Decentralization and Empowerment in Global Health Initiatives

Our failure to make sure all kids globally get all of their basic vaccinations leads to 1.5 million child deaths every year.

According to today’s guest, Varsha Venugopal, for the great majority this has nothing to do with weird conspiracy theories or medical worries — in India 80% of undervaccinated children are already getting some shots. They just aren't getting all of them, for the tragically mundane reason that life can get in the way.

Links to learn more, summary and full transcript.

As Varsha says, we're all sometimes guilty of "valuing our present very differently from the way we value the future", leading to short-term thinking whether about getting vaccines or going to the gym.

So who should we call on to help fix this universal problem? The government, extended family, or maybe village elders?

Varsha says that research shows the most influential figures might actually be local gossips.

In 2018, Varsha heard about the ideas around effective altruism for the first time. By the end of 2019, she’d gone through Charity Entrepreneurship’s strategy incubation program, and quit her normal, stable job to co-found Suvita, a non-profit focused on improving the uptake of immunization in India, which focuses on two models:
1. Sending SMS reminders directly to parents and carers
2. Gossip

The first one is intuitive. You collect birth registers, digitize the paper records, process the data, and send out personalised SMS messages to hundreds of thousands of families. The effect size varies depending on the context but these messages usually increase vaccination rates by 8-18%.

The second approach is less intuitive and isn't yet entirely understood either.

Here’s what happens: Suvita calls up random households and asks, “if there were an event in town, who would be most likely to tell you about it?”

In over 90% of the cases, the households gave both the name and the phone number of a local ‘influencer’.

And when tracked down, more than 95% of the most frequently named 'influencers' agreed to become vaccination ambassadors. Those ambassadors then go on to share information about when and where to get vaccinations, in whatever way seems best to them.

When tested by a team of top academics at the Poverty Action Lab (J-PAL) it raised vaccination rates by 10 percentage points, or about 27%.

The advantage of SMS reminders is that they’re easier to scale up. But Varsha says the ambassador program isn’t actually that far from being a scalable model as well.

A phone call to get a name, another call to ask the influencer join, and boom — you might have just covered a whole village rather than just a single family.

Varsha says that Suvita has two major challenges on the horizon:
1. Maintaining the same degree of oversight of their surveyors as they attempt to scale up the program, in order to ensure the program continues to work just as well
2. Deciding between focusing on reaching a few more additional districts now vs. making longer term investments which could build up to a future exponential increase.

In this episode, Varsha and Rob talk about making these kinds of high-stakes, high-stress decisions, as well as:
• How Suvita got started, and their experience with Charity Entrepreneurship
• Weaknesses of the J-PAL studies
• The importance of co-founders
• Deciding how broad a program should be
• Varsha’s day-to-day experience
• And much more

Chapters:

• Rob’s intro (00:00:00)
• The interview begins (00:01:47)
• The problem of undervaccinated kids (00:03:16)
• Suvita (00:12:47)
• Evidence on SMS reminders (00:20:30)
• Gossip intervention (00:28:43)
• Why parents aren’t already prioritizing vaccinations (00:38:29)
• Weaknesses of studies (00:43:01)
• Biggest challenges for Suvita (00:46:05)
• Staff location (01:06:57)
• Charity Entrepreneurship (01:14:37)
• The importance of co-founders (01:23:23)
• Deciding how broad a program should be (01:28:29)
• Careers at Suvita (01:34:11)
• Varsha’s advice (01:42:30)
• Varsha’s day-to-day experience (01:56:19)

Producer: Keiran Harris
Audio mastering: Ben Cordell
Transcriptions: Katy Moore