Early Childhood Development for the Poor: Impacting at Scale, Odisha, India

• In Event: 2-154 - Cost-effective and Scalable Early Childhood Interventions in LMICs: Evidence from Chile, Kenya, India, and Madagascar.

Integrative Statement

Early childhood investments during the first three years of life are at the foundation of human capital formation. Yet children growing up in poverty often experience low levels of stimulation and low quality of nutrition. Given the high prevalence of children living in poverty, this problem is of first order importance. Interventions that promote child stimulation and emphasize parent-child interactions providing opportunities to play and learn such as home visits and community groups have been identified as having great potential ([7, 8, 2, 4, 1, 5, 3, 6, 9]), but there is a dearth of evidence of cost-effective interventions that can be implemented at scale in very poor environments. In particular, we need to know more about how best to deliver parenting and stimulation interventions to children starting below 18 months of age.
To address this knowledge gap we initiated a research project to analyze the effect of a psychosocial stimulation intervention (including the provision of child development and nutrition information to parents) on children’s developmental level in a variety of domains. The basic structure was guided by the Jamaica experiment by Sally Grantham-McGregor et al. 1991 - Lancet (SGM) which promote child-development in an integrated manner and encourage mothers to teach her children based on events surrounding daily routine activities. However, there are important new elements i) Intervention, the emphasis on designing the program using local resources in a scalable fashion; ii) large scale implementation over a broad geographical area with a large number of clusters (192 villages) and children (~1400 children); iii) mimic scalable delivery at implementation; iv) whenever possible use existing government structures; v) research design, collect detailed household data to allow modeling the behavioral impact of the intervention to identify mechanisms. Our primary outcomes measuring children’s cognitive, language and motor development in addition to children’s anthropometrics. Our secondary outcomes are measures for child rearing practices, the level of stimulation experienced at home, caregiver’s time use and well-being and the presence of play/learning materials and activities both on the extensive and intensive margin.
The intervention lasted two years and ended in December 2017 and it was delivered in two different formats, via weekly individual home visits and through group sessions. The study was carried out in the rural communities of Odisha, India. The study design follows a cluster randomised control trial with assignment of treatment on the village level. Our target children were between 7 and 16 months at the start of the intervention.
We find significant treatment effects on the performance of target children on standardized tests reflecting cognitive, language and motor development. This holds true for both formats, individual and group sessions and there is no statistically significant difference between both treatment arms. Furthermore, we find stimulation level at home for treated children increases as measured by the variety of play activities. For anthropometrics, we do not find any impact on any outcome measure but there is still work pending to assess impacts in nutritional and hygiene practices at home.

Authors

• Pamela Jervis, Institute of Fiscal Studies, London
  Presenting Author

• Costas Meghir, Yale University
  Non-Presenting Author

• Sally Grantham McGregor, University College of London
  Non-Presenting Author

• Jere R. Behrman, University of Pennsylvania
  Non-Presenting Author

• Orazio Attanasio, University College London & Institute for Fiscal Studies
  Non-Presenting Author

• Britta Augsburg, Institute of Fiscal Studies, London
  Non-Presenting Author

• Bet Caeyers, Institute of Fiscal Studies, London
  Non-Presenting Author

• Marta Rubio-Codina, Inter American Development Bank
  Non-Presenting Author

• Monimalika Day, Ambedkar University Delhi
  Non-Presenting Author