The passage from conception to birth and the years leading up to the age of eight are critical to foster healthy cognitive, emotional, and physical growth of children.

Early Childhood Development (ECD)programming strongly affects a child’s well-being, obesity, stunting, mental health, heart disease, literacy and numeracy skills, criminality, and economic participation throughout his/her life (Irwin, et al., 2007). Further studies also suggest that investment in early childhood is the most important investment a country can make, with exceedingly great returns. ECD related interventions in parts of South America, for instance, have been credited with reducing child mortality by 60 percent among participating communities (UNICEF, 2015).

Early interventions aimed at facilitating healthy child development are available and practical for implementation at the community, national, and global levels. The question that remains is whether these interventions adopt an equity-based multisectoral approach capable of fostering a nurturant environment- that provides all conditions necessary for optimal child development. The consensus view, focusing on closely connected and thus, readily identifiable variables, such as child and maternal nutrition, health, child protection, care, and education in addressing the conditions for a child’s optimal development, is dangerously inadequate. Research studies on child development provide compelling evidence on the importance of distal factors in influencing a child’s access to a nurturant environment. These factors include but are not limited to1.institutionalized system for early identification of children with special needs, 2. cash transfer programs to mitigate impacts of poverty and 3.supporting maternal mental health.

In practice, however, these factors are often either overlooked in ECD programming or implemented as stand-alone interventions inclined towards other objectives. Even though there are challenges associated with keeping an integrated cross-sectoral ECD program running, these are fundamental determinants for a child’s optimal development that cannot be sequenced or separated.

An equity-based approach to ECD programming involves the implementation of inclusive programs designed to ameliorate the circumstances of the most disadvantaged and vulnerable children in society. Such inclusive programs must be able to recognize that children with disabilities have the right, just like other children, to fulfil their maximum potential and ought to have parallel access to mainstream health programs and services. Institutionalized systems must also be in place for the prenatal screening of chromosomal abnormalities and more importantly, for early identification of children with disabilities in order to facilitate their timely access to support services. Community structures such as Special Need Education Coordinators (SNEC) could exist within such frameworks to conduct household profiling for the identification of children with special needs. TheCommunity-based rehabilitation (CBR) approach could also be utilized to empower disabled children and their families to overcome and mitigate the impacts of the pervasive stigmatization and discrimination. This can be achieved through community mobilization for awareness and sensitization campaigns.

Secondly, poverty is one of the overarching socio-economic determinants for a child’s optimal development and survival. Unlike the other socio-economic variables, poverty has no accessible solution and it’s the main underlying cause of perinatal and infant mortalities around the globe. Its strong correlation to all aspects of child development and survival implies that poverty mitigating programs, such as, cash transfers, promoting Income Generating Activities (IGAs) for families, establishment of permagardens to provide nutritious food, Village Savings and Loans Associations (VSLAs), and effective money management and budgeting techniques must be included in each and every ECD programming. Cash transfer and other economic assistance programs associated with ECD, in Latin America for instance, have been proven to be a vital investment in breaking the intergenerational cycles of poverty (UNICEF, 2007). Specifically, such programs reduce social inequity and immobility by identifying the most disadvantaged children that are likely to perpetuate cycles of poverty.

Finally, the impacts of perinatal mental disorders on a child’s psychological and psychosocial development have been profoundly studied and subsequently documented throughout academia. The high prevalence of perinatal disorders has been attributed to factors ranging from poverty to marital problems and domestic violence.

A report released by WHO (2008) found that ‘Infants of depressed mothers show dysregulations affecting their behaviour and physiology, thought to be derived from a prenatal exposure to a biochemical imbalance in their mothers’. Infants from such environments are also characterized by several ‘maturity’ disorders and as a consequence, tend to perform less optimally on all the four domains of the child developmental scale. Early recognition of maternal health issues through the prenatal assessment of psychological and psychosocial risk factors is key to minimizing its impacts. The utilization of the General Health Question (GHQ) and Self-Reporting Questionnaire (SRQ) have had a remarkable success in diagnosing psychological distress in pregnant women. Nondirective and cognitive behavioural counselling in addition to the integration of centre-based child programming into parenting interventions have also proved to improve developmental outcomes.

Coordinated governance, adequate financing, and improved data collection and accountability are key to effectively running an integrated multi-sectoral ECD program. Governments in several countries have made considerable efforts to adopt this integrated approach. For example, the Ugandan government’s effort through the National Integrated Early Childhood Development (NIECD) policy to integrate and converge existing ECD initiatives seem propitious and if successful, would significantly reduce the country’s perinatal and infant mortalities. ECD programming is crucial in expanding opportunities for the generations ahead so such programs and services must adopt a holistic approach to child development.