pregnant or lactating women received counseling and health check-ups
children received early childhood development services
birth certificates issued
Children in poor rural communities get a head start
Some 82,000 Nicaraguan children received early childhood services from the IDB-financed Comprehensive Childcare Program (PAININ), which is designed to improve children’s welfare and schooling outcomes by fostering affective, physical, and intellectual development through better health care and nutrition, early intellectual stimulation, and better parenting practices. Through the program, 52,200 families have received counseling services in nutrition, hygiene, reproductive health, and prevention of physical punishment.
PAININ has been supported by the IDB since 1996. Stages III and IV of the program, which were approved by the Bank in 2006 and 2010 respectively, were financed by a total of $27.5 million in loans from the Bank’s Fund for Special Operations to ensure the program’s uninterrupted continuation.
Nicaragua is the region’s second poorest country, with 42.5 percent of its population categorized as below the poverty level and 14.6 percent as living in extreme poverty. The high prevalence of early or unwanted pregnancies in rural and marginalized communities in Nicaragua, combined with low access to health services, have contributed to high neonatal and maternal mortality rates and low child birth weights. The disadvantages under which many children are born is exacerbated in the early years of life by poor nutrition and inadequate child-rearing practices, which frequently result in malnutrition, anemia, and delayed growth and development.
In Nicaragua and elsewhere in the region, an investment in early childhood care and preschool education has been shown to produce significant returns in welfare and schooling outcomes. In addition, early childcare programs increase a child’s contact with the health care system during the critical first years of life. Strengthening the benefits of early interventions requires not only expanding their access by bringing them closer to families but also breaking cultural barriers that prevent families from making use of them.
Along with the financing it has provided for PAININ over the past 16 years, the IDB has also supported other initiatives in early childhood development and maternal health in Nicaragua. Examples include financing for Nicaragua’s Social Safety Net Program (1999-2006), the Program to Improve Maternal-Infant Health (2005-2009), the Program to Improve Family and Community Health (2011-present), and the Program to Strengthen the Ministry of the Family (MIFAMILIA, now MIFAN) to Reach Vulnerable Groups (2005-2011).
These programs have demonstrated the need to explicitly target poor families and to provide comprehensive care that includes aspects of affective development, health, nutrition, and cognitive development. These programs have also shown the need for strengthening the institutions responsible for their implementation to ensure that they are sustainable, build local capacity, and achieve their goals.
PAININ is carried out by MIFAN, which has undergone a process of changes to enable it to fully assume the leading role in implementing the government’s Social Welfare Policy.
The program in brief
PAININ finances a comprehensive series of early childhood interventions that promote better parenting practices and improved psycho-social, cognitive, and physical developmentof children from rural and marginalized communities.
Activities target children up to age six and are designed to improve later school performance and help break the chain of intergenerational transmission of poverty. The program is expanding early child care and preschool education in isolated and remote rural communities. The pedagogical model includes identification of children with special needs and encourages parents not to use physical punishment. The model also integrates traditional and indigenous artistic expressions (storytelling, music, and games) in the curriculum.
Parents receive counseling and group training in child rearing, nutrition, hygiene, and health. Children receive dietary supplements, both through sprinkles that contain essential vitamins and minerals and through light meals provided at childcare centers. Also included is the purchase of teaching, educational, and recreational material, replacement of furniture, and refurbishment of early education facilities.
IDB financing supports training in comprehensive childcare for municipal staff and for community-level workers. Finally, the program supports local governments in issuing birth certificates for beneficiary children; in many of the areas targeted by the program, more than 20 percent of children under age six are not registered.
The IDB's partners
The IDB’s PAININ operation complements the work of other donors, including the World Bank's financing for primary and secondary education. During the operation’s identification phase, meetings were held with the Norwegian Agency for Development Cooperation, which has supported PAININ in prior phases with the World Bank, the Central American Bank for Economic Integration, the United States Agency for International Development, and UNICEF.
Toward the future
Under Stage IV, the program will further improve the infrastructure of the childcare centers by refurbishing flooring, roofing, and latrines in approximately 500 centers. In addition, some 6,000 community-based educators are participating in a new training cycle that reflects updated standards of integrated care. The program’s new stage will also strengthen institutional mechanisms to ensure the integration of the welfare network between the ministries of health, education, and the family at the local and central levels. Training will be provided to 66 municipal early childhood committees, and funding will enable them to carry out social auditing of the program.