The World Bank Economic Review
Abstract
This study experimentally evaluates Nicaragua’s large-scale, government-implemented Home Visit Program. Assignment to receive home visits increased a composite child-development score by 0.11 standard deviations and preschool completion by 7 percentage points; estimates among families who received visits were larger. The study also examines how implementation quality changes under centralized institutional monitoring compared with structured community-led monitoring. Community monitoring improved quality in four domains: the relationship between home visitors and caregivers, preparation and use of materials, visit content, and focus on the caregiver. Improvements in all but the last domain were associated with better child development. The results show that scale-up can produce meaningful benefits and that community monitoring can help preserve service quality as programs expand.