Currently in South Africa, 61 percent of young children live in dire poverty, with 23 percent stunted through malnutrition. 36 percent die from preventable diseases, and South Africa’s child mortality figures for children under five have doubled since 1997, largely as a result of the AIDS pandemic.

Less than half of South Africa’s children have birth certificates, and so cannot access state grants, while less than 16 percent have access to any form of early childhood development programme.

There are a number of different strategies to mitigate the impact of poverty and HIV/AIDS on vulnerable young children. Such strategies include training community-based pre-school personnel; parenting and playgroup programmes; integrated early childhood development (ECD) programmes at household level; community development focussing on the young child; making toys and educational equipment from waste; providing resources for ECD programmes and advocacy and lobbying for the rights of the child.

Integrated ECD initiatives are an opportunity to reach the majority of vulnerable young children, because they see the child firmly rooted in family and community and recognise the need to strengthen a young child’s circles of care.

A helpful ECD initiative could, for example be an informal playgroup programme, through which caregivers and young children gather in a community setting, under the leadership of trained facilitators. Caregivers are encouraged to play with the children using a wide variety of educational toys. They also discuss issues of child development, health, nutrition, hygiene, discipline, psycho-social support and early stimulation, while the children continue to play.

Another successful ECD approach is the formal playgroup programme. Trained play facilitators initiate and support a number of playgroups in their communities, facilitated by the caregivers themselves. The facilitators support caregivers in accessing government services and help them link to community-based pre-schools and primary school Grade R classes to ease children’s transitions into school.

Community-based pre-schools can be an excellent resource in communities affected by HIV and AIDS. In South Africa’s east coast province KwaZulu-Natal most pre-schools are not registered and receive no state resources or support. This means that they are generally poor in quality, employ untrained teachers, have few toys and equipment and don’t offer an exciting, active learning environment for children.

The South African Department of Education and Social Development spends only one percent its annual budget on ECD programmes, although ECD sites could become a valuable resource in the fight to mitigate the impact of poverty and HIV/AIDS on young children.

It would be key to assist pre-schools to develop strategies to identify and reach out to vulnerable children and families in the community. Each pre-school should have a comprehensive HIV/AIDS policy in place that focuses on inclusion, non-discrimination, confidentiality and universal precautions.

They also should be supported to offer other health-related services to their communities: access to basic social services, health and immunisation, nutrition, obtaining documents and grants. In addition, pre-schools could provide a venue for meetings, parenting programmes, toy making, immunisation and health campaigns.

Each pre-school should have family facilitators, who – in exchange for a small stipend – support vulnerable families through Community-Integrated Management of Childhood Illness (C-IMCI) and 16 Key Family Practices, a World Health Organisation (WHO) child health strategy that has been adopted by South Africa’s Department of Health.

Such support should include obtaining documents and state grants; food parcels, food gardens, nutritional support; health and growth monitoring, immunisation, Vitamin A supplementation; hygiene and safety in the home; psycho-social support for children; opportunities to play, laugh, learn, sing and dance; managing childhood illnesses; promoting ‘know your HIV status’, prevention of mother-to-child transmission (PMTCT), voluntary counselling and testing (VCT) and antiretroviral treatment (ART).

Working in communities is never easy. It takes time, sensitivity and a great deal of patience. All community stakeholders need to be involved, and the building of relationships and trust is absolutely critical. For long-term sustainability, the community needs to drive and sustain the process. In poor communities, resourcing, capacity building and support of family-based workers are absolutely critical.

The challenge is to take best practice integrated ECD strategies to scale, so that they can change the lives of the critical mass of vulnerable young children.