To reach their full potential, children need to be well nourished and cared for, stimulated, nurtured and protected from stress from the time their lives begin (The Lancet ECD series). The investments made early in their lives are key to setting them on a higher development trajectory (Harvard Center on the Developing Child). What’s more, early investments have higher rates of return than most remedial later-life investments, as well as the potential to increase returns to other future investments in these children (Cunha and Heckman 2006).
While a consensus exists on what children need and when, the question of how to best deliver is less clear. Ideally, governments should provide a full range of early investments that support the development of all children. But in a context where an all-encompassing, multi-sectoral approach for children age 0-5 years is not immediately feasible, due to limited resources or capacity, what’s the best place to start? Should governments prioritize investments in young children through parents or through centers (daycare and preschools)? What’s more important, and what’s more feasible?
The World Development Report 2018 and Early Child Development Global Solutions Group sponsored a debate to discuss these questions. Representing Team Parents, the IADB’s Caridad Araujo and Laura Rawlings argued that, since they influence every aspect of children’s lives, empowering parents to support healthy development can substantially and sustainably improve children’s outcomes (Aboud and Yousafzai 2015; Britto et al 2016). These programs, delivered during home visits, community meetings or health check-ups, aim to strengthen parenting capacity by improving the quality of daily interactions and routines at home, and increasing the level of stimulation and nourishment children receive. Team Parents argued that these programs improve not only child developmental outcomes, but also caregiving beyond the intervention (e.g., Nicaragua); are most effective for reaching the youngest children and the most marginalized populations; are more cost-effective than traditional center-based care (IADB’s ECD report); and can benefit members of the family beyond the beneficiary child (evidence here).
Sophie Naudeau and Amer Hasan, representing Team Centers, argued that investments are best channeled through centers because SDG target 4.2 calls for every child to have at least one year of pre-primary education. So, if governments are to increase access to preschool, they better do it right (as attending low-quality preschool can actually worsen developmental outcomes! And so can low-quality daycare). Center-based care and education can wield positive impacts on child development (Engle et al 2011), as well as other members of the household (e.g., in Mozambique and Argentina). Plus, early classroom interactions can foster social inclusion while enabling children to develop socio-emotional abilities. Team Centers pointed out that cost-effective approaches to preschools do not necessitate investment in fancy infrastructure, but rather in-service training that builds the social capital of community workers who spend time with children. All acknowledged that quality is key to effectiveness.
So what inputs, when of good quality, are associated with successful early interventions? Well, it depends. In a center-based approach for children 3-5, the minimum level of structural quality can be low and still yield positive outcomes IF children receive high quality interactions and stimulation (Black et al 2016). But for children 0-3, delivering quality center-based interventions is harder and costlier because younger children need far more care and attention. Successful parenting interventions also hinge on quality interactions: those between home visitors/facilitators and parents, and those between these adults and children (plus, just as with center-based programs, the content of the program, staff training, supervision and monitoring are all key). Ultimately what matters is the quality of child-caregiver interaction, which may be easier to monitor in centers than households. But which approach is more likely to deliver quality stimulation and care at scale most cost-effectively?
That brings us to the issue of external validity. The better-known examples of parenting (Jamaica) and center programs (Abecedarian and Perry Preschool programs) were intensive, highly scripted pilot programs conducted and monitored by skilled professionals. These programs delivered very impressive results beyond childhood, including improved labor market outcomes, lower crime rates, and better mental health for beneficiary children 20 to 30 years after the intervention – but they are hard to replicate or scale-up. Yet, both teams pointed to growing and promising evidence on both approaches (e.g., in Bangladesh, Colombia, Ecuador, Mozambique and Indonesia).
When done right, investments through parents and through centers can improve children’s outcomes. In highly constrained environments, it may be most cost-effective to start by channeling investments for children 0-3 through parenting interventions, and via community playgroups and preschools for children 3-5. It is crucial that the most at-risk children not be excluded from interventions due to low parental take up or distance from centers. And there may be complementary steps needed for any approach to yield results, such as providing access to clean water and sanitation, or cash that allows families to feed their children at least one meal a day. Ultimately, countries and communities must determine what the most feasible and cost-effective strategies are for their own challenges, and implement them so that every child has the chance to reach their potential.