The Effect of Improving Child Care Centers on Early Childhood Development in Bolivia

Last registered on June 08, 2017


Trial Information

General Information

The Effect of Improving Child Care Centers on Early Childhood Development in Bolivia
Initial registration date
June 08, 2017
Last updated
June 08, 2017, 6:09 PM EDT


Primary Investigator


Other Primary Investigator(s)

PI Affiliation
Inter-American Development Bank
PI Affiliation
Inter-American Development Bank

Additional Trial Information

In development
Start date
End date
Secondary IDs
It has been widely acknowledged that the grounds for a healthy and productive future are shaped early on for every child. Inadequate health and nutrition, child rearing practices with limited interaction between parents and children, and home environments with few books, toys, and other learning opportunities may all contribute towards poor cognitive growth and overall child development. Early deficits 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., 2001; 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). Among different policy alternatives, center-based child care interventions have proven to be effective in different country settings (Martinez et. al., 2012; Noboa-Hidalgo and Urzúa, 2012), and the provision of public and high quality child care services has become a desired intervention for expanding coverage within early childhood development (ECD) programs.

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, socio-emotional and physical development of vulnerable children under four years of age through increased access to early intervention services. The Program encompasses a series of components financed by a loan from the Inter-American Development Bank, including a facility improvement intervention for eligible existing child care centers, as well as an upgrade in quality standards and guidelines in these centers.

The program includes an experimental impact evaluation design where eligible child care centers are randomly assigned to treatment and control groups. The evaluation will measure the causal effect of the intervention on different measures of the quality of services offered, including structural factors and processes indicators, and child development outcomes in the long run.
External Link(s)

Registration Citation

, , Sebastian Martinez and . 2017. "The Effect of Improving Child Care Centers on Early Childhood Development in Bolivia." AEA RCT Registry. June 08.
Former Citation
, et al. 2017. "The Effect of Improving Child Care Centers on Early Childhood Development in Bolivia." AEA RCT Registry. June 08.
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Experimental Details



Public child care centers in Bolivia provide daycare services for children under 4 years of age, whereas preschool-age children (4-5 years) are required to attend formal education facilities. The program provides major physical upgrading and improvements of content and staffing capabilities for existing facilities. It will also strengthen the existing national norms and protocols providing standardized guidelines for the work in child care centers in all intervention centers. Specifically, the intervention will finance and support:

• Facility infrastructure improvements through the upgrading of existing selected centers in line with improved guidelines (refurbishments of buildings, redesigning of space use, improvement of safety conditions, etc.).
• Provision or replacement of equipment at the child care center, including appliances, cookware, furniture, and materials.
• Hiring of new human resources (1 senior caregiver/tutor per center and 1 nutrition and hygiene specialist for every two centers)
• Training of new and existing personnel in line with improved guidelines.
• Elaboration, complementation and reproduction of guidelines, norms and quality standards.

The intervention will be implemented in a total of 79 eligible child care centers. All centers will receive the soft component of the intervention (additional personnel and training), 2 centers will receive, in addition, the equipment component, and 48 centers will receive the complete package of the intervention (infrastructure improvements, equipment, additional personnel and training).
Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
The purpose of this research is to assess the impact of the child care center intervention on a variety of service quality outcomes. Our measurement of quality will consider structural factors, such as infrastructure, equipment, availability of trained personnel, protocols, etc, as well as processes indicators that focus on the child-caregiver interactions.

Key Short-term Outcomes
• Availability and adequate physical infrastructure, use of space, furniture, and equipment (Infant Toddler Environment Rating Scale – Revised)
• Quantity and quality of child stimulation and availability of child support in the center’s environment (caregiving routines, activities and interactions) (Caregiver Interaction Scale).
• Caregiver’s knowledge about child development processes and child care practices (Knowledge of Infant Development Inventory).

The study will not measure final child development outcomes in the short run, and will rather focus on quality measures of service provision. The application of ECD standardized tests is considered for subsequent follow up surveys (conditional on the availability of funding) including ECD indicators on cognitive, language, gross and fine motor development, and socio-emotional skills with the ASQ-3 or other similar instruments.
Primary Outcomes (explanation)
Baseline Survey:

For experimental validity and balance purposes, between February and May of 2014, we collected data from a baseline survey in a sample of 100 child care centers (50 treatments and 50 controls). We surveyed infrastructure, staff and functioning conditions through the application of questionnaires at the center level, including the application of three standardized quality tests: ITERS-R, CIS and COFAS. Within each center, we randomly selected a class/cohort and then applied ECD Standardized Tests to a randomized selection of 10 children. The total sample at baseline includes information on 100 child care centers and 1,000 children under 4 years old. The baseline data analysis provided a comprehensive overview of the situation of pre-program ECD and child care centers quality indicators in the target sample. It also showed no significant differences in observable characteristics between treatment and control groups (Bedregal 2016).

Follow-up Survey:

The first follow up survey will take place between September and October of 2017 and will collect information from all child care centers where treatment was offered, as well as from an equivalent number of control centers in rural and urban areas of the departments of Chuquisaca and Potosi. Treatment-control pairs will be selected within each municipality; therefore, the evaluation sample will exclude 8 municipalities that have only one child care center. In total, the evaluation sample will contain 158 child centers.

The survey will focus on measuring quality of services provided at the center, including infrastructure conditions, adequate use of space, caregiving routines, defined activities, processes and interactions with children. Specifically, the survey will collect data on:

- Personal care routines, furnishings, language, fine- and gross-motor activities, creative activities, social development, and adult needs (Infant/Toddler Environment Rating Scale ITERS-R).
- Caregiver interactions to evaluate sensitivity, harshness, detachment and permissiveness of caregivers (Care Giver Interaction Scale CIS).
- Knowledge about child care practices and development processes (Knowledge of Infant Development Inventory).
- Infrastructure indicators, including availability and use of space, furniture and equipment.
- Human resources and child care center management indicators.

Contingent on the availability of resources, a subsequent follow-up survey will be implemented in treatment and control communities with the objective of measuring early childhood development outcomes using a sample of resident households with preschool aged children.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Random assignment to treatment and control groups:

The impact evaluation will be based on the design of a Randomized Controlled Trial (RCT). Within each program municipality, eligible child care centers were randomly assigned an order of entrance to the program and listed accordingly. Initially, based on program resources available, 83 child care centers on top of the list were identified for the treatment group and an equivalent number of centers from the bottom of the list were assigned to the control group. In municipalities where there was only one child center, it was directly assigned to treatment; those municipalities, however, will not be part of the experimental sample. Randomization was carried out through public lotteries witnessed by local and UDIT authorities to ensure transparency and legitimacy.

Treatment was assigned at the center level and stratified by municipality.

Planned number of observations: 158 child care centers
- Treatment: 79 centers
- Control: 79 centers

The long run follow-up will include a population based sample of children in the area of influence (community or neighborhood) of treatment and control centers. The sample will include 12 children per area for a total sample of 1900 children.
Experimental Design Details
Randomization Method
Public Lottery
Randomization Unit
Child Care Center
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
158 child care centers
Sample size: planned number of observations
158 child care centers and 1900 households with children 3 to 5 years old
Sample size (or number of clusters) by treatment arms
Treatment group: 79 centers and 950 children
Control group: 79 centers and 950 children
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
The minimum detectable effect size, with power =0.8, significance =0.05, intra-cluster correlation =0.012 (ESNUT2012), is 0.14 standard deviations on the aggregate measure of child development.

Institutional Review Boards (IRBs)

IRB Name
Comisión de Ética de la Investigación del Comité Nacional de Bioética (CEI-CNB)
IRB Approval Date
IRB Approval Number
Approval letter


Post Trial Information

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Is the intervention completed?
Data Collection Complete
Data Publication

Data Publication

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Program Files

Program Files
Reports, Papers & Other Materials

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