Reach Up (icddr,b) – Comprehensive Summary

Last updated: December, 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 child (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 (UNICEF, 2017), and there have been over 230 million girls and women (around 6% of women) who’ve undergone genital mutilation (UNICEF, 2024). People aren’t good parents by default.

Intervention

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).

Evaluation

Methods

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 (giving them each equal weight) to estimate the impact of home visiting parenting programmes.

Impact

The total individual benefit is 14.5 WELLBYs, we add a spillover effect of 7 WELLBYs, for an overall effect of 21.5 WELLBY. We adjust this by 0.23 (a 77% discount; primarily based on replicability concerns) an overall effect of 5 WELLBYs.

Cost

We estimate that it costs $98 per child treated by the icddr,b. 

Cost-effectiveness

The cost-effectiveness of icddr,b’s Reach Up programme is $20 per WELLBY. This means for every $1,000 donated, the organisation creates 50 WELLBYs.

Quality of evidence

Our quality of evidence assessment is stringent. We assess quality of evidence according to an adapted version of the ‘GRADE’ criteria, a widely-used and rigorous tool for assessing evidence quality across healthcare and research fields. The GRADE criteria for evidence quality are very stringent, so we expect very few interventions that we evaluate for wellbeing in LMICs (which tend to be less well-studied) will score more than ‘moderate’ on the quality of their evidence. Considering most decisions about charities are made with little-to-no evidence, this is a substantial improvement.

We characterise the evidence quality as low, and thus the analysis that’s based on it as speculative. 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 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 (40-70%) of the analyses we think are useful.  We’ve spent about 90 hours on this analysis.

Funding need

We think that the icddr,b  could usefully absorb something around $5 million in the next three years for this programme.

This comes from a discussion where they mentioned they could roll out 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. We assume they would 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 ($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 meantime, interested parties should email donate@icddrb.org about restricted donations to the Reach Up programme in Bangladesh.

Conclusion

The Reach Up programme delivered through the icddr,b is a promising way to improve childhood development and ultimately improve wellbeing over the lifetime. While the cost-effectiveness estimate of $50 per WELLBY is encouraging, the evidence base is limited and indirect, making our analysis speculative.

Our reports so far

We have one shallow report on the Reach Up programme so far.