The Illusion of Sustainability

Abstract

Rather than provide development assistance indefinitely, foreign aid donors increasingly seek to help communities sustainably provide local public goods themselves. We examine various strategies for sustainably fighting intestinal worms through voluntary local mobilization. Intestinal worms affect one in four people worldwide, but can be controlled by taking medicine twice annually. Since much of the resulting treatment benefit comes through reduced disease transmission, standard public finance analysis provides a rationale for subsidized treatment. Randomized evaluations suggest several efforts to replace subsidies with sustainable worm control measures were ineffective. A drug cost recovery program reduced take-up by 80%. A mobilization intervention designed to boost drug take up failed. Health education did not affect behavior. People were less likely to take drugs if randomly exposed to more information through their social network. In this context, using external interventions to promote sustainable voluntary provision of local public goods (like worm control) appears unrealistic.

The health knowledge mechanism: evidence on the link between education and health lifestyle in the Philippines

“…Health deficits can be further reduced by implementing campaigns that directly address information gaps among the less educated [12,13,16]. On the other hand, simply providing information to the poor may not always be effective, as negative experiences with some information and education interventions have shown [5,18,31,44]. The potential of an intervention largely depends on the specific context, the complexity of the provided health information, and the characteristics of the recipient [17].…”

Deworming Delusions? Mass Drug Administration in East African Schools

“…They elaborated these points in an important article published in 2007, emphasizing the hazards of generalizing findings from one social group to another (Kremer & Miguel, 2007). They found that families outside of the trial group, but friendly with families in the trial group, were less likely to deworm their children than families who were not friendly with those who had been part of the initial control group.…”

“…However, there has been much less focus on the degree to which such research represents what happens in schools and wider populations that are not closely observed in surveys. As Kremer and Miguel suggested in their 2007 paper on the 'illusion of sustainability', it should not be assumed that they do, while in a paper they published in 2002 they discussed specifically why so many people in Kenya choose not to take deworming medicines (Miguel & Kremer, 2002;Kremer & Miguel, 2007). Deworming can only be effective as a public health strategy if the tablets are consumed.…”

The Dreams Plan: A Blupoint Strategy for e‐Education Provision in South Africa

“…Whether or not one is in agreement with Easterly, it is intuitive to say that there is no such thing as a 'perfect' development program -or at least a perfect development program has not yet been discovered. There is no magic formula or silver bullet for development -if there it would have been discovered by now (Banerjee & He, 2008;Bebbington, Hickey and Mitlin, 2008;Birdsall, 2008;Hoffman, 2008;Hulme, 2008;Kremer & Miguel, 2008;McMillan, 2008). We believe that the ultimate end or purpose of development is people.…”