In global fight against extreme poverty, a potential game-changer

A groundbreaking new study suggests that one approach to extreme poverty alleviation is compassionate, cost-effective, and potent for years after the aid ends.

A.M. Ahad/AP/File
A Bangladeshi child stands in an alley as a boy climbs a ladder outside their home at a slum in Dhaka, Bangladesh, in 2014. A new study looks programs to combat extreme poverty modeled on one in Bangladesh.

In efforts to lift some 2 billion people around the world out of extreme poverty by 2030, the "big push" might not be new, but on the right scale, it could be a game-changer, new research suggests.

The big push as an approach to alleviating extreme poverty has recorded successes, typically on small scales in various countries. But it has not been examined rigorously to see how well it works across cultural and political boundaries.

Now, a study released Thursday suggests that the approach can yield lasting improvements for people in diverse countries. And it shows that when properly implemented, such programs are cost effective.

In general, the big push involves a burst of intensely focused help for a limited period of time – cash to meet basic needs, training on how to earn a living, access to health services, and frequent check-ins from field workers, for example. But one of the most important effects of the approach could well be its tendency to spring participants from a mind-set that sees little or no hope of breaching the extreme-poverty ceiling, some development specialists suggest.

The study explored a particular kind of big push, modeled after a successful version in Bangladesh, and it focused on the impact of the package as a whole. In assessing the tangible elements that contributed to effort's success, however, the researchers suggested that something intangible – and powerful – also had taken place. 

"Perhaps this program worked by making the beneficiaries feel that they mattered, that the rest of society cared about them, that with this initial help they now had some control over their future well-being, and therefore, the future could be better," they write in the journal Science Thursday.

The analysis covered six countries in South Asia, Africa, and Latin America: India, Pakistan, Ethiopia, Ghana, Honduras, and Peru. The programs were focused on people living on less than $1.25 a day.

Aid groups have been applying big push approaches in whole or in part during the past 25 years, refining them as they go. But the results of the new study suggest that a truly comprehensive approach, such as the one team examined, "is definitely getting into the 'let's now scale things up' world," says Dean Karlan, a Yale University economist who focuses on development issues. He is founder of Innovations for Poverty Action, an organization set up to provide rigorous evaluations of development programs, and he is one of the new study's co-authors.

The study comes at a time when a United Nations proposal to reduce extreme poverty by 2 billion people by 2030 is putting increased focus on the best ways to achieve that goal.

The study is groundbreaking because it shows that the positive effects of a well-designed big push approach continue even after the program stops, says Justin Sandefur, a research fellow at the Center for Global Development, an international development think tank in Washington.

"They can run this program, stop all of the transfers, go away for a year, come back, and find that people's consumption and incomes are still higher, and that the effect is just as big a year out as it was at the end of the program," he says.

The approach's design "is not radically different from what hundreds of [nongovernmental organizations] in different countries around the world are doing on a regular basis – an integrated rural-development program. This is meat-and-potatoes work for a lot of NGOs," says Dr. Sandefur, who was not part of the six-nation study.

"But a lot of those programs have never been really carefully tested," he adds. "What's unique here is that it's been put through the paces so carefully, we have high-quality evidence on impact, and they're showing a significant, positive impact on consumption, income, and so on."

That's encouraging news for governments and large donors concerned about getting the most bang for their aid bucks. And it's reassuring for organizations that base their work on the big push approach.

The study provides what Sadna Samaranayake calls gratifying proof that the approach "is adaptable to various cultural, geographic, and poverty contexts," and can be used by different aid groups while still yielding similar strong results, she says. Ms. Samaranayake manages a variant of the big push approach dubbed the Ultra-Poor Graduation Program for BRAC, an aid organization based in Bangladesh once known as the Bangladesh Rehabilitation Assistance Committee.

Participants in the program received cash that gave them breathing room to learn how to earn a living off of the assets they received. For instance, participants were encouraged to open savings accounts. They received coaching in life skills. They received access to health services. And field workers made sure they were properly applying what they were taught and gave general encouragement.

The income support and the initial assets are given to participants because they are too poor to qualify for microloans, small loans that themselves have yielded mixed results for improving the economic lot of the poor.

BRAC has applied its approach in a handful of the 11 countries in which it works. Until now, however, the only rigorous analysis that compared the program's effect with a control group of non-recipients was conducted in Bangladesh. That study, published in 2013, showed an average 38 percent improvement in the income of recipients two years after they had "graduated" from a two-year training and aid effort. It left open the question of whether the approach could readily be adapted elsewhere.

The team conducting the new analysis used BRAC's program as its model largely because of its reputed success and because it is among the most comprehensive and intense approaches people have advocated, says Abhijit Banerjee, an economist with the Massachusetts Institute of Technology's Jameel Poverty Action Lab, and the study's lead author. Results from a program with a lighter touch might give more ambiguous results one way or the other, he explains.

The new study's team worked with local and international NGOs in the six countries during a seven-year period that ended last year. They tracked more than 21,000 people, exploring the effects of a year of training and aid, followed by a year of visits by fieldworkers. After that, people were on their own. The research team conducted followup surveys at the end of years two and three to see how durable any improvements might be.

The team found that the total cost of the program per household over the three years ranged from $3,090 in Honduras to $5,962 in Pakistan. Assuming the benefits last beyond the third-year's surveys, five of the six countries show gains ranging from $6,298 in India to $10,805 in Ethiopia. Honduras was the odd country out, showing a loss in benefits per household of $6,118. The team – which included experts from universities in Ghana and Belgium, in addition to the NGOs administering the program – attributes the result in Honduras to an outbreak of disease that killed most of the chickens that households had selected as their assets.

Still, the overall results were surprisingly positive, says Yale's Dr. Karlan. The team developed indexes to measure results in 10 categories, ranging from total consumption per person, to mental health, to empowerment of women.

"I've never been involved in an evaluation nor read an evaluation that looked at 10 outcomes and seen strong, positive results in 10 out of 10. That's just not the way it usually works," he says of the aggregate results.

The new study doesn't analyze the relative importance of each component of the big push that the team implemented. More work could done to see which elements are the most influential on the outcomes, the researchers suggest. That work could hint at ways of making the approach more effective.

Further study could also make rigorous comparisons between such labor-intensive help and help that is limited to direct cash payments. Some studies have hinted that merely providing cash payments to the poorest of the poor for a period of time may be sufficient to set them on a path to sustained self-employment. That could be an attractive alternative to groups or governments with more money than staff.

But a cash-payment approach would lack one element that appeared to play a key role in the big push success: the impact of persistent coaching on participants' ways of thinking about their situation, says BRAC's Ms. Samaranayake.

In her organization's efforts focusing on women, merely being seen with a field worker each week raises a participant's stature in a village and changes others' perceptions of that individual and her household.

Those workers, she says, "help build self-confidence and a vision of a different future."

[Editor's note: The original article misidentified the number of countries in which BRAC works.]

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