In 2012, there were 896 million people around the world—12.7 percent of the global population—living on less than two dollars a day. The World Food Program estimates that 795 million people worldwide don’t have enough food to “lead a healthy life”; 25 percent of people living in Sub-Saharan Africa are undernourished. Over three million children die every year thanks to poor nutrition, and hunger is the leading cause of death worldwide. In 2012, just three preventable diseases (pneumonia, diarrhea, and malaria) killed 4,600 children every day.
Last month, the World Bank announced the launch of the Global Insights Initiative (GINI). The initiative, which follows in the footsteps of so-called “nudge units” in the United Kingdom and United States, is the Bank’s effort to incorporate insights from the field of behavioral science into the design of international development programs; too often, those programs failed to account for how people behave in the real world. Development policy, according to the Bank’s 2015 World Development Report, is overdue for a “redesign based on careful consideration of human factors.” Researchers have applauded the announcement, but it raises an interesting question: What can nudges really accomplish in the face of the developing world’s overwhelming poverty and health-care deficits?
In fact, researchers have found that instituting small program changes, informed by a better understanding of people’s motivations and limitations, can have big effects on everything from savings rates to vaccination rates to risky sexual behavior. Here are five studies that demonstrate the benefits of bringing empirical social science into the developing world.
AS IN THE DEVELOPED WORLD, PEOPLE IN DEVELOPING COUNTRIES LACK SELF-CONTROL—SO WE NEED TO INCENTIVIZE SAVINGS
One of the elemental insights in behavioral science is that self-control is hard. It’s not easy to put money in the bank for a rainy tomorrow instead of buying something fun today. People in the developing world face the same self-control challenges, but with higher stakes. Small-scale farmers in Africa, for example, often receive a large cash windfall from the sale of their harvest. Farmers may plan to save that money for the lean months before the next harvest, or for the purchase of agricultural inputs for the next year’s planting (fertilizer, for example, which significantly increases yields), but it can be hard to follow through in the face of daily temptations and money requests from friends and family. A randomized experiment in Malawi explored how savings accounts might help solve this self-control problem: Farmers were either offered no savings account, a normal savings account, or a commitment savings account that locked up the deposited money until a future date of the farmer’s choosing. Farmers with the commitment savings accounts saved more money, used more agricultural inputs in the subsequent planting, and enjoyed higher earnings from their next harvest.
—“Commitments to Save: A Field Experiment in Rural Malawi,” Lasse Brune, Xavier Gine, Jessica Goldberg, and Dean Yang, World Bank Policy Research Working Paper, January 2011.
THEY ALSO SOMETIMES FORGET STUFF
Antiretroviral therapy (ART) is a highly effective treatment for HIV, and a number of African countries, including South Africa and Kenya, have rolled out free ART programs in recent years. ART regimens, however, are demanding, and non-adherence both reduces the treatment’s efficacy and encourages the development of drug-resistance strains of the virus. Researchers in Kenya surveyed 403 ART patients about the barriers to adherence; the main reason patients gave for non-adherence was “being busy and forgetting,” which suggests that the barriers to adherence may not be as complex and insurmountable as some have suggested. Although it’s worth noting that some data finds patients in Africa are better at following their ART regimes than American patients.
—“Factors Associated With Non-Adherence to Highly Active Antiretroviral Therapy in Nairobi, Kenya,” Samwel N. Wakibi, Zipporah W. Ng’ang’a, and Gabriel G. Mbugua, AIDS Research and Therapy, Vol. 8, No. 43, December 2011.
SIMPLE REMINDERS CAN HELP
Behavioral scientists have identified attention scarcity as another driver of economically irrational behavior—people can only focus on so many things at once, which means less pressing concerns (like saving for that rainy tomorrow) can fall by the wayside. Simple reminders, however, can combat this problem. An experiment with bank account holders in Peru, Bolivia, and the Philippines, all of whom had recently opened a commitment savings account, tested the effect of reminder messages on saving. Monthly reminders increased saving and helped account holders meet their savings goals—messages that mentioned both savings goals and financial incentives were particularly effective.
—“Getting to the Top of Mind: How Reminders Increase Savings,” Dean Karlan, Margaret McConnell, Sendhil Mullainathan, and Jonathan Zinman, Management Science, forthcoming.
SMALL INCENTIVES CAN HELP TOO
Only 44 percent of children between one and two years of age in India are fully vaccinated (still less in rural areas), even though free vaccines are provided by the government. Many parents bring their children for the first few shots, but don’t manage the five visits to an immunization camp the full immunization schedule requires. Economists have hypothesized that the small costs of the visits might deter families from completing the vaccinations. In a randomized intervention in rural Rajasthan, researchers found that offering parents a small bag of lentils (worth less than a dollar, or the equivalent of 75 percent of a day’s wage) for each vaccination significantly increased immunization rates in both the immunization camp village and neighboring villages.
—“Improving Immunisation Coverage in Rural India: Clustered Randomised Controlled Evaluation of Immunisation Campaigns With and Without Incentives,” Abhijit Banerjee, Esther Duflo, Rachel Glennerster, and Dhruva Kothari, BMJ, Vol. 340, No. 7756, May 2010.
SOMETIMES, GIVING TEENAGERS THE FACTS ABOUT THE LIFELONG CONSEQUENCES OF A RISKY BEHAVIOR CAN ACTUALLY CHANGE THAT BEHAVIOR
In sub-Saharan Africa, cross-generational sexual relationships—between teenage girls and men more than five years older—are common. Older men, who are visibly wealthier, have, in the words of Stanford researcher Pascaline Dupas, “an advantage over teenage boys in negotiating unprotected sex.” Unfortunately, they’re also more likely to be HIV-positive. Dupas studied the effects of a sex education program in Kenyan schools and found that simply providing teenagers with data on HIV prevalence by age (i.e. explaining that older men are more likely to have HIV) decreased teen pregnancies by 28 percent.
—“Do Teenagers Respond to HIV Risk Information? Evidence From a Field Experiment in Kenya,” Pascaline Dupas, American Economic Journal: Applied Economics, Vol. 3, No. 1, January 2011.
Five Studies is Pacific Standard’s biweekly column that identifies and analyzes the best academic research to deliver new insights on human behavior.