance• Comprehensive attention to children

lagging behind• Technical support for children with

disabilities• Preferential access to welfare programs.

Pragmatic and Support Tools

Main Program: Bio-psychosocial Support Program (MDS/MINSAL).

Support Program for the New-born (MDS/MINSAL).

Fund for Childhood Development Support Interventions (MDS/ Municipalities).

Competitive Fund for Childhood Initiatives (MDS/ Public/private implementers).

Fund for Municipal Strengthening (MDS/Municipalities).

Agreements (Fono Infancia, Vulnerability Diagnosis).

Bulk Education Program

System for Registration, Derivation and Monitoring.

Regional Technical Assistance.

PADB: Main ChCC Program (HEALTH)Bio-psychosocial Support Program

Care for Children in Vulnerable

Situations

Strengthening of the Child’s

Overall Development

Attention to the Overall

Development of the Hospitalized

Child

Personalized Care during

Labour

Strengthening Prenatal Development

A B C A B A B A B A

Pregnancy Birth 0 to 4 years of age

PRIMARY CARE PRIMARY CAREHOSPITALS

A. Strengthening of Prenatal Care

B. Development of the Health Plan with a Family Focus

C. Educating the Mother and her Significant Other or Companion

A. Personalized Care during Labour

B. Comprehensive Care during the

Postpartum Period

A. Comprehensive Care for the New-

born Hospitalized in Neontology

B. Comprehensive Care for the New-

born Hospitalized in Pediatrics

A. Strengthening of the Child’s

Health Control for Overall

Development

B. Educational Interventions for Child

Support

A. Strengthening Interventions for

Children in Situations of Vulnerability,

Lagging behind, and Deficient in

Overall Development

Primary objective: Prevent risk situations and promote early childhood health

Personalized Health Plan

Childbirth Preparation Workshops

Humanized Care of the Birth Process

Analgesic Alternatives

Accompanying Support Figure

Ensure Early Attachment

Support for the overall development of hospitalized children.

Toy carts

Toy chests

PARN (Kits)Programa de Apoyo al Recién Nacido (Support Program for the New Born)

Mother’s discharge from the hospital

Workships:

Education for parents and the

family about PARN

Delivery of Set of Materials

Securely Attached Bundle

• Educational booklet• Nursing pillow• Sling-type baby carrier

New-born Care Package

• Massage oil• Liquid soap• Plastic changing table• Regenerating cream• Diapers (20)Package for an Equipped

Pen Cradle• Crib (collapsible) equipped with: Mattress, Blanket, Set of sheets and a Down Quilt.

Baby Clothing Package

• Cotton diapers (3)• Bath towel• Body rompers for up to three months(2)• Rompers for 3 to 6 month old children• Pants for 0-3 month olds (2)• Shirts for 0-3 month olds (2)• One-piece for 0-3 month olds(2)• Two piece for 6 month old (2)• Knit cap for new-borns• Socks for 3 month olds(2)• Diaper bag

DIFFERENTIATED BENEFITS

About Lagging

Lagging: When the child’s development process does not correspond to the standard expected at his or her age.

Approximately 30% of children, exhibit lags or delays in their development before they are four years old.

This amount increases to 45% when it comes to children from more vulnerable sectors.

Scientific evidence indicates that timely detection allows for the speedy recovery of the age appropriate level of development.

Chañaral

Mulchen

Chiloé: roaming service in Buque Cirujano Videla

San Juan de la Costa

Doñihue

Independencia

Chañaral

Chillán

Ludobus - La Florida

Ludoteca Hospital of Valdivia

Ludobus - Rancagua

More than 425 arrangements

functioning in the country

OTHER DIFFERENTIATED BENEFITS

Intended for more socioeconomically vulnerable children (according to the established in law 20.379).

Require the activation of the ChCC Network within a framework of Social Protection work.

Automatic SUF.

Nursery, kindergarten, partial or complete transport for mothers who work, study, are looking for work, or are in a vulnerable situation.

Preferred access to welfare benefits (Levelling of studies, inclusion in the labour force, housing, health and mental care among others.).

Technical support to children with special needs.

Guaranteed access to Chile Solidario when necessary.

Differentiated Benefits

For the 60% of the socioeconomically vulnerable population, as defined by FPS.

Bulk Education Program

The Bulk Education Program is the System for Comprehensive Childhood Protection’s strategy for generating a social environment that is favourable for early childhood care and stimulation through sensitization, promotion, information, and education.

Website www.crececontigo.cl Radial Program “Creciendo Juntos” (Growing Together).Crece Contigo TV and audio-visual support material.Educational pamphlets and booklets. Catalogue of Reproducible Efforts, “When Copying is Good”. Monthly Informative Bulletin, “Growing Together”. Social Networks. Fono Infancia.

2011-2012 Budget Associated with the Unit

Progress

Main CHCC Evaluations

• PADBP’s Quasi-experimental evaluation (non-concurrent cohorts over time), once the base measurement was produced.

• Three sided experimental evaluation of the group workshop for child skills, “No One is Perfect”.

• PADBP’s satisfaction study.

• Satisfaction and PARN usability survey.

• National Survey of Implementation (efficiency conditions for PADBP implementation).

• Qualitative evaluation of the implementation of Bio-psychosocial Support Program

• Quantitative and qualitative evaluacion of Chile Crece Contigo’s communal networks.

Some developments

Consolidation and increase of relevant benefits in order to support childhood development: research of risk factors during pregnancy, household visits, prenatal education and parental skills.

High levels of user satisfaction with Bio-psychosocial Support Program, and Support Program for the New-born (kits), at 81% and 94%, respectively.

Systematic increase in de CHCC budgets (up 8% in 2011), especially in terms or resources or support during pregnancy and the benefit of preschool education.

Some developments

Survey of 340 CHCC communal managers: these results will allow orientation on the use of the Funds for Municipal Strengthening and regional technical assistance teams.

Creation of Indicators of Key Development for 100% of the communes, the object of which is to have indicators that will allow us to identify how the Communal Networks are doing and what support they might need.

Progressive increase in the use of the System for Registration, Derivation, and Monitoring

Some Challenges

Permanent re-installation of work networks. Consolidation of the management model.

The communal teams need more support and need to learn or improve their capacity for work within a network framework.

Quality standards ensured for all the benefits delivered as well as access protocol of the benefits.

Untreated childhood cohorts present a high frequency of lagging and give their primary caregivers parental stress. One third indicates not being able to support the child. Strengthen assistance with families.

LESSONS LEARNED

A single convener address on the transformation of society.

Build on the country’s experience.

National increase in existing interventions.

Creation of new skills in the RRHH.

Elimination of program overlap.

Strengthening and formalization of network jobs on all levels:

• Circulation of information, management and continuous analysis of the information in order to make decisions.

• The mechanics of derivations as pa practice for work.• Formalization of work networks beyond personal will.

Key Concepts of the CHCC Model

Families who are primarily responsible for the upbringing and development of their children: offer more (and better) information to families.

Focus on the quality of the services and benefits provided.

Focus on the personalized accompaniment of each family.

A welcoming and inclusive community that gives special attention to small children.

Multi-professional work teams whose main efforts and focus are on childhood development.

Key Concepts of the CHCC Model

Thank you

The children’s future is always today.

Gabriela Mistral