Scaling Up the Provision of Early Childhood Development and Early Nutrition Services in Mozambique

Early childhood development programs help children acquire the skills needed to succeed in primary school and grow into productive, healthy and successful adults, but evidence is needed on the sustainability of large scale programs and their impact. At the same time, it’s important to make sure that pregnant women and young children get the right nutrition to strengthen their bodies and brains in the first years of life. The evidence gathered from the evaluation of preschool, parenting, and early nutrition programs in Mozambique will provide policymakers with important evidence of what works to improve lives.

The Government of Mozambique has worked to develop the country in the two decades since the civil war ended in 1992. Droughts and flooding have complicated things. Improvement is slow and chronic malnutrition and low primary school completion rates remain serious challenges. Almost half the children under the age of five don’t get enough food, and malnutrition accounts for at least a third of the deaths of children in that age group. Many children, especially those from poor families, are not adequately prepared for primary school at age six and struggle to meet basic standards. Only about 4 percent the country’s 4.5 million children younger than five years old are enrolled in early childhood development programs.

Research area: Early Childhood Nutrition, Development, and Health

Country: Mozambique

Evaluation Sample: Pilot: 76 communities, Preschool scale up & nutrition: 60 communities 

Timeline: 2013 - 2019

Intervention: Community Preschools, nutritional programs, parenting information

Researchers: Sophie Naudeau, World Bank; Marie-Helene Cloutier, World Bank; Sebastian Martinez, Inter-American Development Bank

Partners: Government of Mozambique; National Institute of Statistics; Department for International Development (DFID); Save the Children

Intervention and Evaluation Details

Intervention

The program in Mozambique comprises three distinct interventions focused on early childhood development and primary school readiness:

Pilot community preschools and parenting: From 2008 to 2010, a non-governmental organization, Save the Children, operated 30 community-based preschools. The evaluation measured the impact on households with children between the ages of 3 and 5 – comparing the 30 communities that received the preschools with the 46 that didn’t. The short-term evaluation results showed greater primary school readiness among children in preschool and positive impacts on their caregivers and older siblings.

Large-scale community preschools and parenting: This intervention follows on the Save the Children pilot preschool program. It is now Government-led and has expanded its reach to 600 rural communities across five provinces in Mozambique. Similar to the pilot program, these preschools offer 15-hours of instruction a week and monthly information sessions for parents and pregnant women. The program is administered by the Ministry of Education and implemented by three non-governmental organizations.

Large-scale early nutrition program: This program targets teenage girls, pregnant women, new mothers and children up to two years old and includes childhood growth monitoring and promotion, breastfeeding information and encouragement, pregnancy weight gain monitoring and counseling, and distribution of nutritional supplements.

Evaluation

The evaluation is separated into two experimental designs.

First, the continuing evaluation of the pilot preschool program includes the 2,000 households who were part of the first evaluation. The children, who are now in primary school, were surveyed again in 2014, along with their parents and siblings.

Second, there is an evaluation of the large-scale government preschool and nutrition interventions. To assess the interaction between the preschool/parenting and nutrition programs, 60 communities are randomly divided into four groups: the first participates in both the preschool/parenting and the nutrition programs, the second in just the nutrition program, the third in just the preschool/parenting program, and the final control group doesn’t receive either program. Impact is measured by comparing the health, nutrition and primary school readiness of children in the different groups. Baseline data on the children is collected at the launch of the program and follow-up data after 18 months. Information on parents, caregivers and siblings is also collected.

Policy Impact

The results of these evaluations will inform Mozambique government policy toward preschool education and nutritional programs, while providing evidence that can be used by other low-income countries.