Development Challenge
Chronic Child Malnutrition remains a major development challenge in Ecuador. Although prevalence fell by 4.3 percentage points between 2018 and 2023, nearly one in five children under two (19 percent) still suffers from chronic malnutrition, with higher rates among indigenous (32 percent) and low-income populations (22 percent). During this period, the government introduced measures to address the problem, including the creation of the Bono 1,000 Días (BMD) program—a mix of unconditional and conditional cash transfers linked to prenatal and child health check-ups and early civil registry registration—targeting poor pregnant women and mothers with children under two.
Results and Outcomes
Between September 2023 and March 2025, a World Bank Group team conducted an impact evaluation that generated valuable lessons. Since its launch in June 2023 until March 2025, the BMD program has reached nearly 350,000 pregnant women and mothers with children under two, producing the following results:
- A significant increase in attendance at recommended well-child health check-ups, raising rates by 10-15 percentage points over the control group.
- Suggestive, but not conclusive, positive effects on nutritional outcomes in some periods. The lack of conclusive positive effects on nutritional outcomes can be explained by operational constraints during implementation, such as delayed payments or limited knowledge of conditionalities.
- Evidence shows that combining cash transfers with home-visiting services yields greater impacts on health service utilization, as these visits help beneficiaries learn about BMD conditionalities.
- Through the Project, the number of poor children underage three identified in the Social Registry and receiving a package of cash transfers and early childhood development services increased more than fivefold between 2019 and 2024, reaching 126,000 beneficiaries and covering 33 percent of poor children in this age group.
WBG Approach
In 2019, the World Bank launched an Investment Project Financing (IPF) operation with Performance-Based Conditions (PBCs) to strengthen the equity, and sustainability of Ecuador’s social protection programs. Subsequent additional financings supported continued progress, focusing on identifying poor households through the Social Registry and delivering a bundled package during the critical first 1,000 days of life—including cash transfers, early childhood development services, and maternal and child health care. Disbursements were linked to expanding joint program coverage and improving health personnel productivity, both essential for meeting the conditionalities of the BMD program. The World Bank has also provided technical assistance through trust funds and analytics to document results achieved in reducing chronic child malnutrition, evaluate the BMD program, and recommend improvements to coexisting cash transfer schemes that could undermine the effectiveness of social spending. Active collaboration with the United Nations International Children's Emergency Fund (UNICEF), Inter-American Development Bank (IDB), and Development Bank of Latin America and the Caribbean (CAF) has been instrumental in ensuring harmonized and coordinated support to the Government.