Effectiveness Trial of a Family Home Visiting Intervention to Promote Early Child Development Among Families Served by the Social Protection System in Rwanda

Globally, more than 200 million children may not reach their full developmental potential due to poverty and adversity. This is most evident in World Bank-classified Low- and Middle-Income Countries (LMICs) struggling with the confluence of war, community violence, poverty and disease. Research across a range of cultures and settings finds that children living in compounded adversity face increased risks of poor child development outcomes and emotional and behavioral problems that can perpetuate a cycle of poverty and violence. Integrated programs and family-based interventions for promoting child development, healthy parent-child relationships and reducing household violence affecting children are insufficiently tested in culturally diverse and low-resource settings despite compelling data about such risks. The proposed study will investigate the effectiveness of the Sugira Muryango program as an innovative approach to early childhood development promotion. Sugira Muryango is a preventive, family-based model that uses home visiting and caregiver coaching; it encourages responsive caregiver-child interactions and discourages violence and harsh punishment among families living in extreme poverty. By providing home-based coaching that helps parents manage stress, reduce harsh punishment and engage in responsive parenting with early childhood stimulation, it is possible to effect improvements in parent-child relationships and child development outcomes. Sugira Muryango will be implemented alongside Rwanda's flagship poverty reduction initiative, Vision 2020 Umurenge Program (VUP). Classic VUP components mainly focus on cash-for-work on labor intensive public works projects. With government and development partner support, VUP is piloting a more enhanced public works model that has child and gender sensitive components, with flexible public works options that are closer to beneficiary households. Along such the expanded public works program currently under pilot by VUP, a minimum graduation package is also available, which is providing additional variables of financial literacy, asset transfers, skills training, and sensitizations surrounding a range of topics (e.g., education, health, nutrition).

A four-arm cluster randomized trial (CRT) will enroll 1,040 VUP-eligible families with children aged 6-36 months to compare outcomes among children and parents in families receiving: (1) Control/Classic VUP, (2) Expanded VUP, (3) Combined Classic VUP plus Sugira Muryango and (4) Combined Expanded VUP plus Sugira Muryango. A cost analysis will provide practical information on the feasibility and cost of integrating Sugira Muryango into VUP programming and a process evaluation will produce useful implementation tools for dissemination and scale-up.

Study Aims are to (1) assess effectiveness of Sugira Muryango in promoting responsive parenting, reducing violence and harsh punishment and promoting early child development in families living in poverty; (2) to assess the interaction between Sugira Muryano and classic/expanded VUP programming and (3) to assess costs, barriers and facilitators of integrating the Sugira Muryango package into VUP or other government programming, such as the Ministry of Gender and Family Promotion (MIGEPROF), which holds the early childhood development mandate. This initiative seeks to promote cross sectoral and ministerial collaboration, a key pillar of the Government of Rwanda.