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Thursday, July 23, 2020

Randomised Control Trials and the Alleviation of Poverty in India

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Sattva Vasavada
Sattva Vasavada
South Asia

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Sattva Vasavada

Article Title

Randomised Control Trials and the Alleviation of Poverty in India

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Global Views 360

Publication Date

July 23, 2020

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Poverty in India — A Representative Image

Poverty in India — A Representative Image | Source: Atul Kumar via Unsplash

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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February 4, 2021 4:45 PM

How the failure of political leadership resulted in the explosion of pandemic in Brazil

With over 1.2 million active cases and over 51 thousand deaths as on 30th June 2020, Brazil is one of the worst coronavirus affected countries. Latin America became the epicentre of the coronavirus pandemic in the latter half of May, largely due to Brazil’s incompetency in dealing with the pandemic. Due to the underreporting and low testing rates, the actual number of active cases and deaths are unknown.

The Brazilian Ministry started making changes to the number of cases reported, making it even harder to control the situation the pandemic has caused. The country’s response has been widely criticized in Brazil and outside. The President of Brazil, Jair Bolsonaro, dismissed the threat of the virus and the pandemic. OnMarch 26, 2020, he said that Brazilians are immune to the virus and even if they are drunk in a sewer they “don’t catch a thing.” He defied the guidelines set by his own health ministry and visited a busy commercial district in Brasilia, the capital of Brazil, where he told all the elderly Brazilians to get back to work. He also went on TV many times and called it little flu and accused the media of hysteria. Even as the coronavirus crisis has worsened recently, some major cities have eased their preventive measures, like Sao Paulo opening up shopping malls in Mid-June and beaches getting crowded again. With all of this happening, hospitals are close to running out of intensive care beds.

In early March, Brazil declared a public health emergency, a few days after the World Health Organization. The Ministry of Health in Brazil urged the officials to cancel all the public events and reinforce the measures of social distancing as prescribed by the World Health Organization. Some experts thought that Brazil could handle the pandemic based on its records during past public health emergencies. Brazil’s health care system is underfunded, but it does not fail to provide robust coverage across the country. The efforts of the state government went awry when the President called the virus a “cold” and provided anti-malaria tablets as a solution to the virus. President Bolsonaro’s clash with the governors and officials led to two health ministers leaving- one was fired and the other one quit. This left the military general, with no public health training, in charge of the virus. The clash amongst the government left the citizens of Brazil uncertain about the importance of following the preventive measures kept in place to prevent the spread of the virus. This led to the defying of the measures, which in turn led to the pandemic’s rate being one of the highest in the world.

The Ministry of Health has not presented a comprehensive plan to beat the virus yet. One of the main initiatives by the Ministry of Health is to boost the production of hydroxychloroquine and has encouraged the doctors in the public healthcare system to prescribe the same. The country has struggled to import lifesaving instruments, like coronavirus tests and ventilators. The lack of tests, in turn, has made it difficult to track the spread of the virus. This might result in the undercount of cases of the virus in the country.  Between Jan. 1 and June 6, 23,171 people who were not diagnosed with the coronavirus died from acute respiratory infections, according to data released by Fiocruz, one of Brazil’s state-run health research institutes. Experts believe most of them died from coronavirus.

At a time when Brazil needs to be putting all its efforts into fighting the virus, the president has been wrapped up in his own political battles. The Supreme Court is investigating allegations of disinformation and intimidation by the President’s supporters. Investigations also state that he has interfered in federal police investigations to protect his family. Due to this, the tensions between President Bolsonaro and the judiciary are high.

During the past few months, politics have become bigger than the pandemic. Even though the health crisis is extremely important, the magnitude of the political scandals has had a huge impact on how the country reacts to the pandemic. There is anger over how President Bolsonaro is handling the crisis and at the same time, there is a fear as to where the country is headed after the pandemic passes.

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