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Evaluating the Early Childhood Stimulation Program March 2014 Issue 1 Team Members

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Evaluating the Early Childhood Stimulation Program March 2014 Issue 1 Team Members Evaluating the Early Childhood Stimulation Program March 2014 Issue 1 Team Members Impact Evaluation American Institutes for Research (AIR) has been contracted by the Dr. Marjorie Chinen, AIR World Bank’s Strategic Impact Evaluation Fund (SIEF) to lead the Dr. Julia Lane, AIR evaluation of the Save the Children Early Childhood Stimulation Pro- Dr. Jena Hamadani, gram. AIR’s research proposal was selected from more than 300 International Center for Di- proposals to receive the SIEF funds. arrheal Diseases Bangladesh (icddr,b) Description of the Program- Save the Children’s Early Stim- Dr. Najmul Hossain, ulation Program promotes positive stimulation practices among Data International (DI) mothers of children ages 0–3 years. Community clinics in rural Ban- Dr. Minhaj Mahmud, gladesh are the platform for the intervention. Trained health person- Bangladesh Institute of De- nel—Health Assistants (HAs), Family Welfare Assistants (FWAs) and velopment Studies (BIDS) Community Health Care Providers (CHCPs)—deliver messages on early childhood stimulation practices to households in the communi- World Bank Task Team ties. These messages are integrated with a comprehensive nutrition Leaders package delivered through the Bangladesh National Nutrition Ser- Dr. Ayesha Avawda vice (NNS). Dr. Nkosi Mbuya Research Design- The evaluation is a two-year clustered ran- Program Implementation domized controlled trial, conducted from 2013 through 2015. This (Save the Children) type of trial is the most powerful research design available for drawing Dr. Ivelina Borisova conclusions about an intervention’s impacts on specific outcomes. Ms. Roxana Khanom The evaluation will examine outcomes in households in two sets of community clinics. The intervention group will receive the program’s early stimulation messages, and a control group will operate as usu- al). Households with children between 3-18 months within each of these community clinics’ catchment areas have been selected at ran- dom. The study is being conducted in Satkania (Chittagong), Muladi (Barisal), and Kulaura (Moulvibazar) Upazilas. The four evaluation goals are listed below. Objective 1: Document Intervention Results. Document the 2-year Community Clinic , Satkania Upazila impact of an early childhood stimulation program targeting mothers The CCs are the platform of the program on child development outcomes (Bayley’s Cognitive and Language implementation, and serve as the main Scales of Infant Development), child nutrition outcomes, and mater- location for administration of the Bay- ley’s and anthropometric measurements nal behavior in rural areas of Bangladesh. (see page 2 for description of these data collection instruments). www.air.org/SIEFbangladesh Page 1 Objective 2: Understand the Intervention Process. Describe the mechanism through which the program affects child outcomes. Exam- Advisory Board ine the fidelity with which the programs can be implemented. The Advisory Board con- Estimate the benefits Objective 3: Determine Approach Scalability. sists of Bangladeshi child of the intervention relative to the costs to inform national and interna- development and nutrition tional policy and program development. Integrate with the NNS plat- specialists. AIR collaborat- form to investigate the potential of scaling the program in concert with ed with the World Bank and the extension of the NNS. Save the Children to hand- pick these experts prior to Objective 4: Build Local Capacity and Inform Policy. Use impact evaluation techniques in close collaboration with the government of instrument development Bangladesh, Save the Children, and national-level research and pro- and fieldwork. gram institutions. Reach local networks of subject matter experts, through the evalution team’s technical advisory board. Participate in The group has already con- regular workshops to inform national-level policy and program changes tributed invaluable feed- affecting young children in Bangladesh. back into both design and implementation, and will continue to provide guid- ance to the research team for the remainder of the study. The Data Collector is administering the Bay- ley test. They meet quarterly during the data collection phases, and every 6 months in be- tween. They will also review reports, perform communi- Messages for Mothers and Caregivers ty outreach, and provide ad hoc advice to the research- • Care during pregnancy (for pregnant women): Your baby’s brain ers when requested. is already developing—eat nutritious food and take good care of yourself to help your baby grow well. Prepare for baby’s arrival by Members: making a rattle or other appropriate toy. Ms. Mahmuda Akhter, • Love and affection: Give your child affection every day and show ICHD your love to your child by smiling, hugging, and praising him/her. Dr. Jena Hamadani, • Play and games: Play games with your child every day, and let him iccdr,b or her play with different playthings around the house. Dr. Baren Mandal, RCHCIB • Talking and communicating: Talk with your child while doing house- Dr. Makhduma Nargis, hold work every day and respond to your child’s sounds and at- RCHCIB tempts to talk. Teach him/her new words, songs, and stories. Dr. Md. Lutfor Rahman, • Positive discipline: Practice gentle discipline and praise your child IPHN for good behaviors. Dr. S. M Mustafizur Rahman, • Health and hygiene: Wash your hands and help your child practice NNS hand washing with soap. • Share messages: Share your knowledge with others in the house- hold and the community as often as possible. Page 2 www.air.org/SIEFbangladesh About the NNS Project Timeline The National Nutrition Ser- vice (NNS) is a key compo- June 2013 - October 2013 Instrument Development nent of the recently enacted 18 July 2013 BMRC Approval national Health Population 20 August 2013 1st Advisory Group Meeting Nutrition Sector Develop- 26 July - 07 October 2013 Data Collector Trainings ment Plan (HPNSDP), which 10 October 2013 MOU Signed guides government pro- grams from 2011 to 2016. 31 October - 16 January 2014 Baseline Data Collection March 2014 Launching Ceremony The purpose of the NNS is February-March 2014 Save the Children Training and to address malnutrition by Program Roll-out mainstreaming nutrition April 2014 - June 2015 Monitoring Program within government ser- October 2015 - December 2015 Endline Data Collection vices. They have developed a nutrition training package that will be used to train community clinic service Baseline Instruments providers on how to imple- ment nutrition counseling Household survey: The household survey is administered to the moth- and services at the commu- ers of every household. Information collected includes: child health nity level based on govern- and nutrition, stimulation knowledge, responsive feeding and decision ment-approved IYCF (Infant making. Household amenities are also captured. Young and Child Feeding) training guidelines. Anthropometric measures: All children in the sample have height and weight measurements collected. A key component of the NNS package is the com- Bayley test: Enumerators administer the 3rd Version of Bayley Scales munity-based promotion of Infant and Toddler Development to children in the study sample. This of positive nutrition practic- test consists of a series of developmental play tasks that are scored to es. This includes: exclusive determine the child’s relative performance with children in the same breastfeeding for children age cohorts. up to six months, appropri- ate complementary feeding Service Provider survey: Health Assistants, Family Welfare Assis- practices for children from tants, and Community Health Care Providers provide program knowl- six months to two years of edge, information on delivery mechanisms, and keep track of workload age, screening for malnutri- to help evaluators identify potential program delivery issues. tion, and appropriate refer- ral to healthcare facilities for Administrator survey: District level health personnel provide informa- treatment. Health workers tion on the inner workings of community clinics and the service provid- will also provide micro-nu- ers that these personnel manage. trient supplements. Non-Compliance survey: Basic household characteristics are collect- ed for households that refuse to be included in the study. www.air.org/SIEFbangladesh Page 3 Study Updates About AIR Data collection was completed in January 2014. Data International, Dr. Founded in 1946 as Jena Hamadani’s team of child development experts from icddr,b, and non-partisan not-for-profit Dr. Minhaj Mahmud from Bangladesh Institute of Development Studies organization, AIR is recog- provided excellent field oversight and guidance. nized around the world as a leader in behavioral and The data-collection team engaged the community by locating house- social science research and holds through local service providers, meeting with community lead- evidence-based technical ers, and discussing the roles and relationship of health administrators assistance. to the community clinics. The results have been excellent: 99% of households with eligible children have agreed to participate in the AIR’s staff members have survey! The main challenge encountered has been the imprecision expertise in such fields as of some of the Health Assistant records, which has created problems education, psychology, so- locating some of the sampled households. Hartals (shutdowns) and ciology, economics, psy- strikes have also created transportation obstacles due to scarcity of chometrics, statistics, pub-
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