Thursday, 15 November 2012

Impact of daycare interventions in Latin America

Urbanisation and increased female labour market participation have led to increased demand for daycare services, which in developing countries is partly met by government daycare programmes. Some of these programmes offer subsidised community daycare services, in which women from the community provide full time childcare in their home, food and some recreational or educational activities for the children. Other programmes offer public preschool education to children between 3 and 5 years of age. But do these daycare interventions benefit the child’s development?
Impact evaluations of these programmes were undertaken to assess their effectiveness by comparing the wellbeing of children cared for at daycare (or preschool) to those cared for at home. To synthesise the evidence, researchers of the National Institute of Public Health in Mexico (myself and Jef Leroy, currently at the International Food Policy Research Institute) and the Center for Research and Teaching in Economics (Maite Guijaro), undertook a systematic review. The study, The impact of daycare programmes on child health, nutrition and development in developing countries: a systematic review examined the effects of daycare interventions (formal out-of-home care) on the health, nutrition and development of children under five years of age, in low- and middle-income countries.
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The systematic review identified 13,190 studies, but only six, based in Latin America, met the inclusion criteria in terms of scope, type and quality. Four studies evaluated community-based interventions and two looked at preschool interventions.
The findings showed that attending daycare had positive effects on language skills, social and emotional development of children in the short run. In the medium term, school attendance, student behaviour and test scores witnessed a positive trend. In fact, the effects on the children were more pronounced depending on the exposure to the programme. For example, the Bolivia daycare programme had a positive effect (2-11% increase) on bulk (gross) and fine motor, language and psycho-social skills for children with more than seven months of exposure to the programme. On medium-term outcomes, the Argentina study found that one year of preschool increased mathematics and Spanish test scores at third grade of primary education by eight percent. In Uruguay, it was found that children who attended at least one year of preschool, increased their schooling by nearly one additional year by the age of 15.
On child health outcomes, only one study from Colombia evaluated the impact on prevalence of diarrhoea and acute respiratory infections. Although this study found reductions in the prevalence of both diseases with longer exposure to the programme, it is not clear if the results are a true health effect of the programme or if the comparison group of children with less than one month of exposure to the programme, might have suffered from a steep increase in infections right after joining a daycare centre.
However, no conclusions could be drawn with respect to the nutrition outcomes. One study from Guatemala analysed child dietary intake and found positive impacts, a study from Bolivia found no impact on child growth, and two additional studies from Colombia found inconsistent results on child anthropometrics, such as height and weight.
Finally, the reviewed studies did not provide a good description of the type and quality of care children receive in the absence of the programme. This represents an important limitation of the reviewed studies since the potential impact a daycare programme might have is determined by the “net” treatment, which is the difference in the type and quality of care between daycare interventions and the alternative forms of child care in the absence of the programme. For instance, a positive “net” treatment effect can be expected if daycare interventions provide a high quality childcare alternative to mothers who take care of their children while working. However, a negative “net” treatment effect could be anticipated if children who receive adequate family care are enrolled into a low-quality daycare programme.
Policy implications
The evidence shows that daycare interventions in Latin America, community-based or school-based, have had a positive impact on child development. However, there is not enough evidence to conclude that these programmes have improved child health and nutrition. Based on this information, should policymakers decide not to implement daycare interventions until there is conclusive evidence about its impacts?
Considering the proven impact daycare interventions can have on improving child development in the short and medium term and the increasing demand for out-of-home care, these programmes should be implemented if they provide a high quality alternative to the care children normally receive.
However, it is crucial that new programmes are evaluated and closely monitored, not only to add to the very limited knowledge base of programme effectiveness and pathways of impact, but also to guarantee that unintended negative effects are identified and corrected.
(Paola Gadsden is the Coordinator of Analysis and Evaluation of Public Policies for the State of Morelos, Mexico)
3ie funds impact evaluations and systematic reviews that generate high quality evience on what works in development and why. Evidence on development effectiveness can inform policy and improve the lives of poor people.

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