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

Summary

It’s widely accepted that intervening at the right time, in the right way during childhood can have lifelong effects on health, achievement and surely happiness as well. For most of us, this seems obviously true when we consider what our parents did or didn’t do for us. While a potentially controversial premise, it seems like basic enrichment activities like telling stories or playing with a child aren’t regularly engaged in by caregivers. What’s more, regularly cultivating curious play is a skill that can be cheaply taught or provided with clear short term benefits to development, and potentially much longer effects to wellbeing. 

This shallow ~80 hour report primarily explores the cost-effectiveness of parent based psychosocial stimulation interventions on the subjective wellbeing (SWB) of very young (0 to 3 years) children in low and middle-income countries (LMICs).

Psychosocial stimulation interventions are often delivered by lay health workers in home visits or to groups. Their aim is to improve the lives of children by engaging them in enriching activities such as storytelling, or playing with puzzle toys. 

This is part of our research to try and find the most cost-effective ways to increase wellbeing globally. This is one of the first attempts at performing a wellbeing cost-effectiveness analysis of a charity that aims to improve parenting.

Why wellbeing? We evaluate charities with wellbeing-adjusted life years (WELLBYs). The metric is simple: one WELLBY is equivalent to a 1-point increase on a 0-10 life satisfaction scale for one year. WELLBYs allow us to impartially compare the impact of very different charities addressing very different problems, and while not without limitations, we think it is the best way (yet) of capturing what really matters.

We also explore the wellbeing effect of psychosocial stimulation interventions have on other household members as a secondary ‘spillover’ consideration. 

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 speculatively estimate that a home visiting parenting programme has an effect of 0.23 standard deviations (SDs) 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. 

We estimate the cost-effectiveness of the best funding opportunity in this space we’ve identified: the Reach Up intervention, a home visiting and group parenting programme delivered by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in Bangladesh. 

We estimate that it costs $98 per child treated by the icddr,b, leading to 50 WELLBYs per $1k (WBp1k). But we expect they have room to reduce costs if they scale further. For context, this is around 7 times more cost-effective than GiveDirectly for which we estimated the cost-effectiveness at 7.55 WBp1k (i.e., $132 per WELLBY; McGuire et al., 2022a). 

The programme lead at the icddr,b has indicated they could absorb millions more in funding to scale the programme across Bangladesh over the next decade ($5 million in the next three years). But currently there isn’t a convenient way to fund the programme directly – donations have to be provided as restricted grants at the time of this writing. We compare this opportunity to other funding opportunities on our website here. 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.