Global Health “Game Changers” – But Will the People Play?

Today the Huffington Post carries a story by USAID Administrator Rajiv Shah describing a new approach to tackling – and solving – development: identify “game changers” through “grand challenges.” What this means is, USAID is actively seeking out innovative scientific research and technological innovation that hold significant promise to reduce large-scale barriers to human well being around the world. By way of illustration, the authors lead with a celebration of microbicide trials. What they fail to point out is that in U.S., women’s AIDS activists have been pushing for greater access to microbicides for years; politics has been the principle barrier to widespread access in the past, not technological shortcomings.

I fear the same dilemma will play out for many of the technological innovations that could help us make headway in other areas identified by the administration:

  • How tosustainably provide electricity to rural and hard-to-reach communities in the developing world;
  • How to make education available anytime, anywhere, for anyone;
  • How to better manage and coordinate responses to humanitarian crises and conflicts;
  • How to create resilience in staple grain crops to environmental change and variability; and
  • How to provide high-quality, affordable, primary health care in rural communities.

So while the administration, and readers of the Huffington Post, will likely take it as a given that the public “goods” described and promoted through the “grand challenges” will be well served through ongoing innovation (what isn’t?), much more daunting will be the necessary political will to ensure that research and deployment occurs within a lasting political framework for widespread adoption. To complicate the landscape further, the success of political action will turn on good amounts of social, cultural, and individual acceptability and behavior change – domains that have proven surprisingly selective in terms of technological uptake.

Research carried out by economists like Esther Duflo at MIT’s Jameel Poverty Action Lab (J-PAL) is exciting in this regard. It has long been said that “economics” is as much about good guess work as it is about hard science. Working to understand the behavioral and environment conditions under which economic well-being does and does not flourish, Duflo and her colleagues are revolutionizing the field. For the “grand challenges” to work, it will be important to better understand the conditions under which “solutions” can be implemented successfully. Through the information collected over the years in fields such as health, finance, and agriculture J-PAL is developing an unparalleled – and often myth-busting – view of what works and what doesn’t work when it comes to technological adoption.

A “disruptive” technology is hard to forecast; a “game changer” is even harder to discern. USAID’s strategy to shift the global development needle toward positive outcomes for more people would be well-served to champion not just the technologies but the political and social barriers that will inevitably impede the widespread adoption necessary for success.

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