Interview with Irma Khabazi, OSGF Public Health Program Manager
Discussions on early child development program started in Georgia years ago. Today, there exists the state program, as well as the beneficiaries, who receive the services provided by the program in various regions of Georgia. Still, certain challenges are remaining in the part of geographic availability and quality control. Publika interviewed Irma Khabazi, Open Society Georgia Foundation’s Public Health Program Manager, on this and other issues. Since 2011, the Open Society Georgia Foundation (OSGF) has been supporting the Early Child Development Program and its implementation in Georgia.
When did the discussions on the creation of early child development programs begin in Georgia?
The discussions on early child development programs were launched in Georgia by parents, particularly Nino Tsintsadze, together with the organization Portage.
If I am not wrong, the issue was first raised in 2009. Portage played a huge role in it. It was largely due to their efforts that the state program on early child development existed in the country by that period. The state was providing services to 40 children through vouchers.
There was another organization “First Step,” which was also working in the sphere of early child development.
Shortly speaking, when the Foundation decided to promote this sphere, there already existed the early child development program and very good organizations.
Other related programs also existed for children, but early child development program differs from these programs as the concept of early child development program does not focus on diagnosis, but the entire emphasis is laid on children’s capabilities.
We supported the methodology, envisaging home visits, i.e. providing children with services envisaged by the program at home – a parent spends the most time with a child. A specialist should visit them at home, involve a parent so that the latter continues working with a child.
When we joined this sphere, there were a number of factors promoting us and convincing us of the importance of this issue. As I have already mentioned above, it was parents’ participation, very interested parents, who cared about the fate of their children and spared no efforts for their wellbeing.
Open Society Georgia Foundational had historically worked on the issue of deinstitutionalization; so, we supported this reform aimed at returning the children from state care to their parents’ care.
One of the reasons why children appeared in state care was the parents’ failure to cope with this burden. Therefore, it was important to have support services to prevent the removal of children from their parents’ care. It was one of the factors.
In which particular direction did the Foundation begin its work?
We started to develop an early child development program. We worked in several directions – one of these directions involved empowering service providers. Familiarization with and adaptation to international practice was part of this direction. We wanted to train professionals and pilot correct, evidence-based models. We worked at the level of state policy to ensure that the state had a vision and strategy in this direction.
We invited all people/organizations linked to this sphere and involved them in the processes. Then, we picked three main partners and started working with these three organizations. Later, the Coalition for Early Childhood Development was established in partnership with these organizations. It happened in 2012-2013. The Coalition underwent official registration and we started to insert in our correspondence the names of all the organizations interested in the issue of early child development.
Six basic steps were outlined without which the system could not have worked. Consistent and regular work was needed in this direction. One of the directions involved the work on identification. The selected partners developed an adaptive questionnaire. It was the ages and stages questionnaire. Identification should have taken place according to this questionnaire.
One of the directions involved the assessment and training of service providers.
Portage worked on the relations between early child development programs and kindergarten, and First Step – directly on the services.
It was extremely important to create a framework, in which everybody would work. Services were provided only in frames of the state program. The system of voucher funding already existed. Portage already had 40 beneficiaries, who were receiving vouchers from the state. The work was done in this direction to increase the number of vouchers.
Was the participation in the program tied to diagnosis from the very beginning?
As far as I know, participation in the early child development program is tied to diagnosis. It is desirable that it is tied to the condition of a child.
In the countries, where the system is developed well, service providers, unlike us, enjoy more trust. Hence, the participation in the program is not tied to diagnosis and providers make decisions according to the condition and progress.
Georgia has failed to create such a system so far.
As you have mentioned above, one of the important directions was to work on identification. So, you purposefully worked to improve the process of identification of those children in Georgia, who might need this service. How has the situation changed in this direction?
When we talk about early child development, it is critically important that identification, as well as the provision of services, takes place until a child turns 7. The work may start in a prenatal period – before birth when certain changes to embryo development standards are revealed. Then, it is followed by a maternity hospital, pediatrician, family, and child.
I can tell you that the age of identification has been decreased significantly, it is less than one year. Of course, there is certain progress in this direction.
Presently, the number of service providers is much higher than it was years ago; however, problems remain in terms of geographic coverage. As known, even in the cities, where the program implementation started long ago, the problem of children waiting for the program services is still persisting.
Complete geographic coverage is not provided, but if we look at the dynamics of development, we will see important progress achieved over the years.
The number of beneficiaries has increased from 80 to almost 1000. But if we compare these figures to the figures in other countries, it is only one-tenth per capita. The need for this service is higher in our country.
Yes, we have the list of waiting children and the lack of professionals is one of its reasons. We seemingly have financial resources but we lack professionals.
It was clear from the very beginning that we would not be able to create the system in a minute and it would be developed step by step. So, we created a framework document, outlining all the directions necessary for the development of this sphere. We outlined a series of actions by years – what, when and how they should be done. These actions are improved identification and training of professionals.
The Coalition for Early Child Development plays a key role in training professionals.
A very important achievement that needs further promotion is the program developed for mountain regions. A special program has been developed and it was adapted to mountain regions. As known, the key goal of this program is to provide home services. So, we took international experience into consideration and trained rural professionals on the ground, who later got involved in the program implementation.
We are also conducting research on the results of standard and mountain models, which should be compared with each other.
All those directions, which need further development, should be developed rationally. Funding and training processes should be parallel.
A multidisciplinary team is working on early child development and therefore, various field experts are needed.
Another important issue is related to quality and maintenance. It is extremely important to have a relevant monitoring system based on the system of professional supervision, whereas monitoring should be carried out by the state.
The program already envisages eight visits per month, but maybe there are children, who need more visits.
Parents are advocating for determining the number of visits based on the diagnosis. This choice is dangerous because it contains a risk of discrimination.
In my opinion, in the future, specialists should determine the number of visits according to a child’s condition.
We should also deliberate on how to move ahead, to increase geographic coverage or maybe we need certain changes related to the number of visits.
We should think of it and plan everything rationally. The main force of this system is that we have a correct framework and directions. There are interested parents who are becoming stronger.
Does Open Society Georgia Foundation plan to continue its work in this direction?
If we have a possibility, we will mainly work on parent empowerment. We plan certain activities for the parents working on early child development in November, aimed at advocating and developing a strategy.
Along with the Movement for Changes coalition and with the participation of parents, we will develop an advocacy strategy to determine our subsequent steps towards the system development.
You have mentioned the monitoring system, we were talking about coverage, number, and identification. How do you measure the program efficiency?
In this particular case, we have a standardized instrument and we have translated/adapted this instrument. The Coalition for Early Child Development can use it. At present, all providers are using this instrument and are closely following the progress.