Evidence-based development and the ambivalence of cost-effectiveness

• In Event: Global Health Futures and the Social Good I

Abstract

This presentation explores the complex and at times ambivalent visions of the social good that animate “evidence-based development” by focusing on my interlocutors’ concern with cost-effectiveness. Evidence-based development is the movement to produce evidence about the effectiveness of anti-poverty programs and then using that evidence to shape efficient and effective policymaking in the Global South. It centers around the question of “what works”, on the randomized field experiment as the preferred pathway for producing knowledge, and on cost-effectiveness logics as the basis for adjudicating value and priorities. Drawing on fieldwork across Kenya, India and the USA with NGOs and research centers which work to transform global health pilot interventions into sustainable programs at large scale, this presentation examines how the preoccupation with cost-effectiveness makes visible calculations, but also multiple imaginations and aspirations, which exceed return on investment and business rationales. What does my interlocutors’ practice to introduce “moral weights” into cost-effectiveness models say both about a perceived inadequacy of common metrics used to guide decision making (such as the DALY) and the need to reckon with evidence-based development as more than an objective, scientific endeavor? How do my interlocutors’ ambitions to scale their sanitation program to “millions of people” merge in very concrete way –across slippery roads, broken dispensers, and shifting partnerships– a concern with cost efficiency but also the willingness to reach those whose are beyond the state’s basic infrastructure for living (Redfield 2012)?

Author

• Fiona Gedeon Achi