Cash Transfers, Behavioral Changes, and Cognitive Development in Early Childhood: Evidence from a Randomized Experiment

Macours, Karen; Schady, Norbert; Vakis, Renos

doi:10.1037/e596302012-001

Cited by 105 publications

(120 citation statements)

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“…A range of interventions were tested: unconditional or conditional cash transfers [78, 82, 84, 86, 87, 90, 92], fee exemptions [77, 79, 80, 88, 89], and food incentive schemes [83, 85]. …”

Section: Resultsmentioning

confidence: 99%

A systematic review of strategies to increase access to health services among children in low and middle income countries

Bright

Felix

Kuper

et al. 2017

BMC Health Serv Res

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BackgroundUniversal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented.MethodsWe conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results.ResultsFifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies.ConclusionsThis review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC. It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home. However, given the methodological limitations found in existing studies, the results of this review must be interpreted with caution.Systematic review registrationPROSPERO CRD420160334200 Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2180-9) contains supplementary material, which is available to authorized users.

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“…A range of interventions were tested: unconditional or conditional cash transfers [78, 82, 84, 86, 87, 90, 92], fee exemptions [77, 79, 80, 88, 89], and food incentive schemes [83, 85]. …”

Section: Resultsmentioning

confidence: 99%

A systematic review of strategies to increase access to health services among children in low and middle income countries

Bright

Felix

Kuper

et al. 2017

BMC Health Serv Res

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“…However, the ASQ-3 had lower concurrent validity, suggesting that the Denver-II was the most suitable for use at-scale. In Nicaragua, the Denver-II, administered at home, was sensitive to the impact of a cash transfer program [19]. The poor validity of the ASQ-3 below 30 months is concerning given the test is increasingly used in large scale studies [18, 40].…”

Section: Discussionmentioning

confidence: 99%

“…language) are increasingly used in large scale surveys and impact evaluations [18, 19, 20]. Although not designed for this purpose and often not validated nor standardized locally, these tests are becoming popular alternatives since they are shorter, cheaper, and easier to administer.…”

Section: Introductionmentioning

confidence: 99%

Concurrent Validity and Feasibility of Short Tests Currently Used to Measure Early Childhood Development in Large Scale Studies

et al. 2016

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In low- and middle-income countries (LIMCs), measuring early childhood development (ECD) with standard tests in large scale surveys and evaluations of interventions is difficult and expensive. Multi-dimensional screeners and single-domain tests (‘short tests’) are frequently used as alternatives. However, their validity in these circumstances is unknown. We examined the feasibility, reliability, and concurrent validity of three multi-dimensional screeners (Ages and Stages Questionnaires (ASQ-3), Denver Developmental Screening Test (Denver-II), Battelle Developmental Inventory screener (BDI-2)) and two single-domain tests (MacArthur-Bates Short-Forms (SFI and SFII), WHO Motor Milestones (WHO-Motor)) in 1,311 children 6–42 months in Bogota, Colombia. The scores were compared with those on the Bayley Scales of Infant and Toddler Development (Bayley-III), taken as the ‘gold standard’. The Bayley-III was given at a center by psychologists; whereas the short tests were administered in the home by interviewers, as in a survey setting. Findings indicated good internal validity of all short tests except the ASQ-3. The BDI-2 took long to administer and was expensive, while the single-domain tests were quickest and cheapest and the Denver-II and ASQ-3 were intermediate. Concurrent validity of the multi-dimensional tests’ cognitive, language, and fine motor scales with the corresponding Bayley-III scale was low below 19 months. However, it increased with age, becoming moderate-to-high over 30 months. In contrast, gross motor scales’ concurrence was high under 19 months and then decreased. Of the single-domain tests, the WHO-Motor had high validity with gross motor under 16 months, and the SFI and SFII expressive scales showed moderate correlations with language under 30 months. Overall, the Denver-II was the most feasible and valid multi-dimensional test and the ASQ-3 performed poorly under 31 months. By domain, gross motor development had the highest concurrence below 19 months, and language above. Predictive validity investigation is needed to further guide the choice of instruments for large scale studies.

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“…Nevertheless, they also lead us to be somewhat pessimistic about closing these gaps because the magnitudes of the differential we find are large relative to the program effects that have been estimated in the literature. Berlinski et al (2009) estimate that preschool attendance improves cognitive development by 0.23 standard deviations in Argentina; cash transfers to very poor households improve cognitive development by 0.18 standard deviations in Ecuador (Paxson and Schady 2010), and 0.10 standard deviations in Nicaragua (Macours et al 2012); home visits are estimated to improve cognitive development of young children by approximately 0.25 standard deviations in Colombia (Attanasio et al 2012). In this paper, we estimate that the difference between children in the poorest and the richest quartile in the countries we study are bigger than one standard deviation in urban Colombia and rural Ecuador, and larger than 0.75 standard deviations in the urban and rural areas of all five countries (with the exception of rural Colombia, where the difference is 0.57 standard deviations).…”

Section: Discussionmentioning

confidence: 99%

Wealth Gradients in Early Childhood Cognitive Development in Five Latin American Countries

Schady¹,

Behrman²,

Araujo³

et al. 2015

J. Human Resources

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141

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Research from the United States shows that gaps in early cognitive and non-cognitive ability appear early in the life cycle. Little is known about this important question for developing countries. This paper provides new evidence of sharp differences in cognitive development by socioeconomic status in early childhood for five Latin American countries. To help with comparability, we use the same measure of receptive language ability for all five countries. We find important differences in development in early childhood across countries, and steep socioeconomic gradients within every country. For the three countries where we can follow children over time, there are few substantive changes in scores once children enter school. Our results are robust to different ways of defining socioeconomic status, to different ways of standardizing outcomes, and to selective non-response on our measure of cognitive development.

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Cash Transfers, Behavioral Changes, and Cognitive Development in Early Childhood: Evidence from a Randomized Experiment

Cited by 105 publications

References 0 publications

A systematic review of strategies to increase access to health services among children in low and middle income countries

A systematic review of strategies to increase access to health services among children in low and middle income countries

Concurrent Validity and Feasibility of Short Tests Currently Used to Measure Early Childhood Development in Large Scale Studies

Wealth Gradients in Early Childhood Cognitive Development in Five Latin American Countries

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