This is the summary of the report. Click the button above to read the pdf of the full report (32 pages).

Summary

Early childhood is a critical period for development. But many parents in low and middle income countries (LMICs) are less likely to play or engage with their kids enough, and some use violence to punish their children. These parenting practices can impair cognitive, emotional, and physical growth, leading to lower lifetime wellbeing.

Psychosocial stimulation interventions improve parenting practices by teaching parents to engage with their children in more enriching ways, such as storytelling, reading, and playing, and to avoid maltreatment. These interventions can be delivered by lay health workers in home visits or to groups of caregivers, and they are relatively cheap to provide in LMICs. These interventions have clear short term benefits to development, and potentially much longer effects on wellbeing.

In this shallow report, we spent about 90 hours exploring the cost-effectiveness of these interventions on the subjective wellbeing of children in LMICs. To our knowledge, this is the first wellbeing cost-effectiveness analysis of an intervention to improve parenting.

This forms part of our broader work to assess the cost-effectiveness of interventions and charities based on their impact on subjective wellbeing, measured in terms of wellbeing-adjusted life years (WELLBYs). One WELLBY is equivalent to a 1-point increase on a 0-10 wellbeing scale for one person over one year. We focus on subjective wellbeing because we believe it best captures what ultimately matters, wellbeing. By using wellbeing as a common outcome, it allows to make apples-to-apples comparisons between very different interventions.

The best funding opportunity we found is the Reach Up intervention delivered by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). This is a home visiting and group parenting programme in which health workers make regular home visits to parents of young children (often ages 0 to 3) to help train parents to engage in stimulating daily activities with their children.

There’s considerable evidence of the effect of parenting interventions on short and medium term development outcomes like cognition (20+ RCTs). However, the long-term evidence on wellbeing is relatively weak. We estimate the impact of parenting interventions on long-term wellbeing using two sources of evidence, to which we give equal weight in our analysis (i.e. 50% to each):

• home visitation programmes in LMICs (2 RCTs, n = 426)
• psychosocial stimulation interventions delivered through preschool programmes in high income countries (causal studies = 4, n = 2,502)

Based on this evidence, we speculatively estimate that home visiting parenting programmes have an effect of 0.23 standard deviations (SDs) on depression that lasts 32 years. The naive total individual benefit is 14.5 WELLBYs with a spillover effect of 7 WELLBYs for a total effect of ~22 WELLBYs. However, we discount this by 77% (primarily for replicability concerns) to arrive at our final effect estimate of 5 WELLBYs.

We estimate that it costs $98 per child treated by the icddr,b, leading to a cost-effectiveness of 50 WELLBYs per $1k (WBp1k). For context, this is around 7 times more cost-effective than GiveDirectly for which we estimated to be 7.55 WBp1k (i.e., $132 per WELLBY; McGuire et al., 2022a). We compare this opportunity to other funding opportunities on our website here.

We expect the icddr,b has room to reduce costs if they scale further, which would improve the cost-effectiveness of their programme. The icddr,b has indicated they could absorb millions more in funding to scale the programme across Bangladesh over the next decade.

Funding the Icddr,b’s Reach Up programme seems like a promising, albeit speculative funding opportunity for donors interested in high impact opportunities for increasing wellbeing.