The Importance of Quality for Scaling Up Early Childhood Development Services: Experimental Evidence from Nicaragua

Abstract This study experimentally evaluates the impact of a large-scale, government-implemented Home Visit Program in Nicaragua, finding positive effects of home visits on a composite indicator of child development, preschool completion, and one parenting behavior: cognitive stimulation. The intent-to-treat estimates show that assignment to home visits increased child development scores by 0.11 standard deviations (SD), with a local average treatment effect of 0.26 SD, and raised the likelihood of preschool completion by 7 percentage points (18 percentage points for those who received home visits), making the program highly cost-effective. The study also provides novel evidence regarding the importance of implementation quality in explaining these effects, addressing a key challenge in the literature on scale-up: how to ensure quality. Leveraging random assignment to institutional (centralized) monitoring versus structured, community-led (decentralized) monitoring, the study provides causal evidence that community monitoring improves home-visit quality across four domains: home visitor–caregiver relationship, use of materials and preparation, visit content, and focus on caregiver. In turn, each of these quality domains (except focus on caregiver) is linked to improved child development.