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In Nicaragua, many children in poor rural areas don¡¯t have access to adequate nutrition and early childhood stimulation, and begin school without the basic skills needed to learn.There is little evidence from developing countries on the longer-term impact of early childhood development programs, including home-visit parenting training, on child development and learning outcomes. The findings from this evaluation will be relevant for the Government of Nicaragua¡¯s efforts to adjust its current programs to effectively and sustainably promote early child development at a national scale.

Policy Issue

Investments in early education, stimulation, health and nutrition of young children contribute to their cognitive, motor and socioemotional development and can help prepare them for primary school and learning in the early grades. In countries with limited resources, programs to strengthen parenting practices may be an effective and sustainable way of promoting early childhood development, but there¡¯s little evidence on the longer-term effects of such programs in developing countries. This evaluation in Nicaragua will assess the impact of a home-visit parenting training program on parenting practices and children¡¯s learning, cognitive skills and socioemotional development eight years after participation in the program.

Research area: Early Childhood Nutrition, Development, and Health

Country: Nicaragua

Evaluation Sample: 106 communities, 2,367 households, 3,147 children

Timeline: 2015-2019

Intervention: Home-visit parenting training, community workshops, packages with toys and children¡¯s boooks

Researchers: Karen Macours, Paris School of Economics; Renos Vakis, the World Bank; Patrick Premand, the World Bank

Partners: Jobs UTF

Context

Nicaragua is a lower middle-income country where nearly one-third of the population lives below the national poverty line. More than one in five children are stunted and preschool access is limited, so that many children don¡¯t receive the nutrition or stimulation they need during critical stages of development. In recent years, the Government of Nicaragua has made substantial efforts to improve early childhood development by strengthening the coordination across sectors and through restructuring and adjustmenting existing social protection programs. However, one of the big challenges remains how to bring small successful interventions to a national scale.

Policy Impact

The Atenci¨®n a Crisis Home-Visit Parenting program, which was piloted in 2009-2010, was designed as a low-cost model to improve early childhood development in poor rural areas. The evaluation results on the program¡¯s longer-term impacts will be relevant to the Government as it seeks to adjust and improve its two current large-scale programs that share similar features to the Home-Visit Parenting program. The evaluation will also contribute to the very limited evidence on the longer-term impacts of interventions, especially those aimed at improving parenting practices, to improve early childhood development and nutrition in low-income countries.

Program Description/Intervention

The program aimed to strengthen parenting practices to promote early childhood cognitive and socioemotional development. The program was 18-months long and was implemented by Centro de Investigaci¨®n y Acci¨®n Educativa Social in six municipalities in poor rural areas in the northwestern part of Nicaragua between 2009 and 2010.

The program was designed to help parents adopt practices that benefit early childhood development and nutrition; understand the importance of language, communication skills, playing and games for young children¡¯s development; increase their active role in playing with their children; and improve their knowledge of adequate nutritional practices. This was done through community workshops and bi-monthly home-visits by community educators that had a secondary education. Stimulation packages including toys and children¡¯s books were also distributed to the parents. For some households, the program targeted the home-visits at mothers only while for some it targeted both mothers and fathers, to examine which model is more effective in boosting early child development.

Impact Evaluation

The 2011 evaluation of the Home-Visit Parenting Training program¡¯s short-term impact found that it led to changes in parenting practices and significant improvements in the cognitive, motor and socioemotional development of children shortly after the completion of the program. This follow-up evalution will measure the longer-term impact of the home-visit parenting training program on parenting practices and early childhood development outcomes.

The key research questions for this evaluation are:

• What is the impact after eight years of the home-visit parenting training program on the development and nutrition of 9-15 year-old children?
• Does the home-visit parenting training program have sustained cognitive, motor and socioemotional impacts?
• Do the impacts of the home-visit parenting training program differ depending on whether only mothers or both mothers and fathers were targeted?
• Does the impact on nutrition and development of the home-visit parenting training program differ for boys and girls? And does the age of the child at the time of the intervention affect the results?

The evaluation design is a randomized controlled trial that randomly assigned the program across 106 poor rural communities in six municipalities. Within each of the communities, the program targeted parents of children who were 0-6 years old in 2008. The first treatment group comprises 22 communities in which mothers in 628 households and their 812 children received home-visits. The second treatment group consists of 22 communities where both mothers and fathers in 584 households with 794 children received the parenting training. There are 62 communities in the control group and the 1,155 households and the 1,541 children living in these didn¡¯t receive home-visits. Households in both the treatment groups received stimulation packages.

To examine program impact, the research team will use instruments that allow comparison with the 2011 short-term results on cognitive and non-cognitive skills. The evalution will administer age-appropriate tests of processing speed, short- and longer-term memory, visual integration and receptive vocabulary, as well as other tests to measure cognition. Socioemotional development will be assessed using parental reports as well as observable outcomes. For the 2017 follow-up survey, the children who participated in the program will be in primary school and achievement tests will be used to measure math and language skills. Researchers will also collect information on grade progression, as well as conduct qualitative surveys to explore underlying mechanisms through which the program influenced child development outcomes.

Additional resources:

Learning from the ¡°Atenci¨®n a Crisis¡± Pilot Program in Nicaragua¡¯s Drought Region