Safety Nets and Early Childhood Development

The intervention can be described as having two parts.

First, a baseline safety net intervention is being implemented in rural Burkina Faso and will provide cash transfers to 40,000 households in two of the three regions with the highest levels of chronic poverty and child malnutrition (Est, and Centre-Est). With an average of 7.9 members per household in poor households in rural areas, approximately 316,000 people will directly benefit from the project representing 16 percent of the chronically poor population in the two regions covered by the project. Since children and pregnant and lactating women are most affected by malnutrition, the project will focus on households with young children.

To reach the project objectives, it was decided with the Burkina Faso government to use a combination of targeting methods to reach the poorest households and households with children at risk of malnutrition.

First, the project uses geographic targeting (based on regional poverty data and provincial nutrition data) to select 5 provinces in 2 regions where both chronic poverty and under-5 chronic malnutrition (height-for-age) are the highest in the country. Also, only rural areas were selected as poverty and malnutrition are higher there. Second, it was decided that only households with young children would be eligible for the program. According to the latest household survey data 87% of poor, rural households have children under the age of 6 and close to 100% have children under the age of 15. Because the program also has other objectives beyond reducing childhood malnutrition, it was agreed to also include households with older children.

Finally, the poverty status of households in the participating areas will be assessed through a combination of consumption-based poverty indicators and non-monetary aspects of poverty such as social and physical aspects of exclusion. The project will combine both proxy-means testing and community-based targeting to derive a final set of households that are considered the poorest in the area.

The cash transfers (FCFA 10,000 per month on average, approximately $20 USD) aim to improve human development outcomes by supporting households with a small regular transfer and also providing information about better family practices to try to improve children’s nutritional and ECD outcomes and encourage households to engage in and invest in productive activities.

Supporting households with regular additional revenue allows them to increase the consumption of essential goods/services (more/better food, small assets, and pay for health care). It can also help women spend more time on productive activities and engage with their children if they can use some of the funds to avoid spending time on low return activities. It can also help prevent households from selling productive assets in times of negative shocks.

Second, the intervention will include village-level meeting, women meetings, and home visits by trained outreach teams who provide information and reinforce behavioral change regarding health/nutrition and psycho-social child development. The aim of these home visits is to increase the probability of the households breaking the intergenerational cycle of poverty, reduce the incidence of malnutrition, and improve human development goals related to MDG 1, 2, 4, and 5. The project will target pregnant women and young children, corresponding to the “window of opportunity”, which is a crucial time to ensure optimum physical growth and development of the individual child. The measures will use an approach of Social and Behavior Change Communication (SBCC) regarding the importance of health care and nutrition for pregnant women and children 0-24 months and promotion of cognitive development for children 24-60 months. Note that the accompanying measures will not support direct nutrition interventions such as targeted feeding, nutritional recuperation, food distribution, or provision of micronutrients.

The evaluation will evaluate both of these intervention components (the cash transfers and the home visits) and will also try to disentangle the importance of specific content messages given during the home visits.

The five study groups will be as follows:

Control group: No cash transfers, no information session at the village or group level and no home visit interventions

Treatment 1: Cash transfers only, no information session at the village or group level and no home visit interventions.

Treatment 2: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, plus home visits only for difficult / vulnerable cases.

Treatment 3: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, reinforced with at least two household visits per month for all beneficiaries focusing on health and nutrition practices.

Treatment 4: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, reinforced with at least two household visits per month for all beneficiaries focusing on health and nutrition practices and the psycho-social development of the child

2018-06-01

2020-06-30

The key outcomes are:
• Anthropometric indicators of children under 5 (height, weight, and arm circumference).

• Health outcomes: vaccinations, illnesses, health clinic utilization

• ECD outcomes as measured by age and culturally appropriate standard ECD instruments, such as the Denver Prescreening Developmental Questionnaire, the Strengths and Difficulties test, and the head-toes-knee-shoulder test.

• Change in household consumption, consumption of food (quality, quantity, and variety), accumulation and selling of productive assets, expenditures on health and education.

These indicators will be collected at the baseline and two years later at the follow-up survey.

The key intermediate level indicators are:
• Monthly attendance at village-level meetings promoting better family practices.

• Reports from home visits (in the relevant study arms) conducted at least two times per month

• Parental child-rearing practices and child time use (school enrollment, school attendance, and child labor): We will have time diary for how much time parents spend with children or try to measure what the children are doing during the day. We will have a specific module asking questions about the types of games and toys children play with at home and then who do they play with (mother/father/brother/sister/other) and the frequency they play with them. We have used this module in previous research in Burkina Faso and we have adapted it to the specific context. We will have a specific module asking about nutrition and foods eaten and health practices during the past week/past year. These questions will include indicators about changes in key family practices including infant and young child feeding practices (e.g., exclusive breastfeeding, colostrum feeding, complimentary feeding), hygiene and sanitation (e.g., hand washing with soap), and prenatal care (e.g., onset of antenatal consultation, frequency of antenatal consultation).

There are also some sub-group indicators:
• Gender disaggregated data, both for children and adults will be collected for all outcomes.

• Precise age information in months will also be collected

• Income, wealth, and consumption: even though this project is targeting poor households, we will also collect data about income, wealth, and consumption in order to be able to perform analyses by socio-economic status.

The five study groups will be as follows:

Control group: No cash transfers, no information session at the village or group level and no home visit interventions

Treatment 1: Cash transfers only, no information session at the village or group level and no home visit interventions.

Treatment 2: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, plus home visits only for difficult / vulnerable cases.

Treatment 3: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, reinforced with at least two household visits per month for all beneficiaries focusing on health and nutrition practices.

Treatment 4: Cash transfers plus village-level meetings and women meetings (groups of 25) promoting better family practices, reinforced with at least two household visits per month for all beneficiaries focusing on health and nutrition practices and the psycho-social development of the child

Randomization was carried out by the PI, using an do file on Stata.
The randomization was stratified at the commune level. Villages with less than 90 households were excluded to to get enough beneficiaries to survey (at least 21 households). Villages with more than 400 households were excluded to avoid very large villages where the households to be interviewed would be very spread out.

The treatment is given at the village level, therefore the randomization is at the village level as well. It is stratified at the commune level.

Yes

225 villages will be covered.

4725 households will be surveyed.

45 village in control group and 45 village in each treatment arm.

The table below summarizes the key parameters used for the power calculations. We consider five outcomes of interest: weight-for-age z-scores, height-for-age z-scores, arm circumference z-scores and two Denver Developmental Screening tests (personal-social skills and language). The means for these variables are taken from a survey conducted in the Nahouri province of Burkina Faso in 2008. Akresh, de Walque and Kazianga (2012, 2013, and 2014) describe the survey in more details. The intra-cluster correlations are calculated at the village level. Denver Anthropometrics Language Social WAZ HAZ ACZ Minimum Detectable Size Effect 0.188 0.182 0.157 0.150 0.157 Parameters Mean 0.683 0.031 -1.315 -1.452 -0.570 Standard Deviation 0.951 0.947 1.353 1.664 1.129 ICC 0.070 0.063 0.039 0.033 0.123