Q&A: Working across sectors to increase access to quality early childhood development services

[Editor’s note: Gina Lagomarsino, president and CEO of Results for Development (R4D), recently interviewed Maureen Samms-Vaughan, the first chair of the Early Childhood Commission, a body established by the Government of Jamaica to develop the country’s early childhood sector.

Maureen is an early childhood development expert known internationally for her seminal research, clinical work and policy development in the field of child health, child development and behavior. The interview was conducted during a plenary session of the World Bank’s 2nd Annual Universal Health Coverage Financing Forum in Washington, D.C.

Below is a transcript of the interview, which has been edited and condensed for clarity.]

Gina: I understand that in 2003 you were given the task of leading the development of a new multisector agency for early childhood development in Jamaica. And I suspect many of us have sat in rooms like this in cities around the world and talked about the need for multisectoral collaboration, but rarely does it happen in practice very well. So I think we’re all curious to hear how you’ve done this in Jamaica.

But maybe you can start off with a bit about how this came to be. What were some of the political pressures that led to the idea of creating a new agency and how easy was it to pass this politically?

Maureen: Jamaica has had a long history of support for early childhood education, in particular. And this did not arise from the top down, this was a community-driven process. The early childhood education sector was established long before the Ministry of Education came into play and into being. And it has also had a long history of advocacy at the professional and technical level. So, working together, these led to the need to have a government agency that was responsible for early childhood development. What we were doing was moving from just working on early childhood education, which is starting kids in school from 3 to 6, and we were now considering early childhood development, which is from birth to 6 in this context. And, in terms of the state actors between 0 and 3, the main actor is the Ministry of Health through well child clinics for immunization. From 3 to 6, the main state actor is the Ministry of Education because 95 percent of our kids are in school by 3. But there are other actors, there’s the Ministry of Labor and Social Security, teacher training colleges and universities, the private sector, advocacy groups.

In doing a situational analysis in Jamaica, we found out that there was a lot going on but that it was very poorly coordinated and it was likely to be very wasteful. Therefore, the decision was made by the government to establish a single agency. And because of the strong political support across both our political parties, this was a very easy agency to establish. Also, because of community support, it was very easily done. The agency was established in 2003.

Gina: It’s very interesting that it was politically easy to establish this multisectoral agency in Jamaica. I guess that speaks to the strong need! Can you now tell us a little bit about the programming of the agency? You mentioned education is involved, health is involved, the Ministry of Social Security. Give us a brief overview of the kinds of programs you’re engaging in.

Maureen: The Early Childhood Commission set about to determine what areas we wanted to focus on, and we ended up with five key areas. We used the lifecycle approach, starting with parenting. With the first three years of course being primarily contact with health, high functioning well child clinics was the second pillar. Screening and early identification of children and families at risk was the third pillar. Then there were high quality early childhood institutions. And then there was adequate teacher training. And all of this was based on two pillars of (1) data to inform our decision making and (2) that we were all working together toward a single plan. So, we developed a single cross-sectoral plan that involved everybody and not just ministries, but involved the private sector and all the advocacy groups.

Gina: What were some of the challenges of working in a multistakeholder environment? Was there anything that you did that was particularly effective in managing all those stakeholder groups?

Maureen: The most important thing was having the organizational mandate to do it. So, there was legislation that mandated our function. And then within that legislation, it allowed us to develop an organizational structure that supported it. Within that organizational structure, we had a position that was a director of cross-sectoral coordination. This is a key position because it takes a lot of time to do cross-sectoral work. We are not designed to work together. We are set in separate ministries. Even though we are working for the same children and we want the best for all our children, we are looking after different aspects of the children’s well-being.

So, it was important for us to work with each of the ministries. In order to do that, we had to set targets within each ministry—agreed targets between the Commission and the ministries. For each one of these targets, the Commission had a role to play to help the ministry and the ministry had a role to play to help the Commission. So, we established memorandums of understanding (MOUs) with each agency that we were working with. Within these MOUs, there were responsibilities for both of us.

The other important thing was frequent meetings and annual meetings where we all came together. So, there were individual meetings throughout the year. But there was one meeting every year where we looked at progress made, why we didn’t hit targets if we didn’t, what we needed to do to change, and we also determined what were the targets for the next year based on the accomplishments of the previous year.

Gina: Now that it’s almost 15 years later, what would you do differently? Are there things you would’ve changed or things that were a particular challenge?

Maureen: Things that were a challenge: I’m going to mention three things. One was that having an organization that was cross-sectoral within a particular ministry, there was an expectation that we would focus on those things. So, for us, we were reporting to the Ministry of Education and we were always told we were putting too much health in education. And I suspect that if we were at the Ministry of Health, we would have been told that we were putting too much education in health.

My biggest takeaway from this experience is that if you really think cross-sectoral coordination is important to move countries forward, then that agency needs to report at a higher level—to a nation’s parliament or to a nation’s cabinet, not to a single ministry.

The other thing was about having to work with other agencies. Because of how the early childhood sector had developed with different groups doing different things, we came in as the agency to pull everybody together. We had to help people refocus. It wasn’t so gentle and easy all the time because people had been working independently for years and we had to be sensitive to that and to assist organizations to work with us. We also had to have ministries and agencies refocus a little bit in terms of working toward a strategic plan. Sometimes you were asking people to do more with no additional resources, and that was challenging as well.

Key takeaway: Jamaica’s experience appears to offer many lessons for other countries who want to prioritize early child development through better coordination across the health, education, social protection and finance sectors. We know that engaging multiple sectors to support children under 6 and their families can result in more meaningful impact. Some examples and lessons from programs applying this approach can be found in R4D’s Early Learning Toolkit.

Click here to watch the full plenary session. Gina’s interview begins at the 25:55 mark. The session was organized by David Evans, a consultant for the World Bank, and moderated by Neil Levine, a senior advisor for USAID’s Center of Excellence for Democracy, Human Rights and Governance. The panel also included: Bernice Dahn, M.D., minister of health in Liberia; Johnny Tark, assistant minister of finance in Liberia; Dr. Chi-Man (Winnie) Yip, professor of global health policy and economics at Harvard University; and Jacob Hughes, senior public finance advisor at USAID.

Photo © Nhaka Foundation