Effects of Quality Improvement Strategies on Early Childhood Development in Community-Based Childcare Centers in Malawi: A Randomized Trial

October 3, 2016

Children’s social and cognitive readiness for school is crucial for later success. In Malawi, the government seeks to improve child development outcomes through better preschools. Researchers will study the effects of teacher incentives and training, parental education, and learning materials for children on their physical, emotional, and cognitive development and their readiness for primary school.

Preschool programs are a route for low-income children to get the physical, cognitive and socio-emotional skills they need to be ready for school. Poor countries often struggle to provide access to early childhood programs, particularly for the most vulnerable, such as orphans and the disabled. The programs that do exist often don’t have sufficient trained staff or play and learning materials. This evaluation of an early childhood program in Malawi aims to provide evidence on the effectiveness of different interventions to improve children’s development and school readiness by improving the quality of the centers and giving parents information on how to support their children’s development. 

Research area: Early Childhood Nutrition, Development, and Health

Country: Malawi

Evaluation Sample: 199 child community centers

Timeline: Completed

Intervention: Incentives, training, parental involvement

Researchers: Lia C. H. Fernald, University of California, Berkeley; Patricia Kariger, University of California, Berkeley; Christin McConnell, World Bank; Michelle Neuman, University of Pennsylvania; Berk Özler, World Bank

Partners: Save the ChildrenGovernment of MalawiRapid Social Response Multi-Donor Trust Fund; Early Learning Partnership



Malawi is struggling to meet the development needs of its children. About half the children under five years old are stunted and almost 20 percent are underweight. In addition, almost one in five children is an orphan, in many cases because parents have died from HIV/AIDS. High food and fuel prices, a devastating earthquake in 2009 and localized droughts exasperate the difficulties faced by poor families.

The government, with donor assistance, established Community-Based Childcare Centers in the 1990s to promote children’s development. These centers now enroll about a third of the country’s children aged three to five. The quality of the centers, however, is mixed. Most caregivers are young, part-time volunteers without any formal training in early childhood development and turnover is high.

As part of Malawi’s Protecting Early Child Development Project, which is supported by the World Bank and the Rapid Social Response Multi-Donor Trust Fund, the Government of Malawi is testing four different low-cost approaches for improving the quality of the childcare centers. The results will help inform plans for a scale up.

World Bank

Intervention and Evaluation Details


The program was implemented in 199 childcare centers in four of Malawi’s 28 districts. Centers were divided into four groups – one control and three treatment groups – in order to evaluate what worked best to improve how teachers and families interact with the children. The program ran from May 2012 through November 2012.


After a baseline survey, the centers were randomly assigned to one of three treatment groups or to the control group, with about 50 centers in each group. The control group received only a special UNICEF play and learning kit for use with children. The three treatment groups received the play and learning kit and one of three following interventions:

Caregiver training and mentoring: Five weeks of on-site training program, supported by mentors, were offered to improve caregiver knowledge, skills and practices. Topics covered include health, nutrition, childhood learning processes and activities that support development.

Caregiver training and mentoring PLUS caregiver incentives: Caregivers were offered small monthly cash incentives tied to their regular attendance at the childcare center.

Caregiver training and mentoring PLUS parental education: Parents of children in the centers were invited to 12 group sessions that provided information on activities that can be done at home to improve early development. They also learned about childhood health, nutrition, development milestones and the importance of responding to the needs of children.

The evaluation is a cluster-randomized trial. The research team is using surveys and direct observation of the centers and parents, along with child measurements and assessments to identify the impacts of the interventions on the centers and classrooms, on parenting practices, and on early childhood development outcomes. Data collected includes child growth, health, and development, caregiver knowledge, parents’ knowledge, behaviors and stress levels, childcare center quality and staff retention. Midline data was collected a year after the program was implemented. Part of the endline survey was conducted two years later, between May 2014 and July 2014. The final part of the endline survey is planned for 2015, and will include evaluations of the children who were in the childhood centers at the start, and are now of primary school age.

Policy Impact

The results of the evaluation will assess the impact of various measures to improve the quality of childcare centers in Malawi and the development of children enrolled in those centers. They will provide fact-based analysis to the government as it designs a cost-effective program to promote early childhood development. In addition, results will provide useful data for other low-income countries facing similar challenges.