Hope Walks: The Impact of Clubfoot Treatment on Human Flourishing in Ethiopia

Children born with severe congenital conditions in low-income countries rank among the most disadvantaged among the global ultra-poor. We study the impact of clubfoot and its treatment across multiple dimensions of human flourishing on data collected from 564 children in Ethiopia. Working with Hope Walks, an organization that funds clubfoot interventions in numerous countries, we use a quasi difference-in-differences approach that generates counterfactual outcomes from the nearest-age siblings of children born with clubfoot, nested within a family-level fixed effect. We find that clubfoot status (early treatment) results in an impairment (restoration) of -1.44 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> (0.91 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> ) in physical mobility, -1.17 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> (0.79 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> ) in mental health, -1.07 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> (0.64 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> ) in social inclusion, -0.48 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> (0.98 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> ) in an education index, -0.76 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> (0.42 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> ) in religious faith, and -1.32 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> (0.94 <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>σ</mml:mi></mml:mrow> <mml:annotation>$\sigma $</mml:annotation></mml:semantics> </mml:math> ) in an aggregate index of human flourishing (all <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:semantics><mml:mrow><mml:mi>p</mml:mi> <mml:mo><</mml:mo> <mml:mn>0.05</mml:mn></mml:mrow> <mml:annotation>$p< 0.05$</mml:annotation></mml:semantics> </mml:math> ). We attribute the large, broad, and significant impacts from clubfoot treatment to (i) a highly effective medical intervention that is (ii) carried out in an impoverished setting with scarce existing support for children born with disabilities, which (iii) broadly generates spillover effects across key development outcomes.