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Each year billions of dollars are spent on development programs with relatively few rigorous studies of whether they actually work. In 2004, CGD set out to address this lack of good quality impact evaluations and our recommendations led to the creation of the International Initiative for Impact Evaluation (3ie) in 2009. The number and quality of impact evaluations has risen significantly, but there is still a long way to go to make sure future development interventions are based on evidence of what works.
In recent weeks, the public health world and political pundits alike have been abuzz about results from the “Oregon Experiment,” a study published in the New England Journal of Medicine that finds no statistical link between expanded Medicaid coverage and health outcomes such as high cholesterol or hypertension. Limitations of the study aside, the Oregon Experiment is a good example of the importance of rigorously testing all US health programs, rather than just assuming ‘more care = better health’. The Innovation Center at the United States Centers for Medicaid and Medicare Services, created under the umbrella of the Affordable Care Act, represents a new and encouraging approach to address this problem, an approach that we think has important lessons for global health.
The New England Journal of Medicine recently published the results of “the Oregon experiment” based on the 2008 US Medicaid program expansion in Oregon. The study is one of very few randomized control trials on publicly-subsidized health insurance that exists to guide health policy, and found what some commentators considered a disappointing result: while health care utilization increased and households were protected from financial hardship, expanding Medicaid coverage had “no significant impact on measured physical health outcomes over a 2-year period.”
This paper analyzes some of the elements that cause the perception in the realm of social policy that too little evidence is produced and used on the impact of specific policies and programs on human development. They propose we develop Results-Based Social Policy Design and Implementation systems that focus public attention on better outcomes.
This brief outlines the problems that inhibit learning in social development programs, describes the characteristics of a collective international solution, and shows how the international community can accelerate progress by learning what works in social policy. It draws heavily on the work of CGD's Evaluation Gap Working Group and a year-long process of consultation with policymakers, social program managers, and evaluation experts around the world.
In 2006, CGD published a working group report that addressed the insufficient number of rigorous impact evaluations of social programs in low- and middle-income countries. Last week —marking 10 years since the report’s release—CGD and J-PAL co-hosted the event, “Improving Development Policy through Impact Evaluation,” which echoed three key messages of the 2006 report: 1) conduct more and better evaluations; 2) connect evaluators and policymakers; and 3) recognize that impact evaluations are an important global public good that requires more unconstrained funding.
In September 2008 official aid donors and recipients will meet in Accra, Ghana, to discuss how to make development assistance more effective. CGD president Nancy Birdsall and co-author Kate Vyborny suggest that advocates of better aid who really want a win at Accra forget haggling over broad conceptual issues and focus instead on getting a public commitment from donors to one or more very concrete steps to improve aid effectiveness and to hold donors accountable.
The sudden death of World Health Organization director general Lee Jong-wook at the start of the World Health Assembly has created a leadership vacuum at a time when the WHO faces immense challenges. Ruth Levine, who heads CGD's Global Health Policy Research Network, argues that the WHO leadership must become more independent so that science can shape public health policies and practice.