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4 Evidence of Impact at Scale
4 Evidence of Impact at Scale
Pages 19-26
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From page 19... ...
To address the first need, Walker and her colleagues designed a pilot that delivered parenting interventions through routine child health clinical visits in three countries in the Caribbean region. This pilot was designed using a minimalistic approach.
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From page 20... ...
The mothers were also given message cards and play materials to take home. Walker noted that the pilot demonstrated benefits to children's cognition and parental knowledge of child development, with effect sizes comparable to some home visit programs, though it was not as effective as the more intensive weekly home visitation program.
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From page 21... ...
As with most CCT programs in Latin America, groups of beneficiaries select a representative to serve as a "mother leader" who speaks for them to the program authorities. Rubio-Codina remarked that "mother leaders" displayed characteristics suitable for home visitors, and these 2 This section summarizes information presented by Marta Rubio-Codina, Centre for the Evaluation of Development Policies at the Institute for Fiscal Studies and the Inter-American Development Bank.
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From page 22... ...
Rubio-Codina described a few challenges she and her colleagues encountered: • Design -- including adapting the intervention to deliver to scale, through the participation of local women with limited education (and adapting training materials accordingly) , and incorporat ing the local context, all while maintaining quality and program fidelity • Implementation -- including selection of home visitors, motivation of home visitors, adequate training and mentorship, use of tech nology, sustained engagement of all program personnel as well as beneficiaries, and provision of salaries and career development • Evaluation -- including ensuring a representative sample, main taining enrollment, reaching children at the appropriate age, eval uating both process and outcomes to assess quality of interaction and feasibility of implementation, and providing adequate fund ing for both the program and the evaluation EVALUATING LARGE-SCALE INTERVENTIONS ON CHILD HEALTH IN BRAZIL: THE ROLE OF CONTEXT AND CHALLENGES3 Mauricio L
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From page 23... ...
. Barreto noted that while it is commonly understood that improved sanitation leads to improved health, there are very few evaluations to show the connections.
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From page 24... ...
This effect increased with greater coverage. Barreto also speculated that the Bolsa Familia and Programa Saúde da Família operated synergistically, with the former affecting the social determinants of health, and the latter more directly impacting health.
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From page 25... ...
Human resources and training certification issues were also raised, and panelists noted that there is enormous variability in the skills and competencies of community health workers. Walker further explained that in some countries community health workers are not paid, though
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From page 26... ...
Barreto noted that some studies of Bolsa Familia indicated increasing feelings of empowerment and behavior change among women, as well as a shift in local business as disposable income increased. Women trained as community health workers or home visitors can also model healthy behaviors for other family members as well as in their communities, so that health is valued and a demand for healthy programs is created.
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