Editor’s Note: This blog is one of a series on early childhood development, featuring experts from Brookings and elsewhere that have been discussing the topic as part of work being conducted by the Center for Universal Education.
The cost implications of taking successful or promising pilots to scale is a topic of high interest. The potential usefulness of such information for policy dialogue is enormous, but admittedly this is an area where relevant information remains scarce, especially in low and middle-income contexts. In a recent discussion on the subject at Brookings, we started our conversation by acknowledging three facts:
- Lack of funds is often a key constraint when attempting to shift successful pilot programs to a large scale, but not the only one (for example, limited human resources are another challenge);
- Some decrease in quality is naturally expected when going to scale, and therefore cost data are only really meaningful when coupled with impact/effectiveness data; and
- The cost per beneficiary is likely to be higher in the initial scale-up phase than in the pilot (to account for upfront investments in system building and the additional costs involved in reaching the most vulnerable). For example a $25/child/year pilot ECD program in Mozambique is now costing about twice as much in the initial scale-up period.
The two presentations during our discussion provided detailed information on these questions in the contexts of Turkey and Colombia, respectively.
Scaling Up Early Childhood Development Programs in Turkey
The Mother Child Education Program in Turkey, or MOCEP, is a 25-week-long training program for mothers and their 5 to 6-year-old children that has been found to have positive effects on children’s overall school readiness and on mothers’ interest in school, self-esteem, and communication with their husbands. The implementation and scaling up of MOCEP has been the collaborative success of many actors involved in the process. The Mother Child Education Foundation (ACEV) provided training of trainers, local coordinators, and supervisors, and overall program management and quality control services. The Turkish Ministry of National Education (MoNE) had its staff trained by ACEV as group leaders and provided the space for courses to be held at more than 500 adult education centers around the country. The World Bank provided the initial funding to expand MOCEP. Between 1993 and 2010, ACEV trained over 1,100 group leaders and 150 local coordinators, and MOCEP was scaled up to 71 of Turkey’s 81 provinces, reaching over 310,000 mothers and children. During this period, $17 million was spent on management and implementation costs, averaging $56 per beneficiary. In 2010, MOCEP was nationalized within MoNE’s larger National Family Program, developed with ACEV’s support, enabling an opportunity to go to further scale. The cost per beneficiary had dropped below $40 before this transfer to MoNE, as economies of scale were already fully in place and the ministry was able to reap the benefits of system investments made in previous years.
Outside of Turkey, through local partnerships, MOCEP was translated into English, Arabic, and Spanish and reached over 12,000 mothers and children in Europe (Belgium, France, Switzerland), the Middle East (Bahrain, Jordan, Lebanon, Saudi Arabia), and Latin America (Mexico). MOCEP’s content and methodology also inspired ACEV to develop additional parenting (including fathers), adult training, and early childhood education programs, including TV/internet/mobile-based ones. Through face-to-face programs only, ACEV has reached over 1 million beneficiaries and trained nearly 10,000 group leaders to deliver these courses in Turkey and 13 other areas(Germany, Netherlands, Turkish Republic of Northern Cyprus, the United Kingdom. and Laos, in addition to the eight mentioned above).
Some of the main challenges faced along the way included: (1) sustaining governmental buy-in to the program amid frequent turnover in MoNE leadership and personnel; (2) maintaining implementation quality and local staff sustainability; and (3) managing a continuous and sufficient flow of funding. The unwavering commitment and relentless efforts of ACEV’s leadership and program experts were instrumental in managing these challenges.
Moving Early Childhood Development “From Zero to Always” in Colombia
In Colombia, much has happened in ECD since the national strategy “De Cero a Siempre” (from zero to always) was launched by President Santos in 2011, and new evidence on the impacts of large programs at scale is now available. Hogares Comunitarios (community nurseries), the largest community-based ECD program, has documented a positive impact of about 0.15 to 0.35 of a standard deviation on children’s development (Bernal and Fernández 2013, and Attanasio, Di Maro and Vera-Hernández 2013), which is about the average effect for similar programs in Latin-America. However, a variety of quality issues were identified in the original design, and subsequent quality enhancements demonstrated further impacts. For example, a vocational-training program for the care-providers resulted in an impact on children’s development of 0.2 to 0.3 standard deviations, with a benefit-cost ratio ranging from 4 to 14 depending on the discount rate used in the calculation (Bernal 2014). On the other hand, transitioning children from the community nurseries (where one caregiver served an average of 15 children) to fully equipped child care centers serving close to 300 children each did not seem to be such a great idea. While this transition resulted in a positive effect on nutrition, it also had several negative effects (on children’s health, language and gross motor development) and no effects on socioemotional development (Bernal, Attanasio, Peña and Vera-Hernández 2014). It was also much more expensive ($1,500 per child per year instead of $750).
A separate home visitation program similar to the Jamaican model but at larger scale also showed positive impacts after two years of implementation (Grantham McGregor, 1991, 2011). The effects of the program were smaller in Colombia (an improvement of 0.3 standard deviations in Colombia vs. 0.7 in Jamaica), but still cost-effective and in the range of similar programs in the region (Attanasio et. al. 2014). Some of the key challenges faced in this scale-up included: (1) supervision and monitoring to ensure program fidelity; (2) unavailability of accurate and frequent data on inputs, products and outputs; (3) significant variation in regional costs; and (4) lack of qualified human resources in remote areas.
Strong political support in favor of ECD has been critical in overcoming at least some of these challenges. For example, Colombia’s government recently announced its intention to expand early childhood education coverage to all socioeconomically vulnerable children under age five, as part of the administration’s 2014-2018 national development plan.
So How Do We Cost ECD?
Overall, our main takeaways from the presentations and lively discussion held at Brookings are these:
- More is not always better. As the Colombian example demonstrates, cheaper programs can be more cost-effective than more expensive ones, since process quality (i.e., the types of activities children are engaged in and the quality of their interactions among themselves and with the caregiver) can matter more than structural quality (i.e., the physical environment surrounding children).
- Costs vary at different stages of the scale-up process. While initial phases of a scale up experience can result in higher costs per beneficiary (as in the Mozambique and Turkey cases), the Turkey example shows that economies of scale eventually come into play over time, thus making upfront system-building investments worthwhile, especially when political and financial support can be sustained over time.
- The notion of scale is relative. Most of the programs mentioned in this session still cover only a small subset of the eligible population, even though they are considered to operate “at scale.” In order to reach all children in need of such programs, we need to collectively think creatively by exploring other types of innovative and low-cost solutions, including through more systematic use of widespread technologies.