Innovative Finance
August 1, 2024
Context
Young children in low- and middle-income countries, including Bhutan, are at risk of not meeting their developmental potential due to factors like inadequate cognitive stimulation, stunting, and poverty. In Bhutan, 21% of children under five are affected by stunting, 12.7% of the population lives in poverty, and less than 7% of 3-5-year-olds have three or more children's books. Despite concerted efforts by the Ministry of Education (MoE) and other actors, expanding comprehensive ECCD services to remote communities of Bhutan has been difficult. As of 2017, only 27% of 3-5-year-olds had access to center-based ECCD programs, leaving a significant 80% unreached. This is largely due to scattered populations and the requirement of a minimum of 15 children to establish a center-based program, making equitable expansion unfeasible. This highlights a critical need for accessible early learning and development services
Solution
To address these challenges, the Ministry of Health (MoH) partnered with Save the Children (SC) to implement the “Care for Child Development Program (C4CD) Plus” pilot project. This program is an innovative parenting intervention designed as a contextually appropriate, sustainable, low-cost, and replicable alternative model to center-based ECCD services. The program aims to empower parents and caregivers of 3-5 years-old children with the skills to engage children in early literacy and math activities, enhance responsive caregiving, and practice better health and nutrition routines through monthly group sessions conducted by trained health workers. Village Health Workers (VHWs) are uniquely positioned to reach even the most remote families.
The C4CD Plus project strengthens the existing C4CD program of the MoH by incorporating content on early stimulation, developmental, and health care. It includes nine parenting sessions: seven on early stimulation and two on health and hygiene. Each session incorporates three simple games and activities aimed at building foundational skills in early literacy and math (ELM) and raising healthy children. Parents and caregivers are encouraged to practice session-specific activities at home and read with their children. This is facilitated by allowing parents to borrow storybooks and picture books from a small book bank and take home low-literacy activity cards.
Impact
The C4CD Plus program showed significant impacts on children's learning, with notable gains in literacy and numeracy skills such as writing (18%), oral comprehension (28%), shape ID (38%), and puzzles (26%). Older children benefited more, while gains were consistent across wealth and parental education levels, demonstrating strong equity. Overall, School Readiness Scores were higher for children from the intervention group, with a 50% gain from baseline to end line. The program led to sharp improvements in positive caregiver behaviors, with reading to children rising to 42% and teaching numbers to 76%, while harsh discipline like hitting dropped to 36% compared to 62% in the control group. A long-term evaluation is needed to understand how the program’s early gains translate into success at later schooling levels.