Investing Early Makes Sense and Dollars

1. Investing Early Makes Sense and Dollars Paul Gertler University of California, Berkeley Global Business Case for Early Childhood Development Webinar GBC-Education, ReadyNation/America’s Edge and CUE, Brookings April 4, 2014

2. 200 million children are at riskof not reaching their full potential Lancet, 2011

3. Malnourished mothers lead to malnourished babies In low income countries: • 10-20 % of pregnant women are malnourished • Anemia affects 42% of pregnant women • Only 40% of pregnant women have access to acceptable antenatal care • 16% of babies born have low birth weight (27% in S. Asia)

4. 1 in 4 children in LICs under 5 are stunted UNICEF, 2012 and figure adapted from World Bank

5. Only 17% of children in LICs are in preschool – the poor even less likely

6. Poor children do worse on language tests Source: Lancet, 2011. Data from Young Lives Longitudinal Study

7. Scientific case for early investment (1) Source: Shore, 1997

8. Scientific case for early investment (2)

9. Wealth Disparities in Cognitive Development Begin Early

10. Early gaps can last a lifetime DQ or IQ scores of stunted and non-stunted Jamaican children, age 9-24 mos. to 18 yrs. 0.8 0.6 Non-stunted 0.4 0.2 SD score 0 -0.2 Stunted -0.4 -0.6 Stanford- Griffiths (33-48 mo) WISC-R (11-12 y) WAIS (17-18 y) Griffiths on Binet (7-8 y) Enrollment (9-24 mo) Source: Walker, Pediatrics, 2010

11. Economic case for early investment • Early intervention saves money on costly services later on • Elimination of malnutrition could lead to annual gains of 1-2% to GDP (World Bank) • preschool enrollment to 50% in LMICs has a ROI of 8-18% in future labor productivity

12. Equity case for early investment ECD investments especially benefit disadvantaged children which levels the playing field

13. ECD Interventions from conception to school entry Source: World Bank, 2010

14. Two Successful Early Interventions

15. Argentina’s Plan Nacer • 2002 Financial Crisis • Many lost jobs and health insurance • Maternal and child health • Uninsured • Access to quality care • Mechanisms • Uninsured use of public facilities • More money to public system

16. Financing scheme drives incentives Enrollment NATIONAL GOVERNMENT PROVINCIAL GOVERNMENTS HEALTH FACILITIES Healthoutcomes Provincial HealthInsurance Payfor performance Feefor service Facility decides on use of funds UmbrellaAgreements Performance Agreements EXTERNAL AUDIT EXTERNAL AUDIT

17. Plan Nacerimproves newborn outcomes Low Birth Weight

18. Plan Nacer Very Cost-Effective

19. Jamaica Psycho-Social Stimulation Intervention for Disadvantaged Children • Stunted Children age 9-18 months • Home-based play sessions by Community Health Aid • 1 hr per week for 2 years • Promoted cognitive & socio-emotional development • Name & label things, actions in the environment, play games, praise, build self-esteem • At 24 months introduce size, shapes, position, colors etc • Improve quality of mother-child interaction • Taught mothers how to play w/ children • Encouraged daily play & stimulation • Home-made toys were left after each visit

20. Effect of stimulation on Cognitive Development

21. Long Term Impact of Jamaica Stimulation at age 9-18 Months Amazing Cognitive and socio-emotional skills Increased Earnings of Stunted by 25%, Enough to catch up to non-stunted Raised earnings of disadvantaged and eliminated inequality

22. Conclusions • Early disadvantage leads to long-term disadvantage • Hard & expensive to compensate later in life • ECD investment can • Cost-effectively minimize long-term effects • Create a healthy productive work force • Good for the individual and good for the economy