Thursday, May 19, 2011

To Aid or Not to Aid?

Well-child check-ups, Ghana
 Through this blog, I voice personal opinions, news and notes from the field regarding humanitarian aid and human rights. Here, I would like to bring attention to New York Times writer Nicholas Kristoff's recent column about intervention efforts that work. Kristoff describes successful programs in education and health. He also pleads with the public to continue support of good causes despite news of wasted or ill-spent donations by people who perhaps listened more to their hearts than their heads, as in the case of Greg Mortenson of "Three Cups of Tea" fame. I addressed accusations regarding Mortenson in  my blog, A Cup of Good Intentions Empty of Deeds

Here is Kristoff's Getting Smart on Aid. I think he hits a good note. I'll have more to add later.

May 18, 2011
Getting Smart on Aid
One cost of the uproar over Greg Mortenson, and the allegations that he fictionalized his school-building story in the best-selling book “Three Cups of Tea,” is likely to be cynicism about whether aid makes a difference. But there are also deeper questions about how best to make an impact — even about how to do something as simple as get more kids in school. Mortenson and a number of other education organizations mostly build schools. That seems pretty straightforward. If we want to get more kids in school around the world, what could make more sense than building schools?

How about deworming kids?

But, first, a digression: a paean to economists. When I was in college, I majored in political science. But if I were going through college today, I’d major in economics. It possesses a rigor that other fields in the social sciences don’t — and often greater relevance as well. That’s why economists are shaping national debates about everything from health care to poverty, while political scientists often seem increasingly theoretical and irrelevant.

Economists are successful imperialists of other disciplines because they have better tools. Educators know far more about schools, but economists have used rigorous statistical methods to answer basic questions: Does having a graduate degree make one a better teacher? (Probably not.) Is money better spent on smaller classes or on better teachers? (Probably better teachers.) And, yes, I’m getting to deworming. Hold your horses!

Now we reach a central question for our age: How can we most effectively break cycles of poverty? For decades, we had answers that were mostly anecdotal or hot air. But, increasingly, we are now seeing economists provide answers that are rigorously field-tested, akin to the way drugs are tested in randomized controlled trials, yielding results that are particularly credible and persuasive. 

Prof. Michael Kremer, a Harvard economist, helped pioneer randomized trials in antipoverty work. In the 1990s, Kremer began studying how to improve education in Africa, trying different approaches in randomly selected batches of schools. One intervention he tried was deworming kids — and bingo! In much of the developing world, most kids have intestinal worms, leaving them sick, anemic and more likely to miss school. Deworming is very cheap (a pill costing a few pennies), and, in the experiment he did with Edward Miguel, it resulted in 25 percent less absenteeism. Even years later, the kids who had been randomly chosen to be dewormed were earning more money than other kids. Kremer estimates that the cost of keeping a kid in school for an additional year by building schools or by subsidizing school uniforms is more than $100, while by deworming kids, the cost drops to $3.50. (In a pinch, kids can usually go to “school” in a church or mosque without a uniform.)

Look, school buildings are important, too. My wife and I built a school in Cambodia, and whether it’s our school or one of Greg Mortenson’s, they can make a big difference. My point is that for years people have been arguing until they were blue in the face about how to help people — and, finally, we’re getting some reliable data suggesting how to do that. Another example: What’s the most cost-effective way to prevent H.I.V. transmission in Africa? Most liberals focus on condoms and conservatives on abstinence-only programs. But one program that proved particularly cost-effective in randomized testing in Kenya was simply an initiative to warn teenage girls against “sugar daddies.” This cost less than $1 per girl reached. The result was not that the girls engaged in less sex, but that they slept with boys their age rather than with older men (who, according to prevalence surveys, were more likely to have H.I.V.).

Randomized trials are the hottest thing in the fight against poverty, and two excellent new books have just come out by leaders in the field. One is “Poor Economics,” by Abhijit Banerjee and Esther Duflo, and the other is “More Than Good Intentions,” by Dean Karlan and Jacob Appel. For years, we’ve seen a sterile debate about whether humanitarian aid works. (Sometimes yes, sometimes no.) These terrific books move the debate to the crucial question: What kind of aid works best?

For those who want to be sure that to get the most bang for your buck, there is also a “proven impact fund” ( It supports interventions like deworming or microsavings that have proved to be cost-effective in rigorous trials. I’ve been worried that the “Three Cups of Tea” uproar would lead people to give up on helping others. That would be a tragedy because, over the last decade, we’ve actually gotten much smarter at figuring out how to make a difference. Increasingly, we have a good idea what works — if people still are trusting enough to try to help.

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