Who should donor funds and project energies be invested in? Targeting for need seems obvious: the people in the worst/most vulnerable situation or with the greatest need, get helped first. But some programmes are not that effective for those people in the greatest need.
Take ECD interventions. Early childhood programmes aimed at improving stimulation, caregiver responsiveness, language skills and cognitive development are useful; they improve readiness for learning and have been fairly strongly linked to improved school performance and generally being better off in later life. They even make some difference when a child is stunted. The question is, when malnutrition is a serious problem and/or the majority of children in the most vulnerable target-groups are seriously affected by poor nutrition, can ECD programmes make enough of a difference to justify the expense.
It sounds callous but running programmes for extremely vulnerable groups can be very costly, particularly if the most vulnerable groups are rural or peripheral or otherwise hard to reach. So large amounts of donor money needs to be spent to reach these children. Spending the money on them means that the money is not spent on other children, who may have less difficulties in terms of nutritional deficits, and resultant cognitive problem,s to begin with. This means that the slightly less vulnerable/disadvantages children may gain more (maybe) from ECD interventions. I guess this is targeting for return on investment or effectiveness.
Obviously, targeting purely for return on investment is a problem, because the highest social returns may well come from targeting children who don't really need help. But surely there is room for differentiation. If a programme has the most impact when children are not absolutely disadvantaged, when they have some nutritional stability and security, and those children will benefit significantly from that intervention AND those children would be unable to access the advantages otherwise, it seems reasonable to do it.
It's a really tough NGO call because it means choosing to leave the poorest of the poor or the most vulnerable children without this intervention. Of course, the NGO can work to find another organisation to work with the most vulnerable children, perhaps someone who can focus on the nutrition problems. Or they could advocate strongly for government to play a more supportive role for these children. Whatever approach they take, if the organisation chooses to focus on children who are slightly less disadvantaged but who will gain a lot more from their ECD intervention, they will have to abandon the poorest children. Which is hard to do. It feels crazy, if you have a programme that you know makes a difference, not to implement the programme with the most needy children, even if the impact will be less, and even if the impact with slightly less disadvantaged children would be significantly improved. Donors and public opinion also drive interventions and funding towards those most in need, at least ostensibly and where the donors and public can see easily what NGOs are doing, like in their own countries.
How do you balance effectiveness with need in targeting, so that you can implement an intervention that does the most good, so that you don't scare off funders entirely (because then no children benefit), so that you don't look as though you're taking the easy way out instead of helping those who need it the most?