Syndicate content

Add new comment

Submitted by Enis Baris on
Thank you Adam. the debate on the science of delivery reminded me of the title of one of your previous blogs referring to the old wine in a new bottle, without of course meaning to denigrate the very much welcome focus on how best we can deliver development assistance to eliminate poverty and improve shared prosperity, but simply to point out to the fact that preoccupation with the "how" question has been with us for quite a while, albeit under different terminology. To illustrate, you may know that in 1980s the clinical epidemiologists had the formula below to distinguish efficacy from effectiveness: Effectiveness = efficacy x diagnostic accuracy X coverage X user compliance x provider compliance in which efficacy is all about the delivery of science and the rest of the formula being about the science of delivery, namely making sure that: (i) we only use interventions with proven efficacy; (ii) the targetted population corresponds fully to the population at risk without any "false positives" or "false negatives"; (iii) all are reached by the intervention; (iv) those who implement abide by the guidelines and specifications of the intervention as designed; and (v) the population covered also adhere to the intervention specifications. The challenge for us all is to compile all the knowledge, tacit or otherwise, and render it accessible to Bank staff, and indeed to the wider development community in a systematic manner so that we all understand the gaps between efficacy and effectiveness, as well as the determinants thereof for continuous fine-tuning to improve the robustness of our interventions despite within- and inter-country variations in political economy and actual implementation.