Assessing the effectiveness, cost, and scalability of parenting and cash transfer interventions in Tanzania
Increasing the investment in early childhood development in Tanzania has the potential to improve the life chances of millions of children, ultimately having a positive impact on the country’s future inclusive growth. But there is a need for evidence to help policymakers evaluate which services and investments most improve child development outcomes – and whether those services can be delivered effectively and at scale.
The Kizazi Kijacho research programme, part-funded by Thrive, is assessing three early childhood development interventions. Researchers Ingvild Almas, Bet Caeyers and Ester Elisaria explain more.
It is well understood that the first 1,000 days of a child’s life (from conception until age two) present a significant opportunity for the development of health, learning, behaviour, and psychosocial wellbeing. If children meet their developmental milestones in this early period, it is more likely they will reach their potential and improve their living standards in later life. As well as having a significant impact on individual outcomes, early childhood development also has wider implications for Tanzania’s economy, with its next generation – and future workforce – being better prepared to keep the country on an inclusive and faster growth path.
However, as in many countries in Sub-Saharan Africa, a significant proportion of Tanzanian children do not currently reach their development potential. According to the country’s 2022 Demographic and Health Survey, more than half of children aged 24-59 months are not developmentally on track.
The Tanzanian government has taken decisive action to address these challenges. In 2021, the United Republic of Tanzania became the first country in Eastern and Central Africa to launch a National Multi-Sectoral Early Childhood Development Programme (NM-ECDP) and a national task force has been established. However, when it comes to improving child development at scale in low-and middle-income country settings, there are still major unknowns. In particular, there is a need to better understand how to design targeted cost-effective and sustainable services that can help parents and other caregivers to provide conditions in which children can thrive.
In response, the large-scale Kizazi Kijacho (‘The Next Generation’) Randomised Controlled Trial (RCT) research programme was launched in Tanzania’s Dodoma region in October 2022. It aims to inform childhood development policy and practice for the critical first 1,000 days of a child’s life.
The study involves 3,588 pregnant mothers and their families living in 387 communities, served by 258 health dispensaries in seven districts. The relative cost-effectiveness and impact of three targeted interventions – an innovative parenting programme, an Unconditional Cash Transfer (UCT) programme, and a combination of both – are being tested. They are being introduced during pregnancy and will continue until children are approximately age two (for the parenting programme component) or age one (for the UCT).
The parenting programme is being delivered by community health workers, supported by an innovative digital app. Implemented through monthly home visits and monthly group sessions, the programme focuses on enhancing caregiver skills to create a nurturing environment. Covering early learning stimulation and responsive caregiving; health and nutrition; and safety and security, it combines the Care for Child Development (CCD) approach developed by UNICEF and the World Health Organization (WHO) with elements of the Reach Up parenting programme tailored to the Tanzanian context.
Meanwhile, the UCT programme provides financial support to households through six mobile money transfers over a 15-month period, randomly targeting either the mother or the father. The aim is to empower families to invest in their children's wellbeing by reducing financial constraints. The transfer amounts vary between different groups, allowing a more nuanced examination of how financial resources impact household behaviours and child outcomes. This intervention also enables an analysis of how cash transfers targeted at mothers (versus fathers) affect woman empowerment and child development.
The combined approach evaluates the impact that nurturing caregiving skills coupled with financial support has on family dynamics and child development, compared to the individual interventions alone.
The interventions will be evaluated through cognitive, speech, language, and nutritional assessments, and interviews with household heads, mothers, fathers, community leaders, community health workers, and health dispensary officials. Child socio-emotional status, child-rearing practices (for example, use of health services, child diets, stimulation, and responsive caregiving), household decision-making, and caregiver wellbeing will also be investigated. The findings will be combined with a complementary mixed method process evaluation and a costing/value-for-money analysis.
Cost-effective, publicly funded early childhood development interventions have enormous potential for improving the lives of children growing up in Tanzania – and for enhancing future economic growth. The Kizazi Kijacho programme is a major learning opportunity for the government in its endeavour to develop sustainable services that can be effectively scaled.
Initial findings and observations have been published in a baseline report and policy brief.
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Kizazi Kijacho is a collaboration between the IIES/Stockholm University, Ifakara Health Institute, Chr. Michelsen Institute, FAIR/Norwegian School of Economics, Yale University, the University of Chile, EGPAF, D-Tree International and EDI Global. It is funded by the Swedish Research Council, the Research Council of Norway, the European Research Council, Conrad N. Hilton Foundation and Thrive/UK International Development.