Medium and Long Run Effects of Nutrition and Child Care: Evaluation of a Community Nursery Programme in Rural Colombia

1. Medium and Long Run Effects of Nutrition and Child Care:Evaluation of a Community Nursery Programme in Rural Colombia Orazio P. Attanasio & Marcos Vera-Hernandez IFS and UCL

2. The importance of malnutrition • One third of less than five years old children are stunted in growth (Onis et al 2000) • Poor health and nutrition play a central role in underdevelopment (Dasgupta 1993, Fogel 1994) • Inadequate malnutrition in childhood affects long term physical development (Martorell and Habicht 1986, Baker 1990), as well as the development of cognitive skills (Brown and Pollit, 1996 and Balazs et al 1986).

3. The importance of malnutrition • Policy-makers have increasingly promoted early childhood nutrition programs as way to raise living standards in developing countries (World Bank, 1993; Young 1996) • Improving child nutrition would increase school enrollment (Alderman et al 2001) and improve learning productivity (Glewwe et al)

4. Variety of interventions • INCAP (supplementation with nutritious beverage in Guatemala) increased child height and improvements in nutrition • Deworming drugs in schools or pre-schools improve health and participation rates (Miguel and Kremer 2004) and Bobonis et al (2003) • Iron supplementation improves academic outcomes (Nokes et al 1998) • Conditional cash transfers • Pre-school provision of child care and food

5. Pre-school provision of childcare and food • They have been implemented in several developing countries to improve nutrition and learning (Myers, 1995). • Little is known about their effectiveness though the WB and other agencies have devoted increasing resources to support such efforts (Behrman, Cheng and Todd 2001)

6. An example of Pre-school provision of childcare and food: PIDI in Bolivia • Behrman, Cheng and Todd 2001 Assumption of “Selection on Observables”. • They find negative effects on nutritional outcomes and they claim that their assumption of “selection on observables” is not justified. • Conditional on participating on the program they find more exposure improves weight. • They find positive effects on test scores • They do not try to analyze the channels through which this program can operate.

7. Another example: Hogares Comunitarios in Guatemala City • Ruel, Briere, et al 2002 Assumption of “Selection on Observables”. • They find participating children consume better and more nutrients, including the food they take at home. • Beneficiaries mothers are more likely to have a salaried (and possibly more stable) employment than mothers who use other childcare arrangements. • this results in higher wages and a larger number of employment benefits.

8. Which programs? • Early years interventions are perceived to be particularly important given the evidence on the importance of those years in the process of human capital accumulation • Given the scarcity of resources it is crucial to evaluate the effectiveness of each • This is particularly true in the case of Colombia where the new program Familias en Acción is widely perceived as an alternative to Hogares Comunitarios de Bienestar Familiar • Except for a descriptive study in 1998 I am not aware of any systematic evaluation of Hogares Comunitarios

9. Outline • Hogares comunitarios: details of the program • Evaluation strategy • Nutrition outcomes: a production function approach. • Data • Results

10. Hogares comunitarios • Hogares comunitarios is a nutrition/child care program introduced all over Colombia in the early 1980s. • The program is targeted to poor people. • At the beginning of the program poor parents were encouraged to form ‘parents committees’ that would elect one ‘madre comunitaria’ • The ‘madre comunitaria’ would have to satisfy certain conditions (education, large enough house) and would received up to 12 children

11. Hogares comunitarios • Parents would pay a low monthly fee (about 4 dollars per month) per child which is used to pay a small stipend to the mother (and sometimes to an assistant) • Children 0-6 can be sent to the hogar • Moreover, the parents association receives funds to arrange the delivery of food to the hogar comunitario • The food is kept in the madre comunitaria’s refrigerator and is used to feed the children lunch and a snack • The program was adamant about giving parents the opportunity of choosing the specific food • In addition, kids are fed a nutritional supplement called ‘bienestarina’ • In theory, children should receive 70% of recommended daily intake from the HC

12. Hogares comunitarios • Subsequently, existing Hogares Comunitarios receive new parents. • The madre comunitaria (and therefore the location of the Hogar Comunitario) can change • There seems to be a relatively high turn-over of madres comunitarias • Poor parents can send children to an existing Hogar Comunitario

13. Hogares comunitarios • The program is now very large: there are about 80,000 hogares comunitarios throughout Colombia. • The program is run by the Instituto Colombiano de Bienestar Familiar (ICBF) and is financed with a 3% tax on wages. • Some new programs, and in particular the Colombian version of PROGRESA, Familias en Acción, is widely perceived as an alternative to Hogares Comunitarios

14. Evaluation of a nutrition program • The objective of the paper is to evaluate the effect of Hogares comunitarios on several outcomes: • Height per age • Weight per age • Leg length (stunting) • Long run outcomes: education achievements • Mothers’ labour supply • The basic strategy is to compare children who have been attending Hogares comunitarios to children who have

15. Evaluation of a nutrition program • The problem, of course, is the endogeneity of participation • Parents (mothers?) that can or want to benefit more from the program are those that might be sending the kids to the hogares • Parents who are more aware of the benefits of a good nutrition might be sending the kids to the hogares but would also feed the kids properly anyway • In the absence of a randomized experiment we use an instrumental variable approach: • We consider a variable that affects participation into the program and yet does not affect the nutritional outcome of interest

16. What instrument? • We use distance of the household from the nearest hogar • We also use the average minimum distance from a hogar in the municipality • We present some evidence on the ‘exogeneity’ of this instrument by looking at a ‘pre-intervention’ variable: birth weight • ‘Movers’ never indicate ‘getting closer to a hogar comunitario’ as a reason for moving

17. Data • DNP and FIP commissioned the consortium IFS- Econometria SEI the evaluation of the program Familias en Acción, a conditional cash transfer program. • Education and nutrition • Hogares comunitarios is perceived as the existing alternative to the nutrition component of Familias . • We collected a baseline pre-programme database in 122 communities, 57 of which targeted by Familias. • We have a total of 11,500 households or nearly 80,000 individuals

18. Data • The data contains information on many variables, including current and past attendance to Hogares Comunitarios. • We measure several anthropometric variables including weight, height, leg length. • In this study we use only data from the ‘control’ municipalities, that is municipalities where Familias does not exist

19. Main features of the population • Average family size: 7 • Average monthly consumption 150US$ • Including consumption in kind • Food consumption accounts for about 60% of consumption • 85% of households report consumption in kind

20. Figure 1Age structure 800 700 600 500 400 300 200 100 0 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80 84 88 92 96 100

23. Percentage of children attending Hogares Comunitarios

24. Why do children not attend Hogares?

25. Distribution of Travel time to the nearest Hogar in minutes

26. Defining Treatment • Current Attendance • Exposure=A / B. • A=Number of months the kid has been attending a Hogar during her life • B=Age of the kid in months • Number of months

27. Instruments • Travel_hou = Travel distance from house to the nearest Hogar • Travel_mun= Average of Travel_hou in the municipality

29. First Stage Regressions. Other included variables: Cubic in age and sex, head of household education, head of household’s age, mother’s age, and education, urban/rural. Distance health care centre and school Average distance health care centre and school in the municipality. Presence of hospital. Proportion households with sewage and piped water in the municipality. Municipality wages. Students per teacher, Municipality index quality of life, Altitude.

32. Other included variables Cubic in age and sex, head of household education, head of household’s age, mother’s age, and education, urban/rural. Distance health care centre and school Average distance health care centre and school in the municipality. Presence of hospital. Proportion households with sewage and piped water in the municipality. Municipality wages. Students per teacher, Municipality index quality of life, Altitude.

36. Can we believe our results? • Is our instrument correlated with household awareness of the importance of nutrition? • Is our instrument correlated with mother nutritional status (resources)? • We look at ChildBirth Weight as it should be influenced by mother’s resources and nutrition awareness but cannot be influenced by child attendance to Hogares Comunitarios

38. Heterogeneous impacts • What if the effect of the program is heterogeneous • Alternative estimators: • Propensity score matching • Control function approach • Interactions with observables • Quantiles

39. Propensity score distribution

43. Implications and future work • On the choice between Familias en Accion and Hogares Comunitarios • What is the effect on other areas? • Other dimensions of heterogeneity: quality of the madres comunitarias • Pilots of alternative programs