Health and Nutrition

Health mediators – you are not alone!

By: Ivana Miljković

This blog post is a repost courtesy of UNICEF Serbia. Read the blog in Serbian here.

 

 

Serbia, Bor, Valjevo, 17 September 2020 – Marina Sinanovic, the only health mediator in Bor, is in an abandoned school, visiting the Demiri family. The mom, Elida, explains to her that she has been taking care of the five children on her own during the past month, because their father, Nesat, finally found a job.

Nadjija and Ibarim, already teenagers, help with caring for their younger sisters Elena, 6, and Leonora, 3, and their brother Nebojsa, who is 10.


© UNICEF Srbija/2020/Pančić

“Marina always tells us what to eat, to wash our hands, to study,” says Nadjija. Meanwhile, Elena brings her bag and shows us her toys. “I got building blocks and dolls. It’s for me and my sisters,” she says proudly.

 


Two and a half years ago, Marina decided to become a health mediator because she herself experienced discrimination and rejection as a child. She wanted to help her community, but also to help Roma children grow up to be more self-confident. Today, she cares for 400 Roma families.


 

© UNICEF Srbija/2020/Pančić

 

“There are a lot of Roma people who are uneducated and illiterate and are afraid to go to the doctor. Mothers take their children to get vaccinated, but they don’t go to the gynaecologist. I'm here to convince them, schedule an appointment, take them there. When the coronavirus pandemic started, the parents were afraid for their children, so I kept calling the doctors at the Primary Health Care Centre to ask what to do if the child coughs or has an allergy, which syrup to take, what to eat,” she describes how she spent days during lockdown.

 


During the state of emergency, she would answer more than 100 calls, messages and questions on social media daily. She was especially concerned about pregnant women and young mothers.
“I gave them advice on what to do with their babies, how to breastfeed them. I have excellent cooperation with the visiting nurses as well,” says Marina.


 

The fact that health mediators had many years of training about the importance of early childhood care and development, nutrition and learning through play, and were also empowered to help the Roma population in exercising their rights to health and social protection and education, proved to be especially useful during the COVID-19 pandemic.

 


© UNICEF Srbija/2020/Pančić


Marina and her colleagues were ready to devote themselves to children and help the most vulnerable families in difficult and unpredictable circumstances.


 

 

Marina says she can't tell just how many online meetings and workshops she organized with parents and children. The children learned new words, numbers, learned to calculate, to draw. Whenever there was distribution of humanitarian aid, including family boxes for learning and play, she would use the opportunity to explain to them how some resources, toys and board games can be used both for learning and bringing together family members, particularly siblings.

“I advised parents on how to play with their children, what stories to read to them. They had to fill that time, to forget that they were in lockdown. The children were thrilled, because in this difficult situation, when the family redirected all its money to buying food, the children received toys, to help them connect with their parents,” says Marina.

 


And 180 kilometres west of Bor, in the city of Valjevo, Gordana (Goca) Petrovic takes care of 600 Roma families.

 

“Whatever we needed, from paperwork to food and hygiene packages, we called our Goca. We have four children, and our eldest son Nemanja (16) has cerebral palsy, and she provided us with diapers for him. Can you imagine how much Goca means to us?”  This is how Darko Omerovic, who together with his family, receives welfare and lives in a Roma settlement on the outskirts of the city, talks about a family friend, a mother of three children, and a health mediator.

When Gordana started working 11 years ago, they were the first family she visited.

“That was when I first saw Nemanja, he was 5 at the time. I immediately took him to the dentist and to get vaccinated. I became so attached to this child, but he also became attached to me,” says Gordana.


She has helped them move to a better house, helped Nemanja get help from a neurologist, urologist, and physical therapist, and made sure that Ilija, 15, Aleksandra, 13, and Sara, 3, are vaccinated and that they receive everything they are entitled to through the social, health care and the education systems.

© UNICEF Srbija/2020/Pančić

 

The Omerovic family is just one of 600 Roma families Gordana is helping gain access to health care services. The lockdown due to the coronavirus pandemic was a challenge for everyone, and Gordana had to switch from fieldwork to phone and online counseling.

“We communicated by phone, via Messenger, Viber, and social networks. I connect with the family and teach them how to wash their hands properly and wear masks, I remind them to keep their distance and eat healthy food. I’m proud of all of them because they were disciplined. Until June, we didn’t have a single Roma person who was infected with the coronavirus, and to date, only four have been registered as positive to COVID-19,” says Gordana.

 


© UNICEF Srbija/2020/Pančić


She provided drinking water cisterns to the settlements without sewerage, and together with the Red Cross, she managed to visit each family at least once and bring them hygiene packages, food and toys. She didn't forget the Omerovic family. Sara, the youngest, was the happiest she received some toys and she proudly keeps telling us all the time, “I am three and a half years old.”
 

 

She always has her favourite doll with her. The thing she likes doing the most with Gordana is colouring. They also learned to count to 5, they boast. When her older sister is studying or is at school, what she likes the most is playing with building blocks with her dad.

“I don’t know a better father than Darko. He takes them to school, to the doctor, he plays with them. He gives all of himself to his children,” says Gordana and adds, “I also played dominoes with the children online for an hour and a half. It was a nice and new experience for them.”

However, what many needed the most during the lockdown was psychological support and a kind word.

“They were afraid. It was hard for them not being able to work. You know, many families are financially dependent on just one family member. I kept repeating to everyone – this, too, shall pass, the most important thing for you is to stay healthy,” says Gordana and recalls how she was afraid herself.

 


Gordana and Marina are just two out of 85 health mediators working with 60 Primary Health Care Centres across Serbia. They enjoy the trust of the community because of their dedicated work, but also because they are Roma women who come from Roma settlements and speak the Roma language.

 

In 2008, the Ministry of Health of the Republic of Serbia launched a project within which a network of health mediators was established and through which they were educated and empowered to support Roma communities in the health care system, and above all, to support families with young children. The process of institutionalization (integration) of their occupation and profession into the system is still ongoing. The pandemic has shown very clearly how important their role is, and their impact on families, thanks to the trust they have built.

UNICEF, as the Ministry of Health’s long standing partner, is supporting the continuity and quality of services provided by health mediators during the COVID-19 pandemic thanks to the financial support of GlaxoSmithKline (GSK). GSK is committed to improving the health of Roma children in the Republic of Serbia and the region through the “Together for Better Health” initiative.

 

INTESYS helps the EC Workforce work better - together

"Health, education, a safe and stimulating environment at home and in public spaces...none of these is more important than the other." - Mihaela Ionescu, Program Director at ISSA

Opportunities in integrating early years services

We know that integrated early childhood systems help children and their families, particularly the most vulnerable. They benefit from a "one-stop-shop" approach, through which the widest possible range of agencies and services are able to meet their needs either directly or through referral.

They also have benefits for the personnel working with young children. By offering the workforce opportunities to work across professions, the quality of staff practice is improved immensely. When centers are integrated, expertise can be shared across sectors (between health workers and teachers, for example) and work in both sectors can be boosted.

One U.S. study investigated joint working between mental health professionals, daycare, and pre-school staff found that collaboration made teachers more empathetic and interested in the deeper meaning of behavioral problems. These teachers had a greater level of control over, and responsibility for, behavior in their classroom. Training in integrated practice also allows staff from multiple sectors to develop a common way of working, and it enhances the efficiency and cost-effectiveness of service delivery.

In short, integrated systems help practitioners, managers and policymakers accomplish more together – all the while keeping the child at the center of their work. As those working in the field will tell you, this is what we’re after.

The road to integrating services…

INTESYS is a three-year project funded by the European Commission’s Erasmus+ Programme. A consortium of partners – Aga Khan Foundation, Compagnia San Paolo, Emanuela Zancan Foundation, Calouste Gulbekian Foundation, ISSA, Learning for Well-Being Foundation, Pedagoski Institut and Centre for Innovation in the Early Years – focuses on piloting new approaches to Early Childhood Education and Care (ECEC) systems in Europe. These pilots aim to ensure children and families in vulnerable situations have access to high-quality ECEC provided by services that are better integrated across sectors and professions.

It isn’t always easy. Even the terminology is not as straightforward as one may hope. Petra Bozovičar of Step By Step Center for Quality in Education mentions a question that arose when describing integrated systems to staff members working on the pilot – it is a question that many of us may have.

“If we call each other when there is a problem that we need to solve- is this not an integrated system?”

Representatives of another pilot plainly state just how difficult the road to integration can be:

Sometimes progress is made, other times you get stuck in reverse. It has become quite clear that cooperation and integration needs strong leadership, a driving force to keep partners motivated.

And, that is just what the INTESYS project is about – cooperation. Through the INTESYS project, a consortium is working together to create a toolkit for Integrated Services. This toolkit is meant to promote integration among different sectors, using the ECEC services as an entry point for integration. The approach takes into account the participation of communities, parents and civil society actors in shaping the integration of services. The Toolkit is promoting the importance of quality in integrated services and is opening the space for dialogue among different stakeholders in the early childhood system.

As a finalization of the INTESYS Toolkit is underway, many representatives of pilot projects have been articulating its success, and just how far they’ve come. One pilot explains:

We came to know each other better and connect with each other, which opened the way for new tasks and also contributed to solving current problems. Together we are stronger and more efficient in finding ways to the common goal.

Where can you learn more…

While we await the final toolkit, the draft can be found here.

You can also hear more about the barriers to making this approach work, the crucial role of the workforce and the leadership and the opportunities that it can create for the outcomes of young children listen to the webinar "Challenges and opportunities in integrating early years services: a spotlight on the workforce." 

Or, read this interview with, ISSA’s Program Director, Mihaela Ionescu where she discusses the need for multi-sectorial, integrated interventions that enable nurturing environments and adopt an individual-child and family perspective.


Did you find this interesting? Sign-up for our newsletter to receive updates about new resources and join the conversation about the early childhood workforce on Twitter.

Strengthening & Supporting the Early Childhood Workforce: A Global Overview

By: Radhika Mitter, program associate at R4D

Evidence is growing that early childhood development (ECD) services have a strong, positive impact on children’s development. Research from diverse contexts shows that interventions which promote nurturing care in early environments significantly improve childhood development and later adult outcomes. For example, a study of the Hogares Comunitarios de Bienestar program in Colombia, which provides child care and nutrition services to children under age six, found that adolescents ages 13-17 who had participated in the program were almost 20 percent more likely to be in school than those who had not participated. 

Despite increasing knowledge on the benefits of ECD, however, we still don’t know as much about one of the most critical parts of ECD programs: the early childhood workforce. Research shows that the workforce is one of the most important factors influencing the quality of ECD services. For example, in the early childhood education and care sector, evidence indicates that caregivers’ level of education and participation in training is a better predictor of program quality than other factors such as child-staff ratios or group size.

While we know that the workforce is important, key questions remain unanswered. What do early childhood professionals and paraprofessionals need to know and be able to do in order to perform effectively and how does this vary across contexts? What types of training and support do staff receive? How is the early childhood workforce recruited, monitored, and evaluated?

Answering these questions requires evidence that is global in nature and deeply textured to reflect the diversity of the early childhood workforce. Assessing and learning from the full breadth of early childhood efforts is no easy task, but it is exactly what we seek to do as part of the multi-stakeholder, multi-country Early Childhood Workforce Initiative (ECWI). Through the ECWI, we are carrying out a series of global landscape analyses on four critical themes: competences and standards, training and professional development, monitoring and mentoring, and recognition of the profession.

These analyses aim to establish the size and scope of the challenges faced by the early childhood workforce, while also highlighting promising practices countries have adopted in response to these challenges. Spanning a range of roles including professionals and paraprofessionals, paid and unpaid workers, and frontline workers and managers, from the education and care, health and nutrition, social protection and child protection sectors, these analyses aim to provide a comprehensive overview of the current status of the workforce worldwide. Such a vast review and synthesis of literature on the early childhood workforce has never been done before and is sure to generate some interesting findings.

 

What are the keys to the strengthening the workforce?

We are focusing on four themes which are essential to the strengthening and support of the early childhood workforce:

  • Competences and Standards – Competences and standards ensure that there are agreed requirements and expectations for what early childhood workers should know and be able to do. They also lay the groundwork for the core principles, regulations, guidelines and procedures guiding their work with young children and their families.
  • Training and Professional Development –Since the early childhood workforce is very diverse, including, for example, many volunteers or staff without formal education, training and professional development opportunities support the acquisition of necessary skills and competencies.  
  • Monitoring and Mentoring – Creating systems for monitoring, evaluation/assessment, and continuous feedback and coaching are important for ensuring that workers receive information that they can use to improve their practice on an ongoing basis and for linking members of the workforce to pathways for career advancement.
  • Recognition of the Profession – Currently, the level of remuneration, working conditions, and status of the early childhood workforce are poor, even relative to primary teachers, nurses, social workers, and other similar professions. Recruitment challenges, high turnover, and low morale compromise the quality of provision. There is a need to explore ways to improve the attractiveness and perception of the profession and promote ways to give voice to practitioners in their daily work and in policy discussions, including through collective action.

 

Where we are now and what’s to come

We are currently working on the first two of four landscape analyses covering competences and standards and training and professional development, two interrelated themes. Clearly articulated competences and standards ideally inform the way that training and professional development programs and curricula are designed. Simultaneously, effective training and professional development programs align with predefined competences and standards to ensure that early childhood professionals are equipped with the skills necessary to perform successfully.

The two landscape analyses will provide an overview of general early childhood workforce trends, explore key themes that emerge from the synthesis of literature, and provide in-depth country reviews to illustrate how systems are tackling key workforce challenges.

Initial findings from our research show that the number of university-level pre-service programs are increasing worldwide. In China, for example, more than 250 university-based programs, including 61 with master’s programs, have been established in the social and child protection field since the late 1980s, when social work was legally recognized as a profession. However, universally, challenges persist regarding quality of educational opportunities and in terms of who has access to them. Additionally, while countries have made efforts to align training and professional development opportunities with nationally and internationally recognized competences and standards, gaps persist between policy and practice.  Evidently, despite progress made in raising the status of the early childhood workforce, more work remains to be done. With that said, several countries have made significant efforts to address these gaps. For example, Indonesia has established a set of agreed upon core competences and core subject areas to be applied by all universities and schools of social work, allowing for consistency in the types of competences and skills emphasized in formal training programs for social service workers. Similarly, in the early childhood education and care sector, New Zealand has developed a robust teacher education and course accreditation process that ensures alignment between teacher training programs and predefined quality standards.

Through the ECWI landscape analyses, we plan to highlight promising approaches countries have adopted to address pressing workforce challenges, and also identify areas for further work.

We hope that a diverse group of stakeholders working in ECD can use the findings of these landscape analyses to:

  • Generate lessons for countries looking for ways to support and strengthen the early childhood workforce
  • Enhance existing programs, policies, research, and advocacy efforts concerning the early childhood workforce

Stay tuned for findings from these two studies, to be shared in the coming months.