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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 4:43 PM

Sweden’s No Lockdown Policy: How That Changed The Outcome

Sweden has gone against conventional wisdom in its response to the COVID-19 situation. While the neighbouring countries like Denmark, Finland and Norway imposed strict lockdown on the places and services frequented by the public, Sweden has chosen to not do so at all during the initial phases when COVID-19 started taking the shape of a worldwide pandemic. The public places like Cafes, restaurants, gyms, malls, playgrounds, ski slopes and some of the schools were kept open all across Sweden.

The country’s fight against the threat of pandemic was handled exclusively by the Public Health Authority, with no political interference. They believed that a lockdown only serves to delay the virus, which is not necessary since the health services are equipped to deal with the cases. They also made it clear that achieving herd immunity is also not their aim. The public authorities in Sweden instead relied on the public's sense of responsibility, and appealed to them to do frequent hand washing, observe social distancing and keep people over 70 years old from going out.

The state epidemiologist, Anders Tegnell, made multiple statements about the state’s unusual approach, such as 1) “Once you get into a lockdown, it’s difficult to get out of it,”, “How do you reopen?  When?” 2) “There is no evidence whatsoever that doing more at this stage would make

any difference. It’s far better to introduce stringent measures at very specific intervals, and keep them running for as little time as possible” , 3) " As long as the healthcare system reasonably can cope with and give good care to the ones that need care, it's not clear that having the cases later in time is better”.

The assumption of public responsibility did not work for Sweden and there were people out on the streets, in cafes, restaurants and playgrounds. Not wearing a mask was the social norm instead of the reverse. The models for charting the virus spread given by the concerned authorities also turned out to be faulty forcing them to rescind it. Over 2000 Swedish researchers and doctors signed a petition which claimed that there was not enough testing,tracking or isolation in the country. They believed that the authority has clearly not planned their response and that the authority’s claim for herd immunity has very little scientific basis, even though the government has repeatedly claimed that herd immunity is not what they were aiming for.

Sweden’s lax approach to the combating of coronavirus forced its neighbouring Scandinavian countries to close the border for the Swedish citizens. Some of the Swedish officials were worried for the possible harm to the long term relations between Sweden and its neighbours.  Also, the plan of letting life go on as usual to avoid the economic recession occurring due to a lockdown also failed as it didn’t shield  the country from economic slowdown.

Here comes the question; was the lockdown successful or not? There are some comparisons that have been drawn which indicate more deaths per 100,000 people than in nearby countries with homogenous population, even though it is significantly lesser than some of the European countries. While the infections rates are double that of Denmark, the death rates in comparison are much higher. This difference has been attributed to the fact that approximately half of these deaths have occurred in old care homes despite the stated priority of the officials to protect the elderly. This has been in part to the volunteer program, which replaced symptomatic old age home cares with new volunteers, hence increasing exposure. Another factor is the lack of protective equipment in such homes, along with laws preventing administration of medical procedures without the presence of doctors. There were reports of people threatened with lawsuits for banning visitors.

All of this led to Mr.Tegnell claiming that the ideal policy would have been something between what Sweden adopted and what the other countries did, in the light of what they know now. However this claim of Mr.Tegnell will be put to test when the second wave comes, later in time.

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