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The sooner, the better

June 10, 2013 por Ferdinando Regalia Leave a Comment


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It’s been in the headlines everywhere that early childhood is the most important developmental stage. But, what is the evidence?

A decade ago, Nicaragua implemented a program called Red de Protección Social which benefited approximately 30,000 poor rural families with cash. Of the 42 localities initially targeted, half of them were randomly selected to receive the program from the year 2000 to 2003 while the rest of them received it from 2003 to 2005. This unique setting allowed Tania Barham, Karen Macours, and John A. Maluccio  to investigate whether this type of program has different long-term effects depending on how early in life children were exposed to the intervention.

The research, supported by the IDB, found that 10-year old boys who were exposed to the program in their first 1000 days of life exhibit better cognitive outcomes than those who were exposed to the program from ages 2 to 5.

The data was collected in 2010, ten years after the program started. A detailed battery of seven cognitive development assessments was applied to children who were ten years old at the time and was focused on boys given that the medical literature identifies them as a more vulnerable group during the pre-natal period. Anthropometric data was also collected.

The Nicaraguan program transfers were substantial and represented an average of 18% of the household expenditure. To receive the transfer, families were required to attend bimonthly health workshops and to take all children under 5 to health centers for regular checkups, which included growth monitoring.  Free health services were maintained in those communities that received the CCT, even after the transfer was finished.

The first important finding was that children who were exposed to the CCT while in-utero and during the first two years of life score 0.15 standard deviations higher in the cognitive development assessment than those boys who were exposed to the program when they were 2 to 5 years old.

The second result documents that there are no significant differences in anthropometric outcomes across these two groups of 10-year old boys. That is, there is no difference in height and weight. The absence of a difference between them could be consistent with two possible explanations: either the program had no effect on anthropometrics or boys who received the late treatment were able to catch-up in their physical outcomes. The data seems to support the latter.

In short, the study confirmed the importance of the first 1000 days of life –from conception until the second birthday- for human capital development. However, it also shows no differences in physical outcomes between these two groups. These findings constitute an important contribution to what is still a relatively scarce literature on the long-term impacts of CCTs. They also provide solid empirical evidence in support of policy interventions focused in the first 1000 days of life.

But thinking back of Nicaragua, which exhibits some of the largest deficits the region on cognitive outcomes during early childhood, these findings only reinforce the argument in favor of investing more and investing well in policy interventions that favor long term human capital formation. We are left with one final message: it is crucial to design CCT interventions very carefully and aligned to the evidence to maximize their impact in the long-run.


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Ferdinando Regalia

Ferdinando Regalia is the Social Sector Manager at the Inter-American Development Bank. Prior to his appointment, Mr. Regalia was Chief of the IDB's Social Protection and Health Division (SPH), where he was responsible for overseeing the IDB's support to borrowing member countries' response to the COVID-19 pandemic in the areas of health and social protection. During his service as Head of SPH from 2010 to 2021, Mr. Regalia and his team led the implementation of innovative public-private partnerships and results-based financing mechanisms, such as the Salud Mesoamerica Initiative, to address health inequities. Mr. Regalia promoted research activities and projects that fostered strategies to increase the quality and sustainability of the health, early childhood development, and social inclusion and protection services sectors, working on a variety of enabling factors such as increased adoption of digital tools. Between 2008 and 2009, Mr. Regalia served as the advisor to the Vice President for Sectors and Knowledge of the IDB Group, providing quality oversight of operations and the Vice Presidency's economic and sector research agenda.

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Early Childhood Development

The first years of life are essential to establish the future foundation of a person´s productivity and wellbeing. In this blog, experts from the IDB and thought leaders in the topic, share information and international experiences related to early childhood development. Join us to talk about initiatives implemented in your country in this area

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