Evidence to Policy, a monthly note series on learning what works, highlights studies that evaluate the impact of programs designed to improve. From how to best supply rural health clinics with drugs to what helps students do better in school, World Bank-supported impact evaluations provide governments and development experts with the information they need to use resources most effectively. As impact evaluations increasingly become more important to policymakers, this series offers a non-technical review of the many innovations the World Bank is supporting, and the growing number of rigorous studies analyzing the impacts of those innovations. The note series is managed by SIEF, which receives generous funding from the British government's Department for International Development and the Children’s Investment Fund Foundation (CIFF).
Before the COVID pandemic, more than half of children in lowand middle-income countries suffered from learning poverty: they either were out of school or failed to learn to read with comprehension by age 10. At the same time, numerous studies have documented serious challenges related to the quality of education services, particularly for those serving poor students. In a country like Kenya, for example, teachers exhibit low levels of content and pedagogical knowledge. Previous research has shown that highly structured teaching guides could improve literacy, but scripted lessons are not without critics, who worry that teachers will not be able to adapt content to student’s needs. In places where teachers may be less prepared to tailor high quality lessons to their students, however, scripting may offer a way to standardize a minimum level of quality at scale.
The importance of children’s earliest years, when their brains and bodies are developing, is well-established. Providing children with adequate nutrition and cognitive and psycho-social stimulation during this period can reap benefits not only in their early school years but for many years to come. Extreme poverty and the malnutrition and low levels of stimulation that often come with it, however, prevents approximately 250 million children under five years of age in lower-income countries from reaching their full potential as adults. As evidence grows on this topic, policymakers are showing increasing interest in early childhood development programs to promote healthy early child development. Previous research in high-income countries suggests these programs, when implemented well, can help children go further in their education, earn more, and commit less crime as adults than their disadvantaged peers, but little is known about long-term benefits in lowand middle-income countries.
Children need a safe, nurturing, healthy, and stimulating environment to thrive and reach their full potential. But millions of children living in poverty don’t receive enough stimulation or good nutrition in their first years of life, and poverty also makes them more likely to experience neglect and violence in the home. Domestic violence, however, is rarely addressed in programs promoting young children’s development, which also typically focus on mothers, with little attention on fathers. Previous research suggests home-based parenting programs can lead to positive improvements in children’s brain development. Can these programs be adapted to address family violence as well? Can these services be effectively delivered through government social safety net programs which often target poor, vulnerable families?
In the first years of life, all children need healthy food, a clean environment, and stimulation to thrive and reach their full developmental potential. However, poverty prevents millions of young children in low- and middle-income countries from receiving adequate nutrition and stimulation. As a result, many disadvantaged children’s brain development lags behind that of their well-off peers, which can have lifelong consequences. Previous research from low-income settings has found that encouraging parents to play and interact more with their children can improve children’s brain development, with impacts that can last into adulthood. Delivering these parenting programs at scale and in a cost-effective manner, however, has been a challenge, in part because some of the most successful programs have been delivered through intensive and relatively costly home-based programs.
More people around the world are dying from noncommunicable diseases than ever before. These diseases, which include cancer, chronic respiratory diseases, diabetes, and heart disease, prematurely kill more than 15 million people between ages 30 and 69 each year. Many of these health conditions also make individuals more susceptible to severe forms of other diseases like COVID-19.
Performance pay for teachers generates debate. Proponents argue that many school systems have low levels of accountability and advocate incentivizing teachers by linking their pay to either their own efforts or their students’ learning. Critics, however, raise concerns that performance pay attracts people to the teaching workforce who are “in it for the money” and could diminish the intrinsic motivation to teach among teachers already in classrooms. To inform the Rwandan government about its own incentive structure for teachers, researchers designed a two-year experiment in partnership with Rwandan Education Board and the Ministry of Education, with support from the World Bank’s Strategic Impact Evaluation Fund. The evaluation was set up to separately measure the impact of performance pay on the composition of teachers attracted to the teaching force and its impact on their effort in the classroom once hired.
To prevent the spread of harmful and deadly pathogens, households must be able to access and use a hygienic toilet. In many low-income countries, however, toilets that safely separate feces from human contact have not universally reached poor rural areas, forcing many people to resort to open defecation. Fecal matter that is not properly contained can make its way into the household environment, where it comes into contact with surfaces and food and into drinking water sources, causing diseases such as typhoid and diarrhea, a leading cause of child deaths worldwide, as well as stunting in young children.
Early learning experiences promote child development and help children get prepared for school, providing children with a foundation for learning that can last into primary school and well beyond. Evidence suggests the positive impacts of these experiences are particularly pronounced for disadvantaged children, who often have limited access to learning materials and stimulation at home, and policymakers around the world have expanded access to preprimary education. But how much preprimary education do children need? Is one year enough, or do children reap additional benefits from two years of preschool?
Young children everywhere need sufficient nutrition and stimulation to grow and develop appropriately. A healthy, diverse diet and a supportive caregiving environment can help children grow and develop in their early years, and also make children more likely to succeed later in life. Across low-income countries, however, hundreds of millions of children don’t get enough healthy food for their bodies and brains to develop fully, putting them at a disadvantage starting from an early age. With so many children at risk of stunted growth and development, policymakers are urgently seeking effective and scalable approaches to improve children’s outcomes.
Early childhood is a critical period for growth and development. Research shows that giving young children enough nurturing and stimulating experiences during these early years not only improves their chances of success in school but can also help them succeed and be more productive later in life. Although access to preschool has increased substantially in recent years, in many low-income communities children don’t receive any educational services before they start primary school.
Safe drinking water is essential for healthy human development and survival, but millions of poor people in low-income countries only have access to contaminated drinking water. For children, the problem is particularly dangerous and deadly, with diarrheal diseases like typhoid and cholera responsible for approximately 800,000 child deaths each year.
In Mexico, the government runs a mobile tutor program to send recent university graduates to work in schools in the country’s most rural and marginalized communities, where teachers are typically members of the community with limited education and training. The World Bank’s Strategic Impact Evaluation Fund (SIEF) supported an evaluation to measure the impacts of the mobile tutoring program in the Chiapas region, where a high fraction of the population is poor and indigenous.
Training vouchers and microfinance tools are often used by multilateral organizations, non-governmental organizations, and governments to increase employment and business oppor¬tunities in low- and middle-income countries. An alternative is putting cash directly in the hands of the poor themselves, leaving them to decide how best to use the money for income-generating activities. One of the assumptions underlying these programs is that poor people can generate high returns to capi¬tal but often have trouble saving money and accessing credit. Giving people cash enables them to bypass these obstacles to starting or improving a business. Recent studies have found that simply giving people cash can improve incomes, at least in the first few years, and the cash is very rarely squandered or misused. However, very little is known about the effectiveness of start-up grants in the long run.
Tuberculosis is an infectious bacterial disease spread through the air that can lead to death when left untreated. The disease killed some 1.6 million people in 2017, according to the World Health Organization, making it one of the top ten causes of death worldwide and one of the leading causes of deaths from infectious disease. TB is treatable and patients are usually cured with a standard six-month course of medications. Treatment often is free of charge, but many cases of TB aren’t diagnosed or treated properly, particularly in low-income countries. Improving the detection of TB is crucial to ensure that infected individuals receive proper treatment and to prevent them from infecting others.
Without access to a hygienic toilet, and the motivation to use one, people usually defecate in the open, and fecal matter makes its way into homes, food, and drinking water sources. In places such as rural India where open defecation is very common, finding effective and affordable approaches to increase sanitation coverage is a major public health challenge.
Children everywhere need enough nutritious food and stimulation to grow and develop to their full potential. Yet many disadvantaged children in low-income countries do not receive the support they need in the first years of life, negatively affecting their future health, education, and earnings. This research in Colombia shows that it is possible to deliver a model of early childhood education at scale and through existing government services.
Private schools that cater to low-income students are popular with parents seeking alternatives to government schools. But these private schools, which are often owned by local entrepreneurs, may lack the resources and incentives to expand enrollment or improve quality. They generally operate in markets where access to credit is limited and where there aren't loan products tailored to their needs. This means that any improvements have to be financed through school fees or their own funds. When donors and investors step in to provide support to private schools, they tend to focus on larger operators with a chain of schools, which typically implies selective funding to a limited number of schools rather than broad support to the schooling market. Is this the best way to support private schools that cater to poor families? Could supporting the entire market, rather than select schools—or chains—lead to more competitive pressure to invest in quality improvements that promote students’ learning? And is a market for loans for private schools sustainable?
In many low-income countries, improving service delivery can be challenging, whether it’s making sure that teachers are in the classroom ready to teach or that cash transfers reach intended beneficiaries. It’s often difficult to cost-effectively monitor programs, especially when they cover thousands of communities and include very remote areas. In India, a study tested whether using phone calls to monitor the distribution of government checks to farmers –and telling responsible civil servants that calls were being made to beneficiaries–would lead civil servants to improve their performance so that more farmers received their payments.
To ensure that children arrive in primary school ready to learn, policymakers around the world are increasingly focusing on what happens in preprimary education programs. In Ghana, SIEF-supported researchers used a randomized control trial to measure the impact of the teacher training on its own and of twinning it with an educational component for parents to inform them about what’s developmentally appropriate in preprimary education.
In Pakistan, a public-private partnership program to improve schooling opportunities for both boys and girls provided cash subsidies to private entrepreneurs who established and operated free, co-educational primary schools in villages in remote areas where government schools are not always available. The impact evaluation found that boys and girls in villages that were randomly assigned to program schools were more likely to be in school and that they did better on tests to measure learning than children in villages without such schools.
The World Bank’s Strategic Impact Evaluation Fund (SIEF) supported a study carried out with the Bulgaria-based Trust for Social Achievement to test whether covering the costs of preprimary education would boost enrollment and attendance.
In Brazil, policymakers from the Ceará state government worked with the World Bank and the Brazilian nongovernmental Lemann Foundation to design a program to improve secondary school teacher effectiveness. The program provided feedback to teachers on their classroom practices and gave them access to expert educational coaching through one-on-one sessions delivered via Skype. With support from the World Bank’s Strategic Impact Evaluation Fund, the World Bank team incorporated an impact evaluation into the program to test the effectiveness of the approach.
In Malawi, researchers supported by the Strategic Impact Evaluation Fund (SIEF) worked with the government to study the impact of a pilot program to improve the quality of the country’s Community-Based Childcare Centers, which serve children aged three to five years old in rural areas.
The Government of Bangladesh is working with a variety of partners on initiatives to improve early childhood development and provide the country’s youngest citizens with a good start. The World Bank’s Strategic Impact Evaluation Fund (SIEF) supported an evaluation to test the impact of adding a child stimulation component to a national nutrition program.
An evaluation of an effort to improve child development through a social safety nets program found that behavioral change activities improved women’s knowledge and practices. But there was little impact on children’s physical growth or cognitive development.
In Nepal, researchers supported by the World Bank’s Strategic Impact Evaluation Fund worked with the government to develop a program to inform pregnant women and mothers of young children on how to best care for themselves and their children, using already ongoing community meetings to deliver messages.
The evaluation of an educational pilot program found that giving parents information led to improved test scores, lower fees in the private schools in the village and higher primary school enrollment.
In Tunisia, an evaluation of a program to provide university students with entrepreneurship education and assistance in developing a business plan, found that the program increased self-employment in the short term. However, four years after finishing the program, these same students weren't any more likely than students who didn't take the program to be self- employed. Limited access to capital was a key challenge that many of the program's graduates said they faced.
In India, the Legatum Institute, the World Bank, the British government’s Department for International Development, the educational non-profit Azim Premji Foundation, and the government of the Indian state of Andhra Pradesh worked together to evaluate alternatives for improving education and giving children more choices.
In Indonesia, researchers evaluated a project to expand access to early childhood services in the country’s poorest areas by giving communities grants for preschools and providing teacher training and facilitators to encourage use of services.
In Kenya, the World Bank supported a pilot program to give unemployed youth access to job training and private sector internships.
In Haiti, World Bank researchers worked with the Ministry of Education to evaluate a pilot program to use digital technology to help keep track of teachers in school and enable more effective monitoring of schools.
Researchers worked with the Government of Cambodia to evaluate the impact of three pilot early childhood development programs that were being scaled up with assistance from the World Bank.
Giving parents information led to improved test scores, lower fees in the private schools in the village and higher primary school enrollment. The results indicate that when parents know how well their children are doing in school—and know how well other children are doing in different schools—it can spur better learning.
In Senegal, researchers evaluated a program that focused on local media and community events to encourage regular handwashing with soap and water. While identifying the best routes for effective handwashing and campaigns remains a key goal for researchers, this evaluation underscores the challenges of both changing behavior and measuring impacts.
In Tanzania, the World Bank’s Water and Sanitation Partnership worked with the government to create and implement campaigns to improve sanitation and reduce illness among young children by encouraging hand washing and use of improved sanitation such as toilets.
A World Bank research team, with support from the Strategic Impact Evaluation Fund (SIEF), conducted a systematic review of water and sanitation impact evaluations to provide a basis for future policymaking and research.
An evaluation measures the impact of skills training for youth through the private sector.
Using smartphone technologies to monitor schools turns out to be more complicated than imagined, as this evaluation showed.
Also available in French
In Uganda, an impact evaluation found that communities and health clinics made better decisions on how to improve care when they first received specific data on health clinic functioning and health outcomes.
An evaluation measured whether providing a temporary increase in financial incentives to clinics would encourage them to initiate care for pregnant women in the first trimester—and whether this would continue even after the increase stopped.
In Indonesia, the World Bank worked with the government to set up and evaluate alternative ways to improve parents' knowledge of and involvement in the management of money that the government gives to schools for operational costs.
A study found that when primary school children get deworming treatment, their younger siblings showed cognitive gains, perhaps because of fewer worms in the community.
Also available in French
An evaluation of sanitation coverage underscored that campaigns for ending open defecation need to include a communal approach. Individuals may not be investing in toilets because unless everyone does the same, the direct benefits to are so small.
The World Bank, in collaboration with the Ifakara Health Institute in Tanzania and the University of California, Berkeley, supported the evaluation of a program in Tanzania that gave people cash payments for practicing safe sex.
In Argentina, the World Bank supported a government program, Plan Nacer, to improve maternal-child health outcomes through increased coverage and quality of health services.
Also available in Spanish
In Haiti, most primary schools aren’t government run and they charge fees. A program that gives schools vouchers to cover fees allows children to go to school for free, relieving the financial burden on families, and reduces grade repetition, an impact evaluation found.
Also available in Spanish, French
With HIV/AIDS a critical problem in sub-Saharan Africa, improving the rate of HIV testing is important. This evaluation found that pay-for-performance could be a route for improving testing (and thus making available information on how to prevent HIV transmission) among those who face risk of infection from their partner.
Also available in French
The impact evaluation of a conditional cash transfer program targeting nutrition in young children showed good results, and now the Government of Bangladesh is scaling up the nutrition component of the program to reach more poor households.
Also available in French
In Turkey, researchers from the World Bank worked with the government to evaluate the impact of the Turkish National Employment Agency's (ISKUR) vocational training program to reduce unemployment. Based on the results, the government increased courses by private providers and took steps to ensure the quality of the offerings.
Also available in French
The Philippines is successfully using conditional cash transfers to improve health and education for the poorest families, but the program hasn't been effective at raising school enrollment for older children. Based on the evaluation, the government has increased the transfer amount for older children.
What's the most effective way to reintegrate ex-combatants and reduce illegal activities? This policy note reviews an innovative program that had a big impact.
This policy note reviews the evaluation of a program in Jamaica that targeted mothers of babies stunted due to malnutrition, offering a rare look at the effects of early childhood intervention over the decades.
Also available in Spanish, French
In Tanzania, an innovative conditional cash transfer program that relies on local communities to administer the payments has succeeded in helping the country’s poorest citizens. As the results of a recent impact evaluation indicate, cash transfer systems can be adapted to work well in low-income countries that don’t have a strong central government to administer them.
Power Point Summary
In Indonesia, the World Bank worked with the government to develop new approaches to discourage open defecation and increase the number of toilets in poor, rural areas. An impact evaluation of a program to foster demand for toilets by raising awareness—instead of building sanitation facilities and hoping people would use them—showed a boost in toilet construction and a drop in diarrheal illness.
In Cambodia, a scale-up of early childhood development programs ran into problems, which affected the evaluation and raised important lessons for policymakers and groups working on bringing such programs to scale.
Also available in French
The World Bank works with governments to develop and implement innovative methods for expanding access to education, particularly for girls, and improve school quality.
Also available in French
Impact evaluations from Peru and Vietnam give us more information about the difficulties of changing handwashing behavior on a large scale.
In Colombia, researchers used administrative data to analyze the long-term impact of conditional cash transfers on schooling.
In Uganda, researchers evaluated a government program that gave unsupervised cash grants to youth for small business development and training. Based on final results four years after the intervention, the cash transfers achieved nearly all the goals. Beneficiaries invested most of the cash in building business opportunities. While they still did agricultural work, they spent more time working in skilled industry and services and their incomes rose. (View 2011 policy note on the study)
This bulletin showcases a World Bank supported project in Zambia, where researchers tested two new models for helping rural health facilities stay better supplied with essential medicines. One of the models worked so well that Zambian officials and donors are now considering how to extend it throughout the country. [View original Note - 2010]
Also available in French
In Tunisia, the World Bank worked with the government to evaluate a program designed to give university students entrepreneurship training and assistance developing a business plan. The evaluation found that the program increased self-employment and helped students develop some skills associated with successful entrepreneurship.
Also available in French
This bulletin showcases a World Bank supported study in Cambodia, where researchers set out to study the effects of scholarships on encouraging primary school students to continue their studies in lower secondary school – and whether bigger grants worked better than smaller ones. The results of the study underscore the importance impact evaluation can have for policymakers, even as researchers plan a second round of data collection to answer some important questions raised by the results. [View original Note - 2010]
Also available in French, Bengali
In Indonesia, the World Bank worked with the Government of Indonesia on a community grant program to boost the use of health and education services. The impact evaluation built into the program found that cash transfers to rural communities led to positive impacts on average across health and education indicators, with a strong decline in malnutrition.
To help policymakers assess the effectiveness of Latvia's public works program, the World Bank supported an evaluation of the government-sponsored public works initiative, which was launched in response to the global financial crisis of 2008–2010.The evaluation found that the program successfully reached its intended target, helping Latvia's worst-off cope with the crisis by increasing their short-term incomes. For policymakers and development experts, this evaluation underscores the usefulness of public works programs as emergency social safety net instruments even in upper–middle income countries.
To help build a body of evidence on how to encourage and support quality healthcare, the World Bank supported a study of government-run and faith-based health clinics in Rwanda. The 23-month evaluation, the first rigorous one of its kind in a low-income country, found that performance-based bonuses helped raise the quality and use of health services for women and children.
In order to build evidence of what works, the World Bank funded the Jordan NOW pilot program, which was designed to encourage employment of female college graduates in Jordan through wage subsidy vouchers and soft skills training. Built into the project was an evaluation to measure the impact. Researchers found that vouchers did boost employment—but only for as long as the vouchers were valid. After that, the new hires were let go or left their jobs. The training didn’t show any significant effect on employment.
To understand whether low-cost private schools can improve access to education and promote student learning, the World Bank evaluated a new public-private education partnership in Pakistan at the request of the government. Private schools receive a per-student monthly subsidy in exchange for waiving tuition and meeting testing standards. By linking the subsidy to student learning, the program aims to push schools to perform better. The evaluation found that the threat of losing the subsidy worked.
To understand the role that social protection programs can play in helping people feed themselves and their families, the World Bank supported an evaluation of an ongoing program in Ethiopia. This program includes a public works component for the poor. A complementary initiative works to build household agricultural assets so families can better provide for themselves. The evaluation found that these measures boost food security, helping households better manage year-round.
To learn whether cash grants and training can help poor, rural farmers develop alternative income sources so they better manage during weather “shocks” that harm or destroy crops, the World Bank evaluated a Nicaraguan government program that sought to assist families after a bad drought. Two years after the program ended, researchers found that families that received vocational training or small business grants were better protected against droughts than those who qualified only for conditional cash transfers.
To help policymakers better understand the effects of conditional cash transfers on encouraging parents to take children for regular check-ups, the World Bank supported a study of a pilot cash transfer program in Burkina Faso. The evaluation found that conditional cash transfers boosted routine preventive health care visits, regardless of whether the money was given to the mother or father. On the other hand, unconditional cash transfers, regardless of which parent received the money, did not lead to more regular health visits.
To test the effectiveness of preschool programs on children’s enrollment in and readiness for primary school, the World Bank supported a study of an early childhood development preschool program in Mozambique run by Save the Children. The evaluation showed that children enrolled in preschool were better prepared for the demands of schooling than children who did not attend preschool and that they were more likely to start primary school by age 6.
Also available in French, Spanish
Researchers measured the relative effectiveness of a pilot program implemented by the Indonesian government to test measures to strengthen school committees and improve accountability, thereby leading to better student learning. The pilot found that the most effective way to improve student test scores was to support democratic elections for committee members and strengthen ties between the committees and local groups.
Also available in Spanish
Researchers supported by the World Bank evaluated three Save the Children school feeding programs in Burkina Faso, Laos and Uganda. The results point to the possibilities and limitations of school feeding programs: when properly implemented, they can raise enrollment and possibly lead to better learning. But even then, feeding programs are unlikely to make up for the cognitive and physical lags that result from poor nutrition during pregnancy and the first two years of life.
Researchers evaluated a Kenyan program to use vouchers to encourage young adults to enroll in vocational training programs. The research showed that this was effective at promoting enrollment -- and that those who received vouchers that could be used for a private institution were more likely to sign up and stay in school.
This policy note reviews a World Bank-supported evaluation of Chile's Solidario social assistance program, which aims to reach families living in extreme poverty. The research shows that twinning regular social worker visits with changes to the programs themselves to increase access and better meet demand did lead to increased take-up of subsidies.
Also available in Spanish
A World Bank-supported a study of a program in Indonesia that gave young children special high-nutrition snacks found that the program reduced stunting in children aged 12 months to 24 months. This study provides useful lessons into how governments and policy experts can work to support proper mother and child nutrition during times of economic crisis.
A World Bank-supported study reviewed the impact of a public-private partnership in Colombia that places computers in public schools. The study found that students in participating schools did not show improved test scores, raising questions about the effectiveness of the program, which included teacher training in how to use the computers as teaching aids. Bad news is sometimes good news, blogged HDN Chief Economist Ariel Fiszbein, because it reminds us that “achieving results is not as simple as we sometimes seem to believe.”
This bulletin takes a look at a World Bank supported study in Andhra Pradesh, India, where our team and their counterparts set out to explore whether paying teachers bonuses based on student test scores is more effective at boosting scores than giving schools extra money for supplies or teachers. The results of the project will not end the debate over how to encourage more effective teaching. But it does offer some powerful ideas that can help inform policy in this critical area across the developing world.
This policy brief provides an overview of the ECED sector and uses findings from an ongoing World Bank-supported ECED project to make preliminary policy recommendations to guide these initiatives. This brief shows that the ECED project has had several positive effects, including increased enrollment rates and higher developmental outcomes for children. The project objectives are to increase access to ECED services among the poor and enhance children's school readiness. This is done through a package of interventions which are delivered sequentially and include: community facilitation, block grants, and teacher training.
Also available in Bahasa (Indonesian)
In an effort to understand whether the program is improving children's development and readiness for primary school, and what factors contribute to effectiveness of ECED services, MoNE is undertaking an impact evaluation that tracks over 6,400 children (ages 1 and 4) for a period of three years. The baseline results summarized here are the first to show relationships between parental education, nutrition, and stimulating learning environments and child developmental outcomes in Indonesia.
Also available in Bahasa (Indonesian)