Lentils for Vaccines
By Giorgio Barba Navaretti*
A bag of lentils for the first vaccine and a set of plates for the last booster. Just small things for many saved lives. Minimum intervention for great results is the catching on strategy of many recent programs aimed at poverty reduction in developing countries. An amazing equation within a sector known for its wastes, in which the main parameter taken into account is the amount of money transferred from rich to poor countries. Amazing, but also very effective. Let us go back to the vaccines, and we shall understand why.
Seva Mandir, an NGO operating in India in Udaipur district, could not carry out a wide children vaccination program. Only 3% of the families used to accept the treatment. The problem was that prevention campaigns were perceived as random and hardly reliable. Thus, the NGO started an experimental program in 60 villages, half of those in which it operates. Every morning a nurse went to the villages, where, in prearranged dates, vaccination sessions took place.
The regular scheduling of the sessions was enough to raise the prevention rate up to 17%.
But the share was still low and, more importantly, it used to further decrease between the first administration and the last booster. Therefore the NGO introduced a new practice in 30 other villages: those who got vaccinated were rewarded with a bag of lentils. The rate rose up to 38%.
What does this story tell us? That often fundamental poverty eradication interventions fail because their demand and supply are driven by ineffective incentives. The analysis of these incentive mechanisms, through experimental studies like the Udaipur one, similar to clinical tests on drugs, has been especially developed by the French economist Esther Duflo, who works at MIT with other pioneers, such as Abhijit Banerjee and Michael Kremer (at Harvard). Duflo, who summarized the main results of her works for a non-academic audience in the book “Le Développement Humaine: la Politique de l’Autonomie” (Le seuil, 2010), became one of the most well-known and award-winning economists thanks to this kind of studies. “Time Magazine” included her, at only 38, among the most influential 100 people in the world.
Esther Duflo’s experiments compare samples of treated individuals, like the villagers who took part in the “vaccination with reward” program, with similar individuals who were not treated, like the inhabitants of other villages. In this way, it is possible to quantify the effectiveness of social interventions.
This may seem a trivial procedure, but in fact the experiments are based on a in-depth economic analysis of incentive mechanisms. For instance, it is not obvious why a bag of lentils, worth half a day of farming work, can persuade a family to do something immensely valuable for the future health of their children. The reason is the time inconsistency of economic choices: a future good (avoiding to fall ill thanks to prevention) is valued less than the present cost of the effort of taking children to be immunized. One more reason, the vaccine also implies a benefit external to the individual, an externality on the whole society. The social benefit is the lower transmission of the disease, paid in fact by the private cost of families’ effort. Lentils, although of little value, partially compensate these asymmetries, that would otherwise lead to wrong choices.
The use of aid funds and other social interventions against poverty, thus, is not only a matter of resources, but also of the incentive schemes guiding the use of these resources. And this is true for any field Duflo explores, from health to education.
Clearly, results from experiments cannot always be generalized. However, their value is in the methodology, in the application of precise evaluation schemes, that often highlight obstacles that had not been taken into account previously, but which can be easily removed.
It is a new direction for development policies, now shrank in size and energy by public budget constraints, years of failures and, above all, lack of rigorous impact analysis.
It is also a promising avenue to revitalize the general role of public policies for poverty reduction. This is in contrast with the view, supported by many, that aid should be focused on market based measures e.g. microcredit. The idea is that enabling the entry of the poor into the financial market is sufficient to trigger broader economic activities lifting these individuals out of poverty. This approach, which turns every poor into an entrepreneur, deserves attention, but is not always effective. In conditions of extreme poverty, individuals lack the capability of transforming resources into useful services. And the externalities generated by these services (e.g. vaccines) lead to market failures and thus limit their use.
The work of Esther Duflo and her colleagues is valuable as it provides a methodology to select and fine tune aid policies, which today are stuck in the dilemma between the often wasteful use of public resources and the thrifty philosophy of the “self-sufficient entrepreneurial poor”.
(Translation by Silvia Cerisola)
* Giorgio Barba Navaretti is an LdA Scholar. He is currently Professor of Economics at the University of Milan and Scientific Director at the Centro Studi Luca d’Agliano.
This article reviews Esther Duflo’s book “Le Développement Humaine: la Politique de l’Autonomie” (Le seuil, 2010), translated in Italian as ‘I numeri per agire’, Feltrinelli. The review was originally published in Italian on ‘Il Sole 24 Ore’, May 1, 2011.
Comments
One Comment on Lentils for Vaccines
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d_angemi on
Sat, 18th Jun 2011 06:35
Recent adaptations of experimental science to economic and social dynamics in developing countries provide innovative methodologies to improve our understanding of individual choices under a wide spectrum of financial and social constraints. “Lentils for vaccines” sheds great insight on the importance of incentive schemes designed to yield desired social outcomes. More specifically, it clearly highlights the impact that small rewards such as lentils or plates can have in terms of yielding better vaccination outcomes.
Ironically, this approach to motivate desired social responses evokes the basic structure of one of the most archaic and criticized practices in aid policy: aid conditionality. You do this, I give you that. So why not focus on strengthening social empowerment to prompt self-motivation instead? After all reward-free regular scheduling of vaccination sessions alone prompted a very significant (and debatably more sustainable) increase in vaccination rates.
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