Reach Up in India

India created formal institutions responsible for early childhood development by international standards. In 1975, the Integrated Child Development Services (ICDS), now the world’s largest early childhood program, was created. The backbone of the ICDS was the creation of preschools – called Anganwadi Centers (AWCs)- in every village in India. For the earlier years, Anganwadi workers have been tasked to distribute nutrition (mainly rice) and iron supplementation, although this program has not always operated as planned.

Beyond the nutritional element, the AWCs only cover children between the ages of three and six. Leaving an important gap in the very early years (0-3). Given the increasing evidence on the importance of this age window in laying the foundations for lifetime achievement and wellbeing, our team of researchers set out to design alternative early interventions based on the Reach Up curriculum.

In 2013, researchers at Yale University, the Institute for Fiscal Studies (IFS) and the University College London (UCL), in collaboration with the Centre for Early Childhood Education and Development (CECED) from Ambedkar University and Pratham Education Foundation (India) implemented and evaluated by RCT an home visiting program based on the Reach Up curriculum and approach, for children in the 1-2 years age range at baseline. The program, which lasted 18 months was implemented in the peri-urban slums of Cuttack, with a population of rural migrants who have little access to any formal care or services.

The Cuttack intervention acted as a pilot to a much larger program in rural Odisha (India), where alternative delivery modes were tested across 192 communities with approximately 1,500 children and their mothers. The project required adapting Reach Up to a group setting that admitted children with varied ages of up to 9 months difference, which at the average age of one year. Collaboration between Sally Grantham McGregor, researchers at the IFS and CECED delivered the new curriculum.

Country team

Costas Meghir

Professor of Economics and Principal Investigator, Yale University

Orazio Attanasio

Professor of Economics, Yale University

Britta Augsburg

Associate Director, The Institute for Fiscal Studies

Alison Andrew

Associate Professor, Oxford University

Jere Berhman

Professor of Economics, The University of Pennsylvania

Sally Grantham-McGregor

Emeritus Professor International Child Health, University of London

Pamela Jervis,

Assistant Professor of Economics, University of Chile

Marta Rubio-Codina

Senior Economist, Interamerican Development Bank

Implementation partners

Pratham Education Foundation is one of the largest NGO in India, which focuses on providing high-quality, low-cost and replicable interventions to address gaps in the education system. The team (Smriti Pahwa and Prerna Makkar) were responsible for designing Nutrition curriculum, overall coordination and implementation of the program.

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The Centre for Early Childhood Education and Development, Dr. B.R Ambedkar University Delhi, aims to to address issues of quality and inclusion in policies and provisions for the young child. Dr Monimalika Day from the CECED was responsible for curriculum design of the materials used in the interventions.

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Communities we serve

Our ECD studies in Odisha started with a Pilot study between 2013 and 2015 by a cluster-randomized control trial of a home visiting program across 54 urban slums in Cuttack based on the adaptation and scalability of the Reach Up curriculum.

Project based in the state of Odisha

Following the pilot, between December 2016 and December 2018, we used the same adapted curriculum for different delivery methods (home visiting vs. group visits) and including a nutritional education arm in 192 communities in 3 districts of Odisha (Bolangir, Soro and Salipur).

Bolangir, Soro and Salipur

Our Approach

The home-visiting modality of our pilot study in Cuttack, based on the Reach Up Curriculum, delivered 18 months curriculum for weekly home visits between August 2013 and July 2015. The stimulation intervention was delivered by women in the villages trained by mentors from Pratham. 

 

Home visitors were regularly monitored by supermentors.

 

In addition to home visits, group session involving 6-8 caregivers with their children, were conducted.

Key Stats

The pilot home visits in Cuttack between August 2013 and July 2015 (18 months), reached 194 children, aged 10 – 20 months at the start of the intervention. Visits were conducted weekly and lasted one hour.

The combined home visits and group sessions in Bolangir, Soro and Salipur between December 2016 to December 2018 (24 months) reached approximately 1,500 children, aged 7-16 months at start of intervention. This included weekly home visits and group sessions, which each lasted one hour.

Organisational Structure

The organizational structure of the project included 3 program associates who were responsible for monitoring & support each district overall supervised by the Program Manager. There was also one so-called super-mentor per district, who had degrees in social sciences.

Child development experts train Pratham super-mentors, who themselves train mentors, home visitors and group facilitators  for 4 weeks. Under each super-mentor, there was a District Coordinator. District Coordinators at district level responsible for monitor and support the day-to-day activities of the mentors. Each district has 9-10 mentors which were recruited by Pratham from the local communities.  The mentors were constantly in touch with the home visitors and group facilitators who helped them solve problems with the visits and/or sessions. 

Cultural Adaptations

The Reach-Up curriculum was adapted to the local context by the Ambedkar University Centre for Early Childhood Education and Development (CECED) for both Cuttack and Odisha studies. Most of the toys used during home visits were made with locally-available materials or other low-cost materials, often discarded objects such as empty plastic bottles (where available).

In addition to translation, the original Reach Up curriculum was adapted to make it as relevant as possible for poor rural households in Odisha. All the books were redrawn to reflect the local environment and local games and songs were included. Some activities were included to increase the socio-emotional and gross motor content of the curriculum and to improve the mapping of the activities against current early learning standards for India.

Outcomes

Impact on child development:
Our primary outcomes include Cognitive, Language and Motor skills measured by the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III, Bayley 2006).

Pilot Study (Andrews, et al, 2019)
• Improvement in cognition by 36% of a SD (p<0.004), improvement in language by 26% of a standard deviation (p<0.049). If sustained this is similar to an extra year in school.

• Boys and children of more educated mothers had larger benefits.

Odisha Study (Grantham-McGregor, et al 2020)
• Impacts on cognition (home visiting: 0.324 SD (p<0.001); group sessions: 0.281 SD (p<0.007) and language (home visiting: 0.239 SD (p<0.009); group sessions: 0.302 SD (p<0.001).


Cognition
Expressive and receptive language
Impact on caregivers:
Pilot Study
• Improvement in quality of the home environment (measured by play materials and varieties of play activities scales of the FCI) by 0.288 SD (p<0.016) and in maternal depressive symptoms (CES-D-10) by -0.222SD (p<0.024).

Odisha Study
• The FCI play activities significantly increased in both home visiting and group sessions (home visiting: 0.383 SD (p<0, .001), group sessions: 0.331 SD(p<0.001).

• The home visiting arm had a marginally significant 0.215 SD impact on prosocial skills (p<0.054) using the Social Difficulty Questionnaire (SDQ; Goodman et al., 2010).

Research & Publications

Andrew, A., O Attanasio, B Augsburg, et al.  “Effects of a scalable home visiting intervention on child development in slums of urban India: evidence from a randomised controlled trial” J Child Psychol Psychiatry, Dec. 2019 PMID: 31797385 PMCID: PMC7242140 DOI: 10.1111/jcpp.13171

Grantham-McGregor, S, Adya, A, Attanasio, O, et al. ‘Group Delivery or Home Visits of Early Childhood Stimulation: A Cluster Randomized Control Trial’ Pediatrics Volume 146, number 6, Dec 2020 PMID: 33148771 PMCID: PMC7786825DOI: 10.1542/peds.2020-002725