Landscaping the early child care policy architecture in sub-Saharan Africa and an in-depth review of Kenya.

Background: The demand for quality early child care is rapidly rising globally, yet in sub-Saharan Africa (SSA), there is limited evidence on what drives quality, provision, and distribution of the burden of care across the different providers and what works locally. In particular, it is not clear to what extent existing local and regional as well as global policies and regulatory frameworks set the agenda and priorities for child care, and how explicit they are for care of the 0-3 year old children (early child care). Within a larger project that sought to explore the dynamics of the care economy in the Kenyan context, we conducted a review of the policy architecture of existing national, regional and global policies on early child care to evaluate the scope, implementation strategies, budget commitment and any gaps and challenges in the scope and implementation. We sought to understand the extent to which these policies cater for early child care in non-health care environments and identify gaps particularly in the distribution of the burden (responsibility) across different players at various levels. In this study, the term child care is used to refer to care of young children within their family environment and in any external non-clinical environments, and employs the holistic view of care across the five domains of the nurturing care framework (good health, adequate nutrition, responsive caregiving, opportunities for early learning, safety, and protection) (WHO, 2017). We focused on early child care i.e., care for children ages 0-3 years. Because of its comprehensive nature, early child care is therefore a heavy responsibility but which most of the time disproportionately falls on women. Methodology: A qualitative review of published policy documents both peer reviewed and gray literature was conducted. Using an internally developed review protocol, we searched and reviewed global, regional (SSA) and national policy documents on early child care, focusing on the five areas of the nurturing care framework which include good health, nutrition responsive caregiving, opportunities for early learning, safety and security. For each document, we evaluated the extent each provides for children's rights and wellbeing as stipulated in the UN Convention on the Rights of the Child, strengths and gaps, and made recommendations for improvement. Findings: Findings reveal significant progress in the care policy landscape addressing the various aspects of nurturing care. However, a lot remains to be done. Lack of clarity of policies on early child care for children aged 0-3 years; weak linkages between policy frameworks and implementation; and, the roles of various players. The need for resources to support implementation of the policies especially in resource limited communities as well as a system for regular tracking and evaluation of policy implementation and impact against the intended outcome indicators was evident. Conclusion: Collaborative efforts from policy actors are needed to address the policy gaps toward optimum care for the wellbeing of all children in Africa.