You’ve done the research, and after many sketches and notes, you’ve come up with a masterful solution to the biggest problem in the world. You have made the most convincing argument imaginable for your solution, and you have evidence to back it up. It’s flawless. None of that ‘expert’ business, things are tried and tested. But- that’s not enough.
Lately I’ve been exploring interventions in public health and development economics. Intervention basically refers the case where an outside group enters a community, with the intention to address certain problems. Advances in health and technology have brought inexpensive solutions to problems like infant mortality, water contamination, and malaria. Reading about neonatal interventions in rural India and the work of the Poverty Action Lab in Poor Economics reveals cases where the above problems have inexpensive, effective solutions, but successfully introducing the solutions in the target community has proved problematic. I will outline some of the general difficulties they describe, and follow that with effective measures for intervention.
Difficulties
The difficulty in solution adoption arises for several reasons. In order to understand, one must enter the point of view of the community- the people who are targeted by the health workers, or NGOs or public projects. Why is it that vaccinations, re-hydration tablets, and chlorine bleach would not be used in disease prevention?
Just like anyone else in the world, the community members have years, generations, of culture, history and traditions. Habits did not form randomly, there are reasons behind them. Few people anywhere who go to a doctor base their trust on researching evidence, even in an information rich society like America. The trust exists more as a collective effect- that others trust the doctor as well.
In the above video of Vishwajeet Kumar’s TED talk on neonatal interventions, he describes this as realizing that ‘the cup is not empty’. A thought that pervades development solutions is that those being helped can be given anything, that they are ready to accept. This is just not the case. People cannot be reduced to caricatures, as the introduction to Poor Economics states.
For the neonatal intervention, such was apparent through the many rituals and beliefs surrounding birth- traditions which brought people form various social castes of the community together. Recent advances in health care conflicted with their actions regarding what is safe for a newborn (ex. waiting to breast feed, little initial skin to skin contact introducing the risk for hypothermia). With respect to vaccines, Poor Economics describes a possible reason for lack of use exists in the nature of present-day costs with uncertain future outcomes. Though people understand vaccines may help, they can easily postpone such measures, with the idea that the cost is for today, but the benefits occur in the unknown future, so why not postpone the cost a day. That day comes, and is postponed again. The same logic occurs with the mosquito bed nets, or chlorine.
Solutions
While the intervention may conflict with the beliefs of the community, research has shown that the beliefs are not so rigid; adoption in-part occurred once the health care workers phrased their solutions in terms of the community beliefs (ex. language of hot-cold, emphasis on care for the child).
A potential solution outlined for the ‘postpone’ problem is to use small incentives, like a particular case where dal was given when the family brought their child for a vaccine. Though the vaccine may not have been an effective incentive against beliefs like the ‘evil-eye’, the dal brought people out, illustrating how dynamic beliefs can be.
Some of these ideas are captured within the work of Dr. BJ Fogg who researches behavior change on the scale of individuals and groups. One effective measure he suggests is to start with simple, small interventions first. Instead of flossing all teeth, just floss one. The step from nothing to A is far more difficult than A to B, so make the first step an easy one. If it is within someone’s routine and habits, even better, its even easier.
He highlights how some successful high tech startups are brilliant at this. Facebook placing a message in your inbox of a photo you’re tagged in. With a simple click you’re in and looking at the photo, potentially commenting. Other companies which begin with simple, attractive features, successfully incorporate themselves in our routines. Part of the success comes in understanding what their target group values, what it values, and how to effectively place their product knowing that information.
The Takeaway
Having a great solution is not always enough. But if interventions are simple and accessible to the community they will be more successful. What is important from looking at these cases is that simple is not just a function of physical distance and money. An intervention is also simple with respect to the ‘distance’ from current habits, beliefs, and behaviors of the community (think path of least effort). The only way to understand how to introduce an intervention is to engage and dialogue with members of the community, in order to collect information on the key points of the beliefs, and the routines of the community. By acknowledging the complexity of the social relations, culture, and beliefs of the community, a successful intervention can be achieved.
