Table 1 Policy “process” Analysis of IECD
From: Integrated early childhood development policy in Iran: a qualitative policy process analysis
1. Factors affecting agenda setting for IECD | |||
|---|---|---|---|
Theme | subtheme | Examples | Relation |
1.1- Problem stream | Appreciating the need for a multifaceted, integrated, and justice-oriented approach to child development | -Lack of emphasis on eliminating the existing inequalities. - Lack of focus on all aspects of children’s development - Lack of integration and coordination between various policies and programs | (PM13) (CSP23) (M 27) |
Ignoring child-related affairs compared to other public issues | - Lack of serious attention to child-related issues - Low priority of ECD compared to other programs | (PM21) (CSP16) | |
Children’s inability to speak their needs and rights | -Ignoring children’s rights and needs -Need for a certain body to take care of child-related issues | (M7) (Aca3) | |
1.2- Politics stream | Increased scientific evidence for the importance of IECD | -Understanding the importance of ECD by some policymakers -Considering numerous studies and reports in the world -Indicating the need for investing in ECD, including the Heckman study or papers published in the Lancet. | (PM32) |
International political movements | -Addressing equity from the start according to the recommendations for closing the gap in a generation. -International organizations’ instructions and objectives regarding the rights of the child and ECD | (PM8) | |
National political movements | - Referring to ECD in the Sixth Development Plan -Establishing the Committee on Social Determinants of Health and designating ECD as a priority | (PM30) (PM8) | |
1.3- Policy stream | Designing a national policy for IECD | -Assembling committees in different fields to prepare reports on children’s status -Establishing the IECD secretariat in the Ministry of Health | (PM12) (PM13) |
2. Factors affecting formulation of IECD policies | |||
Theme | Subthemes | Examples | Relation |
2.1- Formulation and approval process | Lengthy and time-consuming administrative procedures for formulating and approving policies | -Spending a long time on planning and formulating IECD documents -Expiration of policies before implementation -Slow pace of processes; -Current policies not being up-to-date due to long intervals between formulation and implementation | (PM25) (NGO-P 28) |
Perfectionism and duplication in formulating programs | -Spending a long time on, formulating and duplicating programs and documents -Presence of several documents and programs regarding IECD with different titles | (PM32) (PM30) | |
2.2- Policy sustainability | Policies changes as a result of changing the managers | -Differences in prioritization -Differences in adopted solutions for addressing problems -Failure to achieve the intended approach in the ECD program -Lack of belief in activities with long-term results and focusing on fast-yielding activities due to short management life | (Aca 24) (M6) (PM8) |
2.3- Mechanisms regarding the participation of stakeholders in policymaking | Lack of participation from other organizations in policy formulation | -Other organizations having no feeling of belonging to programs -Emergence of tensions between organizations and lack of opportunity for optimal collaboration in implementing policies and programs | (M 27) (PM19) |
Inappropriate composition of the Supreme Council of Health Policy | -Not using different specializations like sociology, psychology, economic, etc. for policymaking and decision-making | (Aca3) | |
Using people sharing similar views with the Ministry of Health in related committees | -Removing individuals with opposite views from related committees; -Lack of attention to opposite views in related committees -Unwillingness to suggest opposite ideas for fear of being removed from the related committees | (PM15) | |
3. Factors affecting implementation of ICED policies | |||
Theme | Subtheme | Examples | Relation |
3.1- Conceptual ambiguity | Different interpretations and lack of consensus on the concept of ECD | -Creating problems due to incorrect understanding of the concept of ECD -Resistance against ECD due to considering it a western concept | (PM19) (Aca26) |
3.2- Intersectoral issues | Intersectoral competition | -Poor intersectoral collaboration -Conflicts over stewardship -Resistance against the leading or coordinating role of a same-level organization and believing in supervision and leadership from higher levels -Inconsistency between the Ministry of Health, the Ministry of Education, and the Ministry of Social Welfare. -Pursuing benefits of organization or union. -Weak inter-sectoral collaboration due to cultural context. | (CSP23) (Aca 24) (PM10) (NGO-P 11) (PM 19) |
Inefficiency of intersectoral collaboration in the form of intersectoral agreements | -Organizations’ lack of commitment to intersectoral agreements due to lack of executive requirements | (PM8) | |
3.3- Trans-sectoral issues | Lack of political commitment | -Lack of adequate support from high-level managers for implementing the Document -Lack of executive will due to lack of support from the program in high governmental levels -Lack of commitment in top level managers and convening few meetings in top echelons of organizations in this regard | (PM8) (PM22) (M14) |
Lack of a supreme body or structure for monitoring and coordinating childhood development programs | -Sameness of supervising and executive bodies in children-related issues -Lack of accountability in organizations involved in children’s issues for their programs -Lack of coordination between different organizations involved in children’s issues and problems resulting from lack of coordination including parallel works, waste of resources, contrasting programs, and lack of a comprehensive data bank for children’s data in different areas | (PM31) (PM36) | |
Legal issues | -Inappropriate laws for children and the violation of their rights -Different interpretations of laws resulting in confusion in implementing them -Decreased commitment of organizations to enforcing laws -Presence of legal gaps in some areas related to children | (PM38) (NGO-P2) (CSP35) (PM31) | |
3.4- Mobilization of resources | Shortage of skilled service providers in some fields of ECD | -High workload of healthcare staff for accepting new responsibilities like screening programs -Lack of attention to standards in hiring manpower in kindergartens in terms of numbers of staff and skills -Lack of trained manpower in schools as providers of healthcare and development services -Lack of skilled manpower in some parts of the country in fields of counselling, child psychology, social work, etc. -Absence of a curriculum related to ECD in the education of child-related service providers | (PM10) (PM13) (CSP18) (M14) |
Inadequate budget and improper budget allocation | -Not allocating sufficient budget to ECD due to the low share of health sector and the low share of preventive measures in the budget. -Developmental screening in one age range due to severe shortage of financial resources for developmental screening -Inability to implement efficient educational programs about child development due to the shortage of resources -Insufficiency of allocated budget relative to the total number of children suffering from malnutrition | (M17) (CSP30) (PM10) (M17) | |
Lack of insurance coverage for some services like rehabilitation for developmental disorders, special diseases, counselling, etc. for children | -Increased exposure of families to catastrophic health expenditures -Lack of involvement of specialists working in fields related to children in the diagnosis and treatment of developmental disorders due to lack of insurance coverage and similarity of fees | (PM21) (PM 15) | |
3.5- Structural capacities | Unavailability of required infrastructures | -Shortage of diagnostic and rehabilitative facilities and equipment for developmental disorders -Lack of standard educational environments in kindergartens and primary schools -Unavailability of Kindergarten services for all children -Lack of structures for taking care of the developmental issues of children aged 3–6 years in areas of cognitive, emotional, and social development | (CSP16) (PM12) (Aca37) |
Differences in executive structures at the provincial level | -Creating executive barriers due to lack of knowledge about ECD and executive structures of the State Welfare Organization and the Ministry of Education at the provincial level | (PM35) | |
Weakness in referral and healthcare systems | -Problems in referring children with developmental disorders to second and third levels of healthcare due to lack of the implementation of a referral system -Healthcare system’s lack of capacity for screening children in all age ranges -Problems in the follow-up of children with developmental disorders -Failure to achieve the principles of community participation and intersectoral collaboration in PHC | (Aca24) (M17) (CSP33) (PM12) | |
4. Factors affecting the evaluation of IECD policies | |||
Theme | Subtheme | Examples | Relation |
4.1- Continuous and routine data registry system | Lack of a comprehensive and integrated data registry system | -Lack of an integrated, accurate, and comprehensive database on different aspects of child development | (PM12) |
Superficiality of data collection mechanisms and insufficient research capacities | -Relying on available data and lack of surveys and case studies -Unreliability of available data | (PM32) | |
-Impossibility of responding to children’s issues via single-field activities due to their complexity, variety, and comprehensiveness | (Aca 24) | ||
-Deficiencies in applied research in the field of children -Lack of interdisciplinary relationship in child-related research activities | (PM12) (PM35) | ||
4.2- Comprehensiveness of indexes | Limiting IECD indexes to current indexes | -Lack of indexes in some areas and ignoring these indexes -Inadequate attention to distributive and justice-oriented indexes -Inadequate attention to qualitative indexes in different areas related to children. | (M 27) (PM13) (PM32) |
Lack of a reference body for formulating and designing comprehensive indexes | -Reporting a limited number of indexes by different organizations involved with children | (PM12) | |