The South African National Integrated Early Childhood Development
Policy was approved by the South African Cabinet in 2015. Given
capacity and financial constraints, all services outlined cannot be
implemented in a single step. Priorities must be set. We examine
the budget implications (total cost and cost per child) and benefits of
the four largest components of the Policy: interventions to improve
pregnancy outcomes; home visits for at-risk mothers of children
under 2 years of age; community-based playgroups for mothers
and children, and center-based early childhood development services.
Further, we identify which services are based on the strongest
evidence, the value-based trade-offs that characterise the prioritising
decisions, and which logistical factors favour alternative orderings of
services. The interventions to improve pregnancy outcomes are low
cost, based on sound evidence and would make use of the established
healthcare infrastructure. Home visits for at-risk mothers are
associated with improved development for targeted children and
consequential benefits for caregivers and broader society.
Playgroups are a promising low-cost intervention, but further evidence
is required to determine their effectiveness. Centre-based
services are expensive and generate smaller developmental returns,
but provide childcare. The results highlight the value judgements
required to determine the appropriate sequencing of interventions.