Three-year old Siphol runs the risk of being blinded for life. He has glaucoma, and has already lost the sight in one eye. There is surgery available which could save the sight in his other eye and prevent him becoming completely blind, but his mother refuses to take him to the hospital. Because of his disability his father denies paternity, and his mother is in denial of his progressive sight loss.
This tragedy underlies the great challenges that disabled people face in developing countries. Lack of finance, support, teachers and care as well as stigma add to the burden of being disabled in the first place.
This is why the NGO Sightsavers' work in Malawi is so essential. They work to prevent blindness, restore sight and shine a light on the needs of people who don't have a voice, championing disabled people, children and parents. One billion people around the world are affected by 17 of the most neglected tropical diseases, including trachoma which causes blindness. The prevention of these drives so much of Sightsavers's work.
We travelled to Malawi as part of a global campaign to ensure that an integrated approach to the organisation of services and support in a child's earliest years is at the heart of any new development framework that replaces the Millennium Development Goals in 2015.
We know from our own experience in the UK with SureStart Centres that investing in the earliest years makes the biggest difference to a child's life. If this is right for our children, surely it is right for the poorest children in the world. This visit was an opportunity to learn. It also re-enforced our conviction that the an integrated approach to early childhood development would bring practical benefits to these poorest Malawian children and their families.
Our visit was unique in that Sightsavers's programmes not only include integrated approaches to care for children, but also specifically focus on social inclusion and children with disabilities. This gave us a chance to see both how early childhood programmes can be delivered effectively in countries that lack the resources we have in the UK, and how they can benefit some most disadvantaged and marginalised children in the world.
Support for children in their early months and years in Malawi is scarcely funded. Its budget of only just over £60,000 per year isn't enough to reach even 5% of the countries young families. Delivery and funding of childcare centres is therefore devolved to local level but still only reaches about 35% of children in the country. Cultural perceptions of motherhood, where play and interaction with children are not given the emphasis they are given here, was also a barrier to real progress in early childhood care, particularly for disabled children.
It was clear everywhere we went in Chikwawa - more training, more staffing and more infrastructure would make a big difference, not only to maternal health and early childhood care but to the health and education systems as a whole.
Malawi is one of the poorest countries in the world with development indicators that match those of some of the worse conflict-affected countries. Fifty percent of people live in poverty, 25% in extreme poverty. Fifty percent of the country's children are stunted. Only 25% of girls who enrol in primary school complete all eight years.
Despite these serious challenges to early childhood and to development more generally, we saw many signs of hope. We saw the dedication and passion of teachers like Caroline at Chilomoni Resource Centre in Blantyre. She was working with mothers to communicate with purpose with their disabled children at the very earliest ages.
Government officials we met agreed on the vital importance of the first 1,000 days of a child's life and recognised the potential demographic dividend and long-term economic benefit to investing in the earliest years. We saw a desire to mainstream disability and challenge to the mentality of operating in silos across government.
Slowly but surely things are starting to change, and we learned a great deal about a country facing such tremendous challenges; however more work needs to be done to address the remaining gap between the national level policy and rhetoric and reality of implementation at community level.
Just one paid trainer could help unlock the potential of community-funded organisations to scale up provision. More can be done to harness the existing organisation of community-based care centres to provide other essential services. There is scope to integrate community-based care centres with under-five health clinics and the great work being undertaken through president Joyce Banda's Initiative on Maternal Health and Safe Motherhood. Targeted interventions that help disabled children access care and education would also directly benefit girls' access to the same services.
We saw some remarkably innovative and exciting work from Sightsavers, working with disabled and visually impaired children to ensure they get the best start in life against the odds.
An integrated approach to early childhood development is not only a social policy but a long-term economic policy. Getting it right in the early years is the morally right thing to do but also the smart thing - these children are the parents and workers of tomorrow.
One of the many memories we will take away is sitting in a bare church hall listening to mothers talking about the difference early intervention programmes make for their children both academically and socially. One mother beamed that her child had come top of the class in his first year of primary school. Those mothers could have been anywhere in the world.