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Meeting report on WHO Member States consultation: Framework on Early Childhood Development in the

WHO European Region

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ABSTRACT

The WHO Regional Office for Europe convened a consultation of Member States on the Framework on Early Childhood Development (ECD) in the WHO European Region on 25−26 February 2020. In 2018, the Regional Office consulted with ECD experts to gain up-to-date understandings of the needs of young children in Europe and adequate monitoring of, and response to, developmental difficulties. This process concluded with the recommendation for a European framework on ECD, which subsequently was developed following external-expert and WHO peer reviews. The objectives of the consultation meeting were to discuss and agree Member States’ comments on the framework and share Member States’ experience of gaps in, and challenges to, promoting ECD in their countries. This report outlines discussions around the framework and concludes with agreement by Member States on the need for a European framework on ECD and support for the framework drafted by the WHO Secretariat.

Keywords

EARLY CHILDHOOD DEVELOPMENT CHILD HEALTH WHO

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CONTENTS

Page

Acknowledgements ............................................................................................................. v

Executive summary ........................................................................................................... vi

Introduction ....................................................................................................................... 1

Background ....................................................................................................................... 3

ECD systems in the European Region .......................................................................... 3

ECD interventions in the European Region ................................................................... 3

Session 1. Overview of Regional Office initiatives on ECD ...................................................... 6

ECD in the European Region ....................................................................................... 6

ECD framework development ...................................................................................... 6

Introduction to discussion of comments ....................................................................... 6

Session 2. Review of comments provided by Member States on the ECD framework ................ 7

Session 3. Gaps and challenges to promoting ECD in Europe .................................................. 7

Session 4. Way forward ...................................................................................................... 8

References ........................................................................................................................ 9

Annex 1 ...................................................................................................................... 10

Programme ............................................................................................................. 10

Annex 2 ...................................................................................................................... 12

Participants ............................................................................................................. 12

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Acknowledgements

The WHO Regional Office for Europe would like to thank Member States for their review and valuable comments on the framework and their recommendations for the WHO European Region. The Regional Office is grateful for their key contributions during the discussions that took place during the Member States consultation.

The Child and Adolescent Health programme of the WHO Regional Office for Europe invited selected country experts to complete a brief survey on early childhood development practices in advance of the consultation meeting. The programme would like to thank Freia de Bock (Germany), Nigina Davlyatova (Tajikistan), Svetlana Jankovic (Serbia), Leyla Namazova-Baranova (Russian Federation), Sergey Sargsyan (Armenia) and Marion Weigl (Austria) for the information they provided on early childhood development practices in their countries.

The report was written by Sophia Backhaus, WHO consultant.

Executive summary

Early childhood is a critical period for children to receive the nutrition and care that enable optimal development, and is the time when preventive and health promoting interventions are most effective. Investing in early childhood development (ECD) is one of the best investments a country can make. ECD covers the period from pregnancy to entry into primary school, with a main focus on the development of the child to the age of 3 years.

During this stage, the health sector plays an important role in protecting and promoting children’s health and well-being. The WHO Regional Office for Europe consulted with experts in the field of ECD to gain up-to-date understandings of the needs of young children in Europe and adequate monitoring of, and response to, developmental difficulties. This process concluded with the recommendation for a European framework on ECD, which subsequently was developed following external-expert and WHO peer reviews.

Thirty-five Member States provided comments on the European framework on ECD. The Regional Office convened a Member States consultation on the ECD framework on 25–26 February 2020 in Copenhagen, Denmark to review the comments, discuss disputable issues (if any) and agree on a final version of the framework.

The objectives of the meeting were to: • discuss and agree on comments provided by Member States on the framework; and• share Member States’ experiences of gaps and challenges to promoting ECD in their

countries.

Meeting participants reached consensus on specific and general comments on the ECD framework and text of the document. A panel discussion identified gaps and challenges in countries across the Region, such as shortages of a qualified ECD workforce, lack of immunization and insufficient coordination of ECD services. Group discussions identified support countries need from WHO to promote ECD in the Region, including support during national situation analyses and for the development of national strategies, action plans and indicators and for implementation of monitoring frameworks.

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The WHO Secretariat will present the framework to governing bodies at the Regional Office, develop further tools to accompany the framework and support Member States in their actions to promote ECD in their countries. Participants concluded that the Framework on Early Childhood Development in the European Region is an important document that can help to identify needs and help ensure that policy and service changes are made to address gaps.

Meeting report on WHO Member States consultation: Framework on Early Childhood Development in the WHO European Region page 1

Introduction

Early childhood is a critical period for children to receive the nutrition and care that enable optimal development, and is the time when preventive and health promoting interventions are most effective. Investing in early childhood development (ECD) is one of the best investments a country can make (1). ECD covers the period from pregnancy to entry into primary school, with a main focus on the development of the child to the age of 3 years. During this stage, the health sector plays an important role in protecting and promoting children’s health and well-being by helping parents and families to create a safe, nurturing and stimulating environment. Most countries (44 out of 48 (92%) answering the WHO child and adolescent health strategy survey) have some systems to support the development of all children during early childhood, but only 39% of the 44 countries reported that they support the health and psychosocial well-being of children holistically (2). More than 5 million children in the WHO European Region are at risk of not reaching their full developmental potential. Increasing numbers of children begin their life at a disadvantage because they do not receive the care necessary for their physical and psychosocial development. The United Nations Convention on the Rights of the Child calls on countries to act in the best interest of all children to ensure they live in good health, realize their developmental potential and fully enjoy human rights and fundamental freedoms, starting in early childhood. The United Nations 2030 Agenda for Sustainable Development provides a solid framework for promoting ECD (3). Beyond Goal 3, which deals with health, target 4.2 states specifically that by 2030, all countries should “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”, making ECD a global priority for the 21st century. The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) also highlights the need to ensure that all girls and boys have access to good-quality ECD (4). The WHO Regional Office for Europe has taken ECD forward through Investing in Children: the European Child and Adolescent Health Strategy 2015–2020 (5). In 2014, all ministers of health of the European Region adopted the strategy, which emphasizes the importance of parental health and parenting capacities in promoting the health and well-being of young children. A recent WHO/United Nations Children’s Fund/World Bank initiative, the Nurturing Care Framework (6), encompasses conditions for children to survive and thrive through public policies, programmes and services from conception to age 3 years. The WHO European Region needs an adaptation of this framework that provides additional guidance on how ECD can be promoted and how developmental difficulties can be prevented, identified and addressed within the diverse health systems in the Region. The Regional Office consulted with experts in the field of ECD in October 2018 to gain up-to-date understandings of the needs of young children in Europe and adequate developmental monitoring of, and response to, developmental difficulties. The meeting concluded with the recommendation for a European framework on ECD, which was developed by the Regional Office and went through external-expert and WHO peer reviews (7). The WHO Regional Office for Europe convened a Member States consultation on the European Framework on Early Childhood Development with the aim of reviewing, discussing and

Meeting report on WHO Member States consultation: Framework on Early Childhood Development in the WHO European Region

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agreeing on the final version of the framework. Representatives of 16 ministries of health attended the consultation, reflecting the geographical diversity of the Region. The main objectives of the consultation were to:

• discuss and agree on comments provided by Member States on the framework; and • share Member States’ experience of gaps in, and challenges to, promoting ECD in their

countries.

On behalf of Bente Mikkelsen, Director of the Division of Noncommunicable Diseases and Promoting Health through the Life-course of the WHO Regional Office for Europe, Martin Weber welcomed participants of the Member States consultation on ECD in the WHO European Region. Sergey Sargsyan was appointed Chair of the meeting. Participants were invited to suggest changes to the agenda; none were noted and the programme was adopted (see Annex 1 for the programme and Annex 2 for a list of participants). The meeting consisted of four distinct components:

• Session 1 – overview of Regional Office initiatives on ECD • Session 2 – review of comments provided by Member States on the ECD framework • Session 3 – gaps and challenges to promoting ECD in Europe • Session 4 – way forward.


Background

The Lancet series on early childhood development (1) indicates that the WHO European Region does much better in terms of ECD services and minimization of stunting and wasting than other regions. However, 3% of children in the European Region live in extreme poverty and more than 5 million are at risk of not reaching their full developmental potential. The European Region is diverse. In 2016, for instance, Tajikistan succeeded in improving health and social services, yet 18% of children were stunted and 31% of the population was living under the national poverty line. The double burden of child malnutrition, especially increasing levels of childhood obesity in the Region, is alarming. Europe is facing new and ongoing challenges that affect children from refugee, migrant and Roma populations with limited access to health services and opportunities for early learning.

ECD systems in the European Region

The national health sector plays an important role in determining how children develop their neurological capacities and socioemotional skills. Each system may take a different approach to identifying children at risk of developing a disability. As such, the prevalence of developmental disabilities in children under 5 years of age varies markedly across the Region, ranging from 34 per 1000 child population to approximately every eighth child under 5 being diagnosed with a developmental disability (84 per 1000 live births) (8). The identification of early childhood disabilities through clear health-sector approaches to monitoring child development with, if needed, further support through interventions for children with developmental difficulties needs to become a priority in the Region, which has 3 530 246 children living with a developmental disability (8). Investments in programming to improve ECD by, for example, regularly monitoring child health and development have the potential to decrease the number of disability-adjusted life-years and alleviate the burden of poor health conditions for young children and families, so should be prioritized. Early detection and monitoring and respective interventions therefore are crucial. Developmental monitoring includes approaches in which a health-care provider who follows the child and family regularly uses standardized instruments to monitor the child’s developmental functioning in all areas (cognitive, language, socioemotional, motor and other aspects of child health and family functioning). Working together with caregivers is an important aspect of monitoring and ensuring the child’s optimal development. Developmental screening includes approaches in which groups of children are screened to ascertain whether they have developmental delay by testers who do not necessarily have a continuous relationship with the families. Information beyond the screening test is not assessed. The degree and scope of early monitoring and screening of childhood development in the WHO European Region are diverse. The sections below highlight the diversity in the Region; it remains unclear what the best practices are or how much monitoring is needed.

ECD interventions in the European Region

The health sector plays an important role in the development of a child’s neurological capacities and socioemotional skills by helping parents and families to create a safe and stimulating


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development environment and providing care that improves children’s health, nutritional status, development and well-being. Findings from the WHO European child and adolescent health survey (2) indicate that the range of elements reported by countries on ECD support systems is broad (Fig. 1):

• 17 countries (36%) reported having a system in place that offers both medical treatment and psychosocial interventions;

• 12 countries (27%) reported having a system in place that offers medical treatment; and • three countries (6%) reported having a system in place that offers only psychosocial

interventions Fig. 1. Types of systems in place to support ECD in the European Region

In preparation for the Member States consultation, the WHO Regional Office for Europe Child and Adolescent Health programme distributed a brief survey of ECD practices in the Region to gain an understanding of practices in monitoring of, and response to, child health and development. Professionals from selected countries were contacted in December 2019, with responses received from Armenia, Austria, Germany, the Russian Federation, Serbia and Tajikistan. These are summarized below. All six country contacts reported that paediatricians are among the leading professional groups providing ECD care for young children aged 0–3 years. Regular well-child visits take place in all six countries, but the average number of visits varies widely between countries, from seven in Austria to 30 in Tajikistan (Fig. 2). Country contacts were asked: when primary care providers identify developmental difficulties, who is a child referred to for further assessment and diagnosis? Four country contacts indicated that paediatricians are the first entry point for further assessment and diagnostics (Austria, Germany, Serbia and Tajikistan), but in all countries more than one professional group provides further assessment.


Fig. 2. Average number of well-child visits in the first three years of life in six selected countries

In Austria, paediatricians and medical specialists are responsible for assessment and diagnosis after the identification of developmental difficulties. In Germany, especially in rural areas, children may be assessed by a general practitioner (GP) who most likely will refer to a paediatrician. In Tajikistan, family doctors/GPs and paediatricians step in when, for example nurses and community rehabilitation workers identify developmental difficulties. Children in Armenia with developmental difficulties receive further assessment and help through a network of child developmental and rehabilitation centres. In Serbia, a team of developmental counsellors in primary health-care centres assess for developmental difficulties; the team includes paediatricians, psychologists, nurses, speech therapists and social care associates. Children in the Russian Federation are referred to neurologists and psychiatrists after the identification of developmental difficulties.

7 810

16 17

30

0

5

10

15

20

25

30

Austria Germany Armenia RussianFederation

Serbia Tajikistan


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Session 1. Overview of Regional Office initiatives on ECD

Objective: to provide regional feedback on ECD in Europe, with a focus on ongoing initiatives

ECD in the European Region

Sophia Backhaus presented on the situation of ECD in the European Region. She described the importance of investments in early childhood, reinforcing that investing in ECD is one of the best investments a country can make. Without such investment, the implications for children who are left behind can cause mental and physical consequences in adulthood. Adults who experience adversity in early childhood are estimated to earn close to a third less than their peers’ average annual income in adulthood. These individual costs add up, constraining wealth creation and national earnings. ECD is on the global policy agenda, manifested in the Sustainable Development Goals (SDG), the Global Strategy for Women’s, Children’s and Adolescents’ Health, the European Child and Adolescent Health Strategy and the Nurturing Care Framework. Young children in Europe, however, need a policy agenda tailored to their individual needs. The European Region is diverse in its approach to monitoring child development and responding to developmental difficulties. A framework can help to stress principles and specific actions to ensure that all children across the Region receive the care, support, security and services they need to develop to their full potential.

ECD framework development

Aigul Kuttumuratova presented on the development process of the European Framework on Early Childhood Development in the WHO European Region. The global Nurturing Care Framework was launched in May 2018. In October 2018, the Regional Office invited technical experts in the field of ECD for a regional consultation to identify specific needs and priority areas of promotion, prevention and interventions for ECD in the European Region, particularly through the health sector. The meeting concluded with the recommendation to develop a European framework on ECD. The first draft of the framework was shared with experts in May 2019, then was peer-reviewed by WHO programmes in October 2019. Member States received the final draft for review and input in early January 2020. The consultation on the European ECD framework will lead to a final framework document that will be presented to the WHO Regional Committee for Europe in September 2020. The Regional Office will also provide support for country adaptations and implementation. The framework will be complemented by tools that will include a situation analysis of ECD services in Europe, a tool for ECD country situation analysis, and a repository of useful ECD resources, guidelines and tools.

Introduction to discussion of comments

Martin Weber introduced the proposed process for the Member State consultation. Prior to the consultation, written comments had been provided by 29 Member States, general comments by eight and specific comments by 21.


The WHO Secretariat compiled all comments in an Excel sheet that was available to the countries during the consultation. Based on a review of received comments, the WHO Secretariat proposed changes that would be modified based on discussions between Member States and approved by consensus or vote. Any dissent would be noted. Member States approved the proposed process.

Session 2. Review of comments provided by Member States on the ECD framework

Objective: to discuss and agree on comments provided by Member States on the framework Member States discussed and commented on all sections of the European framework on ECD, including sections with proposed changes from the WHO Secretariat, and reached consensus on the final text. Discussions focused on how specific or general the framework should be, the inclusion of country examples and the relevance of subsections. The applicability of action points across the Region was also considered. The need for extra support for vulnerable groups and universal access to high-quality health-care services were overarching themes across discussion on different sections. General comments were considered in a session on Day 2. Important and parked discussion points that have been identified as cross-cutting were re-evaluated. The need to include a sentence on alternative medicines was addressed and agreed, as was the need to emphasize the skills of non-health workers working with young children. General terminology, such as the use of imperatives, the word “caregivers” and terms translated into Russian, were discussed and consensus reached. The suggestion to stress more strongly the importance of integration of preventive and curative medicine for ECD was accepted and implemented. Member States agreed the proposed structure of the framework. Generally, Member States agreed with most of the proposed changes from the WHO Secretariat, which were based on Member States’ suggestions prior to the consultation. Country examples during the review process stressed the importance of the framework and highlighted the different approaches across the Region. Member States reached consensus on the final document.

Session 3. Gaps and challenges to promoting ECD in Europe

Objective: to share Member States’ experience of gaps in, and challenges to, promoting ECD in their countries The session included a panel discussion on gaps in, and challenges to, promoting ECD in countries with representatives from Belgium, Georgia, Kyrgyzstan, Lithuania, Portugal and Romania. Panellists presented on the major gaps and challenges in their countries and what actions were planned to address them. The shortage of a qualified workforce for promoting ECD was identified as a major challenge in a few countries, and insufficient vaccination/immunization coverage is seen as a big issue across the Region. Lack of coordination of ECD services across


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different sectors and government levels due to fragmented services and different funding bodies was another cross-cutting challenge identified by panellists.

In concluding remarks, the panellists highlighted the need for prioritizing children in policies and through political commitment. The panellists emphasized that the framework will help decision-makers to understand the gaps in relation to ECD and make changes in their countries.

The Member States discussed in small groups what support they need from the WHO Secretariat to promote ECD in their countries. They highlighted the need for a national situation analysis that includes sectors beyond health and emphasized the need for support for developing national action plans and strategies. Specifically, WHO can assist by supporting the process with materials such as policy briefs. Member States also identified a need for support in adapting and integrating standards and tools, such as WHO guidelines, and the WHO Secretariat was asked to support the identification of relevant monitoring indicators. The importance of sharing country experiences and examples of good practices was highlighted.

Session 4. Way forward

Martin Weber set out the next steps moving forward. First, the framework will be amended based on the discussion and consensus of the Member States consultation and will then be presented to the Standing Committee of the Regional Committee and the WHO Regional Committee for Europe. It will be used as the backbone for collaboration with United Nations agencies. A monitoring framework based on international indicators will be developed and adopted to the European context. A situation analysis tool is currently being field-tested and will be developed further based on the evaluation.

Case studies and examples of good practice will be developed, probably based on peer-review processes. The development of the pocketbook of primary health care for children and adolescents for the European Region is currently ongoing and will offer practical guidance for health-care providers working in ECD.

Member States consultation participants. © WHO.


References1

1. Advancing early childhood development: from science to scale. Lancet 2016;389(10064)(https://www.thelancet.com/series/ECD2016).

2. Situation of child and adolescent health in Europe. Copenhagen: WHO Regional Officefor Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/situation-of-child-and-adolescent-health-in-europe-2018).

3. Resolution adopted by the General Assembly on 25 September 2015. Transforming ourworld: the 2030 Agenda for Sustainable Development. New York (NY): United Nations;2015 (A/RES/70/1;http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E).

4. The global strategy for women’s, children’s and adolescents’ health (2016–2030).Survive, thrive, transform. New York (NY): Every Woman Every Child; 2015(https://www.who.int/life-course/publications/global-strategy-2016-2030/en/).

5. Investing in children: the European child and adolescent health strategy 2015–2020.Copenhagen: WHO Regional Office for Europe; 2014(http://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/policy/investing-in-children-the-european-child-and-adolescent-health-strategy-20152020).

6. Nurturing care for early childhood development – a framework for helping childrensurvive and thrive to transform health and human potential. Geneva: World HealthOrganization; 2018 (https://www.who.int/maternal_child_adolescent/child/nurturing-care-framework/en/).

7. Technical meeting on early childhood development in the WHO European Region.Copenhagen: WHO Regional Office for Europe; 2018(http://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/publications/2019/technical-meeting-on-early-childhood-development-in-the-who-european-region,-october-20182019).

8. Global Burden of Disease Study (GBD 2016) population estimates 1950–2016. In:Global health data exchange [online database]. Seattle (WA): Institute for Health Metricsand Evaluation; 2016 (http://ghdx.healthdata.org/record/ihme-data/gbd-2016-population-estimates-1950-2016).

1 All weblinks accessed 2 June 2020.

https://www.thelancet.com/series/ECD2016

http://www.euro.who.int/en/publications/abstracts/situation-of-child-and-adolescent-health-in-europe-2018

http://www.euro.who.int/en/publications/abstracts/situation-of-child-and-adolescent-health-in-europe-2018

http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E

https://www.who.int/life-course/publications/global-strategy-2016-2030/en/

http://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/policy/investing-in-children-the-european-child-and-adolescent-health-strategy-20152020



https://www.who.int/maternal_child_adolescent/child/nurturing-care-framework/en/

https://www.who.int/maternal_child_adolescent/child/nurturing-care-framework/en/

http://www.euro.who.int/en/health-topics/Life-stages/child-and-adolescent-health/publications/2019/technical-meeting-on-early-childhood-development-in-the-who-european-region,-october-20182019



http://ghdx.healthdata.org/record/ihme-data/gbd-2016-population-estimates-1950-2016

http://ghdx.healthdata.org/record/ihme-data/gbd-2016-population-estimates-1950-2016


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Annex 1

PROGRAMME

Day 1. 25 February 2020

Opening session

09:00–09:30 Opening and welcome Election of chairperson

Martin Weber

Introduction of participants

Objectives, expected outcomes and review of agenda Aigul Kuttumuratova

Session 1. Overview of Regional Office initiatives on early childhood development (ECD)

Objective: to provide regional feedback on the Nurturing Care Framework with a focus on the recommendation on ECD in the European Region

09:30–10:00 ECD in the European Region Sophia Backhaus

ECD framework development Aigul Kuttumuratova

Introduction: discussion of comments and agreement on the final text

Martin Weber

Session 2. Review: comments on the ECD framework

Objective: To discuss and agree comments provided by Member States on the ECD framework

10:30–12:30 Review comments provided by Member States on: 1. background and rationale2. goal and objectives3. guiding principles

Aigul Kuttumuratova

Session 2 contd. Review: comments on the ECD framework

Objective: to discuss and agree on comments provided by Member States on the ECD framework

13:30–15:00 Review comments provided by Member States on: 4. Young children’s needs – promoting

development, nutrition and physical health

Sophia Backhaus/ Aigul Kuttumuratova


15:10–16:15 Review comments provided by Member States on: 5. Monitoring young children’s development,

addressing developmental difficulties andearly intervention

Martin Weber

16:45–17:45 Review comments provided by Member States on: 6. Social, economic and environmental risks to

early childhood development7. Strategic country actions

Aigul Kuttumuratova/ Sophia Backhaus

Conclusion of Day 1 Aigul Kuttumuratova

Day 2. 26 February 2020

Session 2 contd. Review: comments on the ECD Framework

Objective: to discuss and agree comments provided by Member States on the ECD framework

09:00–09:15 Recap of day 1 Rapporteurs, Day 1

09:15–10:30 Continue from Day 1 specific comments, if needed Review general comments provided by Member States

Aigul Kuttumuratova

Session 3. Gaps and challenges to promoting ECD in Europe

Objective: to share Member States’ experience of gaps in, and challenges to, promoting ECD in their countries

11:00–12:30 Panel on gaps and challenges to promote ECD in countries Countries: Belgium, Georgia, Kyrgyzstan, Lithuania, Portugal, Romania

Moderator: Martin Weber

Discussion on what support countries need from WHO to promote ECD (small groups)

Aigul Kuttumuratova

Session 4. Way forward and closing

13:30–15:00 Discussion on the way forward and closing Martin Weber


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Annex 2

PARTICIPANTS

Albania2 Dr Ervisa Demollari Public Health Institute of Albania

Armenia Dr Sergey Sargsyan Chief Consultant Paediatrician Ministry of Health of Armenia

Azerbaijan Dr Shahla Ismaylova Head of Medical Quality Standards Department Ministry of Health of Azerbaijan

Belgium Dr Ingrid Morales Director Office of Infant and Child Health Health Department

Croatia Dr Željka Draušnik Acting Head of Department for Primary Healthcare Division of Public Health Croatian Institute of Public Health

Cyprus Dr Irene Cotter Coordinator of School Health Services Medical and Public Health Services Ministry of Health

Georgia Dr Ketevan Goginashvili Chief Specialist of Health Care Policy Division Ministry of Health Germany

2 Did not participate.


Professor Freia de Bock Head of Department of Effectiveness and Efficiency of Health Education Federal Centre for Health Education Ministry of Health

Greece Dr Adamantia Xekalaki Paediatrician Department of Social and Developmental Paediatrics Institute of Child Health

Dr Alexia Prassouli Developmental Paediatrician Department of Social and Developmental Paediatrics Institute of Child Health

Kyrgyzstan Dr Bermet Samaganova Chief Specialist Department of Medical Aid and Drug Policy Ministry of Health of Kyrgyzstan

Lithuania Dr Rita Sketerskienė Head of Health Safety Division Public Health Department Ministry of Health of Lithuania

Portugal Dr Maria Barbara C. de Menezes Division of Infant, Youth, Reproductive and Sexual Health Coordinator of the National Programme for Infant and Youth Health Directorate-General of Health

Republic of Moldova Professor Nelea Revenco Deputy Director for Science IMSP Institute of Mother and Child Head of Paediatric Department of the Sate Medical University


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Romania Dr Petronela Stoian Counsellor at the General Department of Health Care and Public Health Ministry of Health of Romania

Switzerland Ms Nadia Jaggi Research Assistant Health Promotion and Prevention Department for the Prevention of Noncommunicable Diseases Federal Office of Public Health

Tajikistan Professor Zohir Nabiev Head of Maternal and Child Health Department Ministry of Health of Tajikistan

Uzbekistan Dr Marat Sadykov Head of Maternal and Child Health Department Ministry of Health of Uzbekistan

Temporary advisers Ms Sophia Backhaus Developmental Psychologist, PhD candidate Department of Social Policy and Intervention University of Oxford United Kingdom

World Health Organization headquarters Dr Pura Rayco-Solon Scientist, Child Health and Development Maternal, Newborn, Child and Adolescent Health and Ageing

World Health Organization Regional Office for Europe Dr Aigul Kuttumuratova Technical Officer Child and Adolescent Health Division of Noncommunicable Diseases and Promoting Health through the Life-course

Dr Susanne Carai Consultant Child and Adolescent Health Division of Noncommunicable Diseases and Promoting Health through the Life-course

Dr Martin Weber


Programme Manager Child and Adolescent Health Division of Noncommunicable Diseases and Promoting Health through the Life-course

Dr Nurshaim Tilenbaeva National Professional Officer for sexual, reproductive, maternal, newborn, child and adolescent health WHO Country Office in Kyrgyzstan

Ms Olga Pettersson Programme Assistant Child and Adolescent Health Division of Noncommunicable Diseases and Promoting Health through the Life-course

Ms Katharina Schwarz Intern Child and Adolescent Health Division of Noncommunicable Diseases and Promoting Health through the Life-course

Ms Vivien Huelsen Intern Child and Adolescent Health Division of Noncommunicable Diseases and Promoting Health through the Life-course

Ms Yea Eun Lee Intern Child and Adolescent Health Division of Noncommunicable Diseases and Promoting Health through the Life-course

Interpreters Mr Anton Frantsev Helsinki, Finland

Ms Victoria Frantseva Helsinki, Finland


page 16

The WHO Regional Office for Europe

The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves.

Member States

Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands North Macedonia Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Turkey Turkmenistan Ukraine United Kingdom Uzbekistan

World Health Organization Regional Office for Europe

UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: [email protected] Website: www.euro.who.int

WHO/EURO:2020-702-40437-54246

meeting report on who member states consultation ......most effective. investing in early childhood...

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