Study, Adapt, Experiment, Monitor, and Adjust

What Works for Poverty Reduction

The linkages of health to poverty reduction and to long-term economic growth are powerful, much stronger than is generally understood. The burden of disease in some low-income regions, especially sub-Saharan Africa, stands as a stark barrier to economic growth and therefore must be addressed frontally and centrally in any comprehensive development strategy. The control of communicable diseases and improved maternal and child health remain the highest public health priorities. If these conditions were controlled in conjunction with enhanced programs of family planning, impoverished families could not only enjoy lives that are longer, healthier, and more productive, but they would also choose to have fewer children, secure in the knowledge that their children would survive, and could thereby invest more in the education and health of each child. The improvements in health would translate into higher incomes, higher economic growth, and reduced population growth.

The available evidence is insufficient to guarantee that a strategy that has proved effective in dealing with an issue in one setting will work elsewhere. The proposed suggestion implies that those responsible for programs should seek to learn from and draw on what has worked elsewhere rather than to copy it. This might be done through a process that can be summed up in five words:

study, adapt, experiment, monitor, and adjust.

• Study the approaches used in those projects that appear to have
reached poor groups. Even approaches not directly applicable to a
particular setting can be highly instructive. Investigate, as well, the
reasons the poor do not use available health, nutrition, and population
services. Understanding the constraints faced by the poor or
imposed on them by current strategies can be an important first step
in finding solutions.
• Adapt to local conditions the approaches used in successful experiences
elsewhere, applying the knowledge gained through field experience
and through study of the constraints facing the poor.
Adaptation may often involve combining more than one strategy.
Nearly everywhere, it is also likely to call for a liberal dose of common
sense. Developing effective pro-poor approaches is an art, not a
science.
• Experiment with the adapted approaches by implementing them in a
few, but not too few, places to see how well they work. The populations
served have to be large enough to ensure that implementation
takes place under typical rather than optimal administrative conditions,
to get a good idea of what might happen were the approach
more widely introduced.
• Monitor the experience, using one of the relatively simple techniques
available, to ensure an accurate understanding of how well or how
poorly the approach performs. Monitoring does not have to be nearly
as complicated as some evaluation specialists might lead one to
60 Gwatkin, Wagstaff, and Yazbeck
believe, and it is necessary for a sufficiently correct assessment of program
performance. Program administrators relying on their informal
impressions almost always greatly overestimate the effectiveness of
their activities in reaching disadvantaged groups.
• Adjust the approach according to the monitoring findings. It is
unlikely that any approach will work perfectly the first time around.
At least one and possibly many rounds of adjustment will be needed.
Or, if the prospects of eventual success appear hopeless, drop that
particular approach and try something else.


The World Bank, 2006, What Did the Reaching the Poor Studies Find?
D. R. Gwatkin, A. Wagstaff, and A. Yazbeck