Last week I travelled to Malawi to visit some of Sightsavers’ programmes in Blantyre and Chikwawa regions.
Travelling with me were two British Labour MPs – Ivan Lewis, Shadow Secretary of State for International Development, and Dame Tessa Jowell, former minister for London and the Olympics. They were particularly interested in seeing the work that Sightsavers does with very young children, as they develop their thinking around early childhood development programmes (ECD). For Sightsavers it was an opportunity to showcase our work to policymakers in the UK, and make the case that disabled children should be fully included in any new initiatives. What has been lacking until now is evidence and best practice that shows how to adapt ECD interventions for children with disabilities.
There is a wealth of evidence to show that the ‘first 1000 days’ from conception to a child’s second birthday are crucial, and that if children do not receive the food, stimulation, and care they need during this time, the damage to their development cannot be put right later. ECD programmes bring together interventions related to education, health, nutrition, and parenting to set children on a path of good physical, emotional and intellectual development that will help them become happy, healthy and productive adults. What has been lacking until now is evidence and best practice that shows how to adapt ECD interventions for children with disabilities.
The links between poverty and disability are a major focus of Sightsavers’ work – we know that disability can often lead to poverty (not just for the disabled person but their family too) and that poverty, in turn, increases the risk of disability. Sightsavers’ programmes in Malawi are trying to break the link between disability and poverty by intervening early in the lives of disabled children.
In Blantyre we visited a project working with the existing structure of community-based childhood centres, which are run by the local community with little support from the Malawian government. Children attend from two to about six years old – preparing them for primary education, ensuring they receive at least one meal a day (of maize porridge), and enabling their parents to work or, as was the case in Chisomo, attend to their subsistence agriculture work. Sightsavers, along with local partner organisations, has supported the centre to improve its resources and standard of teaching, and to ensure the centre is inclusive of children from the community who have disabilities. As well as working with the centre itself, this also means a lot of outreach and relationship-building with the children’s parents, to encourage more children with disabilities to attend school.
Working with parents is also a major component of the project we visited the following day at the Chilomoni resource centre, which is supported by Sightsavers’ innovation fund. This is a drop-in group, run by an incredibly passionate special needs teacher called Caroline, where blind and visually-impaired toddlers and their mothers come to receive support and advice on how to interact with and stimulate their children: for example, by using audible toys (such as a margarine tub filled with stones) that their children could follow. We were very impressed to hear that Caroline gave up her time for free to run the session; the same was true of the committee who ran the Chisomo centre.
“Silos are the enemy”
A later meeting with FEDOMA, the umbrella group for disabled people’s organisations in Malawi, confirmed the impact that dedicated people can have, even with little resources and against the odds; FEDOMA lobbied for the passing of Malawi’s first Disability Act last year. The Act is just a beginning, however – all speakers stressed issues with implementation. This was echoed in all the meetings on our final day, with the UK’s Department for International Development (DFID)and High Commissioner, Michael Nevin, with a variety of Malawian government ministers (including representatives from the departments of gender, education, health and disability), and later, with the finance minister, Ken Lipenga.
Early childhood development is a very good example of a cross-sectoral issue. In a country like Malawi, where 74 per cent of people live below the poverty line, the challenges with implementation are numerous, but one that came up again was the danger of ‘silos’. This doesn’t mean grain silos – although they also came up in a couple of our meetings! – but the problems that can often occur when different people or departments work on their own issue or project but do not join up with other related efforts. ECD is a very good example of a cross-sectoral issue; to be done effectively it needs to bring together nutrition, health, education, sanitation and much more, to provide an integrated and effective service that tackles poverty from all angles.
The same is true of disability; while Malawi’s Department of Disability can implement some programmes that tackle the specific needs of people with disabilities (eg community-based rehabilitation services), they must also cooperate with efforts to provide education, sanitation, healthcare, employment and more to the general population, to ensure that these are also accessible to the proportion of the population who have a disability. Working across sectors can achieve more without necessarily spending more money, a point our two visitors were keen to make to the finance minister of Malawi over dinner on our final evening. Let’s hope he is able to persuade his Cabinet colleagues that addressing the needs of young children and disabled people is an essential foundation of Malawi’s future development.