In November 2016, the Conrad N. Hilton Foundation board of directors approved a new Young Children Affected by HIV and AIDS strategic initiative. We interviewed Senior Program Officer Lisa Bohmer to learn more about this exciting development and what we can look forward to over the next five years.

The Conrad N. Hilton Foundation has been working to support vulnerable children affected by HIV and AIDS for nearly eight years. What is the Foundation’s new Young Children Affected By HIV and AIDS Strategic Initiative? How does it build off of the first phase?

Informed by learnings to date, the new initiative includes important enhancements but essentially stays the course established during the first phase. Our longer-term goal remains to improve early childhood developmental outcomes for young children living in communities affected by HIV and AIDS. To get there, we plan to focus over the next five years on identifying effective program approaches that can then be scaled. We will continue efforts to improve caregiving and early learning– while placing greater emphasis on the first 1,000 days of a child’s life, when brain development is most rapid. We aim to strengthen both government systems and civil society networks, build the evidence base to inform practice and policy, and encourage increased financing for these critical services.

The key learnings that we pulled into development of our new strategy included the need to focus more on program quality. The new strategy also responds to the need to increase investment in research to generate evidence as to whether programs are working and how they can be improved.

Why does the Foundation continue to focus on young children affected by HIV and AIDS and not a broader focus on early childhood development (ECD) for all children?

We know that HIV and AIDS pose multiple risks for healthy growth and development. These risks include the biological impacts of HIV exposure, as well as the challenges for caregiving when a parent or caregiver raising a young child is also at the same time struggling to manage the illness. It is not the only vulnerability, but we feel it is an important one – particularly given the increasing numbers of children born into families living with HIV. As we see success in testing and initiating larger numbers of people onto life-long treatment, we also need to think about how to better support them as they raise their families– this needs to become a stronger aspect of the agenda.

There is increasing recognition regarding the importance of investing in ECD given that the first five years of life set the stage for the years to come. This is particularly true for children living in communities where there is a high prevalence of HIV and AIDS. We focus on young children because during the first five years of a child’s life, the brain is built and there is an opportunity to really buffer young children from the long-term negative impacts that HIV, poverty and stress have on development.

Our partners support both HIV targeted ECD services as part of existing HIV treatment and support programming as well as HIV sensitive ECD programming that aims to more broadly reach all vulnerable young children and families living in high HIV prevalence communities.

What exactly do you mean by early childhood development (ECD)? How does the Foundation define ECD?

We are concerned with cognitive, socio-emotional and physical development that starts in pregnancy with support for maternal well-being and the well-being of the developing baby. It then follows that mother/caregiver and infant to foster a supportive environment with the things that young children need to develop normally during the first five years so that they are ready to learn once they get to primary school. As we were developing the new strategy, The Lancet released a new series on early childhood development with an emphasis on nurturing care that encompasses health, nutrition, responsive caregiving, security and safety and early learning. We take nurturing care as a starting point and aim to put it into practice in our five focus countries in East and Southern Africa, including Kenya, Tanzania, Malawi, Mozambique and Zambia. The health system offers a great opportunity to include coaching on nutrition and responsive caregiving in order to improve child developmental outcomes.

There has been a lot of emerging research about ECD as it relates to communities affected by HIV and AIDS. How has the landscape changed in this field over the past five years?

There is emerging research on two fronts. Building on research showing how important investments in ECD are for all children, but in particular children facing adversity or stress. We now know that brain development during the first 1,000 days of life is most rapid and sensitive. We also know that once this 1,000 day window closes, there is not opportunity to go back and re-wire the brain – so this urges us to provide support very early and to ensure we are reaching the most vulnerable. We continue to see evidence demonstrating all the things that children need, whether they are infected by HIV or affected living in an HIV affected family. There is emerging evidence of the detrimental effects that mere exposure to HIV can have on child development. The emerging research challenges us to move beyond a child survival paradigm for children affected by AIDS to a paradigm of survive and thrive.

Why is now such an opportune time to contribute to this space?

This is a historic moment in time because we are in the midst of a major shift in political will. Traditionally, ECD investments were seen as optional for young children, rather than necessary. Consequently, the development of young children has not received the attention it deserves. Fortunately, over the last few years, the tide has really turned. We are seeing mounting scientific evidence, as well as increased commitment from high levels. For example, Jim Kim, president of the World Bank and Anthony Lake, executive director of UNICEF, came together last year to launch a new ECD Action Network to elevate ECD as a priority issue for all countries in order to pave the way for a competitive workforce in the future and the economic success that comes with that. With this increased political capital, we have a real opportunity to come together with a growing coalition of actors to move the field forward and advocate for increased investment. To date, investments in ECD have been woefully inadequate and this must change. We want to join forces with others to seize this moment!

In 2015, the UN established the Sustainable Development Goals (SDG). One goal and target, 4.2, focuses on ensuring that all girls and boys have access to quality early childhood development care, pre-primary education, so that they are ready for primary education. What role do the SDGs play in the Foundation’s approach to this initiative area?

The SDGs are both am ambitious call to action and our north star– In order to reach that 2030 goal, we will field test approaches that can then inform scaling -up. We also aim to help determine the best ways to measure several of the indicators in that goal. One of those is 4.2.1, which is the percentage of children who are developmentally on track. We intend to join efforts to field test feasible measures of development of both younger children from birth to age three, as well as just before primary school. These measures will enable countries to track their progress over the next 13 years or so. We also aim to contribute to achievement of the other ECD-related SDG goals- namely goal 3 on health and well-being, which includes targets 3.2 on child mortality and 3.3 on efforts to end AIDS; as well as targets 2.2 to end malnutrition and reduce stunting and 16.2 on ending violence against children.

Tell us about some exciting things that are happening over the next year.

It is definitely an exciting time as we look at planning the next five years. One of the opportunities is the commitment that we made to move beyond funding individual projects to a more coordinated approach. This will involve support to government and a network of civil society partners to define an inter-sectoral package of interventions to strengthen support along the birth-five year continuum.

We spent time in Kenya in January to gauge interest in this approach. We have found strong interest given that Kenya has recently devolved responsibility for ECD from the national level to the county government. We look forward to working with the Siaya County government and a coalition of partners for what I think is going to be a really exciting effort, a great learning opportunity and hopefully a model for other counties.

We’re also supporting scaling of nurturing care as part of health systems in all five focus countries and engaging a group of experts to help us define our research agenda.

Finally, in one sentence, what is the most important thing about your strategy that you would like to share?

Investing in the early years has the power to address the incredible inequities that plague us to create a more peaceful, just and successful world, where everyone has the opportunity to fulfill their potential. There is such promise and excitement in this space and we look forward to contributing to its evolution, alongside our partners.