Reach Up (icddr,b) – Comprehensive Summary
Last updated: November, 2024
Problem
The majority of mothers (83%, it’s 95% for fathers) in low income countries don’t regularly engage in most well accepted enriching activities such as: reading books, telling stories, singing songs or lullabies, taking the child outside the home, playing with the child or naming, counting, or drawing things for or with the child1This comes from Cuartas et al. (2020), using a dataset covering 62 LMICs (n = 205,150)..
Perhaps more troubling, UNICEF reports that 60% of children between the ages of two and four are violently punished by their caregivers globally (2017), and there have been over 230 million girls and women (around 6% of women) who’ve undergone genital mutilation (2024). People aren’t good parents by default.
Intervention
But it’s not too hard to do better. Parent-based psychosocial stimulation interventions, are development and educational programmes primarily aimed at encouraging parents to play with their children more and in more enriching ways.
In addition to playing with their child, parenting interventions often also attempt to teach appropriate discipline, avoid maltreatment, and improve parental mental health (Jeong et al., 2021). Parenting interventions often also provide basic nutritional advice, or teach health behaviours like hand washing, and when possible connect them to relevant health or educational services.
Furthermore, these interventions can be cheaply and widely delivered by lay health workers.
Organisation
The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) was started to study diarrhoeal diseases but has since expanded to research and treat a wide range of diseases and afflictions facing people living in low income countries (icddr,b, 2024).
As of June, 2024 the icddr,b say that using the Reach-Up programme, “…more than 14,000 caregivers of children aged 6-36 months have so far been trained [unclear since when].” (icddr,b, 2024).
The icddr,b, is a large organisation ($78 million in expenses in 2022), so we are trying to establish a way to donate to this project directly. We will update this report as soon as we’ve found a more direct way. In the mean time, interested parties should email donate@icddrb.org about restricted donations to the Reach Up programme in Bangladesh.
Evaluation
Impact
There’s considerable evidence of the effect of these types of interventions on short and medium term development outcomes like cognition (20+ RCTs).
However, the evidence for the long term wellbeing effect of increasing childhood psychosocial stimulation through parenting interventions in LMICs is very weak (2 RCTs, n = 426). The evidence is only somewhat better for psychosocial stimulation through preschool programmes in HICs (causal studies = 4, n = 2,502).
We combine these two sources of evidence to speculatively estimate that a home visiting parenting programme has an effect of 0.23 standard deviations (SDs)2See our methods website page for general definitions about what these units are. on depression that lasts 32 years. The total individual benefit is 14.5 WELLBYs, a spillover effect of 7 WELLBYs, and after a 77% discount (primarily based on replicability concerns), a total benefit of 5 WELLBYs.
Cost
We estimate that it costs $98 per child treated by the icddr,b or
Cost-effectiveness
We estimate that it costs $98 per child treated by the icddr,b, leading to 50 WELLBYs per $1k (WBp1k) or $50 per WELLBY.
Quality of evidence
We characterise the evidence quality as weak, and thus the analysis that’s based on it as speculative, with the primary concern being indirectness.
It’s unclear how relevant the evidence we use is. Some of it is about the Reach Up programme, the programme implemented by the Icddr,b. But most of that evidence is not about wellbeing or has long run outcomes. Around half of the evidence we use is from non Reach Up programmes to support child psychosocial development in high income countries. Hence, we’re using rather indirect evidence on most accounts.
Behind that, the most direct and important piece of evidence we have has very imprecisely measured effect sizes and low power, making it likelier that the result we observe is due to chance.
Depth of our analysis
We also rate the depth of work gone into creating this estimate as low. By this we mean that we believe we have only reviewed some of the relevant available evidence on the topic, and we have completed only some (10-60%) of the analyses we think are useful. Another way of expressing this is we view this report as shallow. For example we put around ~80 hours into this report. Our most in-depth reports might have absorbed 5 to 10 times as much time.
Funding need
Based on our conversation though, we would guess they could usefully absorb something around $5 million in the next three years3This comes from a discussion where they mentioned they could rollout to 600 clinics for $1 million USD which would mean $1667 per clinic or around $26 million to roll out across the country (~15,000 remaining clinics), or $2.6 million every year for 10 years. I assumed they’d otherwise receive $1 million in funding each year for a $1.6 gap in the next 3 years..
The icddr,b, is a large organisation, so we are trying to establish a way to donate to this project directly. We will update this report as soon as we’ve found a more direct way. In the mean time, interested parties should email donate@icddrb.org about restricted donations to the Reach Up programme.
Conclusion
We think of the speculativeness of this cost-effectiveness as only slightly less than those in our other cause area reports (lead exposure, immigration, or pain), and significantly more than for analysis of psychotherapy, cash transfers, and anti-malaria bed nets.
Due to the lack of direct data from the icddr,b’s implementation of Reach-Up, but relatively high cost-effectiveness despite some conservative assumptions, we think it is a reasonable but very speculative bet to fund research for or potentially assist with their scale up in Bangladesh.