The Importance of Quality for Scaling Up Early Childhood Development Services: Experimental Evidence from Nicaragua
通过随机实验评估尼加拉瓜大规模家访项目对儿童发展的影响，发现家访显著提升儿童发展得分和学前完成率，并证明社区监测能改善家访质量，进而促进儿童发展。
Abstract This study experimentally evaluates the impact of a large-scale, government-implemented Home Visit Program in Nicaragua, finding positive effects of home visits on a composite indicator of child development, preschool completion, and one parenting behavior: cognitive stimulation. The intent-to-treat estimates show that assignment to home visits increased child development scores by 0.11 standard deviations (SD), with a local average treatment effect of 0.26 SD, and raised the likelihood of preschool completion by 7 percentage points (18 percentage points for those who received home visits), making the program highly cost-effective. The study also provides novel evidence regarding the importance of implementation quality in explaining these effects, addressing a key challenge in the literature on scale-up: how to ensure quality. Leveraging random assignment to institutional (centralized) monitoring versus structured, community-led (decentralized) monitoring, the study provides causal evidence that community monitoring improves home-visit quality across four domains: home visitor–caregiver relationship, use of materials and preparation, visit content, and focus on caregiver. In turn, each of these quality domains (except focus on caregiver) is linked to improved child development.