Randomized control trials (RCTs) have a narrow scope, restricted to basic intervention schemes. Experimental designs also display specific biases and political uses when implemented in the real world. Despite these limitations, the method has been advertised as the gold standard to evaluate development policies. This article adopts a political economy approach to explore this paradox. It argues that the success of RCTs is driven mainly by a new scientific business model based on a mix of simplicity and mathematical rigour, media and donor appeal, and academic and financial returns. This in turn meets current interests and preferences in the academic world and the donor community.
This paper makes the case that when microfinance institutions exhibit strong financial performance, particularly if there is a well-planned social performance strategy in place, the results for social performance are also better. Studies have suggested this in the past but their conclusions were based on incomplete data. This analysis draws on 2006-2011 data taken from 344 evaluations of 295 MFIs in 51 countries that have a total outreach of more than 12 million borrowers. The conclusion is that the double bottom line is no 'mission impossible' but can be achieved when trade-offs and synergies are combined cleverly, following a well-planned social performance management strategy.
A variety of health financing schemes shaped on pre-payment scheme have been implemented across Sub-Saharan Africa (SSA) to address the Millennium Development Goals (MDGs). In Mauritania, the Obstetric Risk Insurance package (ORI) focusing on maternal and perinatal health has been progressively implemented at the health district level since 2002. Here, our main objective was to assess the effectiveness of the ORI in increasing facility-based delivery rates, as well as increases in family planning, antenatal and postnatal care, caesarean delivery and neonatal health, from demographic and health survey data between 2002 and 2011. We also examined whether the effects of the ORI varied between strata of the population. The study was based on a quasi-experimental before-and-after design to assess the causal link between availability of ORI and increase in use of maternal health services and neonatal mortality. In combination with geographical information system, difference-in-differences and odd ratio approaches were used to address our objectives. Indicators of access to care for pregnant women and neonatal health and improved in both non-intervention and intervention groups during the study period. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services. However, delivery rates in local health centres with ORI increased more rapidly than in those with no ORI, the contrary was shown for hospitals. Caesarean delivery and family planning decreased with ORI. Although late neonatal mortality rates remained low in the country, a significant decrease was seen in districts without ORI. Except for some strata of the population, ORI has not really met its objective of attracting more pregnant women towards facility-based health care.
The last decade has been marked by the resurgence of leftist political movements across Latin America. The rise of the 'New Left' masks the ambivalent relationships these movements have with broader society, and their struggle to find an alternative to the prevailing development model. Across the continent, the microfinance sector, filling the void left by failed public banks, has grown significantly under an increasingly commercial form. Analysis of Nicaragua, Ecuador and Bolivia reveals that the new governments share a common distrust of microfinance. Yet, in the absence of viable alternatives for financial service provision, governments and microfinance stakeholders are forced to coexist. The environment in which they do so varies greatly, depending on local political and institutional factors. Some common trends can nevertheless be discerned. Paradoxically, the sector seems to be polarized into two competing approaches which reinforce the most commercially-oriented institutions on the one hand, and the most subsidized ones on the other, gradually eliminating the economically viable microfinance institutions which have tried to strike a balance between social objectives and the market.
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