The Outcome Measurement Imperative on a Global Scale

We measure what we care about, what we know. But that’s not enough.

The West has spent trillions of dollars to help poor countries, with little real success in reversing poverty and disease. William Easterly, a former World Bank Economist and now a professor at New York University thinks he knows why. For one thing, he argues that we’re measuring success the wrong way – by how much money rich countries spend on poor ones. That’s like judging a film based on its budget Easterly argues in his recently published book, The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good (Penguin Press, 2006).

Instead, Easterly argues, we should measure results and give aid programs and workers timely feedback about what works and doesn’t work to improve lives. In other words, we need to measure outcomes, real improvements in the living conditions of the intended benefactors of the foreign aid. Governments have always been good at measuring one thing: spending. The reason for the focus on money spent is obvious. It’s easy to track. It is much easier to track inputs (e.g., money) and outputs (e.g., the number of aid packages distributed) than the bottom-line outcomes of improved lives. If Easterly is right, the preference for outcome measures in the work we do in the courts is an imperative for measuring foreign aid.

Easterly thinks he knows another reason why the West’s effort to aid the world’s poor and sick has done little good. He notes that malaria infects close to a half a billion people a year, and a million people die, mostly children. But we know that a five dollar insecticide-treated mosquito net prevents most infections, and $2.50 medicine can treat the disease. Why not just siphon off a couple of billions of foreign aid and buy all the mosquito nets and medicines we need? It’s not that simple, writes Easterly. When aid workers hand out free mosquito nets in poor countries, they are directed to black markets or “wind up being used for fishing nets or wedding veils.”

The trouble is, writes Easterly, that aid programs and worker simply don’t get enough feedback about what works and what doesn’t in clear and actionable terms. He contrasts the “Planner” approach of most aid agencies with the “Searcher” approach that he says works in the markets and democracies of the West. Planners think they know what works instead of relying on an incremental process of discovery and problem solving based on outcome measurement and feedback. Most solutions and innovations are uploaded, not downloaded by central planning.

I suspect that foreign aid strategists, like most court leaders and executives simply do not have the detailed knowledge and direct control to know what works to move the (outcome) numbers. The best that they can do is not simply tell people what to do but instead tell them what they want to achieve in terms of clear and actionable outcomes. And then get out of the way to let people discover solutions the way they did in rural Malawi. Instead of giving away mosquito nets, rural clinics sell them to new mothers for 50 cents. In Malawi’s cities, a non-profit agency sells the nets for five dollars, using their profits to subsidize sales in the countryside. There was nearly universal use of the nets by those who paid for them. The program has increased the average number of children sleeping under insecticide-treated netting by 55 percent.

Clear and unambiguous outcome measures, timely feedback about what works to move the numbers to the people who are doing the work, and more trial and error learning and discovery. The lesson is simple and revolutionary!

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