NIGER: Using Behavioral Change Activities to Improve Early Childhood Development

Proper nutrition and psycho-social stimulation is critical for the physical and cognitive development of young children. Many programs in sub-Saharan Africa have provided short-term responses to food crises. Families need sustained programs to become more resilient and ensure that children get the nutrition they need year round to thrive. Conditional cash transfers have proven successful in reducing poverty, improving health check-ups for children and school attendance, but they can be hard to implement in countries where the supply of health and education services is lagging behind. In West Africa, policymakers are increasingly relying on unconditional cash transfers combined with accompanying measures designed to encourage households to invest in their children’s human capital. 

Background
About three quarters of people in Niger live on less than US $2 per day, the fertility rate of 7.6 children per woman is among the highest in the world and more than a third of children under the age of five are stunted because of malnutrition.

Intervention
In 2011, the Government of Niger, with support from the World Bank and UNICEF, established a safety net program combining unconditional cash transfers for women in poor rural households with monthly parental training in village assembly meetings, small-group meetings and home visits on nutrition, health, child protection and psycho-social stimulation.

Evaluation design
Cluster randomized control trial. Two-year intervention directed at for households receiving cash transfers. The evaluation ran from 2012 through 2016.

Eligibility
Mothers of children aged six months to five years old living in chronic poor households  

Results
Mothers improved their nutrition and health practices which translated into positive effects on socio-emotional development, but had no effect on cognitive nor physical development.

Policy impact
The government is using the results to inform the program’s national roll out, including refining the program’s design and improving health and sanitation services aimed at program recipients.

Next steps
A World Bank team will now pilot a program for introducing improved sanitation in areas where the cash transfers are taking place to test whether this will help improve childhood development, specifically physical and cognitive growth.

Additional impacts

• Baseline survey: The results of the baseline survey led to two program changes: One, because the survey showed that children’s cognitive development was weaker than expected, the government reworked the program to give more emphasis to cognitive development; Two, changes were made in the targeting mechanism to identify poor families after the survey carried out for the impact evaluation showed that the targeting mechanism for the program wasn’t working well.
• Randomization: The impact evaluation team used public lotteries to randomly and transparently allocate villages to either receive the program or not. The Government of Niger has now adopted public lotteries to allocate some services after seeing the positive response to this method for dispensing services when there are limited amounts.
• Program design: The results of the impact evaluation has led the government to take steps to improve the safety net program: One, there will be more training and mentoring of the people who deliver the parenting program to improve quality; and two, after some health clinics turned mothers away when they brought their children in to be checked for possible malnutrition, the government committed to training health workers so they understand the importance of seeing children who are brought in.

Contribution to global public knowledge

• Impact on programs in other countries: Niger was the first country to combine unconditional cash transfers for the poorest households with information for parents on how to improve their young children’s development and the program has become a model for other countries in the region seeking a similar approach, among them: Burkina Faso, Mali, Mauritania, Senegal, Ivory Coast, Togo, all of which are implementing similar safety nets.
• SIEF workshops: The design for the impact evaluation was honed at a SIEF workshop in Ethiopia. The experience was critical is building government support and making sure that the government and the impact evaluation team worked hand in hand throughout the process.

Intervention and Evaluation Details

The evaluation focused on two components of the Niger safety net program:

Unconditional cash transfers: The program was geographically targeted to the poorest communes of the country. Within participating villages, data was collected from all households and a poverty targeting formula was applied to establish a list of the poorest households, which was later validated by the community. Women in the poorest households received US $20 a month for two years.

Accompanying measures to encourage parenting practices conducive to Early Childhood Development: All women in beneficiary villages were invited to attend monthly village assemblies on childhood nutrition, hygiene, health and stimulation, and other issues related to healthy development. Village assemblies were delivered by a local non-governmental organization working in the field of childhood nutrition and health. In addition, two other monthly activities sought to boost knowledge of parenting skills and nutrition: a small group meeting for up to 25 beneficiaries; and home visits for each beneficiary. These additional activities were delivered by a community educator. While cash transfers beneficiaries were invited to attend these activities, the cash transfer was not conditional on their participation. In practice, however, over 90% of program beneficiaries participated, along with many non-beneficiaries in program villages.

Evaluation

The evaluation used a multi-arms randomized design. The program’s initial phase targeted the regions of Dosso and Maradi in southern Niger, which together account for about 40 percent of the country’s poor. For the evaluation, eligible villages were grouped into clusters of around 150 households. One hundred and fifty clusters were randomly selected by public lottery for the program. These clusters were randomly placed into one of three groups of 50: a control group that didn’t receive any intervention, a group that receives cash transfers, and a group that receives cash transfers and the package of accompanying measures to encourage parenting practices conducive to Early Childhood Development.

Before the beginning of the program, a baseline survey collected a broad range of data on households, women of child-bearing age and children younger than five years old, with a focus on food security, nutrition, as well as child nutrition, health and cognitive development. A follow-up survey two years later, just before a family leaves the program, collected similar data. A separate study assessed the quality of implementation, and cost data was also assembled.

By comparing the outcomes of clusters in the two treatment groups and the control group, researchers were able to estimate the impact of the cash transfers, as well as the value-added of the parenting training on childhood development indicators.