Childbirth is a time for expectant mothers to revel in the wonders and joy surrounding the arrival of a new human being; one breathing crisp new air, bawling with resonance in finding their voice and opening their eyes in awe to see the world around them. It’s the last conceivable moment where a mother wants to worry about the cleanliness of the birth facility, the baby’s life and, least of all, her own life. But in many developing countries including Nigeria, this is the reality.
Africa impact evaluation
Photo credit: Katrina Kosec.
Can a cash transfer program that relies heavily on communities to target beneficiaries, deliver payments, and monitor conditions, improve outcomes for the poor in the same way that more centrally-run conditional cash transfer programs (CCTs) have elsewhere?
Sudhir Anand and co-authors recently published a fascinating book, The Costs of Inaction, which looks at cost-benefit analysis in a different way. All cost-benefit analysis requires the analyst to specify a counterfactual—how the world would have evolved in the absence of the project of program. This is critical. An evaluation in Kenya included increased use of cellphones as an indicator of project success — neglecting the fact that cellphone use in neighboring villages was just as widespread.
In many cases, the counterfactual could be “doing nothing.” For a number of important areas such as health and education in Africa, The Costs of Inaction calculates the costs of doing nothing in terms of lives lost or under-educated children.
Last October, the Government of Nigeria committed to save one million lives by 2015 by increasing access to cost-effective health services and commodities, a bold goal.
Crucially, the Federal Ministry of Health is coupling the scale-up of services and commodities with a focus on knowledge, using rigorous impact evaluation strategically and systematically across their programs (in partnership with the World Bank’s Development Impact Evaluation Unit and the Gates Foundation). Each evaluation adapts promising evidence from elsewhere in the world to fit the Nigerian context, letting the Government and its partners see which interventions are most effective in saving lives.