Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trial.

OBJECTIVE: To assess the effectiveness of an integrated early child development intervention, combining stimulation and micronutrient supplementation and delivered on a large scale in Colombia, for children's development, growth, and hemoglobin levels. DESIGN: Cluster randomized controlled trial, using a 2 × 2 factorial design, with municipalities assigned to one of four groups: psychosocial stimulation, micronutrient supplementation, combined intervention, or control. SETTING: 96 municipalities in Colombia, located across eight of its 32 departments. PARTICIPANTS: 1420 children aged 12-24 months and their primary carers. INTERVENTION: Psychosocial stimulation (weekly home visits with play demonstrations), micronutrient sprinkles given daily, and both combined. All delivered by female community leaders for 18 months. MAIN OUTCOME MEASURES: Cognitive, receptive and expressive language, and fine and gross motor scores on the Bayley scales of infant development-III; height, weight, and hemoglobin levels measured at the baseline and end of intervention. RESULTS: Stimulation improved cognitive scores (adjusted for age, sex, testers, and baseline levels of outcomes) by 0.26 of a standard deviation (P=0.002). Stimulation also increased receptive language by 0.22 of a standard deviation (P=0.032). Micronutrient supplementation had no significant effect on any outcome and there was no interaction between the interventions. No intervention affected height, weight, or hemoglobin levels. CONCLUSIONS: Using the infrastructure of a national welfare program we implemented the integrated early child development intervention on a large scale and showed its potential for improving children's cognitive development. We found no effect of supplementation on developmental or health outcomes. Moreover, supplementation did not interact with stimulation. The implementation model for delivering stimulation suggests that it may serve as a promising blueprint for future policy on early childhood development.Trial registration Current Controlled trials ISRCTN18991160.

Evidence on public policy: methodological issues, political issues and examples.

In this paper I discuss how evidence on public policy is generated and in particular the issue of evaluation of public policies. In economics, the issue of attribution and the identification of causal links has recently received considerable attention. Important methodological issues have been tackled and new techniques have been proposed and used. Randomized Control Trials have become some sort of gold standard. However, they are not exempt from problems and have important limitations: in some case they cannot be constructed and, more generally, problems of external validity and transferability of results can be important. The paper then moves on to discuss the political economy of policy evaluations for policy evaluations to have an impact for the conduct of actual policy, it is important that the demand for evaluation comes directly from the policy making process and is generated endogenously within it. In this sense it is important that the institutional design of policy making is such that policy making institutions are incentivized to use rigorous evaluation in the process of designing policies and allocating resources to alternative options. Economists are currently involved in the design and evaluation of many policies, including policies about health, nutrition and education. The role they can play in these fields is not completely obvious. The paper argues that their main contribution is in the modelling of how individual reacts to incentives (including those provided by public policies).