Atashbahar Omolbanin, Sari Ali Akbari, Takian Amirhossein, Olyaeemanesh Alireza, Barakati Sayyed Hamed
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Med J Islam Repub Iran. 2019 Dec 23;33:146. doi: 10.34171/mjiri.33.146. eCollection 2019.
Early childhood development (ECD) refers to physical, cognitive, emotional, and social development between 0 and 8 years. The aim of this study was to identify the gaps in ECD-related upstream and health policies in Iran. This qualitative study consisted of 2 main methodologies. First, a document analysis of heath and upstream policies related to ECD in Iran was done. Second, following a purposive sampling approach, 24 semi-structured interviews were conducted with policymakers, managers, academics, and service providers in the field of children health from October 2017 until June 2018 in Tehran, Iran. Also, a mixed approach was used for content and thematic analysis of the data. In this study, 3 categories of gaps and weaknesses were found: (1) the inferior position of ECD in macro policies and lack of health considerations in upstream social development policies; (2) the imbalance approach to policymaking in health, lack of attention to removing inequalities, and centralized policymaking; (3) lack of effective ECD interventions and programs with regards to contextual considerations to improve children's development, and long-standing ignorance of developmental policies for 3-8 year-old children. ECD is a fundamental policy approach for childhood development, which requires the policymakers' deep insight to shift their focus from physical development to combating the shortcomings in children's development cycle, eg, physical, mental, social, emotional, cognitive, and spiritual aspects. Unless policymakers change their approach to decrease nonintegrated and noncomprehensive policymaking for ECD, child development will be compromised, endangering the eventual sustainability of the society.
幼儿发展（ECD）指的是0至8岁儿童在身体、认知、情感和社交方面的发展。本研究的目的是找出伊朗在与幼儿发展相关的上游政策和健康政策方面存在的差距。这项定性研究包括两种主要方法。首先，对伊朗与幼儿发展相关的健康和上游政策进行了文献分析。其次，采用目的抽样法，于2017年10月至2018年6月在伊朗德黑兰对儿童健康领域的政策制定者、管理人员、学者和服务提供者进行了24次半结构化访谈。此外，还采用了混合方法对数据进行内容和主题分析。在本研究中，发现了三类差距和不足：（1）幼儿发展在宏观政策中处于劣势，上游社会发展政策缺乏健康考量；（2）卫生政策制定方法失衡，忽视消除不平等现象，且政策制定集中化；（3）缺乏针对改善儿童发展的背景因素的有效幼儿发展干预措施和项目，长期忽视3至8岁儿童的发展政策。幼儿发展是儿童发展的一项基本政策方针，这要求政策制定者有深刻的洞察力，将重点从身体发展转向应对儿童发展周期中的不足，例如身体、心理、社会、情感、认知和精神方面。除非政策制定者改变其做法，减少针对幼儿发展的非综合和非全面的政策制定，否则儿童发展将受到损害，危及社会最终的可持续性。
