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  • So here it is. You can check: I am short, I'm French,

  • I have a pretty strong French accent,

  • so that's going to be clear in a moment.

  • Maybe a sobering thought

  • and something you all know about.

  • And I suspect many of you gave

  • something to the people of Haiti this year.

  • And there is something else

  • I believe in the back of your mind

  • you also know.

  • That is, every day,

  • 25,000 children die

  • of entirely preventable causes.

  • That's a Haiti earthquake every eight days.

  • And I suspect many of you probably gave something

  • towards that problem as well,

  • but somehow it doesn't happen

  • with the same intensity.

  • So why is that?

  • Well, here is a thought experiment for you.

  • Imagine you have a few million dollars that you've raised --

  • maybe you're a politician in a developing country

  • and you have a budget to spend. You want to spend it on the poor:

  • How do you go about it?

  • Do you believe the people who tell you

  • that all we need to do is to spend money?

  • That we know how to eradicate poverty,

  • we just need to do more?

  • Or do you believe the people who tell you that

  • aid is not going to help, on the contrary it might hurt,

  • it might exacerbate corruption, dependence, etc.?

  • Or maybe you turn to the past.

  • After all, we have spent billions of dollars on aid.

  • Maybe you look at the past and see.

  • Has it done any good?

  • And, sadly, we don't know.

  • And worst of all, we will never know.

  • And the reason is that -- take Africa for example.

  • Africans have already got a lot of aid.

  • These are the blue bars.

  • And the GDP in Africa is not making much progress.

  • Okay, fine. How do you know what

  • would have happened without the aid?

  • Maybe it would have been much worse,

  • or maybe it would have been better.

  • We have no idea. We don't know what the counterfactual is.

  • There's only one Africa.

  • So what do you do?

  • To give the aid, and hope and pray that something comes out of it?

  • Or do you focus on your everyday life

  • and let the earthquake every eight days

  • continue to happen?

  • The thing is, if we don't know

  • whether we are doing any good,

  • we are not any better

  • than the Medieval doctors and their leeches.

  • Sometimes the patient gets better, sometimes the patient dies.

  • Is it the leeches? Is it something else?

  • We don't know.

  • So here are some other questions.

  • They're smaller questions,

  • but they are not that small.

  • Immunization, that's the cheapest way

  • to save a child's life.

  • And the world has spent a lot of money on it:

  • The GAVI and the Gates Foundations

  • are each pledging a lot of money towards it,

  • and developing countries themselves have been doing a lot of effort.

  • And yet, every year

  • at least 25 million children

  • do not get the immunization they should get.

  • So this is what you call a "last mile problem."

  • The technology is there,

  • the infrastructure is there,

  • and yet it doesn't happen.

  • So you have your million.

  • How do you use your million

  • to solve this last mile problem?

  • And here's another question:

  • Malaria. Malaria kills almost

  • 900,000 people every year,

  • most of them in Sub-Saharan Africa,

  • most of them under five.

  • In fact, that is the leading cause of under-five mortality.

  • We already know how to kill malaria,

  • but some people come to you and say,

  • "You have your millions. How about bed nets?"

  • Bed nets are very cheap.

  • For 10 dollars, you can manufacture and ship

  • an insecticide treated bed net

  • and you can teach someone to use them.

  • And, not only do they protect the people who sleep under them,

  • but they have these great contagion benefits.

  • If half of a community sleeps under a net,

  • the other half also benefits

  • because the contagion of the disease spread.

  • And yet, only a quarter of kids at risk sleep under a net.

  • Societies should be willing to go out

  • and subsidize the net, give them for free,

  • or, for that matter, pay people to use them

  • because of those contagion benefits.

  • "Not so fast," say other people.

  • "If you give the nets for free,

  • people are not going to value them.

  • They're not going to use them,

  • or at least they're not going to use them as bed nets,

  • maybe as fishing nets."

  • So, what do you do?

  • Do you give the nets for free to maximize coverage,

  • or do you make people pay

  • in order to make sure that they really value them?

  • How do you know?

  • And a third question: Education.

  • Maybe that's the solution, maybe we should send kids to school.

  • But how do you do that?

  • Do you hire teachers? Do you build more schools?

  • Do you provide school lunch?

  • How do you know?

  • So here is the thing.

  • I cannot answer the big question,

  • whether aid did any good or not.

  • But these three questions, I can answer them.

  • It's not the Middle Ages anymore,

  • it's the 21st century.

  • And in the 20th century,

  • randomized, controlled trials

  • have revolutionized medicine

  • by allowing us to distinguish

  • between drugs that work

  • and drugs that don't work.

  • And you can do the same

  • randomized, controlled trial for social policy.

  • You can put social innovation to the same

  • rigorous, scientific tests

  • that we use for drugs.

  • And in this way, you can take the guesswork

  • out of policy-making

  • by knowing what works,

  • what doesn't work and why.

  • And I'll give you some examples with those three questions.

  • So I start with immunization.

  • Here's Udaipur District, Rajasthan. Beautiful.

  • Well, when I started working there,

  • about one percent of children

  • were fully immunized.

  • That's bad, but there are places like that.

  • Now, it's not because the vaccines are not there --

  • they are there and they are free --

  • and it's not because parents do not care about their kids.

  • The same child that is not immunized against measles,

  • if they do get measles, parents will spend

  • thousands of rupees to help them.

  • So you get these empty village subcenters

  • and crowded hospitals.

  • So what is the problem?

  • Well, part of the problem, surely, is people do not fully understand.

  • After all, in this country as well,

  • all sorts of myths and misconceptions

  • go around immunization.

  • So if that's the case, that's difficult,

  • because persuasion is really difficult.

  • But maybe there is another problem as well.

  • It's going from intention to action.

  • Imagine you are a mother

  • in Udaipur District, Rajasthan.

  • You have to walk a few kilometers to get your kids immunized.

  • And maybe when you get there, what you find is this:

  • The subcenter is closed. Ao you have to come back,

  • and you are so busy and you have so many other things to do,

  • you will always tend to postpone and postpone,

  • and eventually it gets too late.

  • Well, if that's the problem, then that's much easier.

  • Because A, we can make it easy,

  • and B, we can maybe

  • give people a reason to act today,

  • rather than wait till tomorrow.

  • So these are simple ideas, but we didn't know.

  • So let's try them.

  • So what we did is we did a randomized, controlled trial

  • in 134 villages in Udaipur Districts.

  • So the blue dots

  • are selected randomly.

  • We made it easy -- I'll tell you how in a moment.

  • In the red dots, we made it easy

  • and gave people a reason to act now.

  • The white dots are comparisons, nothing changed.

  • So we make it easy by organizing

  • this monthly camp where people can

  • get their kids immunized.

  • And then you make it easy

  • and give a reason to act now

  • by adding a kilo of lentils for each immunization.

  • Now, a kilo of lentils is tiny.

  • It's never going to convince anybody

  • to do something that they don't want to do.

  • On the other hand, if your problem is you tend to postpone,

  • then it might give you a reason to act today

  • rather than later.

  • So what do we find?

  • Well, beforehand, everything is the same.

  • That's the beauty of randomization.

  • Afterwards,

  • the camp -- just having the camp --

  • increases immunization from six percent to 17 percent.

  • That's full immunization.

  • That's not bad, that's a good improvement.

  • Add the lentils and you reach to 38 percent.

  • So here you've got your answer.

  • Make it easy and give a kilo of lentils,

  • you multiply immunization rate by six.

  • Now, you might say, "Well, but it's not sustainable.

  • We cannot keep giving lentils to people."

  • Well, it turns out it's wrong economics,

  • because it is cheaper

  • to give lentils than not to give them.

  • Since you have to pay for the nurse anyway,

  • the cost per immunization

  • ends up being cheaper if you give incentives than if you don't.

  • How about bed nets?

  • Should you give them for free, or should you ask people to pay for them?

  • So the answer hinges

  • on the answer to three simple questions.

  • One is: If people must pay for a bed net,

  • are they going to purchase them?

  • The second one is:

  • If I give bed nets for free,

  • are people going to use them?

  • And the third one is:

  • Do free bed nets discourage future purchase?

  • The third one is important

  • because if we think people get used to handouts,

  • it might destroy markets to distribute free bed nets.

  • Now this is a debate that has generated

  • a lot of emotion and angry rhetoric.

  • It's more ideological than practical,

  • but it turns out it's an easy question.

  • We can know the answer to this question.

  • We can just run an experiment.

  • And many experiments have been run, and they all have the same results,

  • so I'm just going to talk to you about one.

  • And this one that was in Kenya,

  • they went around and distributed to people

  • vouchers, discount vouchers.

  • So people with their voucher

  • could get the bed net in the local pharmacy.

  • And some people get 100 percent discount,

  • and some people get 20 percent discounts,

  • and some people get 50 percent discount, etc.

  • And now we can see what happens.

  • So, how about the purchasing?

  • Well, what you can see is that

  • when people have to pay for their bed nets,

  • the coverage rate really falls down a lot.

  • So even with partial subsidy,

  • three dollars is still not the full cost of a bed net,