This project aims to identify scalable ways to effectively guide and mentor community health workers when delivering complex, integrated early childhood development services.
The evidenced success of approaches delivered by community health workers in low- and middle-income countries hinges on concentrated training, mentoring and supervision that is not sustainable at scale. Identifying cost-effective, scalable models to support community health workers—particularly through digital tools—is essential to sustaining programme quality at scale.
The Thrive project leverages the randomised control trial (RCT) infrastructure of Kizazi Kijacho—meaning ‘Next Generation’—an ongoing, collaborative six-year early childhood development research programme in Tanzania led by the Institute for International Economic Studies (IIES) at Stockholm University. Its focus is on improving outcomes in the first 1,000 days of life by developing a detailed dataset following children’s development from pre-birth to age 2. The RCT was originally designed to compare the relative effectiveness of a parenting intervention (delivered by existing community health workers supported by a digital app) and an unconditional cash transfer (UCT) programme.
Key activities
Thrive is tapping into existing government community health worker supervision structures to reflect how a scaled-up version of the parenting programme would look. The project’s activities include:
- scaling up the parenting programme to 160 communities spread across all eight district councils in the Dodoma region in Tanzania
- recruiting and training 80 existing health care workers to supervise and mentor the community health workers in their respective catchment areas
- delivering a UCT to a sub-set of families, creating a new parenting + UCT treatment arm. The UCT amounts will be calibrated to the cash transfer amounts disbursed by the Tanzanian government as part of its existing flagship social protection programme, Tanzania Social Action Fund (TASAF).
- testing whether a hypothetical tool measuring parental resource allocation and women’s empowerment aligned with actual behaviour, using real money and pop-up shops to observe spending behaviour. It also examined how parenting and cash transfer interventions influenced household spending decisions and mother’s empowerment.
- assessing implementation of the parenting programme at two points (when children are at ages 1 and 2) using real-time digital monitoring data, interviews, and focus group discussions to explore fidelity, feasibility, scalability, sustainability, and perceived programme impacts.
- estimating the full cost of the parenting and cash transfer programmes through financial data and surveys, including direct and opportunity costs. The study aims to inform economic evaluations and future scale-up decisions.
Results will inform government decision-making in Tanzania and similar LMICs worldwide on whether and when the two types of interventions should be combined or implemented in isolation.
This project will refine the understanding of parental investment in child development and provide evidence for designing effective, holistic, scalable, and sustainable child development interventions. Findings could go on to inform early childhood development guidelines and strategies nationally.