The Effect of a Home-Based Community Visits on Early Childhood Development in Bolivia

Prevailing deficits in developmental stages at a very early age have been long documented in developing countries (Grantham-McGregor, 2007) and in Latin America (Schady et al, 2006). Low-quality health and nutrition services and limited interaction between parents and children in poor home environments may all contribute towards poor cognitive and overall early childhood development (ECD). In particular, deficits of psychosocial stimulation lead to increasing inequality in early childhood stages (Walker et al, 2011) that can have life-long consequences, including lower levels of school participation and performance, lower future earnings and income, increased reliance on the health care system and higher rates of criminality (Walker et al, 2011; Naudeau et al, 2010).

The evidence from recent research suggests that well targeted and defined early interventions can accrue positive and sustainable development outcomes (Engle et al 2011, Hoddinott et al, 2008; Gertler et al, 2014). Besides the design of center-based interventions that have proven to be effective (Martinez et al, 2012; Noboa-Hidalgo and Urzúa, 2012), psychosocial stimulation programs based on home visiting models have demonstrated positive short term and long term effects (Gertler et al, 2014; Grantham-McGregor, 1991). A recent publication by Attanasio et al (2014) has found positive effects on cognition (0.260 SD) and receptive language outcomes (0.218 SD) from a home visits intervention in Colombia.

The Early Childhood Development Unit (UDIT) within the Bolivia’s Ministry of Health (MS) is launching a pilot program in the departments of Chuquisaca and Potosi which aims to improve the cognitive, socioemotional and physical development of vulnerable children under four years of age through increased access to early intervention services. The program will target vulnerable families with children under 4 years of age and encompasses a series of components financed by a loan from the Inter-American Development Bank. One of the key program components is a home visiting model intervention in eligible urban neighborhoods and rural communities. Home visits include psychosocial and stimulation curricula to interact with children and mothers.

The program includes an experimental impact evaluation design where eligible neighborhoods and communities are randomly assigned to treatment and control groups. The evaluation will estimate effects of home visits on child care practices and inputs, and on early childhood development outcomes, including gross and fine motor skills, cognitive and language. Results will inform national policy in Bolivia and will provide evidence on the cost effectiveness of home visits to increase performance in early development outcomes and narrow down development gaps.