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Early Childhood Development Through an Integrated Program: Evidence from

the Philippines

Article · June 2006

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 Early Childhood Development through Integrated Programs:
Evidence from the Philippines*
Graeme Armecina, Jere R. Behrmanb, Paulita Duazoa, Sharon Ghumanc, Socorro Gultianoa,

Elizabeth M. Kingd and Nanette Leea, e

Notes on Incorporating Duration of Exposure Data into Estimation of Impact

April 2006

Corresponding author: Elizabeth M. King, The World Bank, 1818 H Street, NW, Washington
DC 20433; [email protected]

Keywords: early childhood development; program evaluation; Philippines

a
Office of Population Studies, University of San Carlos, Cebu City, Philippines
b
Economics Department, University of Pennsylvania, Philadelphia, PA
c
The Population Council, New York, NY
d
The World Bank, Washington, DC
e
University of North Carolina-Chapel Hill
 Notes on Incorporating Duration of Exposure Data into Estimation of Impact

About the Philippine ECD program

• In 1999, the Philippine Government launched a five-year ECD Project in three
southern regions encompassing thirteen provinces and about 2.2 million households
—Region 6 (Western Visayas), Region 7 (Central Visayas), and Region 12 (Central
Mindanao). A few years later, in 2002, the project became part of a broader
governmental program that was formally adopted through the Early Childhood Care
and Development (ECCD) Act (Republic Act 8980).
• The program’s overarching goal is to improve the survival and developmental
potential of children, particularly those who are most vulnerable and disadvantaged
by: 1) minimizing the health risks to very young children; 2) contributing to the
knowledge of parents and the community about child development and encouraging
their active involvement; 3) advocating for child-friendly policy and legislation; 4)
improving the ability and attitude of child-related service providers; and 5)
mobilizing resources and establishing viable financing mechanisms for ECD projects.
The program spans a wide range of health, nutrition, early education, and social
services programs.
• In contrast to some other ECD programs, the Philippine project did not introduce new
services; rather, its innovation is to adopt an integrated, multi-sectoral approach to
delivering a combination of services that include center-based (e.g., day care centers,
pre-schools, health stations) and home-based (e.g., family day care programs, and
home visits by health workers) interventions. To link the center-based and home-
based services, a new service provider, the Child Development Worker (CDW), was
placed in all program areas. The CDWs have the task of complementing the roles of
midwives and health workers in providing food and nutritional supplements and
monitoring children’s health status, and are responsible for community-based parent
education about ECD. The program also set out to improve the national child
surveillance and referral systems, expand community participation and local
ownership to ensure sustainability, and establish the Council for the Welfare of
Children (CWC) which functions as the national ECCD Coordinating Council under
the Office of the President, with counterparts at the provincial, municipal and
barangay levels. Appendix A provides more detail on the specific components of the
program.
• The ECD program assignment to municipalities or LGU’s was a process that took
several steps. First, municipalities that were deemed “high risk or needy” were
identified on the basis of several indicators such as infant mortality rates, maternal
mortality rates, low birth weight, child malnutrition, and schooling attainment among
children and women. Second, an information campaign was launched to enlist the
participation and cooperation of city and town mayors and other local health officials
(planning and development officers, health officers, barangay captains, NGO
representatives) as program partners. Local officials therefore essentially decide the
menu of ECD services to be implemented in each LGU. Accordingly, in the

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 propensity score matching estimates we incorporate baseline characteristics of
barangay and LGU leaders.
Varying implementation lags
• Discussions with the program management unit and field administrative data
indicated that there was substantial variance in the timing of the implementation of
the project across municipalities and barangays, where implementation means
procurement and receipt of material inputs and provider training related to the
program. This variance implies differences in the duration of exposure to the program
across program areas, and thus differences in the amount of time that the
interventions could have had an impact. If program effects are estimated as if the
program began before its actual effectiveness at the barangay level, then those effects
are likely to be underestimated.
• Many evaluations do not take into account this variation in the duration of program
implementation, often because the program start is presumed to be well-defined
(though in reality official starting dates often do not reflect start-up delays on the
ground) and also because data on timing are not available. One exception is the
analysis of the Bolivian PIDI pre-school program mentioned above (Behrman, Cheng
and Todd 2004), which explicitly takes into account the dates of enrollment of
individual children into the program and find that impact is most clearly observed
among children who have been exposed to the program for more than a year,
compared with those exposed for less time.
• With the help of the central project implementation office, we are able to use
administrative data to add another measure of the availability of the program. The
mean length of exposure is about 14 months (with a substantial standard deviation of
six months).
• Based on information on the start of the program provided by the project
implementation office that controls procurement and the release of funds, the duration
of exposure apparently was dependent on administrative lags in central procurement
rules and centralized actions rather than on preferences in the program areas. Data
from this office indicate that due to lags in disbursements, in 70 percent of program
barangays, the program did not get started until after the first round of data was
collected, and in another 29 percent, not until after the second round. In the second
round, lack of funds or delays in releasing funds were a problem reported by 28 of the
33 municipality-level ECD project teams with available data, and was the most
common implementation problem they named (OPS 2005).

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Distribution of Length of Exposure to ECD Program (Months at Round 3)

.08
.06
Density
.04
.02
0

0 10 20 30 40
Length of Exposure to Program at Round 3, months

Mean: 13.7
Standard Deviation: 5.8

• Table 7 shows the distribution of children, by age in years at Round 3, across four
exposure categories. We restrict our estimates to children who lived in barangays that
had at least four months of exposure at Round 3. This involves dropping 252 children
from the analysis. Two barangays received the program inputs about a year and a half
before Round 1, so we exclude these two barangays (N = 33 children); in these cases
the matching variables, measured at baseline, are not likely to be exogenous to the
program initiation. Virtually all barangays had received the program by Round 3,
with one exception which we also excluded from the analysis.

Table 7. Percentage Distribution of Children across Exposure Categories by Age,

Philippines ECD Study
Age in years 13-16
(Round 3) <4 months 4-12 months months 17+ months Total
2 4.42 (24) 33.2 (180) 32.6 (177) 29.8 (162) 100 (543)
3 6.13 (53) 33.7 (291) 28.4 (245) 31.8 (275) 100 (864)
4 6.51 (50) 34.4 (264) 28.4 (218) 30.7 (236) 100 (768)
5 5.67 (49) 39.2 (339) 24.1 (209) 31.1 (269) 100 (866)
6+ 6.92 (76) 36.7 (404) 28.0 (308) 28.3 (311) 100 (1,099)
Total N 252 1,478 1,157 1,253 4,140
Notes: Numbers of children are in parentheses.

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Table B.1. Attrition by Treatment Status, ECD Study
Non-
Follow-up Status Program program Total
Total Interviewed in Round 1 (baseline) 4786 3136 7922
Stayed in Round 1 sample barangay in all three rounds 4197 2577 6774
Total Lost to Follow-up 589 559 1148
Reasons for Attrition:
Outmigrated and not followed-up 276 276 552
Outmigrated but tracked in new barangay 206 193 399
Refusal 52 36 88
Non-availability 28 40 68
Deaths 17 11 28
No information 10 3 13
Note: Cell counts refer to number of children.

• Our estimates of impact are based on nearest-neighbor propensity score matching of a

set of treatment and control observations using the variables described in Appendix
C. Using the “nnmatch.ado” routine in STATA 9 (see Abadie, et al. 2004), we
calculate the sample average treatment effect (or the difference-in-difference
estimator in our case). We condition our estimates on the joint distribution of
children’s age (at Round 3) and a discrete measure of their duration of program
exposure—distinguishing according to 4-12 months, 13-16 months, and 17+ months
duration—and we specify robust standard errors. This strategy allows us to uncover
potentially valuable information about how children of different age groups respond
to varying program exposure. Table 7 shows that there is a sufficient number of
children in program areas in all the age/duration combinations to estimate impacts
within each class.
• Table 8 summarizes our difference-in-difference propensity score matching “intent-
to-treat” program impact estimates by dividing into three groups the 15 child
development indicators that we consider. The three groups are:
I. Predominately positive program impacts (nine indicators)
II. Mixed or virtually no program impacts (four indicators)
III. Predominately negative program impacts (two indicators)
For each indicator, we estimate the impact for each of 15 age-duration groups (i.e., five
ages at Round 3, three durations). Column 1 in Table 8 gives the number of these
estimates that are significantly positive (in the sense of improving child development, so
a reduction in wasting, stunting, diarrhea, worms and anemia is counted as a positive
impact) at the standard 0.05 level. Column 2 gives the number of estimates that are
significantly negative, and column 3 gives the percentage of the significant estimates that
are positive. The 15 indicators that we considered are ordered from highest to lowest in
terms of percentage of significant coefficient estimates that indicate positive program
impact (column 3). Column 4 gives the mean impact in terms of sample standard

5
deviations for the indicators for the significantly positive impacts. Column 5, similarly,
gives the mean impact in terms of standard deviations for the indicators for the
significantly negative impacts.

Table 8. Summary of Estimated Intent-to Treat Positive and Negative Program Impacts
for Nearest Neighbor Matched Estimates with Control for Attrition, Philippines ECD Study
Mean Magnitude of
Number of Significant Coefficients Significant Effects (in
with Program Effect terms of sample SDs)
Positive Negative % Positive Positive Negative
Group I: Predominately positive program impacts
Cognitive skills 9 0 100.0 0.553 na
Expressive language 7 0 100.0 1.085 na
Gross motor skills 7 0 100.0 0.791 na
Self-help 7 0 100.0 0.334 na
Fine motor skills 5 0 100.0 0.647 na
Social-emotional skills 10 1 90.9 0.545 –0.468
Weight-for-height z Score 7 1 87.5 0.234 –0.370
Receptive language 6 2 75.0 1.43 –0.475
Proportion wasted 6 3 66.7 –0.014 0.010
Group II: Mixed or virtually no program impacts
Proportion with diarrhea 3 2 60.0 –0.035 0.016
Proportion with worms 2 2 50.0 –0.085 0.067
Proportion stunted 3 5 37.5 –0.04 0.048
Height-for-age z Score 0 1 0 na –0.292
Group III: Predominately negative program impacts
Proportion anemic 0 8 0 na 0.089
Hemoglobin count 0 9 0 na –0.539
Totals or averages across groups
All groups 49 34 59.0 0.454 –0.192
Group I 41 7 85.4 0.623 –0.326
Notes: “Significant” refers to the 0.05 level.
“na” means “not applicable.”

• Among children below age four at the time of Round 3, there has been a substantial
improvement in cognitive, social, motor and language development in all seven
domains for those in program areas relative to non-program areas. Table 9 indicates
that for two-year-olds, gross motor skills are about 1.1 to 1.5 of a standard deviation
higher in program areas than in non-program areas. For two- and three-year olds
exposed to the program for at least 17 months, expressive and receptive language
skills are about .92 to 1.8 standard deviations higher. Program impacts on cognitive
skills at young ages range from .92 to 1.2 standard deviations (for two year olds) and
.28 to .43 standard deviations (for three year olds). The weight-for-height Z-score
among older children (those four and older) are significantly higher among program
compared to non-program children by about .16 to .27 of one standard deviation
(though similar positive impacts are not evident among children who have been
exposed to the program for 17+ months).

6
Table 9. Intent-to-Treat Impacts by Age in Years (at Round 3) and Duration Class
Based on Difference-in-Difference Nearest Neighbor Propensity Score Matching Estimates:
Group I Indicators – Predominately Positive Program Impacts
ECD Indictors Age at Duration of Exposure (months)
Round 3 4 to 12 13 to 16 17+
Cognitive skills 2 0.917 (.122)* 1.24 (.128)* 1.07 (.094)*
3 0.278 (.096)* 0.362 (.112)* 0.426 (.098)*
4 0.031 (.094) –0.225 (.116)~ 0.034 (.121)
5 0.192 (.088)+ 0.116 (.143) 0.043 (.097)
6+ 0.169 (.102)~ 0.242 (.100)+ 0.313 (.095)*
Expressive language 2 1.02 (.213)* 1.60 (.178)* 1.31 (.190)*
3 0.635 (.146)* 0.517 (.126)* 0.918 (.131)*
4 –0.068 (.113) 0.130 (.184) 0.358 (.113)*
5 0.156 (.092)~ –0.050 (.095) 0.156 (.089)~
6+ –0.251 (.132)~ 0.077 (.083) –0.069 (.091)
Gross motor skills 2 1.14 (.160)* 1.21 (.161)* 1.49 (.170)*
3 0.070 (.136) 0.401 (.131)* 0.286 (.106)*
4 –0.019 (.100) –0.069 (.108) 0.244 (.091)*
5 0.069 (.109) 0.201 (.125) 0.275 (.098)*
6+ –0.135 (.126) –0.009 (.152) 0.040 (.103)
Self-help 2 0.284 (.113)+ 0.241 (.118)+ 0.630 (.142)*
3 0.149 (.104) 0.250 (.119)+ 0.325 (.108)*
4 0.365 (.091)* 0.228 (.104)+ 0.112 (.096)
5 0.078 (.098) –0.018 (.125) –0.061 (.124)
6+ –0.078 (.090) 0.070 (.088) –0.123 (.082)
Fine motor skills 2 0.463 (.206)+ 0.741 (.158)* 0.793 (.158)*
3 –0.122 (.144) 0.144 (.135) 0.165 (.099)~
4 –0.043 (.119) –0.029 (.109) 0.103 (.127)
5 0.332 (.104)* 0.177 (.166) 0.289 (.120)+
6+ 0.166 (.123) 0.162 (.112) 0.020 (.123)
Social-emotional 2 0.800 (.161)* 0.663 (.152)* 0.993 (.121)*
3 0.028 (.123) 0.425 (.096)* 0.535 (.101)*
4 –0.425 (.119)* 0.308 (.132)+ 0.189 (.100)~
5 0.036 (.090) 0.308 (.109)* 0.322 (.105)*
6+ 0.044 (.096) 0.220 (.099)+ 0.374 (.096)*
Weight-for-height Z 2 0.173 (.082)+ –0.327 (.081)* 0.142 (.138)
3 0.140 (.095) 0.099 (.071) –0.085 (.071)
4 0.127 (.055)+ 0.261 (.052)* 0.057 (.045)
5 0.270 (.041)* 0.162 (.058)* 0.025 (.045)
6+ 0.209 (.055)* 0.245 (.041)* 0.085 (.044)~
Receptive language 2 1.00 (.236)* 1.65 (.200)* 1.78 (.183)*
3 0.328 (.134)+ 1.15 (.154)* 1.06 (.147)*
4 –0.153 (.133) 0.217 (.202) 0.226 (.146)
5 –0.164 (.124) –0.260 (.117) –0.115 (.092)
6+ –0.248 (.111)+ –0.524 (.139)* 0.0002 (.109)
Proportion wasted 2 -.107 (.029)* .068 (.021)* -.013 (.033)
3 -.112 (.029)* -.064 (.033)+ -.069 (.028)+
4 -.028 (.017) .001 (.018) -.052 (.019)*
5 -.043 (.019)+ .026 (.013)+ .034 (.013)+

7
 6+ -.0007 (.012) -.024 (.013)~ -.004 (.005)
Note: Standard errors in parentheses.. ~p<.10 +p<.05 *p<.01.

• Table 10 summarizes the significant and positive (at the .05 level) impact estimates
for Group I across all the indicators. It gives the number of significant and positive
estimates for each of the 15 age-duration groups, as well as the marginal totals for the
three duration and the five age groups. In addition, the last column gives the mean
estimated impact in terms of sample deviations by age and the last row gives the
mean estimated impact in terms of sample deviations by the three duration categories.
Though for some of the indicators the estimates in Table 9 indicate significant
positive responses primarily after fairly long duration of program exposure (e.g., after
17 months for gross motor skills, after 13 months for social-emotional skills), the last
two rows of Table 10 suggest only slight evidence of increased impact with greater
duration. In particular, there is a 10 percent increase in the prevalence of positive
coefficients between exposure of 4-12 months to 13+ months and an increase from
0.60 to 0.70 standard deviations of the outcomes with the same increase in exposure.
On the other hand, the summary in the last two columns of Table 10 indicates
substantial concentration of significant positive program impacts among younger
children: 64 percent (or 41 of 64) of these impacts are for children two- or three-years
old at the time of Round 3. The average magnitude of the impacts is 0.90 standard
deviations for two-year olds and 0.49 standard deviations for three-year old, but only
in the 0.24-0.29 range for children older than three.

Table 10. Distribution of Significant Positive Effects by Age and Months of Exposure to
Treatment for Group I (Predominately Positive Impacts)

Mean Impact
Months of Exposure Total (Sample SDs)
Age in Years (Round 3) 4-12m 13-16m 17+ m
2 9 7 7 23 0.90
3 4 7 7 18 0.49
4 2 3 3 8 0.26
5 4 2 3 9 0.24
6+ 1 3 2 6 0.29
Total by duration 20 22 22 64
Mean impact by duration 0.60 0.70 0.72

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 Appendix C. List of Variables Used in Nearest Neighbor Propensity Score Matching
Estimates

The following variables were used for the intent to treat propensity score matching estimates. All
variables are measured at baseline:
Child: had worms in six months prior to survey, stunted, 0, 1 or 2+ siblings, below average
cognitive, social, and motor development, sex.
Household: mother’s schooling, father’s schooling, mother’s age, father’s age, number of
persons in household, mother employed, flush or water sealed toilet present, number of rooms,
electricity present, piped water connection from local water district, own television, own home in
which household members currently are living, own any motor vehicle, own living room
furniture, own a bed, own a fan, nearest road less than five minutes away, distance to health
center, household income (quartiles).
Barangay: Captain’s schooling, captain born in barangay, captain at least 50 years old, health
center in barangay, number of daycare centers in barangay, number of public elementary schools,
number of public secondary schools, barangay has cement road, plaza/park and piped water.
Municipality: Number of doctors per 1000 population, number of health centers per 1000
population, number of barangay health workers per 1000 population, municipality in lowest
income class, proportion of households with electricity, proportion of households with piped
water, citizens can set up meetings with mayor/municipality officials to voice concerns, mayor
has more than college education, mayor is at least 50 years old, mayor belongs to civic or
political group, population.

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