Mapping service gaps: How SA's children face barriers to essential developmental support

Nearly five million children under the age of six in South Africa live in poverty. These children face barriers to achieving their full potential, shaped by factors beyond their control — where they grow up and what services are accessible to their families.

The odds are stacked against them, making it harder to fully participate in society and the economy when they become adults.

Thankfully, this trajectory is not fixed. Investing in adequate early childhood development can shift outcomes, particularly for children from poor backgrounds. The South African government’s commitment of R10-billion over the next three years to strengthen early learning programmes is a major leap forward.

However, early learning is just one of many drivers of child development. The full suite, known as the essential package, also includes adequate nutrition, social services, good health and having a responsive caregiver — all vital to realising children’s constitutional rights.

The services provided by the government, like clinics, waste removal, immunisation and clean water, are meant to underpin the essential package. They are critical.

While South Africans have long known that service delivery is unequal and uneven, the full extent of the problem — especially how it affects children — hasn’t always been clear.

Now, open access research titled Supporting early childhood development through multi-dimensional service delivery in South Africa can pinpoint what public services are missing in 52 municipalities across the country using an Early Childhood Development (ECD) Services Index.

And the finding is alarming: not a single municipality provides the full range of adequate services to support caregivers in providing the essential package for young children’s development. The first-of-its-kind index — paired with maps — offers decision makers a bird’s-eye view of the problem while also allowing them to zoom in on specific areas, helping to allocate funds, manpower and resources more effectively to address delivery gaps.

Many services are delivered at a municipal level, such as waste removal, while others are delivered at a provincial level, such as healthcare. This tool can be used for decision making across all three spheres of government as a cross-cutting view of where attention should be focused.

Poor services leave caregivers with impossible choices

Public services create the environment in which caregiving takes place, either enabling or limiting a caregiver’s ability to meet their child’s needs. When public services are inadequate, caregivers are forced to choose between them, but the elements of the essential package cannot be substituted for each other. They are supposed to complement one another.

Imagine this: A mother lives in a neighbourhood without a clinic nearby, so she’s unable to get life-saving immunisations for her baby. There is no running water or working flush toilets, increasing the risk of disease. Her child is malnourished, and the combination of not eating enough and repeated infections affect her child’s growth and brain development, and manifest as stunting — being too short for one’s age.

There are few safe spaces for her child to play, move and explore, to develop gross and fine motor skills. And, without access to a quality preschool, her child misses out on cognitive stimulation for language development and foundational learning.

This scenario shows that while caregivers are primarily responsible for their children’s wellbeing, the government must deliver services such as healthcare, infrastructure and education.

But the state doesn’t act alone. Aware of its limitations, the government leans on civil society and social partners to reach people in homes and neighbourhoods, through conduits like community health workers. Still, these efforts need to be scaled and expanded to reach more people.

Mapping gaps in service delivery

To ensure all children receive the essential package, we need to understand what is not working and why. That’s where the ECD Services Index comes in. It applies the widely recognised Multidimensional Poverty Index approach to South African data to show where children are — or aren’t — receiving the full range of services needed to support their development.

The index is based on eight services identified as critical for all children to receive in the South African National Integrated Early Childhood Development Policy. These services are grouped into three main categories and broken down into 13 service areas, or sub-domains, with a minimum standard set for each.

The minimum standard for each sub-domain is based on South African policy (such as the National Development Plan) or international best practice.

For example, if fewer than 90% of children in a municipality are fully immunised — an international guideline — the area is considered to have inadequate provision of immunisation (which is one sub-domain in the healthcare domain).

The index finds that almost half the municipalities (24 out of 52) have inadequate service delivery for children in nine or more sub-domains. This forces caregivers to choose between accessing elements of the essential package for their child — a decision they should never be asked to make.

The index uses information from various local data sources spanning 2016 to 2021. While the difference in years is not a major concern since the indicators in question typically shift gradually over time — it’s important to note that the data used was from before the Covid-19 pandemic and related lockdowns, which have deepened child poverty and worsened nutrition. This makes the need to collect new data and improve service delivery even more urgent.

Practical uses for decision makers

The index and accompanying maps will be particularly useful to the Inter-Ministerial Committee on Early Childhood Development, convened by President Cyril Ramaphosa in 2024. This committee brings together a host of national departments: Basic Education, Health, Social Development, Cooperative Governance and Traditional Affairs, Higher Education and Training, Employment and Labour, Sports, Arts and Culture, Correctional Services, Home Affairs, Police, the National Treasury and Planning, Monitoring and Evaluation.

Unfortunately, the committee has not met regularly. As a consequence, efforts to coordinate across departments, align key performance indicators with children’s outcomes and deliver the essential package have faced challenges.

On the upside, tools like the index and maps can help refocus and strengthen these efforts moving forward. They also promote accountability by enabling civil society to track progress and raise the alarm when commitments are not met.

Quality of service delivery matters. With the right data, tools, and political will, we can start shifting the odds in favour of every child, no matter where they are born. DM

Dr Grace Leach is a technical analyst in financing for early childhood development. She holds a PhD in Economics from Stellenbosch University and is committed to working towards a reality where every child in South Africa thrives by five.

Rahima Essop is the Communications Director of the DG Murray Trust (DGMT), a public innovator that invests in projects and opportunities to enhance early childhood development services and outcomes.

Prof Dieter von Fintel is a Professor of Economics and Vice-Dean for Research in the Faculty of Economic and Management Sciences at Stellenbosch University. His research focuses on human and economic development in the past and present.