CRC/C/15/Add.213 page 13 60. The Committee urgently recommends that the State party: (a) Ensure that all children, especially from the most vulnerable groups and in rural areas, have access to primary health care and encourages the State party to pursue its efforts in this respect and implement the recommendations of CEDAW as they relate to children; (b) Develop a national policy in order to ensure an integrated and multidimensional approach to early childhood development; (c) Continue and strengthen implementation of the WHO Integrated Management of Childhood Illness programme; (d) Improve the specialized health care provided to children affected by the Semipalatinsk nuclear testing site, including its psychosocial aspect; (e) Strengthen its efforts to detect and prevent diseases related to nuclear contamination; (f) Focus more on a long-term developmental approach to the assistance to children through, inter alia, supporting United Nations initiatives in this area; (g) Take all appropriate measures, including seeking international cooperation, to prevent and combat the damaging effects of environmental degradation on children, including pollution of the environment and food products. 6. Education, leisure and cultural activities 61. The Committee welcomes the efforts taken by the State party to improve the education system with the introduction of the Education Act 1999 which includes such aims as ensuring compulsory secondary education for all children of school age, providing free textbooks to vulnerable children and compulsory pre-school attendance. The Committee remains concerned at the many difficulties education is facing, inter alia: (a) The increase in the cost of education which limits access to children from economically disadvantaged households and rural areas; (b) The decrease in the number of pre-schools; (c) The increasing drop-out rates in secondary and vocational education; (d) Important regional disparities in the number of educational establishments and in the quality of education, with rural areas being at particular disadvantage; (e) The implementation of education reforms without the necessary preliminary preparation and training of teachers.