Child care centers and child development in Mexico: progress and challenges

Early Childhood Development (ECD) is the basis of human and social capital and the development of nations. That is why ECD is a fundamental pillar of the Sustainable Development Goals.¹ The recently published Lancet ECD Series indicates that is possible to implement intersectoral ECD evidence-based programs on a large scale.^1–4 The evidence clearly shows that these programs should be multifocal, and include health, nutrition, social protection and stimulation and early learning opportunities.^1–4 Evidence also points out that these programs must address the needs of the family and the child throughout the life course, from gestation, through early childhood (birth to 5 years), childhood and adolescence, and in adulthood (parents and other caregivers). Due to the high involvement of parents in the workforce, and evidence of the importance of structured early stimulation and early education, care of children in child care facilities during early childhood has become a global priority to promote ECD.^3,4 Despite this, little is known about the impact of programs in child care facilities.³

In this issue of the Boletín Médico del Hospital Infantil de México, Rizzoli and colleagues report the results of the impact assessment of ECD programs in childcare facilities operating at large scale in Mexico.⁵ This study is extremely relevant because it focuses on the PEI (acronym in Spanish) for early child care and education centers, which was created by the Ministry of Social Development (SEDESOL) (acronym in Spanish) a decade ago to support parents or tutors in poverty, who work or study. These programs manage the care of children from 1 to 3 years old. PEI facilities include education and childcare for eight hours a day, five days a week. The PEI is structured as a standardized comprehensive model that includes stimulation, education, health care and nutrition. An advantage of this study is that it was carried out in Baja California and Campeche, two states with different socio-economic, cultural and geographic contexts that reflect the great diversity of the country. A second advantage is that the study has good statistical power since it included 3387 children between 12 and 48 months old who were taken care of in 177 child care facilities. A third strength of the study is that the Multidimensional Child Development Assessment scale was used to measure the impact of PEI on ECD, including fine and gross motor development, and language and social knowledge. This tool was developed and has been widely validated in Mexico by Rizzoli and collaborators,^6–13 so its results are robust.

The main finding indicates a positive association between adequate child development and participation for six months or more in PEI, compared to children who were less than one month in the program, regardless of the child's age. I agree with the authors that this finding corroborates the crucial importance of promoting the incorporation of children into childcare programs that include activities to encourage their development from an early age. Although this had already been documented previously in Latin American preschoolers,¹⁴ this study demonstrates it in children between one and four years old, which makes it a truly groundbreaking study.

Because the study by Rizzoli et al. is cross-sectional⁵ it is not only important to confirm the findings with prospective studies, but also to have comparison groups (with similar socio-economic conditions, but not enrolled in study PEI or similar programs). Likewise, it is important to follow designs that allow the identification of the quality of the different components of the PEI that are fundamental to the promotion of the ECD, including nutrition, health, and social protection, as well as stimulation and early education. The lack of qualified personnel to implement effective ECD programs is a challenge that has been identified worldwide.⁴ For this reason, it is critical that studies are conducted process evaluation and quality control in Mexico to understand the quality and training needs of the educators according to the nurturing care framework of children promulgated by in the Lancet ECD Series published in 2016.^2–4 These studies should be done at the national level to maintain not only high coverage but also high-quality child care delivery through the PEI and other government structures. The evidence, summarized in the Lancet ECD Series, clearly indicates that childcare facilities must play a fundamental role in educating and involving parents or tutors in the sensitive and caring care of their children, as well as address “new” challenges such as the childhood obesity epidemic.¹⁴

In conclusion, the study by Rizzoli et al.⁵ as well as the evidence presented in the 2016 Lancet ECD Series,^2,4 strongly suggests that based on evidence, progress is being made in Mexico on the issue of ECD in early childhood. However, there is still a long way to go. Human development must be seen as a chain with many links that must be addressed during a lifetime and through different sectors, accordingly with the delivery of high quality standardized multifocal services tailored to the needs of children and their families.^2–4 That is why civil society must continue to work hard in a coordinated way to continue strengthening the political will and funding of the government for the benefit of Mexican children in the 21st century.

Acknowledgements

I dedicate this editorial to Ms. Laura Costas de Labarthe for her more than 50 years of dedication and commitment to the education and development of Mexican girls and boys.