SABER EARLY CHILDHOOD DEVELOPMENT Tuvalu Country...

Tuvalu

EARLY CHILDHOOD DEVELOPMENT SABER Country Report 2014

Policy Goals Status1. Establishing an Enabling Environment

Laws are in place to promote effective early childhood development (ECD) in the health sector, and some policies are in place in the education sector for effective early childhood care and education (ECCE) programs. Several draft laws show promise in their ability to lay solid ground for a well-functioning ECD system but need to be enacted to ensure optimal ECD service delivery. The ECD system would benefit from a multi-sectoral approach to service delivery and transparent, multi-sectoral financing.

2. Implementing WidelyTuvalu provides wide coverage of many essential ECD health services and has reached high rates of preschool enrollment. More than 96 percent of children are immunized, and 98 percent of women give birth in the presence of a qualified attendant. However, more data is needed to capture the scope and coverage of several important ECD interventions. Equity in delivery is high where programs exist. Disparities between rich and poor and urban and rural are mainly found in the registration of newborns.

3. Monitoring and Assuring QualityMore data on relevant ECD indicators is needed to obtain a more comprehensive picture of Tuvalu’s ECD programs across sectors. While some quality standards have been established, they are not always enforced. Mechanisms to coordinate monitoring and quality across sectors and to implement a multi-sectoral budget need to be put into place.

TUVALU EARLY CHILDHOOD DEVELOPMENT SABER COUNTRY REPORT |2014

SYSTEMS APPROACH FOR BETTER EDUCATION RESULTS 2

Table 1: Snapshot of ECD indicators in Tuvalu with regional comparison

Tuvalu Fiji SolomonIslands Tonga Vanuatu

Infant Mortality (deaths per 1,000 live births, 2012) 25 19 26 11 15

Under 5 Mortality (deaths per 1,000 live births, 2012) 30 22 31 13 18

Moderate & Severe Stunting (Below 5, 2012) 10% Unavailable 32% Unavailable 26%

Gross Preprimary Enrollment Ratio (3 6 years) 105%5

(as of 2006)18%

(as of 2009)43%

(as of 2012)35%

(as of 2012)61%

(as of 2010)

Birth registration 2000 2010 50% Unavailable 80% 98% 26%

Source: UNICEF Country Statistics, 2012 (Infant mortality, under 5 mortality, stunting, birth registration); UNESCO Institute for Statistics (preprimary enrollment).

1 SABER ECD is one domain within the World Bank initiative, Systems Approach for Better Education Results (SABER), which is designed to provide comparable andcomprehensive assessments of country policies.2 Pacific Regional MGD Tracking Report (2012), p. 9.3 United Nations Development Program.4 CIA Factbook.5 Latest Statistical Digest for Tuvalu indicates a pre primary net enrollment rate of 82%

This report presents an analysis of early childhooddevelopment (ECD) programs and policies that affectyoung children in Tuvalu and recommendations tomove forward. This report is part of a series of reportsprepared by the World Bank using the SABER ECDframework1 and includes analysis of early learning,health, nutrition, and social and child protectionpolicies and interventions in Tuvalu, along withregional and international comparisons.

Tuvalu and Early Childhood Development

Tuvalu is an island nation in the South Pacific Oceanmade up of three reefs and six atolls. Formerly knownas the Ellice Islands, Tuvalu was granted independencein 1978, three years after splitting with the Britishcolony of Kiribati, then known as the Gilbert Islands.The majority of people (96 percent) are ethnicallyPolynesian, and a small minority is Micronesian (4percent). With a population of just under 11,000,Tuvalu is the third least populated state in the worldand, at just 10 square miles, the fourth smallest.Because of its small size and low population, Tuvaluhas only one hospital, eight prenatal clinics, and 18early childhood care and education (ECCE) centers.

About 50 percent of the inhabitants live in urban areas.The GDP is $3,500 per capital and 26 percent of thepopulation lives below the poverty line in terms of basicneeds.2 Life expectancy at birth is 67.5 years.3 Healthcareis free for all citizens, but health expenditures are high asa percentage of GDP: Tuvalu ranks fourth in the worldfor healthcare costs, behind only Liberia, Sierra Leone,and the U.S.4

The Tuvalu National Preschool Council coordinatespreschool education across the country’s 18 ECCEcenters. The Early Childhood Care and Education Policy(2007) guides the education component of ECD.Published by the Education Department’s Ministry ofEducation and Sports (MoES), the ECCE policy providesstrategies and guidelines and sets a loose curriculum.The Ministry of Health (MoH) implements the health andnutrition components of ECD. There is no regulatoryframework governing multi sectoral ECD strategy, andmechanisms for coordinating financing for ECD acrossministries still need to be put into place.

Table 1 gives a snapshot of key ECD indicators in Tuvalucompared to four other countries in the South Pacificregion.



Systems Approach for Better EducationResults – Early Childhood Development(SABER ECD)SABER–ECD collects, analyzes, and disseminatescomprehensive information on ECD policies around theworld. In each participating country, extensivemultisectoral information is collected on ECD policiesand programs through a desk review of availablegovernment documents, data, and literature, andinterviews with a range of ECD stakeholders, includinggovernment officials, service providers, civil society, anddevelopment partners. The SABER ECD frameworkpresents a holistic and integrated assessment of howthe overall policy environment in a country affectsyoung children’s development. This assessment can beused to identify how countries address the same policychallenges related to ECD, with the ultimate goal ofdesigning effective policies for young children and theirfamilies.

Box 1 presents an abbreviated list of interventions andpolicies that the SABER ECD approach looks for incountries when assessing the level of ECD policydevelopment. This list is not exhaustive, but is meant toprovide an initial checklist for countries to consider thekey policies and interventions needed across sectors.

SABER ECD identifies three core policy goals thatcountries should address to ensure optimal ECDoutcomes: Establishing an Enabling Environment,Implementing Widely, and Monitoring and AssuringQuality. Improving ECD requires an integrated approachto address all three goals. As described in Figure 1, foreach policy goal, a series of policy levers are identified,through which decision makers can strengthen ECD.Strengthening ECD policies can be viewed as acontinuum; as described in Table 2 on the followingpage, countries can range from a latent to advancedlevel of development within the different policy leversand goals.

Box 1: A checklist to consider how well ECD ispromoted at the country levelWhat should be in place at the country level to promotecoordinated and integrated ECD interventions for young

children and their families?Health careStandard health screenings for pregnant womenSkilled attendants at deliveryChildhood immunizationsWell child visits

NutritionBreastfeeding promotionSalt iodizationIron fortification

Early LearningParenting programs (during pregnancy, after delivery, andthroughout early childhood)High quality child care for working parentsFree pre primary school (preferably at least two yearswith developmentally appropriate curriculum andclassrooms, and quality assurance mechanisms)

Social ProtectionServices for orphans and vulnerable childrenPolicies to protect rights of children with special needsand promote their participation / access to ECD servicesFinancial transfer mechanisms or income supports toreach the most vulnerable families (could include cashtransfers, social welfare, etc.)

Child ProtectionMandated birth registrationJob protection and breastfeeding breaks for new mothersSpecific provisions in judicial system for young childrenGuaranteed paid parental leave of least six monthsDomestic violence laws and enforcementTracking of child abuse (especially for young children)Training for law enforcement officers in regards to theparticular needs of young children

Figure 1: Three core ECD policy goals



Table 2: ECD policy goals and levels of development

ECD PolicyGoal

Level of Development

Establishingan EnablingEnvironment

Non existent legalframework; ad hocfinancing; low intersectoral coordination.

Minimal legal framework;some programs withsustained financing;some inter sectoralcoordination.

Regulations in somesectors; functioning intersectoral coordination;sustained financing.

Developed legalframework; robust interinstitutionalcoordination; sustainedfinancing.

ImplementingWidely

Low coverage; pilotprograms in somesectors; high inequality inaccess and outcomes.

Coverage expanding butgaps remain; programsestablished in a fewsectors; inequality inaccess and outcomes.

Near universal coveragein some sectors;established programs inmost sectors; lowinequality in access.

Universal coverage;comprehensive strategiesacross sectors; integratedservices for all, sometailored and targeted.

Monitoringand Assuring

Quality

Minimal survey dataavailable; limitedstandards for provision ofECD services; noenforcement.

Information on outcomesat national level;standards for servicesexist in some sectors; nosystem to monitorcompliance.

Information on outcomesat national, regional, andlocal levels; standards forservices exist for mostsectors; system in placeto regularly monitorcompliance.

Information on outcomesfrom national toindividual levels;standards exist for allsectors; system in placeto regularly monitor andenforce compliance.



Policy Goal 1: Establishing an EnablingEnvironment

Policy Levers: Legal Framework •Intersectoral Coordination • Finance

An Enabling Environment is the foundation for thedesign and implementation of effective ECD policies.6

An enabling environment consists of the following: theexistence of an adequate legal and regulatoryframework to support ECD, coordination within sectorsand across institutions to deliver services effectively, andsufficient fiscal resources with transparent and efficientallocation mechanisms.

Policy Lever 1.1:Legal FrameworkThe legal framework comprises all of the laws andregulations that can affect the development of youngchildren in a country. The laws and regulations that impactECD are diverse due to the array of sectors that influenceECD and the different constituencies that ECD policy canand should target, including pregnant women, youngchildren, parents, and caregivers.

National laws and regulations promote healthcare forwomen and young children. The Tuvalu Health Act(2010) provides free healthcare for all citizens of Tuvalu.As such, women receive free prenatal visits and a skilledattendant is present for 98 percent of deliveries.Women who live on the outer islands are referred toPrincess Margaret Hospital (PMH) on the main island forcare during their first pregnancy because no doctors—only nurses–are available in prenatal clinics on theouter islands. Women with complications duringpregnancy also receive care at PMH. Voluntary testingfor sexually transmitted diseases (STDs) and HIV areavailable to pregnant women, though no cases of HIVwere found among pregnant women in 2010 2011reporting period.7 At that time, a Prevention of Motherto Child Transmission policy was being drafted. 8

Newborns and young children are immunized accordingto an expanded national immunization schedule andnurses on each island monitor the well child visits oftheir patients to ensure that visits are timely.

National laws are not yet in place to promote keyrecommended dietary guidelines for pregnant women

6 Brinkerhoff, 2009; Britto, Yoshikawa & Boller, 2011; Vargas Baron, 2005.7 UNAIDS (2012).8 UNAIDS (2012).

and children. The government of Tuvalu is deliberatingtwo draft policies—one that would encouragebreastfeeding and one that would set regulations forsalt iodization and iron fortification of cereals andstaples. Laws do not yet specifically comply with theInternational Code of Marketing of Breast MilkSubstitutes. However, the National Policy onBreastfeeding and Infant Feeding (1996) promotesexclusive breastfeeding from birth to 4 6 months athospitals, clinics, and on the radio. A survey found that85 percent of mothers breastfeed their infants for sixmonths, and that 35 percent breastfeed exclusively; 57percent breastfeed exclusively for the first threemonths.9

Low birth weight is not considered a problem in Tuvalu,and a 1991 study found that Vitamin A deficiency is nota significant public health concern in the country.Rather, there are concerns about over nutrition forinfants and childhood obesity.10

Government policies mandate protections forpregnant women and new mothers. The TuvaluRevised Employment Act (2008) mandates maternityleave for mothers six weeks before and six weeks aftergiving birth; mothers are also entitled to two half hourbreastfeeding breaks a day. The law requires employersto pay a woman on maternity leave not less than 25percent of her pay; and her employment is guaranteedwhile she is on leave up to 12 weeks.11 Table 3 presentsa comparison of maternity and paternity leave policiesin Tuvalu and four other Pacific Islands.

National laws do not mandate free pre primary school,but do provide free ECD health care services.Preschools are not free, and parents must pay schooltuition and fees for items such as school uniforms. TheTuvalu National Pre School Council coordinatespreschool education, 12 and parents and the localcommunity manage the schools. ECCE has not yet beenformally incorporated into the MoES, but in 2007, theministry issued an ECCE policy and a teacher salarypolicy that laid out general guidelines and staffing rules.The Tuvalu Education Strategic Plan 2011 2015 lays outan ECCE strategy to ensure greater access to ECCEservices for 3 to 5 year olds, promote a more activerole by the Pre School Council, and improve quality andtimeliness of ECCE data collection. Though the

9 Tuvalu Convention on the Rights of the Child, 2011.10 Tuvalu Convention on the Rights of the Child, 2011.11 Tuvalu Employment Act, revised (2008).12 UNICEF, Achieving Education for All in Tuvalu, p. 7.



preschools are non profit, the government offers grantsto help pay preschool teachers’ salaries and contributesto the construction of preschool buildings. Thegovernment also provides resources, curriculum advice,and preschool teacher training.13 All ECD health careservices are free.

Policies to protect children have not been fullyestablished. The judiciary and Ministry of Home Affairsand Rural Development support child victims ofexploitation and abuse, but this could be strengthenedto better protect children.14 There is no specializedtraining for judges or lawyers in cases involving therights of children, and no specialized courts. Only lawenforcement officers are trained to respond to childrenin need of protection. A draft Family Protection bill isunder consideration that would mandate home visits bysocial workers, train health workers to identify abuseand neglect, and create a taskforce on domesticviolence prevention. The registration of newborns ismandated by the Births, Deaths and MarriagesRegistration Ordinance, which states that every childborn in Tuvalu should be registered within 10 days ofbirth. However, between 2005 and 2012, only half of allnewborns were registered.15

Table 3: Comparison of maternity and paternity leave policies inPacific Islands

Tuvalu Fiji SolomonIslands Tonga Vanuatu

Pregnantwomenreceive notless than25% of paywhile onmaternityleave, whichincludes 6weeksbefore and 6weeks aftergiving birth

Allworkers:12 weeksat 17% ofwage,547 daysunpaid;paid byemployer

Allworkers:12 weeksatminimum25% ofwage;paid byemployer

Noparentalleaveguaranteed for allworkers;12 weeksat 100%wage forgovernment workersonly, paidby government

All workers:14 weeks atminimum66% ofwage; paidbyemployer(newlegislationwillregulateacrossemployers)

Source: ILO (2012); Tuvalu Employment Act, revised (2008).

Tuvalu relies on cultural traditions to protect orphans,and vulnerable children and has social protectionpolicies for children with special needs. Tuvalu relies

13 Tuvalu CRC Report, April 2011.14 Tuvalu Convention on the Rights of the Child, 2011.15 UNICEF, Multiple Indicator Cluster Survey.

on customary practices whereby extended familymembers provide support and care for the orphans andvulnerable children in their clans. As such, there is noformal policy to safeguard their wellbeing. The TuvaluEducation Strategic Plan: 2011 2015 states that childrenwith special needs should have equal access to “anexpanding, inclusive, safe, and quality education andcare system” and has developed an inclusive educationpolicy that enables teachers to identify and supportstudents with special needs, provide an enablinglearning environment, and incorporate a regionalstrategy on disability. A special school for children withsevere disabilities has been established.

Box 2: Laws and Regulations

Policy Lever 1.2:Intersectoral CoordinationDevelopment in early childhood is a multi dimensionalprocess.16 In order to meet children’s diverse needsduring the early years, government coordination isessential, both horizontally across different sectors aswell as vertically from the local to national levels. Inmany countries, non state actors (either domestic orinternational) participate in ECD service delivery; for thisreason, mechanisms to coordinate with non state actorsare also essential.

Tuvalu has not yet developed a multi sectoral ECDstrategy. While there is recognition of the importanceof a multi sectoral approach to ECD to ensure the bestoutcomes for child development, no explicit strategyhas yet been endorsed by the government. The 1978Education Act does not require MoES or any otherministry to create or implement an ECD policy and the

16 Naudeau et al., 2011; UNESCO OREALC, 2004; Neuman, 2007.

Tuvalu Health Act (2010)Education Law (1978)Draft Policy on Breastfeeding and Infant FeedingTuvalu Employment Act, revised (2008)Birth, Deaths and Marriage Registration Ordinance(1968)Ministry of Education and Sports’ ECCE Policy(2007)Ministry of Education and Sports’ ECCE TeacherSalary Policy (2007)Ministry of Health Strategic Plan (2009 2019)Tuvalu Education Strategic Plan (2011 2015)



act does not formally incorporate ECCE into theEducation Act. However, the ministry issued an ECCEPolicy in 2007 and is reviewing the Education Act withthe aim of incorporating ECCE policy into the law. In themeantime, the ministry is responsible for implementingthe education components of ECD services only, and inspecial situations may coordinate ECD services acrosssectors or departments. For instance, the ministry mightcoordinate visits to ECCE centers by officials from thehealth or social welfare departments or by interesteddonor organizations.

The government has yet to take steps to establish anational cross sectoral ECD institutional anchor thatwould be responsible for coordinating ECD policy andimplementation between sectors and departments.Local governments in each island implement ECCEpolicy and are empowered to address gaps in ECDdelivery. The health and education sectors haveseparate ECD programs and schedules ofimplementation.

There is little coordination of interventions at thepoint of service delivery. ECCE providers in theeducation sector meet infrequently. Those in the capitalcity meet semi annually; ECCE officers visit providers onthe outer islands once a year. There are no manuals orguidelines for integrated service delivery of ECD. TheMoH implements separate ECD programs and visitsprenatal clinics separately.

State and non state actors coordinate ECD provision,particularly on the capital island, Funafuti. Non stateactors have a strong voice in ECD service provision. Theyhave a guaranteed seat on the Tuvalu National PreSchool Council that is responsible for the educationcomponents of the ECD. Annual coordination meetingsare convened and feedback is welcomed on hotlinesand radio programs designed to encourage non stateactors to participate in implementing ECD policy. ECCEproviders located in Funafuti meet once each term. Dueto far distances between the outer islands, the ECCEofficials of the MoES have limited capacity to coordinateacross all islands. ECCE officials have only one officialvisit a year for meeting ECCE providers located onremote islands.

Policy Lever 1.3:FinanceWhile legal frameworks and intersectoral coordinationare crucial to establishing an enabling environment for

ECD, adequate financial investment is key to ensure thatresources are available to implement policies andachieve service provision goals. Investments in ECD canyield high public returns, but are often undersuppliedwithout government support. Investments during theearly years can yield greater returns than equivalentinvestments made later in a child’s life cycle and canlead to long lasting intergenerational benefits.17 Notonly do investments in ECD generate high and persistentreturns, they can also enhance the effectiveness of othersocial investments and help governments addressmultiple priorities with single investments.

There is a limited transparent budget process. Criteriato develop a budget for ECD are available only in theeducation sector, which gathers data on a limitednumber of indicators to determine the amount of thebudget it devotes to ECD. Health, nutrition, and childand social protection sectors do not offer explicitcriteria at the national or sub national level to decideECD spending. However, the MoH’s Strategic HealthPlan 2009 2019 includes plans for the National HealthAccount, which provides data on health indicators, tolink health outcomes to the budget. Though the plandoes not mention ECD data specifically, this element ofthe strategic health plan could help the governmentdetermine how best to allocate health resources toECD.

There is no coordinated effort to determine ECDbudget allocation across ministries and due to limitedbudget reporting, the level of ECD financing acrosssectors is largely unknown. Strong evidence suggeststhat investing early in children will bring high returns tosociety in the future. The government falls short inensuring that adequate expenditures are allocatedtowards young children. There is no data on thepercentage of the MoH budget spent on routine EPIvaccines, and other ministries involved in ECD servicesdo not provide budget breakdowns of ECDexpenditures. The MoES is the only ministry withbudget data available on ECD services. In 2012, theMoES reported an annual recurrent ECCE budget of$115,332, representing only 2 percent of its overalleducation budget. See Table 4 for a snapshot of the ECDbudget across sectors in Tuvalu for 2011 and 2012.

Without adequate funding from the educationministry, communities and parents of young childrenbear much of the burden of financing ECCE services. In

17 Valerio & Garcia, 2012; WHO, 2005; Hanushek & Kimko, 2000; Hanushek &Luque, 2003.



Tuvalu, pre primary education is not free and, asmentioned above, parents are responsible for payingtuition and fees. The ministry’s education budget offersgrants to pay for some ECCE costs, such as teachers’salaries and construction of schools, but ECCEmanagement committees or private providers areresponsible for staff salaries, which are based on ateacher’s level of education.18 Island Councils pay thesalaries for unqualified workers. Teachers entering thepre primary school field receive less than 50 percent ofthe salary of a primary school teacher.

The burden of finance for healthcare is equitablydistributed across society. Health care is free to allcitizens in Tuvalu, so there are no fees levied at thepoint of delivery for services such as prenatal care,labor and delivery, or child immunizations. Tuvalu hasone of the world’s highest health care expenditures as apercentage of GDP (17.3 percent). The Strategic HealthPlan 2009 2019 includes plans to review the costeffectiveness of the Tuvalu Medical Treatment Schemeto ensure more appropriate medical referrals. Table 4displays a regional comparison of select healthexpenditure indicators.

Table 4: Regional comparison of select health expenditureindicators

Tuvalu Samoa SolomonIslands Tonga Vanuatu

Out of pocket expenditureas a percentage of privatehealth expenditures, 2011

100% 63% 57% 68% 57%

Government expenditure onhealth as a percentageofGDP,2011

17% 5.7% 8.0% 4.1% 4.8%

Routine EPI vaccinesfinanced by government,2010

Notavailable 100% 45% 90% N/A

Source: WHO Global Health Expenditure Database, 2011; UNICEF Country Statistics,2010.

Policy Options to Strengthen the EnablingEnvironment for ECD in Tuvalu

The government has taken important steps tointegrate pre primary school into the MoES portfolioand is encouraged to continue moving forward withthe ECCE strategy within the Tuvalu EducationStrategic Plan. Given that ECCE has not yet beenformally incorporated into the MoES, the legal

18 ECCE Policy (2007); ECCE Staffing Policy.

framework for ECCE still remains relatively weak.Updating Tuvalu education policy to include ECDaged children may lead to more accountability of theMoES in applying the ECCE policy in practice.

Additionally, passing the draft laws underconsideration in these sectors is an essentialcomponent of developing a comprehensive andeffective ECD program. These include the draftBreastfeeding Policy, the draft Food Safetyregulation, and the Family Protection bill. Given thatonly 50 percent of births are registered in Tuvalu, thegovernment should also consider devising methodsto encourage compliance with the ordinancerequiring the registration of newborns.

Tuvalu has made strides in recent years towardincorporating ECCE policy into the general educationportfolio and has developed strong coordinationbetween state and non state actors in the delivery ofECD services. In that same spirit of cooperation, thegovernment could benefit from the creation of aninstitutional anchor designated to coordinate ECDpolicy and service delivery across sectors, includingeducation, health, nutrition, and child and socialprotection. Such coordination would be beneficial atthe national policy level as well as the local point ofservice delivery level. The focus of the present reportis primarily in the early childhood development andeducation subsector, and thus, emphasis is placedprimarily on strengthening coordination within theeducation sector. In practice, coordination amongconcerned ministries is the most challenging one.

Creating an intersectoral framework couldimprove coordination of services and help to fill ingaps in service delivery that currently exist. Such acollaborative process would ensure that childrenreceive the highest level of care and attention in allsectors that contribute to ECD. Box 3 displays anexample from Jamaica, where a highly synergeticapproach to effective intersectoral coordination hascreated an ECD system where the holistic needs ofchildren are met.



Box 3: Relevant lessons from Jamaica: multisectoralinstitutional arrangements for ECD

To improve the efficiency of public spending onyoung children, the government could better track,report, and coordinate budgets across ECD sectors.The government may consider creating effectivemechanisms to capture data for ECD aged childrenacross sectors to better allocate resources and to

implement a process that monitors effective budgetcoordination between ECD sectors. To efficientlyprovide comprehensive ECD services to the childrenof Tuvalu, the health and education sectors shouldbetter coordinate budgets and develop amethodology for quantifying ECD investments. Ifeach ministry reports disaggregated spending byECD age group, the government could bettercapture and monitor ECD services across sectorsand identify the most cost effective interventions.In developing a comprehensive methodology, itwould also be useful to work closely with non stateECD stakeholders to capture the full spectrum ofECD investment. Given that the non state sector isvery involved in provision of ECD services, havingdetailed information to evaluate the costeffectiveness of interventions will allowpolicymakers to shift financial allocation tointerventions with the greatest return oninvestment.19

Additionally, given that the government faces alimited budget, it should consider developingalternative sources of funding to ensure that thelevel of finance for ECD services is adequate to meetthe needs of its population. Tuvalu may considerleveraging more private funding from foundations,community groups, or private enterprises. Publicprivate partnerships with matching funds for capitalinvestment initiatives may also be an effective wayto expand ECD services.

Policy Goal 2: Implementing WidelyPolicy Levers: Scope of Programs •

Coverage • EquityImplementing Widely refers to the scope of ECDprograms available, the extent of coverage (as a shareof the eligible population), and the degree of equitywithin ECD service provision. By definition, a focus onECD involves (at a minimum) interventions in health,nutrition, education, and social and child protection, andshould target pregnant women, young children, andtheir parents and caregivers. A robust ECD policy shouldinclude programs in all essential sectors, providingcomparable coverage and equitable access acrossregions and socioeconomic status – especially reachingthe most disadvantaged young children and theirfamilies.

19 UNICEF is in the process of conducting a cost and financing study. Thestudy will help the government consider how to best institutionalize ECD andexplore financing options for ECE that may be supported by the MoES.

Summary: In 2003, the Government of Jamaica establishedthe Early Childhood Commission (ECC) as an official agencyto govern the administration of ECD in Jamaica (EarlyChildhood Commission Act). Operating under the Ministry ofEducation (MoE), the ECC is responsible for advising theMoE on ECD policy matters. It assists in the preparation aswell as monitoring and evaluation of ECD plans andprograms, acts as a coordinating agency to streamline ECDactivities, manages the national ECD budget, and supervisesand regulates early childhood institutions (ECIs). The ECCincludes a governance arm comprised of the officiallyappointed Executive Director, a Board of Commissioners,and seven sub committees representing governmental andnon governmental organizations. It also has an operationalarm that provides support to the board and subcommittees.The ECC is designed with representation from all relevantsectors, including education, health, local government andcommunity development, labor, finance, protection, andplanning. Each ministry or government agency nominates arepresentative to serve on the Board of Commissioners. Theseven sub committees, which provide technical support tothe ECC board, are comprised of 50 governmental and nongovernmental agencies.

Furthermore, the newly established National ParentingSupport Commission creates links between Jamaicanparents and the government of Jamaica. In 2012, the MoEintroduced the National Parenting Support Policy. Thegovernment recognized that parents should serve animportant role to promote and coordinate organizationalefforts and resources for positive parenting practices. TheNational Parenting Support Commission Act furtherestablished an official coordinating body to ensure effectivestreamlining of government activities related to parenting.

Key considerations for Tuvalu:Established cross sectoral institutional anchor withrepresentation from all relevant sectors, includingeducation, health, local government and communitydevelopment, labor, finance, protection, and planning.Highly synergetic approach to policy design.Improved coordination amongst relevant sectors toeffectively respond to the comprehensivedevelopmental needs of young children.



Policy Lever 2.1:Scope of ProgramsEffective ECD systems have programs established in allessential sectors and ensure that every child andexpectant mothers have guaranteed access to theessential services and interventions they need to livehealthfully. The scope of programs assesses the extentto which ECD programs across key sectors reach allbeneficiaries. Figure 2 presents a summary of the keyinterventions needed to support young children andtheir families via different sectors at different stages in achild’s life.

ECD programs target all beneficiaries in the health,nutrition, and education sectors, but child and socialprotection interventions do not exist. Tuvalu hasestablished several essential health, nutrition, andeducation services necessary to promote a positiveenvironment for ECD. While the data may be limited inscope, the programs in place target all beneficiarygroups, including pregnant women, mothers, andchildren ages 0 83 months.

On the following page, Figure 3 presents the scope ofECD interventions in Tuvalu by target population andsector. Table 5 on the next page provides an overviewof ECD programs and coverage in Tuvalu.

The MoH has implemented an expanded program toprovide immunizations to all children. Pre and postnatal care includes prenatal clinical visits and post natalscreening for maternal depression as well as births inthe presence of a skilled attended. Child wellness andgrowth monitoring are mandated and parentingprograms are available at health centers. Non stateactors implement many of the programs in coordinationwith the Tuvalu Association of NGOs (TANGO).

Countrywide programs to promote essential nutritionalintake include breastfeeding for new mothers andhealthy eating and exercise programs for children tofight childhood obesity. However, programs do not existto promote micronutrient or food supplements forexpectant mothers, new mothers, and children.Community based ECCE programs are offered to allchildren at Tuvalu’s 18 ECCE centers, and home visitsprovide parents with key ECD messaging.



Figure 2: Essential interventions during different periods ofyoung children's development

Figure 3: Scope of ECD interventions in Tuvalu bytarget population and sector



Policy Lever 2.2:CoverageA robust ECD policy should establish programs in allessential sectors, ensure high degrees of coverage andreach the entire population equitably–especially themost disadvantaged young children–so that every childand expecting mother have guaranteed access toessential ECD services.

Levels of access to essential ECD health interventionsare high for pregnant women. Prenatal care is nearlyuniversal in Tuvalu: skilled attendants are present at 98percent of births; 97 percent of pregnant women get atleast once prenatal checkup; and 67 percent of womenget four checkups during their pregnancy. There are eightprenatal care facilities in Tuvalu—one for each islandexcept Niulakita, which had a population of 41 people in2011. As mentioned above, voluntary HIV testing forpregnant women is offered at the Princess MargaretHospital and at prenatal clinics, but no cases of HIV

Table 5: ECD programs and coverage in Tuvalu

ECD Intervention

Scale

PilotPrograms

Number ofRegionsCovered

UniversalCoverage

EducationState sponsored pre primary/kindergarten educationState sponsored ECCECommunity based ECCE All YesHealthPrenatal and newborn care All YesIntegrated management of childhood illnesses and care for developmentChildhood wellness and growth monitoring All YesNational immunization program All YesNutritionMicronutrient support for pregnant womenFood supplements for pregnant womenMicronutrient support for young childrenFood supplements for young childrenFood fortificationBreastfeeding promotion programs All YesAnti obesity programs encouraging healthy eating/exercise All YesFeeding programs in pre primary/kindergarten schoolsParentingParenting integrated into health/community programs All YesHome visiting programs to provide parenting messages All YesSpecial NeedsPrograms for OVCs (boarding schools & children’s homes)Interventions for children with special (emotional and physical) needs All YesAnti povertyCash transfers conditional on ECD services or enrollmentComprehensiveA comprehensive system that tracks individual children’s needs andintervenes as necessary

All Yes



among pregnant women were reported in the 2010 2011reporting period.20 As of 2005, one third of pregnantwomen had anemia; the MoH is encouraged to gathermore up to date data for an accurate understanding ofthis nutritional concern. Table 6 provides a regionalcomparison of levels of access to essential health andnutrition for pregnant women in Tuvalu and four otherPacific Island nations.

For young children, the levels of access to someessential ECD health interventions are high, but levels ofaccess to essential nutrition are relatively low orunknown. Infant immunization against DPT, polio,hepatitis, and other childhood diseases is nearlyuniversal, at 97 percent or higher.21 Forty four percent ofchildren under 5 with diarrhea received oral rehydrationfrom 2008 2012.22 No information was available on theprevalence of pneumonia, tetanus, or malaria amongyoung children.23

In terms of child nutrition, there is no data on twoessential indicators—the number of children aged 6 59months who get regular supplements of Vitamin A, andthe percentage of the population that consumes iodizedsalt. Despite a drafted national breastfeeding policy thatis promoted at Tuvalu’s hospital and prenatal clinics, only35 percent of infants younger than 6 months wereexclusively breastfed between 2007 and 2011—a lowrate compared to other Pacific Island nations. The WorldHealth Organization (WHO) and UNICEF recommendexclusive breastfeeding for the first six months of a

20 UNAIDS (2012).21 UNICEF, MISC (2012).22 UNICEF, MICS (2012).23 UNICEF, MICS (2012).

child’s life. Anemia is high among children under 5, at 34percent from 2005 to 2010.24 Table 7 presents a regionalcomparison of levels of access to essential health andnutrition for ECD aged children.

Table 7: Regional comparison of level of access to essentialhealth and nutrition interventions for ECD aged children

Tuvalu Fiji SolomonIslands

Tonga Vanuatu

1 year old childrenimmunized against DPT(correspondingvaccines DPT3ß)

96% 99% 88% 99% 68%

Children below 5 withmoderate/severestunting

10% Notavailable 33% Not

availableNot

available

Infants exclusivelybreastfed until 6months

35% 40% 74% Notavailable 40%

Infants with low birthweight 6% 10% 13% 3% 10%

Prevalence of anemiain children below 5(2005 2010)

34% 39% Notavailable

Notavailable

Notavailable

Source: UNICEF Country Statistics, 2007 2012; WHO Global Database onAnemia, 2005; World Bank Indicators: Nutrition intake and supplements (20052010).

Half of all newborns are registered and receive birthcertificates. Birth registration is an essential part ofensuring that young children receive adequate ECDservices. While Tuvalu adopted the Births, Deaths, andMarriages Registration Ordinance (1968) requiringregistration of all newborns within 10 days of birth,between 2005 and 2011, only 50 percent of childrenwere registered. Table 8 provides a regional comparisonof birth registration rates.

Table 8: Regional comparison of birth registration ratesTuvalu Fiji Solomon

IslandsTonga Vanuatu

Birth registration2000 2010 50% Not

availableNot

availableNot

available 26%

Source: UNICEF MICS4, 2011; UNICEF Country Statistics, 2007 2011.

Tuvalu has a high rate of pre primary enrollmentcompared to other Pacific Island nations. Tuvalu has thehighest rate of pre primary enrollment among the PacificIslands nations of Fiji, Samoa, the Solomon Islands,Tonga, and Vanuatu. Gross enrollment in pre primaryschool in Tuvalu has hovered around 100 percent since2000 and gross enrollment exceeded 100 percent in2006.25 Figure 4 presents a comparison of pre primarygross enrollment rates in the Pacific Islands.

24 World Bank Indicators: Nutrition intake and supplements (2005 2010).25 Latest Statistical Digest for Tuvalu indicates a pre primary net enrollmentrate of 82%.

Table 6: Regional comparison of level of access to essentialhealth and nutrition interventions for pregnant women

Tuvalu Fiji SolomonIslands

Tonga Vanuatu

Skilled attendant atbirth 98% 100% 86% 98% 74%

Pregnant womenreceiving antenatalcare (at least fourvisits)

67% Notavailable 65% Not

availableNot

available

Pregnant womenreceiving antenatalcare (at least onevisit)

97% 100% 74% 98% 84%

Prevalence ofanemia in pregnantwomen (2005)

33% 56% 51% 34% 57%

Source: UNICEF Country Statistics, 2007 2012; UNAIDS, 2012; WHO GlobalDatabase on Anemia, 2006.



Figure 4: Gross pre primary enrollment rates in PacificIslands

Policy Lever 2.3:EquityBased on the robust evidence of the positive effects ECDinterventions can have for children from disadvantagedbackgrounds, every government should pay specialattention to equitable provision of ECD services.26 One ofthe fundamental goals of any ECD policy should be toprovide equitable opportunities to all young childrenand their families.

Tuvalu exhibits few disparities in access to ECD healthand education services. Boys and girls equitably attendpre primary school, and the ratio of boys to girls isrelatively equal at 1.2 to 1. The MoES EducationStrategic Plan (2011 2015) mandates inclusive policiesthat cater to the needs of children with special needsenrolled in ECCE centers.

Both rich and poor mothers were accompanied byskilled attendants during labor in equal measure: 99percent of the poorest and 98 percent of the richestgave birth in the presence of a doctor or a skilledmidwife. Similarly, there is almost no difference in poorand rich households when comparing underweightchildren. Only 1 percent of the poorest children wereunderweight and none of the children from the richesthouseholds was underweight. Only birth registrationshowed a disparity: 39 percent of the poorest

26 Engle et al, 2011; Naudeau et al., 2011.

households had registered their newborn, while 71percent of the richest had done so. Birth registrationrates also vary by location. More urban householdsregistered the birth of their children (60 percent) thanrural households (38 percent). The disparity did notapply to access to improved sanitation facilities: bothurban and rural had nearly equal access—88 percent forurban and 81 percent for rural.

Policy Options to Implement ECD Widely inTuvalu

The government has taken several steps toincrease the scope of ECD programs in the health,education, and nutrition sectors. However, datawere limited to fully ascertain the scope of existingprograms that contribute to positive ECD services.Mapping of programs and collaboration across ECDsectors would be useful to ensure an adequate scopeof programs as available for pregnant women, youngchildren, and parents. More programs to reachpregnant women and young children with essentialnutrients, for instance, could boost health outcomes.The government might also consider Incorporatingchild and social protection programs into the ECDsystem, as this would be beneficial to increasing theoverall scope of programs offered. Prioritizing whichinterventions to invest in will depend on thegovernment’s consideration of context, costs, needs,and capacity. Box 4 reviews several areas to considerwhen deciding where to prioritize.

0

20

40

60

80

100

120

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

PrePrim

aryGrossE

nrollm

entR

ate

Year

Fiji(data missingin 2002, 2005,2007, 2010)

Samoa(data missingin 2002 2005)

SolomonIslands(data missing2001, 20032005)Tonga(data missing2001 2003,2005)

Tuvalu(data missing2002, 2003,2007 present)



Box 4: Considerations for prioritizing ECD interventions

Parents are the primary entry point to improveoutcomes for young children. Parenting programsalready exist in Tuvalu. Reaching parents andcaregivers with messages on young children’sdevelopment and positive parenting can significantlyimprove outcomes for children. Stimulation foryoung children occurs through responsive andincreasingly complex, and developmentallyappropriate, interactions between caregivers andchildren. Strengthening family support in ECD couldbe a promising strategy to promote school readiness.Efforts to promote positive parenting practices havedemonstrated impacts on cognitive skills, socialadjustment, and academic performance oncechildren reach school. Encouraging parents toprovide learning opportunities at home candemonstrate positive effects on children’s literacyand numeracy at age 5.

While Tuvalu’s coverage of many ECDinterventions is near universal, such as childimmunizations and prenatal visits for pregnantwomen, some other essential interventions areinsufficiently provided or unavailable. Thegovernment could improve coverage of ECD servicesby increasing data collection for key coverageindicators, such as the percentage of children whoreceive vitamin A supplements and the percentage

of the population that consumes iodized salt. Thegovernment could ensure the universality of ECDcoverage by improving the rate of birth registration.ECCE services would benefit from an expansion ofprograms to reach children ages 0 3.

While most ECD services are equitablyprovided, the government could improve equalaccess to services through programs targetingTuvalu’s lower income and rural residents,particularly to register newborns among thesedemographic groups. The government could alsotarget parents with messaging to increase girls’access to pre primary school to close the smallgender gap in attendance rates.

Policy Goal 3: Monitoring and AssuringQuality

Policy Levers: Data Availability • QualityStandards • Compliance with Standards

Monitoring and Assuring Quality refers to the existenceof information systems to monitor access to ECDservicesand outcomes across children, standards for ECDservices and systems to monitor and enforce compliancewith those standards. Ensuring the quality of ECDinterventions is vital because evidence has shown thatunless programs are of high quality, the impact onchildren can be negligible, or even detrimental.

Policy Lever 3.1:Data AvailabilityAccurate, comprehensive, and timely data collection canpromote more effective policy making. Well developedinformation systems can improve decision making. Inparticular, data can inform policy choices regarding thevolume and allocation of public financing, staffrecruitment and training, program quality, adherence tostandards and efforts to target children most in need.

Data are collected for only a select number of ECDindicators. UNICEF’s Multiple Indicator Cluster Survey(MICS) collects data for some health, education, andnutrition indicators for Tuvalu, such as birth weight,immunizations, and access to prenatal care. Thegovernment also collects some administrative data. Forexample, ECCE centers in each island track and reportthe number of children enrolled in pre primary school,including urban/rural divisions. Health administratorscount and report the number of children who benefitfrom well child visits as well as national usage of

On the basis of the ECD diagnostic and taking into accountcosts and funding, countries should prioritize interventionswith three considerations in mind:

Start early: The needs of the very young are key, especiallyduring the 1,000 days between conception and 24 months.Interventions during that period have lifelong impacts on achild’s ability to grow, learn, and rise out of poverty.Address risk factors for poor growth and development:

Four main risk factors affecting at least 20 25 percent ofinfants and young children in developing countries are: (1)stunting and wasting; (2) inadequate cognitive stimulation;(3) iodine deficiency; and (4) iron deficiency anemia. Otherpriority risk factors include malaria, intrauterine growthrestriction, lead exposure, maternal depression, andexposure to violence.Target the most vulnerable: While a system providing

universal coverage for ECD interventions is ideal, underbudget constraints countries should first target the mostvulnerable. For example, home visiting programs could focuson households with stunted children and those facing higherrisks of delayed cognitive development.From: Investing in Young Children for High Return (Denboba, et al, 2014)



nutrition interventions for children by ethnicity,location, and age. Authorities also track the percentageof children registered at birth, the percentage of 1 yearolds immunized, and the percentage of pregnantmothers who receive prenatal visits. However, there areno data collected for other essential ECD indicators,such as the average ratio of students per teacher. Table9 presents an overview of the availability of data tomonitor ECD in Tuvalu.

Some data are collected to measure child developmentoutcomes. Cognitive, linguistic, physical, and socioemotional data are collected to support teachers inproviding holistic and appropriately individualizedprograms for pre primary school children. Individualchildren’s development outcomes are also tracked. Butdata are not compiled to determine ECCE outcomes forvarious subgroups of children. ECCE access andoutcomes, for instance, are tracked by gender andlocation only. Language, ethnic, socioeconomic status,and special needs are not specifically tracked.

Table 9: Availability of data to monitor ECD in TuvaluAdministrative Data:

Indicator Tracked

ECCE enrollment rates by region XSpecial needs children enrolled in ECCE (#)Children attending well child visits (#)Children benefitting from nutrition interventions (#)Women receiving prenatal nutrition interventions (#) XChildren enrolled in ECCE by sub national region (#)Average student to teacher ratio in public ECCEIs ECCE spending in education sector differentiatedwithin education budget?Is ECD spending in health sector differentiated withinhealth budget? X

Survey DataIndicator Tracked

Population consuming iodized salt (%) XVitamin A supplementation for children 6 59 mo (%) XAnemia prevalence among pregnant women (%) XChildren below the age of 5 registered at birth (%)Children immunized against DPT3 at age 12 months (%)Pregnant women attending 4 antenatal visits (%)Children enrolled in ECCE by socioeconomic status (%) X

Ensuring quality ECD service provision is essential. Afocus on access – without a commensurate focus onensuring quality – jeopardizes the very benefits thatpolicymakers hope children will gain through ECDinterventions. The quality of ECD programs is directly

related to better cognitive and social development inchildren.27

The MoES is in the process of developing learningstandards. There are no clear learning standards forECCE, but educators are working with localcommunities, parents, and other stakeholders todevelop National Early Learning DevelopmentStandards. For now, ECCE teachers who receivedcertificates from the University of the South Pacific’sTuvalu campus use their knowledge to developindividual curricula according to the pupils’ interest,culture, and environment. Trained ECCE teachers holdworkshops to learn how to align their curricula withprimary school to bridge the transition from ECCE toprimary.

There are minimum requirements for pre primaryschool teachers, but ECCE training and developmentvaries and is not regulated by the government. Preprimary school teachers must complete high school andtake vocational training classes in ECD to become ateacher, but there is no specific in service trainingrequirement to develop pedagogical and teaching skills.Private teacher training institutions regulate their ownpre service training. Most ECCE teachers are trainedthrough distance and flexible learning programs. TheUniversity of the South Pacific’s (USP) Tuvalu campustrains the majority of pre primary school teachers.USP’s course requires an eight week practicum. TheAustralian Pacific Training Center offers an ECCEcertificate that requires a six month practicum two daysa week.

Health workers are required to receive training indelivering ECD messages. Doctors, nurses, andmidwives receive training on child developmentalmilestones, child care, parenting, and early stimulationchild development techniques.

There are infrastructure and service delivery standardsfor ECCE. The MoES’s ECCE Policy 2007 stipulates thatthe ratio of children to teachers should be 6:1 for 2 to3 year olds, 10:1 for 3 to 4 year olds, and 15:1 for 4 to5 year olds. Preschools should operate a minimum of15 hours per week. There are no national standards forthe amount of space required for a preschool and the

27 Taylor & Bennett, 2008; Bryce et al, 2003; Naudeau et al, 2011V; Victoria etal, 2003.

Policy Lever 3.2:Quality Standards



ECCE Policy does not mention hygiene or potable waterin its guidelines for physical environment.

ECCE facilities must be registered and accredited. The2007 ECCE Policy stipulates that ECCE centers mustregister with the Department of Education. Facilitiesmust meet basic building, health, safety, andeducational requirements and are inspected annually.

There are construction standards for health andeducation facilities. Tuvalu’s eight health centers andone hospital must comply with building code standardsset for health facilities, according to the MoH and thepublic works division/architectural design. There arealso construction requirements for Tuvalu’s 18 ECCEcenters.

Policy Lever 3.3:Compliance with StandardsEstablishing standards is essential to providing qualityECD services and to promoting the healthy developmentof children. Once standards have been established, it iscritical that mechanisms are put in place to ensurecompliance with standards.

There are no data available on whether ECCE providerscomply with standards for training professionalqualifications. According to the Tuvalu TeacherEducation Management Information System (TEMIS), 60teachers of children aged 24 59 months had receivedin service training and an additional 60 had received inservice training for children aged 60 83 months in 2012.The MoES’ 2007 ECCE Teachers Salary Policydifferentiates the salary paid to qualified andunqualified teachers.

ECCE facilities comply with operating but notconstruction standards. All 18 of Tuvalu’s ECCE centersenforce the 10:1 child to teacher ratio requirement andoperated the required 15 hours per week. However,only 8 of 18 facilities meet construction standards.

Policy Options to Monitor and Assure ECDQuality in Tuvalu

Tuvalu would benefit from a more robust datacollection system that could be used to make betterinformed decisions about ECD across sectors.Specifically, data to differentiate access andoutcomes for special groups would help thegovernment better assess equity issues. While datacurrently collected are disaggregated by urban/ruraland gender, they are not collected to differentiated

children’s access and outcomes by socioeconomicstatus, ethnic minority background, or specialneeds. Such a breadth of information would give amore in depth picture of the coverage and equity ofECD programs offered in Tuvalu.

In May 2014, regional guidelines for ECCEsystems were endorsed by Ministers of Education ata Forum in Cook Islands. The government isencouraged to incorporate these guidelines tostrengthen the quality of the ECCE system.Monitoring and enforcing compliance withstandards ensures that public standards of qualityof ECD programs are met and maintained. To thisend, early learning outcomes could benefit by aconcerted effort to make sure that requirementsthat preschool teachers are properly trained andqualified are enforced.

The current effort to create National EarlyLearning Development Standards provides a goodstarting point to ensure quality. The government isencouraged to finalize these standards and couldturn to the neighboring island state of Vanuatu,where the national preschool association has alsodeveloped early learning and developmentstandards in 2010. The government might alsoconsider establishing monitoring and evaluationmechanisms to ensure that various ECD standardsare met across sectors. Similarly, the governmentcould benefit from establishing mechanisms toensure that ECCE centers comply with buildingcodes. Box 5 provides an example from Jamaica,where a system of monitoring and assuring qualityis well established.



Box 5: Relevant Lessons from Jamaica in Monitoringand Assuring Quality

Comparing Official Policies with OutcomesThe existence of laws and policies alone do not alwaysguarantee a correlation with desired ECD outcomes. Inmany countries, policies on paper and the reality ofaccess and service delivery on the ground are notaligned. Table 10 compares ECD policies in Tuvalu withECD outcomes. In Tuvalu, the MoH implemented anexpanded and free immunization program available inall healthcare facilities that has resulted in very highrates of immunization for children. Other policies arestill in draft form, such as the policy to encouragebreastfeeding for infants under 6 months old. Whilemessaging at Tuvalu’s health facilities currentlypromote the benefits of breastfeeding, less than half ofall women exclusively breastfeed for six months.

Table 10: Comparing ECD policies with outcomes in TuvaluECD Policies Outcomes

1996 Draft Breastfeed & InfantFeeding Policy encourages

breastfeeding

Exclusive breastfeedingrate (> 6 mo):

35%

Preprimary school is not freeor compulsory in Tuvalu

Pre primary schoolenrollment:

106 %

Young children are required toreceive a complete course of

childhood immunizations

Children with DPT (1223 months):

96 %

Policy does not mandate theregistration of children at birth

in Tuvalu

Completeness of birthregistration:

50%

Preliminary Benchmarking and InternationalComparison of ECD in TuvaluTable 11 presents the classification of ECD policy inTuvalu within each of the nine policy levers and threepolicy goals. The SABER ECD classification system doesnot rank countries according to any overall scoring;rather, it is intended to share information on howdifferent ECD systems address the same policychallenges.

On the following page, Table 12 presents the status ofECD policy development in Tuvalu alongside a selectionof other countries in the region.

Example from Jamaica: Ensuring Quality in ECCE provisionJamaica’s Early Childhood Commission (ECC) is responsible for thesupervision and regulation of early childhood institutions (ECI) in thecountry.

Standards for the operation, management and administration ofECIs: In Jamaican law, there are two types of standards; thosetransmitted by an Act or Regulations and which therefore carry legalconsequences, and those that serve to improve practice voluntarilyand are not legally binding. For practical purposes, quality standardsfor ECIs include both sets of standards, with clear indications of thosestandards that are legally binding.

Standard statements for ECI: To improve the quality of servicesprovided by ECIs, the ECC has developed a range of robust operationalquality standards for ECIs. The Act and Regulations, which togethercomprise the legal requirements, specify the minimum levels ofpractice below which institutions will not be registered or allowed tooperate. The standards that are not legally binding define bestpractices for early childhood institutions and serve to encourageinstitutions to raise their level of practice above minimumrequirements. While ECIs are encouraged to achieve the highestpossible standards to ensure the best outcomes for children, thelegally binding standards guarantee that minimum standards are met.

Inspection and registration: Inspection of ECIs is the proceduredesignated under the Early Childhood Act for ensuring that operatorscomply with the minimum acceptable standards of practice. The ECC isrequired to inspect each ECI twice annually. It is a requirement ofregistration that the registered operator cooperates with the ECC’sinspection process. The “registered operator” is defined as the personrequired to apply for registration of an ECI and may be an individual ora group. In deciding on the suitability of an ECI for registration underthe Early Childhood Act, the ECC will, based on information obtainedat inspection visits, determine whether or not an ECI meets andcomplies with the Act and Regulations. Where existing provision fallsshort of the legal requirements, and the shortfall does not present areal and present danger to children, a permit to operate until fullrequirements are met will be granted, with time scales for institutionsto meet requirements. The ECC encourages the promotion of thehighest standards of practice by monitoring not only the minimumrequirements at inspection visits, but also by monitoring thosestandards that are not legally binding.

Key Lessons for Tuvalu:Consider establishing legally binding requirements for ECCEservice provision to guarantee that acceptable minimumstandards are met.Consider assigning a special entity with a delineated role tomonitor and regulate ECCE service providers. An improved qualitymonitoring system will ensure that best outcomes are achieved.



ConclusionThe SABER ECD initiative is designed to enable ECDpolicymakers and development partners to identifyopportunities for further development of effective ECDsystems. This country report presents a framework to

compare Tuvalu’s ECD system with other countries inthe region and internationally. Each of the nine policylevers are examined in detail and some policy optionsare identified to strengthen ECD are offered.

This report is intended to serve as a first step fordecision making within the government to improve theECD system. Now that some areas in need of policy

Table 11: Benchmarking Early Childhood Development Policy in Tuvalu

ECD Policy Goal Level ofDevelopment Policy Lever

Level ofDevelopment

Establishing an EnablingEnvironment

Legal Framework

Inter sectoral Coordination

Finance

Implementing Widely

Scope of Programs

Coverage

Equity

Monitoring and AssuringQuality

Data Availability

Quality Standards

Compliance with Standards

Legend:Latent Emerging Established Advanced

Table 12: International Classification and Comparison of ECD Systems

ECD Policy Goal Policy LeverLevel of Development

Tuvalu Australia Samoa SolomonIslands Tonga Vanuatu

Establishing anEnabling

Environment

Legal Framework

Coordination

Finance

ImplementingWidely

Scope of Programs

Coverage

Equity

Monitoring andAssuring Quality

Data Availability

Quality Standards

Compliance withStandards

Legend:Latent Emerging Established Advanced



attention have been identified, the government canmove forward in prioritizing policy options to promotehealthy and robust development during their earlyyears. It will be important to ensure that the definitionof short term policy goals align with longer term policyoptions. A multi sectoral costed implementation planwill be essential for identifying and prioritizingactionable steps for the government and otherstakeholders. A costed plan will also help ensure thatadequate human talent and financial resources areavailable to meet the goals of Tuvalu’s ECD policy. Inprioritizing policy areas, the government shouldconsider establishing a multisectoral platform andappoint a ministry to lead ECD to ensure effectivedelivery of ECD services. Given that preschools arecommunity managed in Tuvalu and paid for mainly byparents, the government should also consider creating a

nation wide curriculum and monitoring the quality ofteachers and the physical state of preschools.Additionally, because strong data collection is soessential to ensuring quality ECD services, thegovernment may consider creating a robust datacollection mechanism to improve programs and allocateresources.

Table 13 summarizes the key policy options identified toinform policy dialogue and improve the provision ofessential ECD services in Tuvalu. It is critical that allrelevant ECD sectors mobilize their resources to ensurethat children receive the highest quality care. This willrequire implementing comprehensive policies andmonitoring delivery of services at the national and thecommunity levels.

Table 13: Summary of policy options to improve ECD in TuvaluPolicyGoal Policy Options and Recommendations

Establishing anEnabling

Environment

Incorporate ECCE into the MoES regulatory frameworkPass draft policies, including Breastfeeding Policy, Food Safety Regulations bill, and the Family Protection billAppoint a government agency to coordinate ECD activities across sectorsTrack, report, and coordinate budget allocations for services for young children across the ECCE, health,nutrition, and child and social protection sectorsConsider additional sources of funding to ensure adequate finance for ECD services, including public privatepartnerships

ImplementingWidely

Conduct a mapping exercise of all ECD programsCreate messaging focused on increasing the prevalence of breastfeeding exclusively for the first six months ofa newborn’s lifeCollect data on nutrition, including the percentage of the population that consumes iodized salt and thepercentage of children who take vitamin A supplementsIncrease equity in access to services by targeting poorer and rural residents, particularly to ensure that theirchildren are registered at birth

Monitoring andAssuringQuality

Develop more robust data collection system to better assess the level of coverage and equity of ECD accessand outcomes and better target services to specific needsDevelop standards to monitor quality of ECD services, such as the percentage of teachers who holdcertificates and are qualified to teachRegulate ECCE teacher training programsCreate a national ECCE curriculumEnforce building codes for pre primary schools to ensure children learn in a physically safe environment



AcknowledgementsThis Country Report was prepared by the SABER ECD team at theWorld Bank headquarters in Washington, DC. The report presentscountry data collected using the SABER ECD policy and program datacollection instruments and data from external sources. The reportwas prepared in consultation with the World Bank HumanDevelopment East Asia and Pacific team and the Government ofTuvalu. For technical questions or comments about this report,please contact the SABER ECD team ([email protected])

AcronymsECD Early Childhood Development

ECCE Early Childhood Care & Education (usedinterchangeably with pre primary or preschool)

MoES Ministry of Education and Sports

MoH Ministry of Health

ReferencesSABER ECD Policy Instrument, Tuvalu 2013.SABER ECD Program Instrument, Tuvalu 2013.Britto, P., Yoshikawa, H., Boller, K. 2011. “Quality of Early Childhood

Development Programs: Rationale for Investment, Conceptual Frameworkand Implications for Equity.” Social Policy Report, 25 (2):1 31.

Denboba, A., Sayre, R., Wodon, Q., Elder, L., Rawlings, L., and Lombardi, J.,2014, Investing in Young Children for High Returns. Washington, DC: TheWorld Bank.

Engle, P. L., L. C. H. Fernald, H. Alderman, J. Behrman, C. O’Gara, A. Yousafzai,M. Cabral de Mello, M. Hidrobo, N. Ulkuer, and the Global Child

Development Steer Group. “Strategies for reducing inequalities and improvingdevelopmental outcomes for young children in low income and middleincome countries.” The Lancet, Early Online Publication, 23 September2011. Doi:10.1016/S0140 6736(11) 60889 1.

Hanushek, E. (2003). "The Failure of Input Based Schooling Policies." TheEconomic Journal 113; 64 98.

Hanushek, E. A. and D. D. Kimko. (2000). “Schooling, Labor Force Quality, andthe Growth of Nations." The American Economic Review, Vol. 90, No. 5,1184 1208.

Naudeau, S, N. Kataoka, A. Valerio, M. J. Neuman, L. K. Elder. 2011. Investingin Young Children: An Early Childhood Development Guide for PolicyDialogue and Project Preparation. World Bank, Washington, DC.

Neuman, M. & Devercelli, A. 2013. "What Matters Most for Early ChildhoodDevelopment: A Framework Paper." SABER, World Bank, Washington DC

Neuman, M. J. 2007. “Good Governance of Early Childhood Care andEducation: Lessons from the 2007 Education for All Global MonitoringReport.” UNESCO Policy Briefs on Early Childhood. United NationsEducational, Scientific and Cultural Organization, New York.

OECD (Organisation for Economic Co operation and Development). 2011.“Starting Strong III: A Quality Toolbox for Early Childhood Education andCare.” OECD Publications, Paris.

UNESCO OREALC. 2004. “Intersectoral Co ordination in Early ChildhoodPolicies and Programmes: A Synthesis of Experiences in Latin America.”Regional Bureau of Education for Latin America and the Caribbean, UnitedNational Educational, Scientific and Cultural Organization.

Vargas Barón, E. 2005. “Planning Policies for Early Childhood Development:Guidelines for Action.” Paris: UNESCO/ADEA/UNICEF (United NationsEducational, Scientific and Cultural Organization/ Association for theDevelopment of Education in Africa/United Nations Children’sFund).

Victoria, B. H., L. Adair, C. Fall, P. C. Hallal, R. Martorell, L. Richter, and H. S.Sachdev 2008. “Maternal and Child Undernutrition: Consequences for AdultHealth and Human Capital. “ The Lancet 371 (9609): 340 57.



The Systems Approach for Better Education Results (SABER) initiativeproduces comparative data and knowledge on education policies andinstitutions, with the aim of helping countries systematically strengthentheir education systems. SABER evaluates the quality of educationpolicies against evidence based global standards, using new diagnostictools and detailed policy data. The SABER country reports give allparties with a stake in educational results—from administrators,teachers, and parents to policymakers and business people—anaccessible, objective snapshot showing how well the policies of theircountry's education system are oriented toward ensuring that allchildren and youth learn.

This report focuses specifically on policies in the area of EarlyChildhood Development.

This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusionsexpressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or thegovernments they represent. The World Bank does not guarantee the accuracy of the data included in this work. Theboundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on thepart of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.

www.worldbank.org/education/saber

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