DEPARTMENT FOR BUSINESS, ENERGY & INDUSTRIAL STRATEGY

Improving the Quality of Universal Home Visiting: The case of Creciendo con Nuestros Hijos (CNH) in Ecuador

Project disclaimer

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Description

It is well established that the first years of life lay the basis for lifelong development. However, many children in developing countries are exposed to poverty, malnutrition, illnesses, and un-stimulating home environments. These factors are likely to have a detrimental effect on children's cognitive, motor, physical, and socio-emotional development, thus hindering them from reaching their full developmental potential. As adults, they are more likely to provide fewer adequate stimulation and resources for their children, thus contributing to the intergenerational transmission of poverty and inequality. A consolidated body of research has provided evidence that interventions in the early years of life can improve well-being across the life course by promoting early childhood development. The most effective interventions provide direct learning experiences to children and their families. In the last few decades, home-visiting programmes have grown in popularity in Latin America and the Caribbean (LAC) and elsewhere. While small-scale trials have shown sustained long-term results, however the important question remains as to whether such results can be achieved at scale. The focus on monitoring is critical, since the impact of these programs might be weakened by implementation challenges across a diversity of settings, human resources, systems, and geographical configurations, both within and across countries. An important research and policy agenda is therefore to monitor, report and sustain the performance of the home visitors, especially when the programmes are run at scale. In this research, we propose to co-design, set up and use a sustainable monitoring system for a large-scale home visiting programme for disadvantaged children in Ecuador: Creciendo con Nuestros Hijos (CNH). This is a home visiting program which targets pregnant women and children of ages 0 to 36 months with weekly visits. The home visitors provide counselling for caregivers regarding child development, healthy behaviours, and proper nutrition; and promote awareness of other social programs. CNH has been in place for more than twenty years, and is currently reaching almost 200,000 children; however, a centralised system for monitoring and reporting key performance indicators has never been put in place. In this project, we propose a partnership between an interdisciplinary academic team of experts in early interventions and home visiting from University College London, together with the Ministry of Economic and Social Inclusion (MIES) of Ecuador and J-PAL Latin America (JPAL-LAC), to pursue this important goal. In the first part of the project, we will set up an Information and Reporting System (IRS) for CNH. First, we will co-develop with the programme staff and key stakeholders a performance indicators and systems outcomes framework, which identifies the relevant data to be collected. This will include both data on the program implementation, such as frequency, duration and content of the visits (currently not recorded), and data on children's growth and cognitive development (now collected in paper format). The appropriate software app will be developed for the tablets and the home visitors will be trained in their use. In the second part of the project, we will use the CNH-IRS to improve the quality of the home visiting program. First, we will co-design the template for a standardised reporting card and examine how much variation there is in programme quality; whether certain observable characteristics of the home visitors are associated with better performance; and whether better performance indicators are associated with better children's outcomes. Second, we will co-design a low-cost motivational intervention via SMS messages, and evaluate with a randomized controlled trial its impact on performance and children's outcomes. Our project has the potential to yield significant benefits for the development of children in Ecuador.

Objectives

The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.

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Location

The country, countries or regions that benefit from this Programme.

Ecuador

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