Nourishing the Future: Impact and Lessons from Ecuador's Bono 1000 Días Program

Development Challenge

Chronic Child Malnutrition remains a major development challenge in Ecuador. Although prevalence fell by 4.3 percentage points between 2018 and 2023, nearly one in five children under two (19 percent) still suffers from chronic malnutrition, with higher rates among indigenous (32 percent) and low-income populations (22 percent). During this period, the government introduced measures to address the problem, including the creation of the Bono 1,000 Días (BMD) program-a mix of unconditional and conditional cash transfers linked to prenatal and child health check-ups and early civil registry registration-targeting poor pregnant women and mothers with children under two.

Results and Outcomes

Between September 2023 and March 2025, a World Bank Group team conducted an impact evaluation that generated valuable lessons. Since its launch in June 2023 until March 2025, the BMD program has reached nearly 350,000 pregnant women and mothers with children under two, producing the following results:

• A significant increase in attendance at recommended well-child health check-ups, raising rates by 10-15 percentage points over the control group.
• Suggestive, but not conclusive, positive effects on nutritional outcomes in some periods. The lack of conclusive positive effects on nutritional outcomes can be explained by operational constraints during implementation, such as delayed payments or limited knowledge of conditionalities.
• Evidence shows that combining cash transfers with home-visiting services yields greater impacts on health service utilization, as these visits help beneficiaries learn about BMD conditionalities.
• Through the Project, the number of poor children underage three identified in the Social Registry and receiving a package of cash transfers and early childhood development services increased more than fivefold between 2019 and 2024, reaching 126,000 beneficiaries and covering 33 percent of poor children in this age group.

WBG Approach

In 2019, the World Bank launched an Investment Project Financing (IPF) operation with Performance-Based Conditions (PBCs) to strengthen the equity, and sustainability of Ecuador's social protection programs. Subsequent additional financings supported continued progress, focusing on identifying poor households through the Social Registry and delivering a bundled package during the critical first 1,000 days of life-including cash transfers, early childhood development services, and maternal and child health care. Disbursements were linked to expanding joint program coverage and improving health personnel productivity, both essential for meeting the conditionalities of the BMD program. The World Bank has also provided technical assistance through trust funds and analytics to document results achieved in reducing chronic child malnutrition, evaluate the BMD program, and recommend improvements to coexisting cash transfer schemes that could undermine the effectiveness of social spending. Active collaboration with the United Nations International Children's Emergency Fund (UNICEF), Inter-American Development Bank (IDB), and Development Bank of Latin America and the Caribbean (CAF) has been instrumental in ensuring harmonized and coordinated support to the Government.

Contribution to WBG Targets and Jobs

The BMD program directly contributes to the World Bank Group target to increase the number of beneficiaries of social safety net programs. As of September 2025, BMD has reached 175,000 beneficiaries under the age of two, within a broader total of 1.46 million recipients of cash transfers nationwide across other stages of the life cycle. By incentivizing preventive health visits during early childhood, the program also advances the World Bank Group target for people receiving quality health, nutrition, and population services.

"The 1000 Days Bonus was very important, helping significantly with my son's growth and development. Thanks to this cash benefit, I bought food and fruit for him so he could grow up healthy and safe, ensuring he has a good development."

- Fernandina Yumbo -

Lessons Learned

A conditional cash transfer program with specific and verifiable conditionalities is key to driving behavior change. The experience of the BMD program in Ecuador shows positive results in improving access to health services. However, achieving additional effects on nutrition outcomes raises questions about areas for improvement, such as strengthening the program's delivery system-including communication strategies, better engagement of government personnel directly involved in implementation (including health staff) , and harmonizing coexisting cash transfer schemes (both conditional and non-conditional) to avoid confusion among the population regarding which program they benefit from and the associated conditionalities.

Next Steps

The World Bank will support the Government of Ecuador, through a proposed third Additional Financing of the Social Safety Net Project (under preparation) to scale up progress in reducing chronic child malnutrition and extend positive impacts into early childhood. This will include sustainably expanding coverage of early childhood services and developing an integrated cash transfer scheme informed by lessons from the BMD evaluation. The scheme will also address social risks that limit human capital development throughout the life cycle. It will be closely integrated with labor market and productive inclusion programs to help households transition out of cash transfers and establish the foundations for an efficient and sustainable social protection system.

RELATED

News: Bono 1000 Días en Ecuador: Gobierno anuncia ampliación para incluir a 20.000 nuevos beneficiarios (in Spanish)

News: Conozca cómo acceder al Bono de los 1 000 Días en Ecuador (in Spanish)

Official Site: Transferencias monetarias no contributivas (in Spanish)