Empowering Home Visitors in Early Intervention: Impact Evaluation of Teacher Training and Use of Technology on Childhood Development - Evidence from t

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.

The aim of our research is to co-design, implement and use for quality improvement purposes a sustainable monitoring system for a large-scale home visiting programme for disadvantaged children in Ecuador: Creciendo con Nuestros Hijos (CNH). Even though the program has an organizational structure that seeks to facilitate the supervision of home visitors there is no centralized information system to monitor the quality of the programme from the headquarters and there is only a small set of fidelity benchmarks in place. Hence, our first objective is to identify, jointly with the visitors, and other stakeholders, key fidelity benchmarks for the program, and to design a new performance indicators framework to track them. An initial workshop will set out the aims of the project and fully ground it in the local context. This will allow us to assess the quality of the implementation of CNH, the correlates and consequences of quality (our second objective), and to develop and evaluate digital interventions to promote quality (our third objective).

This project and its results are relevant to academics and policy makers who are interested in understanding how monitoring technologies can help improve productivity in public service delivery, increase the quality of the service provided and ultimately the outcomes of the end users. We expect this project to benefit a large community outside the academia, including:

1. Children below age 3 and pregnant women who participate in the programme and will benefit directly from quality improvements in CNH that will translate into better outcomes and increased welfare, in the short and in the long run;
2. Home visitors, who will allocate less time to administrative tasks after the introduction of tablets to collect information during the visits, which is expected to boost their productivity;
3. MIES staff and authorities, that will benefit directly from the knowledge transfer related to the set-up of home visiting benchmarks, fidelity measurement and assessment, program evaluation, etc;
4. Other organizations that participate in the provision of the home visiting programme, that will also benefit from having clear benchmarks that can be monitored to improve the service across time;
5. The organizations that provide daycare services for children below 5 years and work with cooperation agreements with MIES, who will benefit from the new culture of measurement and monitoring MIES;
5. Civil servants and policy-makers at the Ministry of Health who could take the general components of CNH's monitoring system, adapt them and implement a monitoring system for their programmes;
6. Think-tanks, charities, and other government bodies looking for robust evidence to highlight and disseminate the importance of providing counseling to mothers regarding child development;
7. International organisations supporting actions in the developing world and funding research on the impact of early childhood interventions and the design and evaluation of policies aimed to break the intergenerational transmission of poverty, such as the World Bank, the IDB, the EBRD and the OECD;
8. The general public, considering that child development is an issue that concerns us all.

Representatives from all these groups will be invited to our end-of-project workshop, which will present the results of the research and the lessons learnt. With our project, we expect these groups to benefit from a better understanding of: 1. the process of human capital formation during early childhood and the importance of early interventions for poverty reduction; 2. the importance of establishing clear benchmarks that are measurable, realistic and policy relevant when setting up successful large-scale social programmes; 3. the need for centralized information systems to track fidelity, in particular in large-scale programmes; 4. the importance of setting up monitoring systems to improve productivity in public service delivery.