Poster #217 - Enhancing Nurturing Care in Poor Chinese Families: An Evaluation of Home Visits at Scale

• In Event: 1-115 - Poster Session 03
  In Poster Session: PS 03 Section - Social Policy

Integrative Statement

This study implements a Randomized Controlled Trial (RCT) of a large- scale home visiting program in rural China. Only two other studies, in Colombia and Pakistan, measure the impact of home visits by paraprofessionals at scale (Attanasio et al., 2014; Yousafzai et al., 2014). The home visiting program, called Rural Education and Child Health project (China REACH), implements a culturally adapted version of the Jamaican Reach Up Early Childhood Parenting Program, which was found to improve child development in the short-run, and education and income in the long-run (Gertler et al., 2014; Grantham-McGregor, Powell, Walker, & Himes, 1991). Between September 2015 and September 2017, trained volunteers performed weekly visits to caregivers of children aged 6 to 42 months to provide one-hour guidance on stimulation of the child's development using toys, games, songs and books. The volunteers were local married women with secondary education and adequate childcare or early education experience.
China REACH covers a nationally designated rural poverty county, including all 111 villages. These villages were randomized into the treatment or the control group. Both groups received nutrition supplementation, but only the treatment group received home visits. The sample comprises 1767 children, of whom 1252 were followed up after two years. The attrition is larger in the treatment group, and thus systematic. We deal with this issue by applying Lee bounds.
We find that the program significantly improved nurturing care and child development. The Home Observation Measurement of the Environment-Short Form (HOME-SF) score improved by between 0.13 and 0.50 standard deviation, compared to an OLS point estimate of 0.23 standard deviation. Relative to the control group, the home visits also significantly increased the percentage of children at a normal development level with between 11.3 and 26.2 percentage points according to the Denver Developmental Screening test II (Denver II). The OLS point estimate is close to the lower bound at 11.9 percentage points. At the same time, we find no significant improvement on a continuous Denver II score. Kernel density functions show that this is the result of China REACH benefiting children at the margin of a developmental delay most. We conclude that home visits on top of nutrition supplementation could be an effective way to improve the development of children from poor families in rural China who are at the margin of a normal development level.

Authors

• Emilie Berkhout, Amsterdam Institute for Global Health and Development (AIGHD)
  Presenting Author

• Bei Liu, China Development Research Foundation
  Non-Presenting Author

• Peng Liu, China Development Research Foundation
  Non-Presenting Author

• Menno Pradhan, University of Amsterdam
  Non-Presenting Author

• Mary E Young, Stanford Institute for International Studies
  Non-Presenting Author