Too many lives missed!
Sri Lanka is well known for it’s health care structure indicative of outcomes that are seen as exemplary to the developing world. With 99% of all maternal deaths occurring in the developing world, the South Asian region accounts to the predominance of these. Sri Lanka’s closest neighbour India both on geographical as well as on influential grounds, has an estimated 300 maternal deaths per 100,000 births whilst in Sri Lanka it is less than 30 per 100,000 live births. A similar trend is also seen in infant mortality rate. These indicators illuminate the long established healthcare structure of the country, that has prioritized training health professionals towards serving the poorest and the most under resourced communities in the country. It also stand as a testament to the long establish medical education of the country ensued solely by state investments.
Investment disparity in acute and rehabilitative care for children
Nevertheless when skilled doctors in the country save lives at the birth of infants who have odd chances to live, there remains a dire lack in trained professionals monitoring and facilitating optimal child development. Infants who have faced complications before, during and after birth are at risk in achieving milestones in their development. Some of the disabilities are presented on full scale later on in a child’s life due to medical professionals and parents missing out on early presenting signs. Many children in the country have been diagnosed with childhood developmental disabilities the effects of which could have been minimized or even reversed if early detection and treatment were provided.
The most common conditions that call forth for investments made in child development are Learning Disability, Cerebral Palsey and Autism Spectrum Disorder (ASD) All of these conditions have the ability present better outcomes if detected early. Following early identification, intervention needs to be provided early enough within the period where a child’s brain is still developing where the brain is more responsive to stimulation. Thus systematic environmental exposures can change the outcomes of a child’s life if facilitated early enough, ideally before the age of five.
Beyond mere living, making children contributors
Yet in Sri Lanka it is still a farfetched reality to many at risk children to be a part of an early intervention program that could change their level of functioning for the rest of their lives. Despite the great strengths indicated by the health system, adequate recognition and financial investments have not been made for the area of child development and rehabilitation. The government and other emerging main stream private health care systems at present focus mainly only on acute care pertaining to child health and much less on preventive and rehabilitative measures pertaining to childhood disabilities. The current health structures have failed to recognize that following acute care a process involves in making a child functional, beyond mere living.
High and rising prevalence
According to global statistics about 15% of children aged 3 to 17 are diagnosed with a developmental disability. The presence of Autism have increased by 289.5% globally over the last decade. Prevalence of Attention Deficit Hyperactive disorder (ADHD) have by increased 33.0%. Males children are seen to be having twice the prevalence of any Developmental Disorder than females and more specifically had higher prevalence of ADHD, autism, learning disabilities, stuttering/stammering.
In Sri Lanka too there has been a rise in the presence of developmental disabilities in children with a recent study showing 1 in 93 children in Sri Lanka are affected by the disorder. However at present there also remains a significant gap in the amount of data available on these conditions with minimal research done despite its presence being seen evidently more within health and school settings.
Minimal goal oriented investments made for child development
Dr. Samanmali Sumanasena, Consultant Peaditrician and Senior Lecturer at the Faculty of Medicine, University of Kelaniya, is a developmental peaditrician with many years of experience both within the hospital and academic setting of Sri Lanka. Speaking to Ceylon FT she stated that at present minimal planned, goal oriented investments are made by authorities towards facilitating optimal child development through early identification and intervention given to developmental disorders.
“ Given the rate at which we encounter children with developmental disabilities the country is likely to end up with a significant amount of the population being unable to contribute positively to the country within the next two decades, simply because we as a country failed to recognize the need to invest in child development. We need to take immediate measures to reverse these outcomes of at risk children by investing within the education and heath care structures. Well trained professionals to identify and provide 360 degree treatment to these children are very important, without which these children will fall through the cracks and will be labeled as invalids and be highly dependant in the future.”
Comprising a high number of depandants who are unable to contribute to the developments of the country poses a critical thereat to a country’s economy. Thus the dire need for a national program that would facilitate child development to all children at risk for disability and having a disability is currently seen as a critical investments the authorities should make.
More Economically Developed Countries (MEDC) and Early Intervention investments
Many developed economies have singularly recognized the need for investments made in early intervention and thus are reaping the benefits of a more productive labor force that contribute to the economy overcoming and despite disabilities. Head Start is a program of the of the United States Department of Health and Human Services which provides comprehensive early childhood education, health, nutrition, and parent involvement services to low-income children and their families. Studies have shown that young children with multiple disabilities who are enrolled in this program have better outcomes in reading, writing and math scores. The Return On Investment (ROI) of the Federally/Nationally funded Head Start program in the US ranges from USD 7-9 for every dollar invested.
Recommendations have been made to the National Commission on Fiscal Responsibility and Budget Reform that budgetary allocations should be made and not cut for such programs. It is also reported that such programs yields a higher rate of return to society than spending money on secondary education and job training programs. The European Union has also recognized and endorsed investments made in the like by the governments of countries in Europe. Canada, Australia and the United Kingdom too have recognized and facilitated such programs as part of a national initiative.
Parental investment in spending time with children in play
Investments made in children should be multifaceted starting from creating a home environment conducive towards a child’s development. Many parents have traded one-on one time with children with electronic devices such as televisions and phones, which has significantly affected the regression of a child’s overall development. This has also contributed to the increase of the severity of certain developmental disabilities. Speaking further Dr. Sumanasena said that there is much that needs to be done by the child development authorities particularly in training professionals involved with children.
“ Currently there is no screening available for babies and toddlers to detect developmental concerns. Many pre school teachers are absorbed into our education system with no or minimal qualifications and training on child development. Little do we realize that these are the individuals who will shape our children’s lives to the better or to the worse. This is very important because at this age a child’ s brain is still developing and there is much that can be changed and improved through the exposures a child gets through pre school. It is therefore critical to have ongoing trainings for these professionals as they would be the ones who will be shaping the lives of the next generation.”
Minimal public infrastructure conducive for child development
Investments should also be made in public infrastructure targeting early childhood development. Facilities and schools designed in a way condusive to providing optimal brain stimulation for children should be a part of a national program. Other facilities such as themed parks, museums and other stimulatory environments needs to be build and be accessible for all children in this country. Including for children with disabilities.
“ Awareness should be raised within all stakeholders on child development. Parents, doctors, teachers, health professionals and all other professionals need to take action now, if we want citizens in this country who are well developed not just grown.”
UNICEF has strongly emphasized that ‘Evidence-based research and multi-country experiences provide a strong rationale for investing in Early Childhood Development (ECD), especially for children at risk of developmental delay or with a disability. Both the Convention on the Rights of the Child (CRC) and the Convention on the Rights of People with Disabilities (CRPD) state that all children with disabilities have the right to develop “to the maximum extent possible”.’ Sri Lanka at present having ratified the United Nations CRPD thus should take active measures to include these investments within its health care structures in viewing capital spent on child development a lucrative investment made in the country.