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

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. 16 NATIONAL GOVERNMENT PROVINCIAL GOVERNMENTS Health outcomes Enrollment Pay for performance HEALTHFACILITIES Fee for service Umbrella Agreements EXTERNAL AUDIT Provincial Health Insurance Performance Agreements EXTERNAL AUDIT Facility decides on use of funds Financing scheme drives incentives

17. Plan Nacer improves 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