What leads to policy change on family and child health and wellbeing?

In Peru there was a shift from targeted strategies on food and welfare assistance towards comprehensive, multi-sectoral strategies to address child poverty through improved food security, access to health services and social protection. Three rounds of political and electoral change post 2000 provided opportunities to raise policy attention, develop, adopt and institutionalise policy change. Thematic policy round tables (Mesas) facilitated inclusive dialogue across civil society, technical and political actors to set new policy directions, while civil society engaged political actors through electoral pledges.  Multi-sectoral strategies were developed, drawing on experience in the regions, and results-based budgets, communication outreach and capacity support used to incentivize policy uptake. Each opportunity was used to make advances, while work was implemented to strengthen the institutional arrangements for co-ordination of cross sectoral work and to monitor service delivery to consolidate implementer, political and public support.

A window of opportunity for policy change opened in Rwanda with the government consultation on its plans for socioeconomic development and transformation in the late 1990s. International actors and Rwandan civil society profiled children’s wellbeing and while initial measures separated health and education concerns and policies, by 2010 an integrated approach to early child development (ECD) was being promoted. With support from President and First Lady and from international organisations, the case study shows how even one of the world’s poorest countries has made progress in adoption and the implementation of a policy for integrated ECD..

The 2005 Children’s Act and 2007 Children’s Amendment Act introduced a rights based, comprehensive and collective approach to child wellbeing. Political change and the passing of a new national Constitution in South Africa created an opportunity for this legal reform. Multiple civil society organisations working with children formed a an effectively co-ordinated coalition, pooling evidence and bringing children’s voice into reform proposals. A statutory law review commission convened wide consultation on the reforms, supporting their legitimacy. Parliamentary hearings opened opportunities for social advocacy and built champions for the reforms. The continuity of engagement was sustained by networks and committed individuals, and the law reform process, while long, was viewed as not an end in itself, but a platform for changes in social norms and institutional practice.

In post-apartheid South Africa, a change in the political order enabled advances in holistic child health and education policies. A committed academic group facilitated a comprehensive policy development process with provincial actors, building relationships between government departments, researchers, policy makers and others. A window of opportunity opened in 2009, when committed political leaders advanced high-level inter-sectoral relationships and drove reforms that brought together local learning with regional and international experience, culminating in the Integrated School Health Policy. Measures were taken to facilitate its application in different provinces, given their varying level of delivery of school health services.

There has been significant progress in Sweden in child rights and direct child voice, despite the challenges faced. A strong welfare state and long-held public views of children as actors in their own right was reinforced by ratification of the UN Convention on the Rights of the Child (CRC), raising awareness and dialogue among state and non-state groups on how to strengthen the inclusion of child rights Swedish law, including the right to be heard. Political adoption of an act of parliament to incorporate the CRC was preceded by iterative processes of policy debate, adoption and implementation, supported by practitioner alliances, learning and exchange and by regional peer pressure. Cross-party support, a broad, consultative policy-process and close working relationships between government and civil society helped to advance the legal reforms.