Lessons in the Design and Initial Implementation of the System on Prevention, Early Identification, Referral, and Intervention for Delays, Disorders, and Disabilities in Early Childhood in the Philippines
Approximately 1 in every 10 children has a disability and in developing countries, fewer than one out of 10 of them go to school (1) (2). Persons with disabilities experience overlapping deprivations that contribute to marginalization, significant discrimination, and ultimately, exclusion in societal participation, perpetrating the vicious cycle of disability and poverty (3) (4).
Early childhood is the time when the impact of disability into adulthood can be maximally mitigated. It is, therefore, crucial for identification to be carried out at the earliest possible instance and appropriate intervention is provided.
In the Philippines, efforts are underway to implement a system on prevention, early identification, referral, and intervention for delays, disorders, and disabilities in early childhood in select subnational areas. This is a project that is being implemented through the national Early Childhood Care and Development Council and the Department of Health with support from UNICEF and Humanity and Inclusion.
Important lessons can be taken forward from the design and initial implementation of this system. First, it was necessary to work around the locally existing Early Childhood Care and Development (ECCD) tool that has been normed for Filipino children ages 0-4 years. This tool is the ECCD Checklist Records 1 and 2 for children ages 0-3 years and 1 month, and those 3 years and 1 month to 4 years and 11 months, respectively. Because the tool targets two separate age bands that can be reached with distinct service delivery platforms, close collaboration between health and early learning services was necessary from design to implementation.
Second, the design of the system had to be responsive to the local health and early learning systems context for the feasibility of implementation throughout the care pathway. This required several stakeholder consultations, the development of simplified tools and referral mechanisms across the care pathway, iterative revisions of these tools based on end-user feedback, and cadre-specific capacity-building activities.
Third, in a middle-income country (MIC) with devolved governance, engagement and buy-in of the local chief executive (mayor or governor) for every town/city or province were critical for both effectiveness and sustainability. The implementation of the system involves more than one sector (health and social services) and local ordinances had to be drafted to support its institutionalization. Buy-in of local chief executives (LCE) also opened the possibility of having budget allocations in the annual local budgeting process.
Finally, it cannot be overemphasized that identification of delays and disabilities is inevitably demand generating. This simply means that the supply side of the system has to be ready to respond to the demand that is being created and provide appropriate services for the children identified with disabilities. Therefore, for the initial implementation of this system, parallel work with service providers and other partners at both primary and referral facilities was necessary to ensure that there was some degree of supply-side readiness before the implementation. The initial gains in the upstream work on health financing that established the four social health insurance packages for children with mobility, hearing, visual, and developmental disabilities complement this downstream work and offers the possibility of eventual scale-up.
Figure 1. System on Prevention, Early Identification, Referral, and Intervention for Delays, Disorders, and Disabilities in Early Childhood (simplified schema for the health sector)
- UNICEF, WHO. Assistive Technology for Children with Disabilities: Creating Opportunities for Education, Inclusion and Participation (2015). Geneva : World Health Organization, 2015.
- United Nations Children's Fund. State of the World's Children 2013: Children with Disabilities. New York : United Nations Children's Fund, 2013.
- Poverty and Disability in Low and Middle Income Countries . Banks LM, Kuper H, Polack S. 12, 2017, PLoS One, Vol. 12, pp. 1-19.
- B, Rohwerder. Disability inclusion: Topic Guide. United Kingdom : GSDRC University of Birmingham, November 2015.
- World Health Organization and The World Bank. World Report on Disability . Geneva : World Health Organization, 2011.
Ma. Bella P. Ponferrada, MD, MPH
Former Health Specialist, UNICEF Philippines, worked with UNICEF Philippines as Health Specialist for Children with Disabilities and Integrated ECD in the First 1,000 Days, from September 2019 to August 2021.
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