The Challenge

There is a need for more frequent and precise measurement of all inputs and outcomes in the child development process, starting in-utero, so that we can better understand what interventions are most effective, when, and why. Many of the “gold-standard” measurements of child development outcomes that originated in wealthier countries take a long time to administer and require highly skilled and trained assessors, all of which is not cost-effective in low- and middle-income countries (LMIC). Moreover, a lack of knowledge and evidence on how to effectively design and deliver scalable and contextually appropriate early child development (ECD) interventions in LMICs has hindered investment and scale-up in this critical area of development. There is a need to gather rigorous evidence on the impact of innovative service delivery solutions, such as digital tools, to support frontline workers in delivering high-quality, respectful and standardized household ECD services, especially when considering how to take these programs to scale.

The Objective

To address these challenges and fill the existing knowledge gaps, the Institute for International Economic Studies (IIES), Yale University, University of Chile, FAIR (NHH Norwegian School of Economics) and Ifakara Health Institute (IHI), in collaboration with implementing partners D-tree International, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and EDI Global, are carrying out a groundbreaking six-year ECD research program in Tanzania entitled “Kizazi Kijacho” (The Next Generation). This program, launched in March 2021, will use novel longitudinal and experimental data from a nationally-representative sample to yield actionable evidence for policy makers, donors and practitioners about the design of cost-effective, scalable, sustainable, integrated ECD parenting programs, from the prenatal period until the child’s 3rd year of life – the "first 1,000 days.” 

Specifically, this program proposes to carry out a randomized controlled trial (RCT) to test the effectiveness of a parenting intervention in which Community Health Workers (CHW) will be guided by an innovative digital application to help provide caregivers with continuous support in all aspects of nurturing care (i.e., health, sanitation, nutrition and early stimulation). The program also aims to make a major scientific contribution by improving child development measurement (i.e. developing state-of-the-art measures that are cost and time efficient, scalable and comparable over time)  and by establishing and analyzing a large and exceptionally rich nationally-representative longitudinal cohort dataset using state-of-the-art methods to measure child development and its multidimensional inputs from in-utero until 3 years old—the first research of its kind in an LMIC setting.

Anticipated Impact

The rich longitudinal cohort dataset we will generate through this program will help us develop a detailed picture of how children from the poorer parts of Tanzania are developing from in-utero until age 3 in this era of massive economic change. The resulting findings on the human development process will enable us to identify critical points in the child’s early life when specific domains develop, when specific inputs (such as nutrition and stimulation) are most impactful, and when their influence wanes. In addition, this research will gather evidence on how best to design parenting programs that intervene early, are holistic and support CHWs to sustainably deliver high-quality ECD parenting services at scale. Combined, our research will advance the field of practice on how to design cost-effective, integrated ECD programs in low-income settings to ensure that they scale and have maximum impact. Supplemented by sizable efforts to disseminate our research findings to relevant stakeholders and decision makers, our research also has the potential to strengthen ECD policy and programming in LMICs more broadly, thereby helping to break the intergenerational cycle of poverty and contribute to the UN Sustainable Development Goals.

Funding

The research program has received generous funding from the British Academy, FAIR/NHH, the John Templeton Foundation and the Swedish Research Council.