Impact case study database

Poor Early Childhood Development (ECD) in low and middle-income countries is a major public problem, affecting an estimated 250,000,000 children under 5 years, who fail to reach their developmental potential due to poverty, associated lack of poor nutrition, and a lack of psychosocial stimulation (visual, auditory, tactile and emotional stimulation provided via an affectionate caregiver-child bond). Attanasio’s research [R1] has provided a scalable ECD model which has been replicated, adapted, and implemented by governments in Latin-America (Colombia, Peru, Ecuador) to improve the childhood development and cognition of 100,000+ children between 2014 and 2021.

Establishing and expanding a scalable cost-effective ECD programme in Colombia

In 2014-2016, following research [leading to the publication of R1, R3] Attanasio adapted his ECD intervention strategy to integrate it into FAMI (Familia, Mujer e Infancia) a public large-scale parenting support service for vulnerable families in rural Colombia) for the Colombian government. The Director of Monitoring and Evaluation of Public Policies in the National Planning Department in Colombia describes how Attanasio contributed to FAMI’s aim of “seek[ing] to promote the integral development of girls and boys in early childhood” through the design of an “intervention that is by construction scalable” which led to evaluation to evidence “impact on cognitive knowledge and nutritional status for the most disadvantaged children” [A]. They further attest that Attanasio’s research [R1/R2/R3] has “contributed to date to the policy debate in Colombia and the policy decision-making” around early-childhood development [A].

In June 2017, policy-makers cited [R1] in a report by the Early Childhood Workforce Initiative, noting that “stimulation reduced the cognitive gap between poor and wealthy children by nearly one-third” in Colombia [B]. Attanasio’s research contributed to the Colombian government taking an evidence-based approach to ECD policy dialogues and decision-making. In 2018-2019, the Colombian Government included 8 studies conducted by Attanasio in an “evidence map” on ECD, specifically created to inform policy [C]. For Colombia’s National Planning Department, Professor Attanasio’s work and its inclusion in the evidence map “has been important and used to generate helpful information” which “helped policy stakeholders make decisions based on evidence” including interventions that have “positive effects on cognitive development and health, as [those] evaluated by Professor Attanasio in Colombia have show[n]” [A].

Latin American governments’ adoption of the ECD model reaching 100,000+ children

The Inter-American Development Bank (IADB) promoted Attanasio’s model for scalable early-childhood interventions [R1/R2/R3] in Latin American countries, leading to further replication. The Principal Economic Advisor at the IADB attests to the success of the scalability of the model [from R1/R2]: “Professor Attanasio’s research on a home visiting program in Colombia, published in the American Economic Review and the BMJ, has been decisive in the scale-up of these programs in many countries in the region where the IADB provides financial and technical assistance, including Brazil and Peru, where they now benefit hundreds of thousands of poor children and their families” [D].

The IADB promotion of Attanasio’s scalable model led to the Peruvian government launching an ECD intervention programme which reaches 93,000 children from disadvantaged rural families. To implement the programme, the Peruvian government created a home visit service called Servicio de Acompañamiento Familias (SAF). A 2015 evaluation of the programme (jointly prepared by the IADB and the Peruvian Ministry of Finance) cited [R1] several times and evidenced the significance of the SAF intervention upon children as being “equivalent to closing the socioeconomic gap in cognitive performance by 18% and the communication gap for boys and girls in the study sample by 35%” [E].

Since 2018, the IADB has supported the government in Ecuador to strengthen home visitation services, incorporating lessons from Attanasio’s research in Colombia [R1-R3, FAMI]. The Principal Economic Advisor for the Social Sector at IABD credits Attanasio’s research with influencing the design and focus of services: “[m]any features of the design of these programs—for example, with regard to the hiring of local women as home visitors, the desirability (or not) of including a nutritional component in home visits, and the curriculum — build directly on Professor Attanasio’s papers. […] The Ministry of Economic and Social Inclusion of Ecuador is currently revising the technical and operational guides that define childcare provision in public childcare centres for children younger than 36 months-of-age to improve their quality. The curricular content is also being revised to highlight the importance of interactions between caregiver and child, a critical element of process quality, as shown by Professor Attanasio’s research” [D].

Global expansion of ECD interventions via engagement with NGOs, the IADB, and WHO.

Scalable ECD intervention models are especially needed in India, where in 2016, 63,400,000 children aged under 5 were reported as being at risk of not reaching their developmental potential, more than any other country. Attanasio’s research, in partnership with Pratham, India’s largest education NGO, expanded the scalability of the ECD intervention model to enable NGO-government partnerships, and proved the efficacy of group interventions. Pratham Education Foundation’s Advisor emphasized the importance of Attanasio’s research in designing scalable cost-efficient interventions in India: “a detailed cost-analysis of the intervention shows that a lower-cost model is feasible, facilitating intervention at scale” and commented on the possibility of “partnerships with state governments or large-scale community programs in India, potentially impacting millions of children” that Attanasio’s adjusted ECD model have created [F].

Between publication in September 2014 and 6 October 2020, [R1] has been downloaded 14,587 times [G] and frequently cited in reports by policymakers [H]. In 2015 the IADB published the open-access book The Early Years: Child Well-Being and the Role of Public Policy. Explicitly directed at an audience of policymakers, the book “offers suggestions for improving public policy in this critical area” [I]. In the preface, Luis Alberto Moreno, the president of IADB, argued that “Governments can – and should – make a major positive difference […] An investment in a well-crafted government program, using the tools that we know today can be highly effective, can have a huge development impact” [I, p. xvi]. The IADB consulted Attanasio on “the scope of this publication” and 5 separate outputs by him are cited, including [R1] [I, p. ix]. The World Health Organization (WHO) cited [R1] in their 2017 report, ‘An evidence map of social, behavioural and community engagement interventions for reproductive, maternal, new-born and child health’, which was downloaded 2400 times between April 2020 and September 2020. Publications by the IADB and Inter-American Development Bank citing [R1] have been downloaded over 15,000 times, providing access to leading ECD research to policymakers and medical professionals worldwide’.