Problem: Low levels of early childhood education; low levels of childhood immunization; disparities in health and social indicators for vulnerable groups.
Solution highlights: As part of a wider initiative for the social protection of children in post-war Bosnia and Herzegovina, UNICEF partnered with cantons and municipal governments in 2010 to establish Integrated Early Childhood Development (IECD) Centres; a situational analysis and piloting of the approach supported a sharpening of priorities and the development of practical solutions; longstanding partnerships between government actors and development agencies allowed for gradual capacity-building at the subnational level, enabling local uptake of new roles and responsibilities relating to early childhood development; aligning national policy with municipal action encouraged widespread adoption of changes, increasing consistency in approaches and securing sustainability of local efforts.
Description of practice
Throughout the early 2000s, early childhood development indicators in Bosnia and Herzegovina showed unfavourable health and social outcomes. As little as 10% of children were enrolled in early education and approximately half of all infants were iron deficient. Vulnerable groups, including children from Roma or low-income families and children with disabilities, were found to be at greater risk of social exclusion and poor health. Although indicators showed a universally low rate for under-five childhood immunizations at 68% in 2004, immunization rates among Roma children were less than 5%. Roma children were also at greater risk for growth stunting, which was reported to be 35% in this group in 2010, compared to a national average of 10%.
Select municipalities designed and implemented Integrated Early Childhood Development (IECD) Centres in cooperation with the United Nations Children’s Fund (UNICEF) as a means to expand services relating to early childhood development. Services provided by IECD Centres include day care for children, education and competency strengthening relating to early childhood development for pregnant women and caregivers, and referrals to additional services. IECD Centres employ a multidisciplinary staff and are typically co-located with other municipal services. Satellite IECD Centres and home-visit services aim to increase access for vulnerable groups, particularly rural and Roma populations. While IECD Centres are designed to assist all children, the greatest improvements have been observed for children with disabilities, who now benefit from early detection, treatment and support made available through IECD Centres. At present, municipal governments continue to support, expand and scale up IECD Centres with assistance and oversight provided by UNICEF. Although initially established at the municipal level, the success of IECD Centres has since gained national attention from the Government of Federation of Bosnia and Herzegovina and the Government of Republic of Srpska, who have each developed and adopted intersectoral policies relating to early childhood development in support of the initiative.
Implementation of practice
What stage is the practice currently in?
Fully implemented and scaled up
Who was/is responsible for the implementation of the practice?
Partnerships between international and government actors were the driving force behind the initiative. UNICEF led the design process, developing the model in partnership with motivated municipal governments wishing to pilot IECD Centres. While UNICEF established the Centres, many municipalities have now assumed responsibility for managing them and are self-sustaining. More recently, cross-sector government policies at the national level have been developed in both the Federation of Bosnia and Herzegovina and Republic of Srpska to support activities, reflecting a strong recognition of the need for coordinated efforts across sectors to achieve desired improvements in early childhood development.
Many children across Bosnia and Herzegovina now benefit from early education and development services through IECD Centres. A user satisfaction survey revealed that the majority of respondents were satisfied with IECD Centre services (89%) and felt that services met urgent needs for the wider community and those most in need (85%). Almost two thirds of respondents (64%) reported weekly use of IECD Centre services.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Drazenka Malicbegovic
- Ministry of Health