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Killing Two Development Problems with One Tablet
November 16, 2011
Development news like this report of a large-scale de-worming program from India makes my day. Why?
Four very good reasons:
1) At scale intervention, 2) Easy to administer, 3) Low-cost, and 4) multi-impact
It’s always exciting to read about proven development solutions that go to scale because of their potential impact–in this case, a state-wide (Bihar) school-based de-worming program targeting all 21 million school-age children. To put that number into perspective, it’s almost the size of Australia’s population! More importantly, we rarely hear about large-scale programs that involve proven interventions that have spillover benefits. Bihar’s state government implemented a simple (1 or 2 tablets per child per year), safe, low-cost (~ $0.50 per child per year), and proven effective intervention to keep worms out of little children, and to keep children in school. This prevents malnutrition and anemia of course, but it also reduces absenteeism, and increases children’s ability to learn.
But why does this matter?
Of course, it will be important to understand how health, nutrition, and learning outcomes in Bihar are affected by this large scale administration of a simple solution. But, for now, there is one big lesson for the jet-set development thinkers: in our current era of innovation as a hot topic, novel solutions for the world’s most important problems are more likely to move from idea to high-impact action if they think big, simple, cheap, and laterally.
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4 Responses to “Killing Two Development Problems with One Tablet”
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November 16th, 2011 at 9:37 pm
Yes you are absolutely right Nandini, this is a great story of an extremely cost-effective intervention reaching universal coverage almost instantly. There is one very good reason why this programme has been 1) at scale 2) easy to administer and 3) low cost (due to economies of scale and low admin costs). It’s because it has been 100% publicly financed.
Clearly there has been a lot of private-not-for-profit involvement on the service delivery side, but all the funds to cover the 50c per child costs have come from public sources. There has been no attempt been made to raise any revenue from any child. This has also meant that there have been no costs associated with means testing and targeting. More importantly no children were excluded because of fees. These results would not have been achieved had the State Government of Bihar tried to socially market these medicines at a small price to the consumer.
One can say this with confidence, because this programme was also built on a sound evidence base. So not only was the intervention proven to be cost-effective by Kremer and Miguel’s award winning research but they also demonstrated the merits of the free distribution policy too: http://www.povertyactionlab.or.....ainable-ap
But rather than having to wait for occasional good news stories like this, wouldn’t it be great if this policy of reaching universal coverage using public financing could be extended to other proven cost-effective interventions. Thankfully in India, at the highest levels of Government, people are now recognising the wisdom of this approach: http://www.thehindu.com/news/n.....482623.ece
November 20th, 2011 at 3:52 pm
It is quite amazing when the government of any country makes the health of their children a priority; and how far reaching the impact is on their overall well-being. Kudos to the government of Bihar for implementing this cost efficient system of giving 1 or 2 tablets per child per year to de-worm their school-age children. Yes, simple and inexpensive measures can be effective if planned properly. Of course Nandini you are absolutely right, preventing illnesses cause by worms such as malnutrition and anemia will keep children in school, allowing them to properly learn and develop. Healthcare in any country is expensive; however treatable childhood diseases need to be addressed to prevent an increase in morbidity and mortality.
November 20th, 2011 at 4:11 pm
It is exciting and encouraging reading this type of news, which tells us that there are simple, low cost, large scale solutions for some health problems that affect the quality of life of some populations. In this case, the de-worming program from India seems to be the solution to many of the problems that affect that community, because worms in children bring along many other health, social and economic issues, such as anemia, malnutrition, difficulty learning, and many others. This type of interventions should be considered in different parts of the world that have similar types of health issues, and even in places with completely different ones, because initiative and action is required to make a difference anywhere in the world, from developing countries to developed ones.
December 1st, 2011 at 9:27 am
http://www.youtube.com/watch?v=_KkmFuM77qU