Scaling Program Investments for Young Children Globally: Evidence from Latin America and the Caribbean: Summary of a Joint Workshop by the Institute of Medicine, the National Research Council, and Fundação Maria Cecilia Souto Vidigal, São Paulo (2015)

7

Components of Scaling and Sustainability

In the afternoon of the workshop, participants broke into smaller groups for concurrent sessions to further discuss themes raised in the panel presentations. These themes included results-based financing, measurements and indicators, and methodologies for measuring public investments in young children.

RESULTS-BASED FINANCING¹

Martin Benavides Abanto shared participants’ remarks from the breakout session on results-based financing. He noted that there has been a change in the past few years in terms of how public resources are managed, which has provided a number of benefits and challenges. One benefit mentioned was the targeting of resources toward people’s interests, which has resulted in addressing specific social concerns, such as issues related to nutrition, education, and violence, but also has served as a mechanism to empower people. For example, participatory research enables communities to take part in the generation of information, which gives them better knowledge of issues and more effective routes of action.

However, a number of challenges were raised as well, and Abanto noted two. Results-based financing is a very intensive approach, he observed, and not all countries have robust information systems that are

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¹ This section summarizes information presented by Martin Benavides Abanto, Group for the Analysis of Development (GRADE).

able to generate enough data analysis to inform budgets. Abanto raised the question of how information systems might be improved. At the same time, he mentioned that some group participants questioned how successfully this methodology could be taken up when some programs are still ideologically or politically driven.

A second issue Abanto reported was the concern around producing results. He remarked that when talking about childhood, most of the outcomes are not in the short term, but medium to long term, so impact assessments can have a time lag. One way he suggested working through this is by assessing intermediary results as progress toward the final assessment. These results would not necessarily be outcomes, but rather process indicators that show progress toward the desired outcomes.

MEASUREMENTS AND INDICATORS²

Mark Miller shared the discussions of the breakout group on measurements and indicators, noting that participants discussed possible relevant outcomes to be measured, and measuring them from a population or individual perspective. The group named different types of indicators that could be used, including process indicators, such as measuring inputs and outputs; assessing management or operations of services; investment indicators, both financial and time-related, at national, local, and household levels; knowledge, attitude, and practice indicators; technical indicators; and indicators of coverage of service, particularly in vulnerable or marginalized populations.

Several participants in the group also described initiatives implemented in the Latin America and Caribbean (LAC) region that explore the measurement of outcomes. Marta Rubio-Codina described one initiative that enrolled 1,300 children from lower- and middle-income households and compared various measurement tools for precision. She explained that as more indicators are assessed, the accuracy of the tool increases, as does the cost. Miller queried whether an optimal tool could be developed that meets a standard of precision and usefulness but is still cost-effective. He also noted that Rubio-Codina and her colleagues are also exploring different tools with easy and quick quality indicators for policy makers for use in decision making.

Aimee Verdisco of the Inter-American Development Bank shared information about the development of a new instrument, validated in four countries in Latin America, that measures indicators for early childhood education. This work has led to a dialogue of these measures, as well

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² This section summarizes information presented by Mark Miller, National Institutes of Health.

as further exploration of population-based measures, cultural adaptation, and nationally representative samples. Four domains were being measured—cognition, language and communication, social and emotional skills, and motor skills in children 24 to 59 months of age.

Maureen Samms-Vaughn also discussed experiences in Jamaica, which has had many outcome measures in the health sector for early childhood, but not in education. She and her colleagues have introduced several measures using parental screening questionnaires, population-based surveys, and longitudinal data from birth cohorts. Finally, Miller stated, the group participants raised some questions about the connection between early childhood outcomes and long-term effects. Specifically, whether early childhood outcomes are predictors of the future, what role environmental factors play, and how to explore resilience-type factors.

METHODOLOGY FOR MEASURING PUBLIC INVESTMENTS IN YOUNG CHILDREN³

Javier Curcio explained that participants in the third concurrent session discussed methodologies for measuring investment in early childhood, using an example of an exercise being implemented in nine countries in Latin America.⁴ Curcio observed that the current system that connects problems of early childhood to state policies often does not incorporate analysis of the financial investments involved. This exercise complements analysis by considering the system with states’ financial investments, and the methodology includes six variables:

1. The early childhood age group, up to age 7 years, including maternal health
2. Incorporation of the actions taken by countries at different government levels
3. Registration database that indicates adherence to public policies
4. Policy mapping of the functions of various sectors—social services, justice, protection of rights, and documentation of identity
5. Financial strength of types of expenditures and how they affect early childhood, and functional classification of these types of expenditures
6. Frequency of investment analysis

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³ This section summarizes information presented by Javier Curcio, University of Buenos Aires (UBA) and General Sarmiento National University (UNGS).

⁴ This exercise is coordinated by the Information System on Early Childhood in Latin America (SIPI) and UNICEF Regional Office for Latin America and the Caribbean in collaboration with nine UNICEF country offices.

Several questions were raised regarding this exercise, including how to make comparisons between different countries, how to make the process more adaptable to different contexts, how to sustain and institutionalize the process, and how to support each country’s ownership. One participant noted the difficulty in mapping investment at the federal level in Brazil because the funds are often mixed across sectors—there is no clear picture of funding directly for early childhood. Another participant remarked that a group working in the Health Ministry is trying to study the methodology in order to examine all the investments in children’s health. Lastly, a participant mused that while many variables are unique to country contexts, it could be possible to identify universal ones for comparison.