Reports and presenter:

KS Kary Stewart





Interviewees:



PRB Pia Rebello Britto

LG Lena Garcia

MB Dr Manuel Bravo

GA Dr Gisela Alvarez

MHR Margarita Hernández Rodríguez

IPV Irina Perez Valdez

OQG Omara Quintero Goicoechea

MTC María Teresa Cabreja

XVS Xiomara Vasquez Sanchez

RHR Regla Hernandez Ruiz

ALD Anna Lucia D’Emilio

MCB Maria Carmen Borges

DM Dr Monica

MC Marta Copadea

MS Male speaker

KS In Cuba, programmes for early childhood development [ECD] have been a priority for over 60 years. Early childhood is a key period for brain development. During the early years of life, and especially in the first thousand days, a child’s brain is characterised by its plasticity. This means that positive experiences such as good nutrition and a stable and safe family environment benefit the development and formation of a child’s brain, whereas negative experiences such as prenatal alcohol exposure, violence and nutritional deficiencies can cause abnormal, neural and behavioural development, hindering the child’s potential.



PRB Because it is in this window of time that cells can make connections almost a thousand a second. I am Pia Rebello Britto, senior adviser and global chief for early childhood development at Unicef. And so this exuberance that is experienced in these early, early years is never repeated in the same manner. Really, the onus is on us to capitalise on that because that’s the time in which the child has a maximum potential to learn from and absorb from the environment.

KS According to the ministry of education, today of 855,000 or more children under six in Cuba 99.5% of them attend an early childhood education programme or institution. Not surprisingly, the country is reaping the rewards. My name is Kary Stewart, and for this episode of the Global Development podcast I visit Havana and speak to families, mothers, doctors and teachers about Cuba’s highly successful programme of early childhood development. Lena Garcia is 27 years old, her baby son, Luis, has just turned 10 months old.

LG When you’re pregnant at 11 weeks they do a check up and your controls start. They do about three or four throughout your pregnancy to see if the baby’s growing well.

MB There are four subgroups of families. One, for the supposedly healthy individuals. Two, those at risk. Three, sick people. And four, disabled people.

KS Dr Manuel Bravo is Lena Garcia’s doctor. He works in a polyclinic in the Playa district of Havana and he runs the Infant and Child programme which begins with the type of prenatal care that Lena is describing.

LG And then at the end of your pregnancy from 38 weeks you have weekly checks, then when you are about to give birth the checks are more frequent.

KS It’s a very personal as well as a comprehensive service. Sometimes it can even begin at the family planning stage, and the same level of care continues once the child has been born.

LG Up to one year old it’s once a month. They weigh and measure the baby, they tell you what you can give them, what you can’t, the vaccinations.

KS ECD services in Cuba are not compulsory but they are entirely funded by the state and delivered via the national education and health systems. Dr Gisela Alvarez works with Dr Bravo Flatus at the polyclinic and they make up a team of three that look after the mother and child and which also includes a nurse.

GA When I have a child under a year of age who is overweight then that child is referred from group one to group two, it’s an at-risk child. The health actions that are implemented by the doctor and the nurse should seek to modify this risk. They tell the family how to feed the child so the child doesn’t get to group three, which is the group of ill children.

KS As a polyclinic they look after 1,072 patients and their focus is always on prevention.

GA The health sector cannot achieve all this alone, it has to be through coordination with other agencies concerned with the population’s health.

KS One of the strengths of the Cuban model is that it is integrated. The work of all institutions is coordinated and linked at all levels of the country’s political administrative organisation.

GA Here we have a single healthcare system implemented nationwide in the mountains and also in the cities and in the capital where we are now. We also have the mass organisations such as the federation of Cuban women, which gathers together women over 14. Because these organisations are based in the community so they can easily know where a pregnant woman is. If she is a single mother, if she’s not breastfeeding, that’s it.

KS Even mothers in prison are accounted for.

GA Because when a mother is in prison, then during her pregnancy she is under custody. She remains in prison and the child stays with her until the baby is one year old.

MHR So this is where families come together, it’s a community programme, an educational programme, because the community participates in it – and all the families.

KS Margarita Hernández Rodríguez facilitates the programme for ten or so families here in John Lennon Park. It’s for children from one to six who do not attend day care centres or pre-school classrooms.

MHR It’s a park with very big lush trees that bring shade. There’s the part with the lawn where we teach them how to look after the environment, not to litter, not to walk on the grass, and they do the activities on the part where there’s concrete, which is a large area. This park measures an entire block and here in the middle there’s a part that they use to play and to carry out activities for stimulation and development.

IPV Irina Perez Valdez. I am the grandmother and he’s Luis Corto Malanda. We are the grandparents of Luis Alejandro Malanda Corto. We are all a working family. The mother of the boy is not earning, his father is self employed, his grandfather is self employed too. I left work to actually raise the child. When we come and do activities here, almost always the whole family is here.

OQG I am Omara Quintero Goicoechea, I work at the ministry of education. I am the national programme strategist and I look after the Educate Your Child programme. The Educate Your Child programme is the result of a research project that lasted 10 years. Back in 1992 the results showed that children weren’t making it in the first grade with a good level of learning, so a group of researchers trained the family to stimulate the development of their children so by the time they entered school they could be ready. The results were very positive and the programme was slowly implemented in other areas. After 10 years it was decided that the programme would slowly be introduced at a national level. As we enter our 25th year now, the Educate Your Child programme has been proven to have a very positive result among Cuban families.

KS Essentially the idea behind the Educate Your Child programme is based on the family’s potential to become a key player in the child’s development. Parents are trained to become their own children’s teachers, these meetings in the park form part of the programme that is not associated with an institution such as a school and they’re a way for parents, families and children to interact.

OQG It takes unity, we always have to be united and clear and all be speaking from the same page. We all have to follow the same lines so the child knows which is the right path.

MTC My name is María Teresa Cabreja, I work at the ministry of education. You’re getting a small glimpse here in this small municipality of Plaza de la Revolución but this programme is nationwide, at the level of all the town councils, municipalities, regions and it is very important, to the point that it’s not just the mother that comes to bring in their child, it could even be the grandmother, uncle or aunt. And the fathers too, which took a lot of work to get them involved but they are now also integrating more into the programme.

KS So how long have you been coming here?

MS Since he was two years old.

KS And why do you come here?

MS Because our boys develop a lot through coming here. He learns how to interact with the other children, they do many activities, the changes that the children go through are incredible. We work, well his grandfather always comes, but when possible his aunt, his mum, dad, grandad, we all attend.

KS The family really plays a pivotal role in Educate Your Child, families are the direct target of the programme as it is about training and preparing them to improve their parenting skills. At home families are guided to provide educational activities for their children. Entertainment in the form of games and computers is limited in Cuba and parents are advised to ration TV. Today I’m visiting Escuela Primaria Union, a pre-school located within the primary school building. This means that when the time comes the children can integrate seamlessly from pre- to primary school, and this falls under the institutional modality at ECD which takes place in a classroom setting.

XVS My name is Xiomara Vasquez Sanchez, I am the director of this primary school, but it also includes the pre-school grades with the younger children. We used to call it school rejection but these children who are six years old and in pre-school don’t experience a school rejection because they know their surroundings. If this didn’t exist it would be like many years ago. When a child is starting in the pre-school in the first week then September would be terrible because they would cry every day, they hadn’t been adapted.

KS In the classroom twin boys are sitting side by side. One has a learning disability and attends school alongside his brother.

XVS There is no singling out but the boy has this disability and here what he receives is special attention, for example with motor activities to develop motor skills, the teacher has a different activity for him so he doesn’t feel excluded. Because we cannot say to him you are not going to do the activity, no, we need to give this boy a different kind of activity. So he participates and so he doesn’t feel like he can’t because he’s limited.

KS Making a child feel included is a strong theme of the ECD system. Regla Hernandez Ruiz is one of the teachers at the centre.

RHR We have to work very closely with the family, especially with very small children because I have to know the characteristics of every child, whether they felt bad, if they haven’t eaten or slept well. This is also why we visit the home. Sometimes the families are dysfunctional, and as a teacher you have to monitor the child from that kind of family more closely so he or she doesn’t run the risk of becoming someone that we don’t want, so that they grow up an honest person with principles and values.

KS The Círculo Infantil Elpidio Valdez is one of the 1,078 day care centres in the country, mostly for working mothers. Here children attend as soon as they can walk. One of the mothers, Dr Monica, is a transplant surgeon and is on call 365 days a year.

DM I don’t have time off. If I didn’t have a centre like this my child wouldn’t be able to have any established routines or schedules to rest or eat at the same time because my work is so unpredictable.

KS From the ages of five to six Cuban children have the opportunity to attend pre-school day care centres and community programmes, which are provided for free.

DM Every month there is that activity, and the parents can see how the children are progressing and what difficulties they are having. The children love this place, which is also very important. You can tell, especially on Mondays. Even though they have spent the weekend with you when they go through that door they look happy. They are still looking forward to going to the centre.

KS Maria Carmen Borges has been head of this day care centre for 17 years.

MCB My motivation in life is to see consistency in my work and the results. I feel good because it’s part of my life, collectivisation is important, women shouldn’t stay at home inactive, just washing, ironing, cooking and cleaning.

KS Cuba’s maternity laws supports the uptake of the programme, it’s one of the most progressive in the region. Mothers are granted six weeks paid leave prior to birth and then one year paid leave after birth, and the last six months of that period the family can also decide to send the mother back to work and for the father to take leave instead.

MCB It’s not common here because the laws of our society are still progressing, but it’s called here machismo Latino, we all know it, it’s a little bit behind. But there are cases of fathers that have taken the paternity leave.

KS I’m in the day care centre playground and the scene is pretty lively with loads of happy children running around as you would expect. What’s a little different here though is that all the toys are papier-mâché. They’ve all been made by the mothers and the teachers and the children as well and there’s a papier-mâché washing machine, there’s a papier-mâché toaster, a tea set. Cuba’s a developing nation and resources are not abundant, as a result communities naturally work together and they support each other like they do on the Educate Your Child programme and also here at the day care centre.

MCB Sometimes it’s complicated and there are several generations living in one house, but it is also very comfortable because if you don’t have the energy the grandparents will have it or the neighbour, and to be able to have a centre which is part of that family: the type of place that you can always rely on, it’s the type of place that when you get there, if there are mums saying that one of the children had a fever, the first thing the head will say is, “how is your child?”.

KS Dr Bravo Flatus again.

MB It’s part of the Cuban culture to participate massively in programmes. If we didn’t have the population and the mass organisations working together the family programme wouldn’t be as successful as it has been, it would be very difficult for us to actually reach very isolated areas.

KS The role of the family here cannot be underestimated. article 35 of the Constitution of the Republic of Cuba recognises the family as “the basic element of the society”, and assigns it “fundamental responsibilities for the education and formation of future generations”. Unicef was a key alliance of the Cuban state in the 1990s as it developed the Educate Your Child programme. Today Unicef’s role is to help facilitate access to resources for healthcare and education. Anna Lucia D’Emilio is a Unicef country representative. I asked her to explain in a nutshell what makes the Cuban model so successful.

ALD Yes, I think that the first one is the political will, the second one is that they are aware of the importance of the child and therefore really they make a lot of effort, and we have a second point that is the kind of approach that they have, that is an integrated approach. On the other hand, another important issue is the articulation between the different levels, the national one and the local one, there is a kind of articulation and this then allows that you can really see the change at the level of the children and of the families.

KS And the results speak for themselves. According to Unesco, keeping children involved in the third and sixth grades at primary school they perform above the results of other children in the Latin American region in the areas of mathematics, language and natural science. And despite its scant resources, Cuba has eradicated illiteracy, reduced infant mortality at birth to about four per thousand, and created a sense of solidarity and pride among Cuban families. Pia Rebello Britto from Unicef.

PRB And when you look at economic growth in countries and you try to go back and you try to study the point at which maybe a transition occurred or a change occurred in that economic trajectory and try to link it to policies that a country took forward at that time and how those policies were implemented we start to see a change and we start to see a linkage between policies that address families and children especially in the earliest years of life.

KS But the situation here is unique. Part of Cuba’s success is also down to a sustained policy which doesn’t get interrupted by changes in government. So how transferable is the Cuban model to other countries and regions?

PRB Countries such as Cuba have demonstrated it’s possible, so the call really now is for political commitment and for families to be empowered to demand this change. In Uganda the government has just launched the National Early Childhood Policy where there are clear recommendations that every village will have an Early Childhood Centre, it will be linked to a child protection scheme. The private sector has committed to supporting the government in the application of this policy and the government has allocated a $350m budget to make that happen.

OQG Thanks to Unicef, the Educate Your Child programme is being taken up and adapted in different parts of Latin America.

KS That’s Omara Quintero Goicoechea from the ministry of education again.

OQG For example, in Ecuador, in Mexico, Venezuela, Peru, Brazil, not long ago there was a consultation in Honduras. In Honduras, the politicians decided to support Early Childhood and there is in the strategy “criando con amor”, raising your children with love, and Ecuador also uses this strategy. Every country has adapted into their own context.

KS As Cuba edges slowly towards change it’s clear that the commitment from the national, regional and local government, as well as the collaboration of families and the community at large that drives the Early Childhood Development system will remain firm. Anna Lucia D’Emilio.

ALD I think that what makes Cuba really special is that people here made the revolution and when you make a revolution you want more and more, you know what you have and you want more and this is really very interesting in working with Cuba.

KS It’s no wonder then that mothers with young sons like Marta Copadea are very protective of the Early Childhood Development programme in their country.

MC What I do believe we should continue with strongly is education. The educational system in our country, and I’m sorry if anyone is offended by this, but for me is the best in the world. And I think that we as parents, educators, should look after this. We can lose other things but we can’t lose this, we can’t lose it.

KS I’m Kary Stewart and that’s all for this episode of the Global Development podcast. You can listen to all our podcasts on theguardian.com/global-development or on iTunes, SoundCloud and all podcasting apps. Thank you for listening. Goodbye.