Development as medicine?

Today I am in Loiyangalani, day 14 of 23!

International development is all about fads. Starting with the Big Push “You need to develop an entire economy at once with a huge amount of funding to create a virtuous circle” to increased capital to the Washington Consensus “You just need free markets” to the more recent trends, like microfinance, there seems to be this underlying belief that somehow, a phenomenon as enduring and multidimensional as poverty can be solved through a single intervention. However, while I’m not willing to brand it a panacea, I am giving a great deal more credence to the latest “big idea” than I am to ones in the past. The method: randomized controlled trials (RCTs).

Say what? You ask. Here is the just of them:

In medicine, humans used to rely on methods without really knowing whether or not they worked. We used leeches to drain people of their blood, since we were pretty sure that was effective medical treatment. Some times it worked, some times it didn’t, but we couldn’t really be sure as to whether or not leeches were an effective treatment. However, years later, we developed the clinical trial. Give a randomly selected group of people a treatment, another half a placebo, and see whether or not the treatment actually accomplishes the desired effect.

The idea is similar in development. We practitioners do all sorts of interventions, confident that they must work, and sometimes they do, sometimes they don’t. However, what we lack is a counterfactual. We can see what happened when we did the treatment, but we don’t know what would have happened had we done nothing.

The solution that international development has begun to use recently: randomize. If you randomly give half the people a treatment, and half not, but collect data on both, you can start to get a better idea of whether or not what you’re actually doing is working.

To take a fantastic example, one of my former professors at Georgetown is doing an RCT on road safety here in Kenya. I’m sure you’ve heard how malaria, HIV/AIDS, diarrhea and tuberculosis are all major killers in developing countries. Perhaps less well publicized though is the fact that for people in the prime of their lives, traffic accidents are one of the largest killers.

A major cause of these accidents here in Kenya is the reckless way that matatus (minivans/buses) here in Kenya drive. If traffic isn’t moving anywhere on the street, you drive on the sidewalk. If a light is turning red, you may as well gun it and make it (after all, traffic lights are basically just suggestions, right?). And while I can’t claim this is representative, I’ve found from personal experience that when traffic is slowing down up ahead, you don’t begin to slow down gradually, you continue to accelerate, and then slam on the brakes.

My professor’s solution to this problem: stickers. Specifically, he put stickers inside of the matatus, encouraging passengers to tell the drivers to slow down. Maybe, he figured, passengers want the matatus to drive more safely, but are too afraid to say anything. By having stickers that tell passengers they need to speak up, and in some cases scaring them to speak up by having pictures of dismembered limbs, he hoped traffic accidents would be reduced.

To get a good counterfactual, he randomly assigned treatment to this. His team began collecting data on a wide variety of matatus. Matatus with even last numbers of their license plates were given the stickers, ones with odd last numbers no stickers, but were still observed.

What did he find? By looking at insurance claims on all the matatus in his sample, he was able to see that accidents dropped significantly among cars with the stickers (by something like 50% or more). Simply encouraging people to speak up was able to make a difference. Given that stickers cost basically nothing, a basic analysis suggests this is one of the most cost-effective ways of saving one’s life.

Unlike past experiments, where at best we are armed with anecdotal evidence, or a basic before/after analysis, the randomization makes it possible to determine causality. It’s a push towards a more rigorous, scientific way of making decisions, and while there are some limitations to it (in fact, I wrote my Senior International Development Thesis on the very subject) I think the use of RCTs will make it possible to make more serious advances in the field of international development than perhaps we have in the past.

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