Introducción. La mayoría de las estrategias o programas que apoyan el desarrollo de la primera infancia en México son esfuerzos independientes que varían en escala, servicios que ofrecen y modo de proporcionarlos. Para la evaluación de la calidad de estos programas, un aspecto de suma importancia es el contenido curricular. El objetivo de este estudio fue realizar un análisis y comparación curricular de las distintas estrategias o programas enfocados en la promoción e intervención del desarrollo infantil temprano que ofrece el Gobierno Federal en los sectores Salud y Educación en México.
Método. Se realizó una revisión de la información de los contenidos curriculares de las estrategias o programas. La fase cualitativa consistió en un análisis documental comparativo con un ejercicio hermenéutico donde se identificaron los 75 indicadores propuestos por el Banco Interamericano de Desarrollo. La fase cuantitativa consistió en el análisis descriptivo de los indicadores. Finalmente, se hizo la comparación de los análisis para establecer el desempeño de cada uno.
Resultados. Se identificaron seis estrategias o programas. En el análisis de la presencia de indicadores, la estrategia Oportunidades de Aprendizaje (OA) fue la que presentó un mayor número de indicadores. En el análisis de amplitud, tanto PEI-CONAFE como OA fueron los mejor balanceados. Por último, en el análisis de profundidad de los indicadores, OA y Habilidades para la Vida fueron los mejor balanceados, mientras que PEI-CONAFE resultó el mejor balanceado para el área socio-emocional, CeNSIA para lenguaje y OA para el área cognitiva.
Conclusiones. La estrategia OA fue la que garantizó un mayor acercamiento a los contenidos establecidos por el Banco Interamericano de Desarrollo.
Background: Most of the strategies or programs that support early childhood development in Mexico are independent efforts that vary in scale, services offered and means to providing them. For the evaluation of the quality of these programs, an important aspect is the curriculum content. The aim of this study was to analyze and compare the curriculum content of the different strategies or programs focused on the promotion and intervention of early childhood development, which are offered by the Federal Government in Health and Education sectors in Mexico.
Methods: We conducted a review of the curriculum content of the strategies and programs. The qualitative phase consisted of a comparative analysis where 75 indicators proposed by the Inter-American Development Bank were identified. The quantitative phase consisted of a descriptive analysis of the indicators. Finally, the analyses were compared to stablish the performance of each one.
Results: Six strategies or programs were identified. In the analysis of the presence of indicators, the Oportunidades de Aprendizaje (Learning Opportunities, LO) strategy showed a larger number of indicators. In the amplitude analysis, both PEI-CONAFE and LO were the best balanced. Finally, in-depth analysis of the indicators LO and Skills for life were the best balanced while PEI-CONAFE was the best balanced in the social-emotional area, CeNSIA program for language and LO for cognitive development area.
Conclusions: LO strategy showed the closest level of contents established by the Inter-American Development Bank.
1. Introduction
Without any doubt, the first years of life are the most critical in terms of development of children as human beings. This is a short but unique period of life, during which it is possible to stimulate the potential of individuals in cognitive and non-cognitive areas since the basic formative processes of human beings are closely linked to early experiences of life. Therefore, it turns out to be the most significant period in the formation of the individual and it is key for the development of human capital1.
Stimulated children tend to show a greater development in the physical area and sensory systems (vision and hearing); on the other hand, they tend to show a greater ability for learning at later ages. The importance of investing in the development of children during their first years of life has been widely documented by specialized literature2.
It is estimated that more than 200 million children < 5 years of age who live in developing countries will not be able to achieve their maximum potential of development due to poverty and precarious conditions in their health and nutrition. These children are likely to have a poor school performance and limited economic opportunities in adulthood, perpetuating poverty and social inequality which will have serious implications for the growth and development of those countries3.
In Mexico, as in the whole world, significant changes that involve redefinition of roles of institutions aimed to support families—care centers, schools and health centers—have occurred, assuming a greater responsibility for the development and well-being of children. This responsibility was assumed through the creation of various strategies, programs, services or actions that favor the early childhood development (ECD), which only concerns children < 5 years of age, and are consolidating as a mechanism to improve life conditions of children and their families.
However, most of these strategies or programs that support ECD are independent efforts that vary in scale, services offered and means of providing them. The term ‘quality’ in these programs also varies considerably, as it may be inferred. Each program sees the definition of this concept through the prism of its context, opportunities and needs.
For governments, to improve quality usually means to ensure that the highest standards are set and that the development and learning of children are in accordance to their objectives. For the evaluation of the quality of these programs, various sectoral initiatives which intend to use indicators that represent a particular vision of the world on what is desirable in each program have arisen. An extremely important aspect—but unfortunately forgotten within this evaluation of quality—is the curriculum content, which importance lies in the setting of objectives and, therefore, desirable goals in pro of ECD4.
The objective of this study was to conduct the analysis and curriculum comparison of different strategies or programs focused on the promotion and intervention of ECD offered by the Federal Government in health and education sectors in Mexico. This type of analysis will allow the recognition of strengths and weaknesses in the curriculum content of current programs focused on ECD operating in Mexico and, similarly, to give solid recommendations (based on evidence) for the creation of new curriculum contents seeking to actually have an impact on Mexican children.
2. Methods
We conducted a qualitative and quantitative study. Initially, the strategies or programs that exist in Mexico were reviewed; only those programs offered by the Federal Government in health and education sectors responsible for promoting and/or intervene in the ECD in children < 5 years were grouped and analyzed. The information of its curriculum contents, operating rules, standards and evaluations (impact, operational and satisfaction) was used as well as other secondary sources (internet). Despite having broad coverage and being crucial for children < 5 years of age, those which did not include any component for ECD were excluded.
The qualitative phase was developed after obtaining the required information. This consisted of a comparative documentary analysis with a hermeneutic exercise of multiple sources of data where two researchers identified, independently, each of the 75 indicators proposed by the Inter-American Development Bank (IDB) within the curriculum content of each strategy or program5. These 75 indicators were divided into two sections, one from 0 to 36 months and another from 36 to 60 months, altogether assessing four domains of development: physical/motor, social/emotional, language and cognitive (Tables 1-8).
These indicators present the following characteristics:
• They respond to the objectives proposed in this study
• They are short and precise
• They evaluate only one aspect of the program
Different opinions regarding the identification of indicators in any area of the curriculum contents were reviewed and agreed on.
The quantitative phase consisted of the descriptive analysis of the indicators which included the following information:
• Presence of indicators: percentage of indicators for each domain present within the curriculum content of the strategy or program.
• Amplitude of indicators: percentage of the total curriculum content of the strategy or program dedicated to each domain according to IDB indicators.
• Depth of indicators: percentage of each indicator in the curriculum content of the strategy or program in every domain according to IDB indicators.
Finally, the comparison of the previously described analysis was made to establish the performance of each strategy or program according to the indicators. Microsoft Excel 2013 statistical software was used for the quantitative analysis.
3. Results
A total of six strategies or programs of health and education sectors were included in the analysis. These programs or strategies were the Technical Guidelines for Early Stimulation from the National Center for Child and Adolescent Health (CeNSIA, for its Spanish acronym), Community Workshops for Self-care in Health (TCAS, for its Spanish acronym) from the Social Inclusion Program (PROSPERA, for its Spanish acronym), Growing and Learning Together (CyAJ, for its Spanish acronym) and Learning Opportunities (OA, for its Spanish acronym) from the National Commission for Social Protection in Health (CNPSS, for its Spanish acronym), Skills for Life (HV, for its Spanish acronym) from the Popular Health Insurance, and the Non-schooled Initial Education Program from the National Council for Education Development (PEI-CONAFE, for its Spanish acronym). Table 9 shows a brief description of each one of these strategies or programs.
3.1. Analysis of the presence of indicators
Following the completion of this analysis, it was observed that none of the strategies or programs analyzed contained 100% of the indicators in the four domains proposed by the IDB. OA strategy showed the greatest number of these indicators, with 100% (12/12) indicators for physical/motor skills, 90.9% (20/22) for social/emotional skills, 76.5% (13/17) for language skills and 70% (14/20) for cognitive skills; while CeNSIA showed the least presence of indicators in all the areas (Figure 1). On the other hand, two particular aspects draw our attention:
Figure 1 Presence of indicators in each of the strategies or programs focused on ECD from the Federal Government in the health and education sectors. CeNSIA, Technical Guidelines for Early Stimulation from the National Center for Child and Adolescent Health; TCAS, Community Workshops for Self-care in Health; CyAJ, Growing and Learning Together; OA, Learning Opportunities; HV, Skills for Life; PEI-CONAFE, Initial Education Program from the National Council for Education Development.
• The clear trend of an increased presence of physical/motor indicators in all programs or strategies analyzed, ranging from 50 to 100%.
• The negligible presence of the cognitive domain indicators in the vast majority of these programs or strategies.
3.2. Analysis of the amplitude of indicators
Following the completion of this analysis, it was noted that there is a tendency of strategies or programs to allocate a greater percentage of their contents for the physical/motor domain. The exception was the PEI-CONAFE program, which allocated the highest percentage of its curriculum to the social/emotional domain (35%). On the other hand, no strategy showed an amplitude balance in its contents and the majority dedicated a low or null percentage in the cognitive domain. Those better balanced programs were PEI-CONAFE and OA, while CeNSIA was the most unbalanced (Figure 2). It should not be forgotten that this is a general picture of the curriculum of both strategies, and the amplitude of indicators may behave differently according to the different ages at which they are directed to.
Figure 2 Amplitude of indicators in each of the strategies or programs focused on ECD from the Federal Government in the health and education sectors. CeNSIA, Technical Guidelines for Early Stimulation from the National Center for Child and Adolescent Health; TCAS, Community Workshops for Self-care in Health; CyAJ, Growing and Learning Together; OA, Learning Opportunities; HV, Skills for Life; PEI-CONAFE, Initial Education Program from the National Council for Education Development.
3.3. Analysis of the depth of indicators
For this analysis, the main indicators for each of the four domains were chosen according to the criterion of the researchers.
3.3.1. Physical/motor domain
The following indicators were selected for this domain:
• Attention
• Sensory processing
• Sensory integration
• Gross motor skills
We observed a great variability in the percentage that these indicators are addressed by the programs or strategies. In contrast to others, OA and HV are those which include these four indicators in a relatively balanced way (Figure 3). It is worth noting that all programs or strategies analyzed have a preferential predominance by aspects of gross motor skills (20-41.6%) and a frank tendency to not address the indicator of attention (2-17.9%).
Figure 3 Depth of the main indicators of the physical/motor domain in each of the strategies or programs focused on ECD from the Federal Government in the health and education sectors. CeNSIA, Technical Guidelines for Early Stimulation from the National Center for Child and Adolescent Health; TCAS, Community Workshops for Self-care in Health; CyAJ, Growing and Learning Together; OA, Learning Opportunities; HV, Skills for Life; PEI-CONAFE, Initial Education Program from the National Council for Education Development.
3.3.2. Social/emotional domain
For this area the following indicators were selected:
• Initiative
• Empathy
• Expression of emotions
• Interest and exploration behavior
In this area, it was found that indicators are addressed poorly. The vast majority do not address the indicators “initiative” and “expression of emotions”. On the other hand, the only indicator that is approached consistently by the curriculum of all strategies or programs is the “interest and exploration behavior” (Figure 4). PEI-CONAFE was the better balanced in these indicators, despite treating them very little within its curriculum.
Figure 4 Depth of the main indicators of the social/emotional domain in each of the strategies or programs focused on ECD from the Federal Government in the health and education sectors. CeNSIA, Technical Guidelines for Early Stimulation from the National Center for Child and Adolescent Health; TCAS, Community Workshops for Self-care in Health; CyAJ, Growing and Learning Together; OA, Learning Opportunities; HV, Skills for Life; PEI-CONAFE, Initial Education Program from the National Council for Education Development.
3.3.3. Language domain
The following indicators were selected for this domain:
• Non-verbal communication
• Verbal communication (receptive and expressive)
• Speech
• Music
The indicators in this area are heterogeneous in the curriculum content of the different programs analyzed. CeNSIA is the only program that shows a balanced approach of them, while HV only addresses “speech” (64%) and “music” (21%) indicators (Figure 5). While these aspects of language are practically treated in the same way, it is worth noting that there is a slight tendency to prefer the aspects of “speech” over “verbal communication”.
Figure 5 Depth of the main indicators of the language domain in each of the strategies or programs focused on ECD from the Federal Government in the health and education sectors. CeNSIA, Technical Guidelines for Early Stimulation from the National Center for Child and Adolescent Health; TCAS, Community Workshops for Self-care in Health; CyAJ, Growing and Learning Together; OA, Learning Opportunities; HV, Skills for Life; PEI-CONAFE, Initial Education Program from the National Council for Education Development.
3.3.4. Cognitive domain
The following indicators were selected for this area:
• Imitation
• Symbolic game
• Permanence of objects
• Personal information
Indicators in this area are practically null in the curriculum content of the analyzed programs. OA is the only program that shows a relatively balanced approach of them; CyAJ only approaches the indicator “imitation” (16.6%) and the rest of the programs or strategies do not address any of the other indicators (Figure 6).
Figure 6 Depth of the main indicators of the cognitive domain in each of the strategies or programs focused on ECD from the Federal Government in the health and education sectors. CeNSIA, Technical Guidelines for Early Stimulation from the National Center for Child and Adolescent Health; TCAS, Community Workshops for Self-care in Health; CyAJ, Growing and Learning Together; OA, Learning Opportunities; HV, Skills for Life; PEI-CONAFE, Initial Education Program from the National Council for Education Development.
4. Discussion
In Mexico, several programs or strategies to promote ECD and improve life conditions of families have been developed. Policies for early childhood have been designed and implemented by a variety of institutions that relate to different secretariats of the Federal Government, as the Secretariat of Health and the Secretariat of Public Education, therefore are independent efforts that vary in scale, services offered and means to providing them6.
According to the proposal of Peralta and Fujimoto7—in which the “relevance of content” is one of seven conditions that early childhood programs must meet—in this analysis the vast majority of programs or strategies showed a predominance in the presence of indicators of the physical/motor domain, the partial presence of both social/ emotional and language domains and a poor presence of the cognitive domain. There is no complete certainty of the causes that have led to this situation. However, as a situation that does not only occur in our country, it can be assumed that it is mainly due to the predominance of the psychomotor therapy approach (which is purely physical and motor) of those who design and implement the curriculum content. This makes it necessary to consider that the approach of ECD in Mexico is currently focused on a single vision within a large number of currents, each one with a very particular point of view to understand and address childhood development. Physicians, rehabilitation physicians, therapists and psychomotor therapists have a very particular way to understand and address ECD; therefore, there is the need to include other figures, such as teachers and psychologists, for the construction of interventions and actions focused on stimulation. An example of the above, which was constructed by a group of physicians, psychologists, educators and language therapists and showed a good performance in the presence of indicators, was the OA program.
Furthermore, the amplitude of indicators analysis showed that, on the one hand, the vast majority of programs are unbalanced in their content, with a predominance of the physical/motor domain; on the other hand, the only balanced program was PEI-CONAFE (17% in the physical/motor area, 35% in social/emotional area, 28% in the language domain and 20% in the cognitive domain). These percentages may lead to consider a holistic view in the distribution of its content yet not in the quantity of indicators, since the presence of indicators of all areas within the curriculum reached only 50%. Given this, it is important to consider not only the richness and variety of the content, but also the number of times it is worked within each area.
Although it is desirable to have a balanced content, the particular conditions of children should be considered first. Elvir and Ascencio proposed that early learning programs should be designed according to the development of children, respond to the social context in which they are immersed and implement pedagogies that place children in the center of each activity.8 According to this, the construction of curriculum content should be based in population studies on the conditions and development of children that will be addressed. In 2014, Rizzoli-Cordoba, et al.9 reported that 29,484 children under 5 years of age in the state of Guanajuato, Mexico, were evaluated with the Child Development Evaluation (CDE) screening test. From these children, 79.9% showed normal development; 14.9%, developmental lag; and 4.2%, risk of developmental delay. In the groups with developmental lag and risk of delay, a higher prevalence of problems in the gross motor area was noted in the first year of age; in the area of language, in the second year of age; and in the cognitive area, during the third and fourth years of life. These data were consistent both in rural and urban populations. This makes it necessary to consider the construction of not-balanced curriculum contents aimed to strengthen the particular weaknesses in different periods of child development: in the first year of life focused on the physical/motor area; in the second year focused on language; and during the third and fourth year focused on the cognitive area.
With respect to the analysis of depth we have verified the indicators, and therefore the primary actions necessary to work in each of the areas for the different curricula contents analyzed. In general, the indicator with the highest presence was the gross motor followed by development and sensory integration within the physical/motor domain. As stated before, we consider that this preponderance is due to the strong psychomotor trend in the construction of the curricula. In our opinion, emphasis to this area should continue during the first year of life but not exclusively for the gross motor indicator. It is important to remember that motor and sensory-perception skills develop in a reciprocal way, parallel to the process of maturation; the development of these functions is a starting point to establish milestones in other areas of the ECD.10
From the social/emotional domain, the interest and exploration behavior indicator was approached. Nevertheless, the aspects of initiative and empathy should not be left behind; particularly the latter, since poor empathy-related problems have been associated to various mental disorders.11
In the area of language, it is noteworthy that the vast majority of the curricula focus on basic topics, such as speech, but actually not on the understanding and emission indicators (receptive and expressive verbal communication). It is well known that the problems of interpretation and expression of the language will have an impact on the academic processes of school age at older ages and, in general, in other skills or cognitive functions, such as working memory in the adult age.12
Finally, with regard to the cognition domain, virtually any program addresses aspects related to this area. During childhood and adolescence, the exposure to multiple socio-cultural risk factors impacts directly on children’s cognitive development. Poor academic performance, poor employment opportunities in adult life and the inability to break cycles of poverty may come as consequences of the absence of actions or interventions focused on this area. It is essential that the curriculum contents of these programs or strategies focus on promoting indicators of this domain at all cost.13
On the other hand, our group has found some other interesting aspects in the curriculum contents which are not related to the indicators of the IDB but are worth mentioning:
• Within the strategies or programs revised none of them has a content aimed at preventing risk factors and promoting child development from the prenatal period. Intrauterine life span represents one of the most sensitive periods of the development of the child. It is known that the exposure to various adverse circumstances, such as maternal depression, maternal malnutrition, restriction of intrauterine growth, among others, can influence immune/inflammatory processes that will impact directly on the postnatal development of the child.14 Our group proposes the construction of curriculum contents that may be evaluated from the prenatal period.
• All programs reviewed have a net approach to stimulation actions, but none of them shows a clear focus on parenting practices. There are several studies that demonstrated the existence of a link between the upbringing and the child’s cognitive development. Specifically, some studies framed within the paradigm of development cognitive neuroscience found that changes in parenting practices may impact the neurodevelopment of children and, concomitantly, their behavior and their cognitive performance. An adequate family support with psychosocial favorable factors in the early childhood influence a greater volume of the hippocampus of both temporal lobes.15 We propose the creation of new curricula with a clear and direct focus on parenting practices.
• All the revised curricula showed efforts to stimulate a single milestone of development, or in other cases, to facilitate the acquisition of a single competition. The vision for addressing child development should be holistic, and comprehensive in all aspects and senses since cognitive, emotional and language development results from brain plasticity and integration of different areas through the years. As a result, no independent skills arise but a series of interconnected and interrelated milestones in different areas.16 We suggest to create, for future curriculum contents, activities that promote several developmental skills at the same time.
This analysis highlights the strengths and weaknesses of the curricular content of the main strategies or programs focused on the promotion and intervention of early childhood development offered by the Federal Government in the health and education sectors in Mexico.
OA is the strategy that guarantees a better approach to the contents established by the IDB. Therefore, in this review, OA is considered as a prototype of strategy since it fulfilled the diverse curriculum content analyses based on the 75 indicators from the IDB in the best way, while the rest complied partially with the proposed indicators. Despite this, it is important to strengthen the cognitive and language areas in all the programs.
It will be necessary to perform another type of analysis focused on operational aspects of the programs, such as the mode of delivery, location and teaching staff—since they can be offered at home, in community centers or in childhood development centers—as well as the type of program, resources, intensity of the intervention, goals and needs of the population served.
The need for multidisciplinary work with a holistic view of the curriculum of different strategies to give quality and variety in the aspects of intervention and stimulation to Mexican children is imminent.
Ethical disclosure
Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this study.
Confidentiality of data. The authors declare that no patient data appear in this article.
Right to privacy and informed consent. The authors declare that no patient data appear in this article.
Funding
External funds came from the agreement of collaboration between the Hospital Infantil de Mexico Federico Gomez and the National Commission for Social Protection in Health from the Popular Health Insurance (agreement CNPSS/Art 1°/023/2013: Design of implementation and evaluation of the childhood development strategy for children < 5 years of age beneficiaries of the ‘Oportunidades’ program).
Conflict of interest
The authors declare no conflicts of interest of any nature.
Acknowledgments
To Dra. Fátima Adriana Antillón Ocampo, Lic. María Esther Valadez Correa, Dra. Hortensia Reyes Morales, Lic. Elías Hernández Ramírez and Ana Alicia Jiménez Burgos.
Received 23 October 2015;
accepted 23 October 2015
Available online 27 March 2016
☆ Please cite this article as: Vargas-López G, et al. Análisis y comparación curricular de las estrategias o programas para el desarrollo infantil temprano en México. Bol Med Hosp Infant Mex. 2016;73:90-104.
* Corresponding author.
E-mail:zucca@live.com.mx; gvargas@himfg.edu.mx (G. Vargas-López).