Improving Impact: Health Lessons from an MIT/EdX Course

Why Some Health Interventions Fail In Developing Interventions And How To Do Better

Evan Pye

This week I worked on an online class through EdX from MIT called “The Challenges of Global Poverty.” The course is taught by Esther Duflo and Abhijit Banerjee, who wrote a book together called Poor Economics. They focus on finding the most impactful interventions to reduce extreme poverty through randomized controlled trials.

I have been learning from this course in small chunks. This week I completed the “Health” section and began the “Education” section. The Health section investigated why there is a low supply and demand for health in poor areas. The low supply shows itself in the form of understaffed clinics or hospitals, where absenteeism among doctors and nurses is high. This leads patients to rely less on formal health services and more on traditional health practices. In countries where health care and medicines are less regulated, it is easy to visit a semi-trained physician and receive drugs from them to cure a minor illness. In fact, more people visit doctors of any kind for minor illnesses compared to more life-threatening ones. Patients lose faith in the health system’s ability to treat dangerous diseases, because the outcomes are often less favorable.

Patients in developing countries also have a hard time investing their time or money into preventive care for a variety of reasons. First, it is difficult to appreciate the benefits of preventive care, because the results go unnoticed if it is successful. To make matters worse, one might see a person who goes unimmunized stay healthy in a community of people who have been immunized and conclude that immunizations are unnecessary. However, the fact that the rest of the community has been immunized is the very reason that a few might remain healthy without immunizations. Finally, trust in the health care professionals is often weak in developing countries. Esther Duflo explains one example from India in which people were hesitant to get immunizations because they remembered a period of time when the Indian government used the administering of vaccines to deceive people into getting sterilized in order to control population growth.

Although poor people may have reasons not to trust formal the health care system or adopt what are generally regarded as best practices when it comes to prevention and treatment, well-designed policies and interventions can still be effective. Making certain health practices compulsory, such as most of the world does with immunizations, is a good way to take the decisionmaking process out of the hands of a population. Otherwise, interventions should be made convenient and cheap. Most people are not so against immunizations or doctor’s visits that they will go out of their way to avoid them. The problem is that they often have to go out of their way just to get  those services. Professor Duflo provides the example of a chlorine dispenser placed right at a water source as a method of getting people to chlorinate their water. It eliminates all effort and decisionmaking, because the act of fetching water reminds people to use chlorine right at the source.

Health interventions, like many development efforts in poor countries, can fail very easily despite the best of intentions. It is important to understand the communities being served and certain principles of economic behavior and rational decision-making when designing interventions of any kind. And instead of attributing failure to the beneficiaries or the deliverers or culturally incompetent outsiders, it is useful to have experimental trials that help identify the weaknesses and potential solutions, rather than labeling certain places or people as “difficult to work with.”

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