Friday, April 11, 2014

Political change - the role of information and popular waves

There is a very strong, if not dominant, belief among development researchers that lack of adequate information and awareness is responsible for holding back reforms that could have improved development outcomes. 

Accordingly, they believe that if the poor quality of student learning outcomes or care delivered by government doctors are appropriately highlighted it could trigger the reforms required to address these deficiencies. Similarly, a credible demonstration (say, empirically or through rigorous field experiments) of the effectiveness of cash transfers or technical solutions to eliminating an inefficiency in a public service delivery system would lead to its adoption. Even the more prudent among them believe that it would go a long way towards achieving the reforms.

This betrays an inadequate understanding of the dynamics of political change. Political change is and has always been about ideological or populist waves anchored around a problem or felt-need that galvanize the public (or stakeholders) mood into demanding action. In fact, as Lant Pritchett has argued, development itself is a faith-based movement. Knowing about a problem is not the same thing as having the urge to address the problem. Change happens not when stakeholders become aware of some problem but when they are triggered into action. And there is some distance to travel between knowing and acting.

Consider the two examples of poor quality of education and health care delivered by public institutions across India and many developing countries. It is now exhaustively documented, by both public audits and third party assessments, that student learning levels in government schools across India are shockingly low. Every year, for nearly a decade, the annual ASER reports, through quantified metrics on learning achievements, tell us that less than a half of Class V children have achieved even Class II competencies. Furthermore, learning levels have been worsening. The same reports have also consistently shown that private schools achieve better results at a fraction of the cost of public schools. It is also well documented that teacher truancy is a major problem in government schools. Conventional wisdom would have it that learning outcomes should occupy the center of the education agenda. 

Similarly, a number of studies have exposed the poor quality of care in primary health centers (PHCs). In fact, the Planning Commission itself estimates that PHCs account for less than one-fifth of all first contact in the referral chain. The remaining are with private care providers, mainly the unqualified rural medical practitioners (RMPs). Numerous studies have shown widespread unauthorized absenteeism among nurses and doctors. Recent studies have also shown that compared to even RMPs, PHC doctors spend less time per patient and mis-diagnose more frequently. Again conventional wisdom would have it that primary health care reforms, including integration of RMPs, should be a no-brainer. 

Many of these findings come from rigorous studies like randomized control trials conducted by very reputed agencies and researchers. In any case, none of them have been disputed by any of the stakeholders. Further, most of them have cognitively striking headline numbers, which presumably should unsettle any rational audience. However, in reality, the impact of such research findings has been remarkably marginal. Researchers blame governments and express incredulousness at its unwillingness to take action to change the order.

India is not alone in being afflicted by this trend. One only needs to look at public debates in the United States to understand the persistence and hold of ideological and other prejudices on the face of overwhelming evidence. Arguments in favor of lowering the marginal income tax rate, despite unambiguous evidence of dramatic concentration of wealth and declining returns to labor income, dominate conservative thinking. Climate change deniers and opponents of gun control are not amenable to conclusive evidence and well-reasoned arguments that contradict their views.

But I am not one bit surprised by this. Paradigm re-defining reforms rarely happen because someone comes up with striking figures that reveal something completely new and deeply unsettling, forcing governments into action. Almost always those insights are widely known and have been deeply internalized by most stakeholders, though not necessarily quantitatively. It is just that the changes - in terms of re-orienting values as well as accommodating losses of various stakeholders - required are much more daunting than could be achieved with mere revelation of facts, however unsettling. They require upending of well-established political and administrative orders and social values, which would cause loss to powerful and entrenched vested interests and destabilize the passive tolerance (for whatever reasons) of poor quality service by its intended beneficiaries (or now losers!). 

The debates on these issues have a dynamic of their own, and needs to accumulate the importance and urgency that generates the demand for immediate and decisive action. They need some long enough period of deep personal engagement by those immediately affected with the problem. But unfortunately a mere dissemination of information about ground realities is unlikely to, by itself, result in the deep engagement required. It would need careful strategic communication to get the stakeholders to face up to the reality and demand change. People are too cognitively ensconced, despite the obvious failings of the existing arrangement and their resultant losses, to come out and fight for change.

This is not to say that such research has no role in addressing such issues. But research findings, while undoubtedly important to the public debate on these issues, are just one of the contributors to change. The most important trigger for action on such issues is the realization and internalization of the need for change among atleast the most important stakeholders.

It is one thing to legislate rules that promise good quality education or health care, but entirely another thing to actually create the conditions that will enable its realization. In fact, in areas like education and health care, we may already have enough information and insights to stop worrying about them and get down to the business of actually creating the conditions required for change. Advocates of change need to realize this and work to create the conditions for change. Merely providing more information or insights alone may already be into the phase of diminishing returns.

1 comment:

Anonymous said...

Absenteeism is a great example of how institutional interests within the aid industry affect the way problems are framed and approached.

If development agencies were full of "Senior Absenteeism Experts" rather than "Senior Curriculum Development Experts", the topic would draw far more attention.

Also, absenteeism is far too "political", with obvious losers (lazy teachers), so the win-win argot so loved by the aid industry cannot be brought to bear.

Where the aid industry does not have a hammer, it usually prefers to ignore the nail.

Plus, have you EVER seen an aid organization identify "laziness" of staff within institutions as a problem? It's only a problem in rich countries it seems...