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behavioral interventions

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.

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.