**1. Introduction**

Global initiatives, among them, *A World Fit for Children, Education for All (EFA), the Millennium Development Goals (MDGs)* and now*, the Sustainable Development Goals 2030* (with specific reference to Goal 4.2 – that reads "… ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education") have all devoted attention to the well-being and development of children indiscriminately. To this effect, the issue of providing children below 3 years of age with quality early care and stimulation, is of paramount importance because to ensure a good start in early childhood, children need attention from the earliest moments of their lives. Therefore quality early childhood services matter. Furthermore, following the quest for action to implement the rights of children below 3 years of age to "survive and thrive", global institutions (WHO, UNICEF, World Bank, Maternal

Health and Newborn and Child Health) partnered to turn this wish into reality, and implementation of the rights of the children through developing the Nurturing Care Framework.

#### **1.1 Nurturing care framework**

The Framework is a new initiative that was launched at the 71st World Health Academy to address recognition of the importance of, and research evidence on investments in early childhood development. The Framework addresses five main components of care which are; *good health, adequate nutrition, safety and security, responsive* caregiving *and opportunities for learning*. Needless to say, the components listed form the basis for child survival and development. It all begins with a pregnant mother who has to stay healthy, eat well, be emotionally balanced and is safe and protected in order that the unborn baby is surrounded by a positive environment that ensures its survival when it is born.

The quality of care and nurturing could however differ in different contexts depending on each family's socio-economic background. For instance, where families are poor, infants and children become vulnerable and they face many threats that affect their quality of life, such as infant and childhood diseases like diarrhea, and exposure to poor nutrition due to families' inability to provide food and other livelihood needs.

As the world journeys to 2030, countries have committed to "leave no one behind" hence the SDGs require urgent action in order to implement actions and programmes that will ensure all children are included in the global development agenda.

#### **2. The context**

The Kingdom of Lesotho is a small landlocked mountainous country located in Southern Africa and it is completely surrounded by the Republic of South Africa. The country has four distinct ecological zones; the mountains, foothills and Senqu River Valley which altogether occupy almost three quarters of the total land area in the eastern parts, and lastly, the remaining one quarter of the land is the western lowlands area. Lesotho's population is estimated at 2.2 million people [1]. Children aged between 0 and 5 years are reported to form 13.5 percent of Lesotho's total population [2]. The 0-5 years old children are served in early childhood development programmes and the parents who afford to pay the fees charged in the ECD and daycare centres enroll their children [3]. The Government of Lesotho regards education as key to the country's economic development and; early childhood development and education (ECDE) is recognized as the foundation level for lifelong learning. The Lesotho government is therefore committed to supporting programmes for the 0 to 5 year old children [4] and for government, setting up quality programmes that offer integrated and holistic early childhood services are the hallmark of child development.

Lesotho, like many developing countries, experiences challenges in providing quality early childhood services for children below 3 years of age. Despite research on neuroscience informing that the first three years of life are critically important for ensuring good child development, many countries still face challenges in improving children's developmental outcomes. The Lesotho National Policy for Integrated Early Childhood Care and Development (IECCD) 2013 [5], calls for individualized and intensive home visiting services for Lesotho's most vulnerable

#### *Child Care for the under 3 Year Old Children: Experiences from Lesotho DOI: http://dx.doi.org/10.5772/intechopen.93918*

children who, if they are not identified and served between 0 – 36 months of age, shall cost society and result in provision of costly remedial services to children later.

In Lesotho, one of the strategic goals for Early Childhood Care and Development (ECCD) is "Improved access to comprehensive early childhood care and education, especially for the most vulnerable and disadvantaged children [4]. As it is currently, there is yet no formal early childcare and education programme for children below 3 years of age in Lesotho, except for the informal daycare centres run by inexperienced child-minders who provide a much needed service by the working parents while they go to earn income for their families. Realizing the gap in child services for the children below 3 years of age, in April 2015, Catholic Relief Services Lesotho, one of the partners and a member of the IECCD Multi sectoral team, embarked on a project for this age group, named *Whose Child Is This?* (WCiT). The intention was to support efforts of the ECCD programme in the delivery of quality informal early childhood survival and learning environments.

This chapter presents a case of a specific daycare centre in Thetsane industrial area in Maseru and shares experiences of Lesotho regarding the extent to which the care practices implemented by the caregiver seemingly address the five components of the Nurturing Care Framework. A combination of care and nurture attributes that are: trained caregiver, childcare facility, child care guidelines and early stimulation, health and nutrition, safety and protection, are likely to enhance the quality of care of infants who could otherwise be vulnerable and disadvantaged if they never received such care.

Until recently, early childhood education in Lesotho was offered through three approaches: the Early Childhood Care and Development (ECCD) centres for children aged 3–5 years, the Home base centres (2-5 year old children) and the preschool/reception class phase for 5 years old children who will enroll in primary schooling at age 6. The newest approach is the daycare service that provides childcare services for toddlers and infants below 3 years of age.

A number of stakeholders such as ECCD service providers, line ministries, non-governmental organizations and individuals in the country have, over the years expressed concern over the plight of children aged below 3 years. This age cohort is generally serviced in uncoordinated services that present poor health conditions, poor nutrition, inadequate social welfare and protection. As a result, the development of these children is compromised. Lesotho's population is approximately 2.2 million people and of that about 227,000 are children aged between 2 and 4 years.

The Lesotho Demographic Health Survey [2] presents the situation of children in Lesotho. Statistics below depict a depressing picture of the children. The under 5 mortality is 85 deaths per 1000 live births, while infant mortality is 59 deaths per 1000 live births. Breastfeeding stands at 95 percent with 67 percent babies exclusively breastfed while maternal mortality stands at 1,024 deaths per 100,000 live births. Immunization coverage is 68 percent, stunting stands at 33 percent while birth registration at national level is 68 percent and lastly, hand washing with soap and water stands at 46.2 percent. This situation calls for concerted effort of all stakeholders to engage in actions that provide care aimed at addressing the overall well-being of children below 3 years of age.

In Lesotho, because of an increasing number of women engaged in paid employment, particularly young women in urban areas living around the textile factories, infants and toddlers of some of the working mothers are cared for in paid daycare facilities that offer child minding services in the absence of better options for child care in the family. The facilities are usually private family homes where the caregiver uses her house for both child care services and own household activities. Caregivers who are providing the service are volunteers. They charge a monthly fee

amounting to about US\$18 - US\$22 which is deemed rather steep by many parents. While the day care service is critical for families that access it, the caregivers are mostly untrained and have quite limited information about child development and child care for that age cohort.

Catholic Relief Services (CRS) attests to this situation as they highlight that "delivery of quality IECCD services to all children in Lesotho under the age of 5, regardless of their social or household economic status, is not currently a reality. Poorly trained teachers are working in sub-standard teaching environments with little support from the community; parental training programmes for the stimulation of children are not provided…" [6]. Due to lack of training, the caregivers have limited knowledge of how to run a daycare service while others regard the service as mainly income generation opportunity. In these circumstances, the lives of the children are in danger. Therefore, in a country that is concerned about its young, quality and well-structured early child care programmes are a requirement and must ensure holistic development of the children. The Lesotho National IECCD policy expresses the need to pay attention to the critical ages of early childhood however the government of Lesotho is not yet formally committed to support the daycare programme where children aged below 3 years are cared for. Although legislation such as policies, guidelines and protocols for children exist within different ministries that address children's matters, (particularly Ministry of Education and Training, Ministry of Social Development, Ministry of Health and Ministry of Home Affairs), what remains is the need for strengthened collaboration between these ministries to agree on cost sharing of activities and services for young children.

#### **2.1 Retšepile Jesu Daycare Centre**

Retšepile Jesu Daycare centre was started in 2009 as a voluntary service of child care provided by a young woman aged about 30 years. The daycare facility is located in the Thetsane industrial area which is inhabited largely by families comprised of single mothers who are employed in the textile factories in the area. The caregiver was prompted to open the daycare centre after realizing that the women factory workers with babies and young children did not have a place to leave their children while they were at work. She started the centre with only three (3) children; a boy aged 3 months, a girl aged 5 months and another girl aged fifteen months. The caregiver used her two-roomed rented house and particularly her kitchen was used for all activities with the children. She provided child care services of feeding and changing nappies only. There was no schedule for daily routine or any organized child activity. A monthly fee ranging between US\$4.4 (for toddlers who were toilet trained) and US\$6.9 (for toddlers who were not toilet trained) was charged for the child care service. With time, other women also brought their young children. The centre grew and more children were enrolled. There was no feeding programme as a result the parents who could afford, provided meals for their children. In many cases, the food was not nutritious and it comprised mainly of soft porridge and one vegetable or soft porridge with beef stock. The caregiver had no training in child care except the experience she had from raising her own children. She was not aware of what quality child care meant and why it was important. However, there was concern from some ECCD teachers in the area that since the caregiver cared for infants; she had to inform the community chief about the daycare centre. Infants and young children need special care offered by a knowledgeable or trained adult who would be able to monitor their safety and general wellbeing. Similar conditions in many other surrounding daycare facilities in the area were experienced. The situation of the young children cared for in those facilities called for immediate attention and intervention that would save their lives.
