It is commonplace to lament the lack of integration in programs, beginning with conceptualization and planning. The sectoral segregation that characterizes most planning processes can be particularly harmful for programs of early childhood care and development, whose premise is that they should provide integrated attention because of the integral nature of children's development. A growing literature suggests that integrated programs bring a synergistic effect, helping to make better use of the resources each sector provides.

Integration at the level of ideas and policy
Integration begins with the conception of early childhood development. If the notion that children's development is an integral process is not accepted, integrating plans and programs and the delivery of services is more difficult. To foster acceptance of this idea, it may be necessary to devote time to advocacy at the outset of a project.

Integrated planning involves more than simply placing sectoral plans side by side, so that health, nutrition, and education components are all represented in a program. Truly integrated planning will ensure that these components get to children at the same time and that health and nutrition components provide an opportunity for learning, while education components contain health and nutrition content.

In ECCD programs it is possible to take a phased approach, integrating components in a stepwise fashion rather than all at once from the outset. That can make integration more feasible in the long run, even though it means sacrificing some integration at the beginning. And it may involve adding on to projects that are already under way. In health and nutrition services many ways have been found to integrate missing components. For example:

• Health posts in Chile have incorporated monitoring of psychosocial development into their maternal and child health monitoring.

• The PROAPE program in Brazil was conceived as a nutrition supplementation program but converted into an integrated program of child care and development.

• Nutritional recuperation programs have incorporated a psychosocial component with extraordinarily successful results.

• Programs focused on growth monitoring have taken advantage of the periodic sessions to weigh children by providing their mothers with information about early childhood stimulation.

Similarly, preschool, child development, and child care programs can integrate health and nutrition into their activities. They can make formal arrangements with health posts for periodic checkups, including monitoring of nutritional status, vision, and hearing. Or they can make cooperative arrangements with food supplementation programs. Child care centers can become focal points for immunization or micronutrient supplementation. Preschools or home day care centers can create small gardens that both provide food and teach nutrition habits. Centers can introduce simple procedures to monitor children's health and cleanliness (many centers regularly check fingernails and the cleanliness of hands). And they can build a curriculum around health and nutrition themes, with feeding time a learning time for children.

Integration of services
More difficult and more important than integration in planning is integration in delivering services. There is a tendency to want to incorporate all the dimensions of child development into one integrated service. But we need to be careful not to get hung up on the notion of an integrated service in which all the components are delivered by the same organization or in which disparate services are expected to integrate their deliveries. Although creating an integrated national plan of action for children is feasible, experience suggests that it is difficult if not impossible to integrate into one service the delivery of health and education components, for example. Government bureaucracies are vertically organized, each with its own budget and rules of project selection and operation, and trying to combine them is seldom fruitful.

For that reason it is useful to work toward the convergence of services on particular groups or communities or on one location, such as a community or home day care center, a preschool, a workplace, a health post, a community kitchen, or a supplementary feeding center. If this convergence can be achieved, it falls to the communities and local institutions to integrate the services locally. This process requires a certain level of agreement about who is most in need and who the main beneficiaries of a project should be. Fostering the participation of communities and families at all stages of a project can help support this local integration.

Integration in content
Integration in the content of programs also appears to be feasible. For example, health education programs directed to parents could incorporate a component on psychosocial development. To provide this content, the health sector could hire a psychologist, educator, or early childhood specialist, avoiding the need to "integrate" with another sector. Content from several fields can be brought together in education programs directed to caregivers and the general public, as shown by an example in the 1988 UNICEF publication "Facts for Life." Content has also been integrated in many child-to-child programs directed to children aged 10-12 who care for younger siblings.

Integration in the minds and actions of caregivers, families, and communities
Integration also occurs in the minds and actions of the people who surround children as they grow and develop, and here, fortunately, integration is not a problem in most of the world. Most people do not separate mental and social well-being from physical well-being. The challenge is to find ways to strengthen and build on the integrated concept of the child, and to fill in gaps in knowledge without disrupting the holistic vision that most caregivers have.