Monday, June 22, 2020

Gaza under Israeli blockade — Its Impact on COVID-19

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Kanika Bajaj

Article Title

Gaza under Israeli blockade — Its Impact on COVID-19

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Global Views 360

Publication Date

June 22, 2020

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Empty street on Gaza Strip

Empty street on Gaza Strip | Source:Catholic Church (England and Wales) via Creativecommons.org

The Gaza Strip has faced massive destruction due to Israeli-led blockade since 2007. Israel controls all the entry and exit points of Gaza which it uses to restrict the movement of goods and people between Gaza and the outside world, effectively turning it into the “largest open-air prison” in the world. Gaza, as a result of the humanitarian crisis since the last 13 years is now one of the most densely populated yet the poorest spaces in the world. This has adversely impacted the delivery of public services, including healthcare service in Gaza strip. According to the head of the International Committee of the Red Cross (ICRC) sub-delegation to Gaza, Ignacio Casares, the health system in Gaza “is already overstretched, already at its limit,”. Daily power cuts and irregular electricity supply add on to this which forces Doctors to rely on generators during emergencies. This horrible condition was documented earlier as well in a 2017 UN Report which stated that the Gaza Strip would be “unlivable” by 2020. 

The 13 years long blockade has forced the government as well as people living in Gaza to manage the harsh conditions with the meagre resource at their disposal.  The WHO  had pointed out in a report last year that all the patients and their companions were required to apply for Israeli permits to exit the Gaza Strip for accessing the hospitals in the West Bank, including East Jerusalem, and Israel,". "Access has been particularly problematic in 2019, with the patient permit approval rate declining”. 

People in Gaza strip are now battling the COVID-19 pandemic also with the help of simple whatever meagre resources at their disposal. The healthcare and other authorities understood that they would not be able to provide the hospitalization if the pandemic broke out, so they took some immediate steps to contain the COVID-19 from the early stage. The places of large public gathering like street markets, shops, shopping malls, wedding halls were ordered to lock down by State authorities. A senior official with the Hamas movement said at a news conference that officials were considering imposing a curfew. Using the traditional methods, the authorities built more than 1000 quarantine rooms in the Gaza Strip. Palestinian Ministry of Health states that quarantine centres are established in three places: Rafah, Deir Al-Balah, and Khan Younis. More than 1000 people who came from the Israel and Egypt borders were quarantined in schools, hotels, and hospitals. 

With the increase in the number of cases, society started displaying anxiety and fear but it was overcome by mutual cooperation. The State of Palestine and its citizens has proved that the constraints cannot become an obstacle in dealing with the pandemic.

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February 4, 2021 4:52 PM

Randomised Control Trials and the Alleviation of Poverty in India

Abhijit Banerjee and Esther Duflo won the 2019 Nobel Prize in Economics for their “experimental approach in alleviating global poverty”. Their experimental approach encompassed a variety of novel methods to understand and analyse interventions and Randomised Control Trials (RCTs). Their research has been used by policy makers to make informed policy decisions to best help the marginalised.

What are RCTs?

To understand the effect of a policy, intervention, or medicine, decision makers try to measure the efficacy of the treatment. Do deworming pills given to children improve test scores? Does providing chlorinated water improve the health and economic outcomes of villages? These are some causal (read causal, i.e. caused by, not casual) questions researchers are interested in. The best way to analyse causal effects is to randomise the selection of people in the treatment and the control group (for example: children who are given deworming pills versus children who are not given the pills). This random selection of the two groups removes many statistical biases that might affect the results.

RCTs in India:

Many of the RCTs performed by Banerjee and Duflo were in India. They involved short- and long-term impact assessments of various interventions, policies, models, and treatments. We look at a few RCTs implemented in India:

Teacher absenteeism rates:

Troubled by the low attendance rates (or high absence rates) of public-school teachers in India, Duflo assessed the impact of financial incentives on the absence rates of teachers in Rajasthan. The study monitored teacher attendance by cameras, which was tied to a financial incentive if the attendance was high. From a baseline absence rate of 44%, teacher absenteeism in the treatment group fell by 21%, relative to the control group. High teacher attendance caused child test scores to improve too.

COVID-19 and health-seeking behaviour:

In the context of COVID-19, Banerjee tested the effect of sending messages via SMS that promoted health preserving behaviour. The results were very positive. By sending a short, 2.5-minute clip to 25 million randomly selected individuals in West Bengal, the intervention i) found a two-fold increase in symptom reporting to village health workers, ii) increased hand washing rates by 7%, and iii) increased mask-wearing by 2%. While mask-wearing rates increased only marginally, the spillover effects (wearing a mask stops the virus from infecting more people) were moderately high and positive.

Asset Transfers and the Notion of Poverty:

An RCT by Banerjee in West Bengal involving a productive asset transfer accompanied with training found large and persistent effects on monthly consumption and other variables. The treatment group reported 25% higher consumption levels relative to the control group, who did not receive the asset transfer and training. Implications of such RCTs are huge. The notion that the poor are lazy and unwilling to perform strenuous labour is falsified by this RCT. Often, what the poor lack are opportunities that are hard to come by, given their financial status. A small nudge, like the asset transfer, can cause large and positive effects on their well-being.  

Salt fortification to reduce anaemia:

RCTs also help rule out less cost-effective interventions. Duflo and Banerjee evaluated an RCT which distributed fortified salt in 400 villages of Bihar, to reduce the prevalence of anaemia. However, this intervention found no statistically significant impact on health outcomes like anaemia, hemoglobin, etc.  Thus, while RCTs help introduce novel methods of impacting the lives of the poor, they also help in ruling out in-effective measures. A policy maker might try other alternatives to reduce the prevalence of anaemia.

Are RCTs the gold standard?

Maybe. Extrapolating results from a regional RCT to national policies could present problems. Contextuality matters. A study that indicates positive gains for one region might present different, and rather adverse effects for another region. Nation wide effects might not be as prominent as regional results of a single RCT. The good part is that Banerjee and Duflo have a solution. Just perform more RCTs!

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