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Ebola: How a people’s science helped end an epidemic

Duncan Green's picture

Guest book review from Anita Makri, an editor and writer going freelance after 5+ years with SciDev.Net. (@anita_makri)

I’m sure that to readers of this blog the Ebola epidemic that devastated West Africa a couple of years ago needs no introduction (just in case, here’s a nice summary by the Guardian’s health editor). So I’ll cut to the chase, and to a narrative that at the time was bubbling underneath more familiar debates about responding to health crises – you know, things like imperfect governance, fragile health systems, drug shortages.

All of them important, but this narrative was new. It was about fear, communication and cooperation – the human and social side of the crisis (explored in a SciDev.Net collection I commissioned at the time). There was also an unsettling undercurrent to it – one that conveyed ‘otherness’ and ignorance on the part of West Africans, fuelled by reports of violence against health workers and of communities resisting expert advice against risky funeral rites.

But if you listened closely, you could just about make out the voices of anthropologists trying to dispel notions that these reactions were about exotic or traditional cultures. Paul Richards was one of those voices, and luckily he’s put together a rare account of evidence, theory and experience in a book that should trigger real reflection on how we can do better in handling similar crises (hint: more listening).

Ebola: How a People’s Science Helped End an Epidemic tells the story of the epidemic through the eyes of someone with intimate knowledge of the region and the rules that influence human interactions – very much an anthropologist’s perspective, not an epidemiologist’s. The book turns the mainstream discourse on its head, putting what Richards calls “people’s science” on an equal footing with the more orthodox science behind the international response. It captures how people and experts adapted to each other, falling into a process of knowledge co-production.

What explains advocacy success in setting global agendas? Comparing Tobacco v Alcohol and four other global advocacy efforts

Duncan Green's picture

Oxfam researcher/evaluation adviser Uwe Gneiting introduces a new set of case studies

It’s an age-old puzzle – why do some advocacy and campaigning efforts manage to influence the political agendas of governments, international institutions and corporations but others don’t? What explains the difference in attention, resource mobilization, and policy traction of some issues (e.g. anti-Apartheid, HIV/AIDS) compared to others (e.g. the limited success of gun control advocacy in the U.S.)?

The technical response to these questions is that it’s an evidence problem – issues gain traction if there is sufficient evidence regarding their severity, cause and an effective solution. But as has been discussed elsewhere (including on this blog), focusing on evidence alone neglects the role of power and politics in explaining which issues gain attention and policy traction and which ones don’t.

This was why a group of researchers (including me) recently published a set of studies that put forward a more nuanced explanation for the variation in advocacy effectiveness. The way we approached the task was to analyze and compare pairs of issues (we focused on global health) of similar types and harm levels but varying attention (newborn vs maternal mortality, pneumonia vs tuberculosis, and alcohol vs tobacco). We ended up with ten factors across three categories that in conjunction help to explain varying levels of advocacy success (see table below)

How do you make aid programmes truly adaptive? New lessons from Bangladesh and Cambodia

Duncan Green's picture
Lisa Denney Daniel Harris Leni Wild

Following on from yesterday’s post on adaptive aid, a guest piece from Lisa Denney (far left), Daniel Harris (middle) and Leni Wild (near left), all of ODI.

A swelling chorus of the development community has been advocating for more flexible and adaptive programming that can respond to the twists and turns of political reform processes. They argue that in order to achieve better aid outcomes, we need to do development differently. As part of this agenda, ODI and The Asia Foundation, with the assistance of the Australian Department of Foreign Affairs and Trade, tracked and analysed three programmes in Bangladesh, Cambodia, and Mongolia. These programmes explicitly sought to work politically in practice, using a relatively small amount of money, a relatively short timeframe, and a focus on tangible changes. We followed attempts to achieve environmental compliance and increase exports in the leather sector in Bangladesh, and to improve solid waste management in Cambodia and Mongolia; issues identified for their potential to make important contributions (economic, health, environmental, etc.) to the wellbeing of citizens. Two of our case studies were released this month, telling the story of how the reforms unfolded and shifted strategy to better leverage the incentives of influential stakeholders, as well as the mechanics of how the Foundation supported adaptive ways of working.
 

How adaptation worked in practice

In each case, the programme teams (led by staff in the Foundation’s local office, and supported by a variety of contracted partners and a wider uncontracted reform network reaching both inside and outside of government) made significant changes to strategy during the implementation phase that helped to address difficult, multidimensional problems. In Cambodia, the team faced a complex and often opaque challenge in which waste collection is characterized by a single company with a long-term confidential contract that is difficult to monitor, a fee structure that does not encourage improved household waste collection, garbage collectors whose conditions do not incentivize performance, and communities that are difficult to access and do not always understand the importance of sanitary waste disposal. With a small Foundation team and limited funding, the approach relied on working with individuals selected as much for personal connections, disposition, and political know-how in working politically and flexibly, as for technical knowledge. The team began by cultivating relations between City Hall and the single contractor providing solid waste management services, then moved to work with the sole provider to improve their delivery, and finally, resolved to end the single contractor model in favour of competition.

Reading ICAI’s review of DFID WASH results

Suvojit Chattopadhyay's picture

The Independent Commission for Aid Impact (ICAI), UK’s aid watch dog, today, released its review of DFID’s programming and results in water sanitation and hygiene (WASH). In this impact review, they take a close look at the results DFID reported in its 2015 Annual Report; results that cost £ 713 million between 2010 – 2014. 

Do read the full report here.

Some thoughts on the areas of concern in the report:

  • The focus on ‘leaving no one behind’ is spot on. It is easy to stack up impressive WASH numbers if one ignores the poorest and the most vulnerable in communities. Safe sanitation and hygiene need to be universal for health benefits to accrue to communities. Within WASH, sanitation is specifically complex, sometimes also called a ‘wicked problem’ – a challenge foremost, of inducing lasting behaviour change. The very nature of careful social engineering required to bring about this behaviour change seems to run contrary to some of the factors that make an intervention scalable – an ability to standardise inputs and break programme components down to easily replicable bits.
  • Within the broad basket of ‘service delivery’ interventions, WASH is one of the trickier sectors when it comes to measuring sustained impact, especially at scale. Naturally then, ICAI find that while DFID’s claims of having reached 62.9 million people are broadly correct, it is very hard to establish if the benefits are sustained. Therefore, the results reported remain at the ‘output’ level and that is what ICAI ends up assessing, even though what they set out to do is an ‘impact’ review. While the report speculates on sustaining benefits beyond the 2011-15 period, I wonder whether those that accessed the programme in 2011-12 continued to experience any benefits in 2015.
  • The link with government systems, in terms of implementation, monitoring and sustenance remains unclear: another typical WASH issue. Barring say, India, (and this is true especially in sub-Saharan countries, government WASH budgets are highly inadequate. A lot of the work that happens is funded by donors and this implies that monitoring and maintenance happens outside the official system. Achieving local ownership in such a context is a challenge.
  • ICAI finds it difficult to assess value for money (VfM) in DFID’s WASH programmes. On one hand, it finds that there isn’t enough competitive procurement, but also there is a lack of established metrics and benchmarks to analyse VfM. Following DFID’s own 3Es framework, an Economy and Efficiency analysis should be possile across the portfolio, and as far as I can tell, is rapidly being developed in the sector, and within DFID. However, partly as a consequence of the lack of ‘outcome/impact’ data, cost-effectiveness studies are likely to remain a challenge. This work by an OPM-led consortium should be particularly relevant in improving VfM analysis across the sector.

Blog post of the month: The 2016 Multidimensional Poverty Index was launched last week. What does it say?

Duncan Green's picture

Each month People, Spaces, Deliberation shares the blog post that generated the most interest and discussion. In June 2016, the featured blog post is "The 2016 Multidimensional Poverty Index was launched last week. What does it say?" by Duncan Green.


This is at the geeky, number-crunching end of my spectrum, but I think it’s worth a look (and anyway, they asked nicely). The 2016 Multi-Dimensional Poverty Indexwas published yesterday. It now covers 102 countries in total, including 75 per cent of the world’s population, or 5.2 billion people. Of this proportion, 30 per cent of people (1.6 billion) are identified as multidimensionally poor.

The Global MPI has 3 dimensions and 10 indicators (for details see here and the graphic, right). A person is identified as multidimensionally poor (or ‘MPI poor’) if they are deprived in at least one third of the dimensions. The MPI is calculated by multiplying the incidence of poverty (the percentage of people identified as MPI poor) by the average intensity of poverty across the poor. So it reflects both the share of people in poverty and the degree to which they are deprived.

The MPI increasingly digs down below national level, giving separate results for 962 sub-national regions, which range from having 0% to 100% of people poor (see African map, below). It is also disaggregated by rural-urban areas for nearly all countries as well as by age.

Campaign Art: Salvaging cars and saving lives

Davinia Levy's picture

People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

We all know that organ donations save lives. Some people have to wait months and years to receive the organ they need to stay alive. Sadly, some die before a compatible organ is found for them. According to the US Government, 22 people die each day waiting for an organ in that country alone. Globally, there are some countries that are very generous when it comes to organ donation. Argentina is not one of them.

A metaphor to view this issue is to compare the human body to car parts. If you think about it, in a way we all have a chassis (our skin, muscles and bones), a motor (our heart), we stay well-greased with oil (our blood), and our exhaust pipe is… well you can guess.

To incentivize organ donations in Argentina, a taxi company has been using donated car parts from a scrapyard to fix taxis in their fleet. In exchange, the taxis become visible awareness campaigns for the cause of organ donations.

CUCAIBA: Donor cars

Source: Ad Agency J. Walter Thompson Buenos Aires

The 2016 Multidimensional Poverty Index was launched last week. What does it say?

Duncan Green's picture

This is at the geeky, number-crunching end of my spectrum, but I think it’s worth a look (and anyway, they asked nicely). The 2016 Multi-Dimensional Poverty Index was published yesterday. It now covers 102 countries in total, including 75 per cent of the world’s population, or 5.2 billion people. Of this proportion, 30 per cent of people (1.6 billion) are identified as multidimensionally poor.

The Global MPI has 3 dimensions and 10 indicators (for details see here and the graphic, right). A person is identified as multidimensionally poor (or ‘MPI poor’) if they are deprived in at least one third of the dimensions. The MPI is calculated by multiplying the incidence of poverty (the percentage of people identified as MPI poor) by the average intensity of poverty across the poor. So it reflects both the share of people in poverty and the degree to which they are deprived.

The MPI increasingly digs down below national level, giving separate results for 962 sub-national regions, which range from having 0% to 100% of people poor (see African map, below). It is also disaggregated by rural-urban areas for nearly all countries as well as by age.

Campaign Art: Soap that helps early detection of cancer

Davinia Levy's picture
People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

If you think about your community (family, friends, colleagues, etc), you probably know someone who has or has had breast cancer. According to the World Cancer Research Fund International, in 2012, breast cancer was the second most common cancer, with about 1.7 million new cases registered.
 
The good news, if any, is that breast cancer has a very high survival rates (of over 90%) when detected and treated at an early stage. A good way to detect cancer early is to perform routine self-exams to search for any lumps or changes in the breast area. A recommended time to do these self-exams is when we are naked and alone – and these conditions are met when we are in the shower.

To incentivize self-exams amongst the local population in Puerto Rico, HIMA San Pablo – a network of hospitals – came up with this public health awareness campaign. They distributed soap with a reminder carved in each soap bar and with waterproof instructions to correctly perform self-examinations in the shower.
 
The Life Soap

Tackling cholera through radio in Kenya

BBC Media Action's picture

David Njuguna, a mentor for BBC Media Action Kenya, looks at how a volunteer-run local radio station is helping prevent cholera in Kenya.

Kamadi, presenter at Mtaani Radio in Nairobi, Kenya
Kamadi, presenter at Mtaani Radio in
Nairobi, Kenya

Last year Kenya was facing a devastating cholera outbreak. It started in the capital, Nairobi and by June 2015, a total of 4,937 cases and 97 deaths had been reported nationally.

According to public health officials, the spread of cholera in Nairobi particularly affected people living in slums. Frequent bursting of sewer lines, poor sanitation facilities and heavy rains played a major role in the outbreak. Poor hygiene practices – such as not washing hands before eating or preparing food – also contributed to the spread of disease. The outbreak eventually petered out, but the environment and practices that contributed to the spread of cholera continue to pose a threat.

In a quiet courtyard, away from the hustle and bustle of Nairobi’s Kawangware slum, a community radio station was planning a response.

Local radio

Mtaani Radio, run by a team of volunteers, was a hive of activity when I walked into their studio last week. They were recording content for ‘WASH Wednesdays’, a show looking at ways listeners can improve their health and hygiene. The show, reaching over 100,000 people in the Kawangware community, was just about to start.

What can historical success teach us about tackling sanitation and hygiene?

Duncan Green's picture

Ooh good, another ‘lessons of history’ research piece. Check out the excellent new WaterAid report: Achieving total sanitation and hygiene coverage within a generation – lessons from East Asia.

The paper summarizes the findings of four country case studies: Singapore, South Korea, Malaysia and Thailand, all of which produced ‘rapid and remarkable results in delivering total sanitation coverage in their formative stages as nation states’. I can certainly vouch for Singapore – I spent 3 years there as a child in the late 60s. Whenever the rains came, the main roads flooded, turning the city into an insanitary swamp. Not any longer.

The paper concludes: ‘Although their initial conditions were very different from those currently found in ‘fragile’ and ‘least-developed’ countries in Africa and South Asia, some useful conclusions can be used to inform discussions on development of strategic approaches to delivering sanitation for all:

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