Nearly 10 years ago South Africa outlined its commitment to invest in the health and development of young children.
The National Integrated Early Childhood Development Policy of 2015 detailed government's intention to provide a comprehensive set of services to pregnant women, young children and their families by 2030. This includes healthcare, nutrition support, social protection, parent support and early learning programmes.
Early investments in the care of young children provide a critical foundation for lifelong health and development. The developing brain is highly plastic and moulded by young children's exposure to care or adversity in ways that can be difficult to change later in life. It is therefore vital to build a strong foundation for lifelong health and development starting before the baby is born.
So, to what extent has South Africa succeeded in creating a nurturing and enabling environment for young children, and what needs to be done to enhance their development?
The 2024 issue of the South African Child Gauge, an annual report by the University of Cape Town's Children's Institute, highlights how South Africa has sold its children short and failed to achieve what it set out to do almost a decade ago.
While there have been improvements in access to maternal and child health services, critical gaps remain:
- one infant in 5 is not fully immunised by their first birthday
- one in 6 children living in poverty is not receiving a child support grant
- only 2 in 3 children aged between 3 and 5 are accessing an early learning programme.
These gaps in the delivery of essential services are likely to widen as expected government austerity cuts further erode children's access to health, education and social services.
Chronic underfunding
Financial allocations to early childhood services are a clear signal of a country's commitment to its youngest children, yet the suite of early childhood interventions remains chronically underfunded with investments skewed towards older children.
Only one in three early learning programmes is able to access the state's early child development subsidy of R17 (about 95 US cents) per child per day.
This subsidy has not increased since 2019 and is not sufficient to cover the costs of running a child care centre or even the salaries of early childhood development workers.
Most centres remain reliant on fees paid by parents. This can compromise access and quality of learning programmes, especially for children living in poor households. In contrast, older children can attend no-fee schools.
It's therefore not surprising that fewer than half of those between 4 and 5 years old attending early learning programmes are developmentally on track for their age.
At the same time, child poverty is rising:
- 7 in every 10 young children now live below the poverty line of R1,558 (US$87) per person per month
- 3 in 10 are stunted - a sign of chronic malnutrition that impedes physical growth and cognitive development, with long term impacts on their health, education and employment prospects.
Of greatest concern is what appears to be an increase in under-five mortality, with 1 in 25 children dying before their fifth birthday.
What needs to be done
Key recommendations cover five areas: health, nutrition, early learning, care and support for parents and caregivers, and support for children in need of extra care.
1.) South Africa must strengthen investments in the health and care of pregnant women and young children to intervene early to address challenges such as domestic violence, food insecurity and threats to child health and development.
2.) Families need support including affordable childcare and timely access to the child support grant, as uptake remains low in the first year of life.
3.) Restoring the value of the child support grant from R530 a month to the food poverty line of R760, supporting breastfeeding and appropriate complementary feeding and regulating the marketing of unhealthy foods to children would help address the growing burden of malnutrition.
4.) The quality of early learning programmes can be improved by streamlining their registration, increasing the value of the subsidy and supporting the professional development of early child development practitioners.
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5.) Early identification and intervention is needed to protect young children from harm and to maximise developmental potential for those who are most at risk, as well as children living with disabilities and other long-term health conditions.
At a time when South Africa is seeking solutions to complex societal challenges, the findings of the latest Child Gauge remind us that the answers lie in early childhood. We therefore call on government and the whole of society to boost investment in the optimal health, care and development of our youngest children
Read more: Malnutrition, stunting and the importance of a child's first 1000 days
Wiedaad Slemming, Director, Children's Insitute, University of Cape Town
Linda Biersteker, Early childhood development, University of Cape Town
Lori Lake, University of Cape Town
