80,000 Hours Podcast
#124 Classic episode – Karen Levy on fads and misaligned incentives in global development, and scaling deworming to reach hundreds of millions
Episode guests
Podcast summary created with Snipd AI
Quick takeaways
- The gap between academic research and policy implementation in global health is significant, with different success metrics and focuses driving each field.
- Karen Levy's journey illustrates how evidence-based practices can lead to meaningful change when academic insights are correctly applied in real-world scenarios.
- The Deworm the World initiative showcases the power of utilizing existing infrastructures, like schools, to scale effective public health solutions for children.
- Community engagement and clear communication are crucial for the success of health programs, as they help dispel misinformation and promote treatment acceptance.
- Sustainability in global health programs requires embedding initiatives within local government frameworks and ensuring consistent funding through strong relationships and advocacy.
Deep dives
Distinction Between Academia and Policy Implementation
The podcast elaborates on the significant differences between academic research and policy implementation in global health. In academia, the focus is often on finding optimal answers, while in policy, the aim is to optimize solutions within various constraints. This shift in perspective impacts how studies are designed and the types of questions asked. Success metrics also vary greatly; academic rewards may stem from research output, whereas policy success is contingent on actual implementation and tangible outcomes.
Role of Academics in Successful Scaling
Successful programs often hinge on the engagement of committed academics who understand and value the policy implications of their research. When evidence is lifted directly from studies to real-world applications, numerous questions arise regarding implementation, such as the mechanisms at play and potential changes to the intervention. Academics who are willing to collaborate closely with policymakers can significantly enhance the transition from evidence to practical application. The episode emphasizes that this partnership fosters better understanding and ultimately leads to more effective solutions.
Karen Levy's Journey in Global Health
Karen Levy's extensive career in global health and development was kickstarted when she collaborated with a Dutch NGO focused on child health in Kenya. Her introduction to rigorous research began when she encountered a key randomized control trial which examined the impact of deworming on children’s health and educational outcomes. This awakened her passion for evidence-based practices and led to her involvement in establishing the Innovations for Poverty Action office in Kenya. Levy’s journey showcases the potential for academic insights to create meaningful change when applied in real-world contexts.
Impact of the Deworm the World Initiative
The Deworm the World initiative aims to provide deworming treatment to millions of children and was driven by evidence demonstrating significant health and educational benefits. The program's success is attributed to a strategic approach that utilized existing school infrastructures for mass drug administration, thus efficiently reaching children in need. This initiative has grown to treat millions in Kenya and has inspired similar programs in other countries, showcasing how scalable solutions can emerge from rigorous research findings. The concept of using schools as distribution points for deworming medications has proven effective and sustainable.
Adapting Strategies for Program Delivery
The effective delivery of the deworming program required continuous adaptation and monitoring to ensure quality and reach. One key lesson learned was the importance of having robust processes in place, such as ensuring accurate school lists and optimizing training sessions for teachers. As the program expanded, adaptations like enhanced monitoring, resource allocation, and logistical planning became crucial. By setting up systematic approaches and feedback mechanisms, the program was able to maintain fidelity to its original design while scaling effectively.
The Importance of Community Involvement
Engaging the community was essential for the success of the deworming program, necessitating efforts in public sensitization to ensure awareness and uptake. Miscommunication could lead to misunderstandings about the safety and necessity of the treatment, highlighting the need for clear messaging. By implementing community awareness campaigns and training sessions, program leaders fostered an environment that encouraged participation. This community-centric approach helped to overcome skepticism and maximize the effectiveness of the mass deworming initiative.
Institutional Knowledge and Sustainability
The sustainability of programs like deworming relies on embedding them into local government health frameworks and ensuring consistent funding and political support. The podcast discusses how established deworming programs end up relying on passionate champions within the government, highlighting the importance of maintaining relationships despite political turnover. While programs may not experience immediate public pressure to continue, building robust institutional support can ensure longevity and impact. Sustained commitment from both philanthropic donors and local governments is necessary for continued success.
Scholarly Collaboration for Enhancing Impact
The podcast underscores the value of collaboration between researchers and practitioners in scaling effective programs. By maintaining ongoing dialogues and open communication between funders and implementers, both parties can align their goals and enhance the program's impact. Academics should be encouraged to engage in practical applications of their research while practitioners need to provide opportunities for scholarly inquiry. Such collaborations can lead to innovative solutions for complex global health challenges and ensure that interventions remain grounded in evidence.
Challenges in Navigating the Aid Landscape
Levy addresses the inherent challenges faced by researchers and practitioners working within the aid industry, particularly related to complex funding models and the pursuit of sustainability. Traditional funding practices often create misaligned incentives, leaving organizations conflicted about priorities. Levy emphasizes the importance of candid discussions about risks and project viability with donors, allowing for the adjustment of expectations. By fostering a culture that values transparency and collaboration, organizations can enhance their capacity to innovate and implement effectively.
If someone said a global health and development programme was sustainable, participatory, and holistic, you'd have to guess that they were saying something positive. But according to today's guest Karen Levy — deworming pioneer and veteran of Innovations for Poverty Action, Evidence Action, and Y Combinator — each of those three concepts has become so fashionable that they're at risk of being seriously overrated and applied where they don't belong.
Rebroadcast: this episode was originally released in March 2022.
Links to learn more, highlights, and full transcript.
Such concepts might even cause harm — trying to make a project embody all three is as likely to ruin it as help it flourish.
First, what do people mean by 'sustainability'? Usually they mean something like the programme will eventually be able to continue without needing further financial support from the donor. But how is that possible? Governments, nonprofits, and aid agencies aim to provide health services, education, infrastructure, financial services, and so on — and all of these require ongoing funding to pay for materials and staff to keep them running.
Given that someone needs to keep paying, Karen tells us that in practice, 'sustainability' is usually a euphemism for the programme at some point being passed on to someone else to fund — usually the national government. And while that can be fine, the national government of Kenya only spends $400 per person to provide each and every government service — just 2% of what the US spends on each resident. Incredibly tight budgets like that are typical of low-income countries.
'Participatory' also sounds nice, and inasmuch as it means leaders are accountable to the people they're trying to help, it probably is. But Karen tells us that in the field, ‘participatory’ usually means that recipients are expected to be involved in planning and delivering services themselves.
While that might be suitable in some situations, it's hardly something people in rich countries always want for themselves. Ideally we want government healthcare and education to be high quality without us having to attend meetings to keep it on track — and people in poor countries have as many or more pressures on their time. While accountability is desirable, an expectation of participation can be as much a burden as a blessing.
Finally, making a programme 'holistic' could be smart, but as Karen lays out, it also has some major downsides. For one, it means you're doing lots of things at once, which makes it hard to tell which parts of the project are making the biggest difference relative to their cost. For another, when you have a lot of goals at once, it's hard to tell whether you're making progress, or really put your mind to focusing on making one thing go extremely well. And finally, holistic programmes can be impractically expensive — Karen tells the story of a wonderful 'holistic school health' programme that, if continued, was going to cost 3.5 times the entire school's budget.
In this in-depth conversation, originally released in March 2022, Karen Levy and host Rob Wiblin chat about the above, as well as:
- Why it pays to figure out how you'll interpret the results of an experiment ahead of time
- The trouble with misaligned incentives within the development industry
- Projects that don't deliver value for money and should be scaled down
- How Karen accidentally became a leading figure in the push to deworm tens of millions of schoolchildren
- Logistical challenges in reaching huge numbers of people with essential services
- Lessons from Karen's many-decades career
- And much more
Chapters:
- Cold open (00:00:00)
- Rob's intro (00:01:33)
- The interview begins (00:02:21)
- Funding for effective altruist–mentality development projects (00:04:59)
- Pre-policy plans (00:08:36)
- ‘Sustainability’, and other myths in typical international development practice (00:21:37)
- ‘Participatoriness’ (00:36:20)
- ‘Holistic approaches’ (00:40:20)
- How the development industry sees evidence-based development (00:51:31)
- Initiatives in Africa that should be significantly curtailed (00:56:30)
- Misaligned incentives within the development industry (01:05:46)
- Deworming: the early days (01:21:09)
- The problem of deworming (01:34:27)
- Deworm the World (01:45:43)
- Where the majority of the work was happening (01:55:38)
- Logistical issues (02:20:41)
- The importance of a theory of change (02:31:46)
- Ways that things have changed since 2006 (02:36:07)
- Academic work vs policy work (02:38:33)
- Fit for Purpose (02:43:40)
- Living in Kenya (03:00:32)
- Underrated life advice (03:05:29)
- Rob’s outro (03:09:18)
Producer: Keiran Harris
Audio mastering: Ben Cordell and Ryan Kessler
Transcriptions: Katy Moore
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