Chile’s Crece Contigo Programme: A case study on effectively using multisectoral action to improve early childhood development
Chile is a middle-income country with low infant mortality (8.3 per 1000 live births) and broad health coverage, but Chile still faces important inequities in education, wealth distribution and health. In the 1990s, with sustained political commitment to equity, Chile began to strengthen social policies to address inequities in living conditions of the people. In that decade, specific equity-oriented programmes on education, health and housing proliferated, but programmes were often limited to their own sector and missed opportunities to harmonize and augment other programmes. By the 2000s, Chile recognized the need for a multisectoral action to effectively tackle complex social and health inequities. New policy strategies maintained the explicit focus on equity and prioritized expanding the sectors that needed to participate in social interventions; the President lent strong political support to this work. At the same time, in 2005, Chile underwent health system reform. The shift in policy focus from the 1990s to the 2000s, the explicit policy focus on equity and health system reform effectively set the stage for the landmark social protection system to foster early childhood development, Chile Crece Contigo (ChCC).
ChCC is a human rights- and evidence-based social protection system aimed at eliminating socioeconomic differences between children from gestation through pre-kindergarten. From its start, a presidential council sought regional, national and international input from experts, civil society and community actors across sectors. By 2007, new initiatives were introduced, providing universal access to parental protection, nursery and pre-school, improved prenatal care, birth with paternal participation and improved well child care, all with added support for vulnerable families.
This ambitious agenda was feasible only through multisectoral action: The first stage of implementation began with creating a Coordinating Team (part of the Social Determinants of Health and Health Equity Secretariat) within the Ministry of Health. ChCC continues to be characterized by close collaboration between the Ministries of Planning and Health, sustained political support and municipal implementation through local inter-sectoral networks. Specifically, in 2009, ChCC was made mandatory in all municipalities. An accompanying decree established a Committee of Nine Ministers, including the Ministers of Planning, Health, Education, Justice, Women’s National Service, Finance, Presidency, Labor and Housing. The national technical committee was expanded to include all public services related to children, and a permanent working group was established. Implementation at the Regional level is coordinated by a Regional Cabinet and led by the Regional Ministerial Secretary of Planning, while the Director of each municipal Health Service Unit serves as territorial manager of the Local Intervention Network (the primary care center serves as the entry point for families).
The Registry Monitoring and Reference System (SDRM) was established with participation of all sectors in order to monitor and evaluate every child from entry in prenatal care to four years of age, measuring process, intermediate results and impact. SDRM’s software is accessible to all actors linked to the programme, facilitating immediate access to benefits. Since its inception, more than 650,000 pregnant women entered into ChCC, and in 2012, more than 638,000 home visits were made to vulnerable families. Since 2009, every child born in Chile receives a set of basic childcare aids. In response to its own aspirations for child development, Uruguay launched Uruguay Crece Contigo in 2012, modeled after ChCC.