The Real Price of Care: Inside Brazil’s PADIN Home Visiting Program Cost Structure

The World Bank’s study of Brazil’s PADIN program reveals an annual cost of USD 438 per child and highlights significant municipal financial contributions and data discrepancies. It underscores the need for transparent, ingredient-based costing to ensure equitable and sustainable early childhood development interventions.

In an ambitious attempt to unravel the real financial demands behind large-scale early childhood development initiatives, the World Bank’s People Vertical, under the Office of the Chief Economist, joined forces with Brazil’s State Secretariat for Education (SEDUC) of Ceará to conduct a detailed cost analysis of the Programa de Apoio ao Desenvolvimento Infantil (PADIN). Authored by Alaka Holla and Yilin Pan, the study examines the operational realities of a state-run home visiting program for rural, low-income families, employing a rigorous ingredients-based costing method. The result is a rare, ground-up financial x-ray of how such programs function, what they truly cost, and who ends up footing the bill.

Unveiling the True Price Tag of PADIN

Launched in 2017, PADIN targets rural households receiving Bolsa Familia benefits with children under the age of 47 months. College-educated home visitors, called agentes de desenvolvimento infantil (ADIs), visit homes twice monthly, guiding parents on play-based cognitive and emotional development. Community meetings further reinforce these practices. Though PADIN is initiated by the Ceará state government, municipalities are the engine behind its delivery.

The study estimates the annual cost per child at BRL 1,597, or USD 438, for 10 months of implementation in 2018, equivalent to USD 44 per child per month. This figure aligns with global peers such as China’s REACH and Colombia’s Reach-Up and Learn. Personnel expenditures account for nearly two-thirds of the cost: 27% goes to home visitors, 23% to state-level oversight, and 14% to municipal supervision. Additional expenses include transport, food, teaching kits, and supplies. The costs associated with volunteers’ time, while present, were negligible per child and thus excluded from major calculations.

Municipalities Carry an Unexpected Financial Load

While PADIN is often perceived as a state-led initiative, the study reveals that municipalities contribute, on average, 38% of the total costs, a substantial and mostly unrecognized burden. The municipal share varies widely, from 22% to 52%, yet without a direct relationship to municipal wealth. This cost-sharing, not clearly defined in program design, could jeopardize long-term sustainability. Municipalities with tighter budgets or fewer administrative resources may struggle to maintain service quality or coverage.

Moreover, some municipalities provided additional compensation to home visitors and supervisors, while others did not. For example, four municipalities paid home visitors between BRL 98 and BRL 532 above the state-provided stipend. Supervisors also varied in their time commitment and earnings, with reported monthly salaries ranging from BRL 700 to BRL 4,575. Such disparities suggest that families in different municipalities may receive unequal levels of support, undermining PADIN’s objective to reduce inequality.

When Official Data Paint the Wrong Picture

A striking finding of the study is the weakness of existing administrative data systems. The Online Monitoring System, one of PADIN’s official tracking tools, frequently overreported the number of home visitors and underreported the number of children served. Relying on this source alone would have inflated cost estimates by 27%. Similarly, records used for transportation expenses lumped PADIN-related travel with other programs, offering little clarity.

To overcome these gaps, the researchers combined multiple data streams, including surveys, interviews, and GIS mapping, to verify and calculate actual resource use. For transportation, where many home visitors paid out of pocket without reimbursement, they mapped the road distances between municipal offices and household clusters to simulate realistic commute patterns. This revealed that official records often dramatically underestimated the actual cost and effort involved in reaching families.

One Program, Many Realities on the Ground

The study also documents notable variation in how PADIN is implemented across municipalities. While the program prescribes biweekly visits, five municipalities exceeded this, offering weekly visits. Community meeting frequencies ranged from monthly to as infrequent as twice a year. Some municipalities strictly followed the training and planning regimen; others adapted it to local constraints. Even supervision, meant to be a standardized activity, showed wide divergence. Supervisors reported time devoted to PADIN ranged from 25% to 100%, depending on their other duties and local staffing models.

These variations, both in financial inputs and operational delivery, mean that PADIN is not experienced equally by all children. In essence, what was designed as a standardized intervention ends up functioning as a patchwork of local adaptations, driven by resources, capacity, and local priorities.

Rethinking Costing: A Model for Future Programs

The study's strongest message is its endorsement of the ingredients-based costing method, a detailed, resource-by-resource approach that contrasts sharply with conventional budget analyses. By identifying the actual quantities and prices of inputs needed to implement PADIN, the researchers exposed not only underreported costs but also the silent burdens borne by municipalities and even frontline workers.

This approach has global relevance. It shows that without deliberate, transparent cost planning and multi-level coordination, even the best-intentioned programs can produce unequal results or risk collapse under financial strain. If governments want to scale or replicate such programs sustainably, they must ensure that funding models are matched by operational realities. PADIN, despite its relatively low cost per child, stands as both a model of innovation and a cautionary tale, a reminder that success hinges not only on design and intent but on how well a program is funded, tracked, and supported from the ground up.