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BRIEF June 3, 2021

Ecuador: Nimble messaging to improve Early Child Development in Ecuador

Some 24 percent of children under the age of five in Ecuador are stunted, according to World Bank figures, and reversing this in the early years is critical to building human capital so all children can thrive and succeed. The Government of Ecuador is seeking to change these statistics by improving child nutrition during the first 1000 days of life, a key development period. They are revamping an existing nationwide home visiting program where trained staff, Educators, discuss prenatal care, early child development, healthy nutrition, breastfeeding, and hygiene. Due to COVID-19 these serves transitioned to virtual and hybrid models of implementation.  Using administrative data, the evaluation will test the impact of two complementary interventions.  The first sends text messages to Educators twice a week to promote improved understanding of the virtual and hybrid implementation protocols, and to help keep Educators motivated for high quality service delivery.  The second intervention the evaluation tests is whether sending text messages directly to caregivers of children under one year of age with information, reminders, and positive encouragement to implement the healthy behaviors the standard services promote.  The evaluation team will use both administrative data (never before used for this purpose) as well as phone surveys to estimate impacts of each intervention on Educator compliance with protocols, service quality as well as staff retention and on caregiver knowledge and behaviors as well as child development, respectively.

Study title:Nimble messaging to improve Early Child Development in Ecuador
Research question:1. Can text messages complement the training of Educators and improve the quality of service provided to families?
2. Can text messages with information and reminders increase caregivers' knowledge of good child development and health and nutrition practices?
Policy problem:Chronic malnutrition in young children and inconsistent knowledge among Educadoras who make home visits to households to provide information on early nutrition and low compliance by caregivers with key preventative behaviors that con improve child nutrition.
Evaluation design:

Educator Level
Control: Educators receive status quo staff support and implementing standard ECD service provision (approximately 1,500 Educators)
Treatment: Educators receive status quo staff support and implementing standard ECD service provision plus twice weekly text messages with information, reminders and motivational content to encourage adherence to service delivery protocols and standards and encourage motivation (approximately 1,500 Educators)

Caregiver Level
Control: Receive regular ECD services (approximately 1,000 attention centers, 2,500 caregivers).
Treatment: Receive regular ECD services plus twice weekly text messages with age-specific information about child development, nutrition and healthy behaviors (approximately 1,000 attention centers, 2,500 caregivers).
The caregiver level is a cluster randomized assignment at the attention center level.

Data sources:Administrative data on Educators service delivery and staff retention, administrative health records of anthropometric measures, experience of illness, and health visits, and phone surveys that provide indicators of caregiver knowledge, caregiver behaviors, and child development. 
Researchers: ,