Brookings: Experts - Jessica Cohen

The Future of India's Foreign Policy: A Conversation with Yashwant Sinha

Wed, 30 May 2012 14:00:00 -0400

Event Information

May 30, 2012
2:00 PM - 3:00 PM EDT

Saul Room
Brookings Institution
1775 Massachusetts Avenue NW
Washington, DC 20036

On May 30, Foreign Policy at Brookings hosted Yashwant Sinha, former minister of external affairs and finance of the Republic of India, for a discussion on the challenges and opportunities facing India’s foreign policy. Mr. Sinha reviewed the prospects for India’s relations with the U.S. and discuss the main international economic and trade issues affecting his country, with particular regard to Pakistan and other South Asian neighbors. He also shared his perspective on how he expects India’s policy will develop toward China.

After a 24-year long career in the Indian Administrative Service, Mr. Sinha joined politics in 1984 and, as a member of the Bharatiya Janata Party, has since then served as minister for finance from1990-91 and1998-2002 and external affairs from 2002-04. He is currently a member of the Lower House of the Indian Parliament, where he chairs the Standing Committee on Finance. Brookings Senior Fellow Stephen P. Cohen will provide introductory remarks, and Brookings Nonresident Senior Fellow Teresita C. Schaffer will moderate the discussion.

After the program, Mr. Sinha took audience questions.

Rationally and Effectively Combating Malaria Through Diagnostics

Jessica Cohen — Fri, 23 Apr 2010 12:05:00 -0400

Increasing evidence shows that a large fraction of people who seek treatment for malaria don’t have the disease. A recent randomized trial in Kenya that I conducted with Pascaline Dupas and Simone Schaner uncovered that less than 40 percent of older children and adults who purchase antimalarials from drug stores actually have malaria. Several other non-randomized studies have found similar rates of over-treatment in health clinics and hospitals. These and other studies are telling us that any rational strategy aimed at fighting malaria will have to incorporate diagnostic tools in addition to traditional approaches.

Therefore, as World Malaria Day approaches, I’d like to bring attention to diagnostics—a tool that has been evidently stashed at the bottom of the malaria control toolkit. It is certainly less saliently linked to malaria mortality than bed nets or antimalarial medicines, but its lowly status is arguably at the heart of the inadequate coverage levels of both of these life-saving tools.

The great majority of people treated for malaria in Sub-Saharan Africa self-diagnose and buy medicine from a drug store or pharmacy, bypassing the formal health care system altogether. Many others are treated for malaria in health centers based on clinical symptoms such as fever, as blood tests are extremely rare. Often, the symptoms are the result of a cold, virus or possibly a bacterial infection like pneumonia yet are treated with antimalarial medications.

So what’s the harm in treating someone for malaria when they don’t have it? There is little danger to the individual, because the side effects are moderate. The harm stems from the false impression that they actually have the disease. Erroneous beliefs about malaria can lead to all of the harmful “irrational” behavior that we observe in malaria-endemic populations. Many people continue to not sleep under bed nets, to buy ineffective or sub-standard antimalarials and to take partial, incomplete doses of their regimen. One explanation for low usage of these life-saving tools is that it is difficult for people to learn their benefits when so much uncertainty exists about what is and what is not malaria.

Some argue that such massive overtreatment has fueled the emergence of parasite resistance to previous generations of antimalarials and that limiting overtreatment could help stem resistance to the only remaining effective medicines. What is certain is that this confusion about when an illness is actually malaria has ripple effects, weakening maternal and child health programs and wasting precious millions in foreign aid for malaria control.

Technological innovations in the form of rapid diagnostic tests (RDTs) for malaria have made diagnosis a possibility for remote populations with poor access to quality health care. RDTs are blood tests that give results in 15 minutes and many brands are reliable and easy to use. Before RDTs, a person had to have access to a health facility with a working microscope and a lab technician. Several recent studies with community health workers have found that RDTs can be used effectively by people without formal medical training. Pharmacists could also be trained to administer RDTs to customers.

Malaria diagnostics do not only benefit those stricken with malaria. For example, pneumonia remains a leading cause of death among children under five. Because fever is a common symptom of pneumonia, children are often first presumptively treated for malaria. Only when their symptoms don't improve are other possible causes explored. Pneumonia can progress quickly in children and thus eliminating the possibility of malaria early allows the exploration of other potential diagnoses.

As with so many public health products, developing the technology and increasing access is not enough. Psychological barriers must be reduced as well. In our Kenya study, 65 percent of people who tested negative for malaria went on to buy the medicine anyway. More research into how adherence to test results can be improved is needed and increased access to RDTs will need to be coupled with better information about the importance of malaria diagnosis.

In several months, the Global Fund to Fight AIDS, TB and Malaria is spearheading an innovative intervention to increase access to effective antimalarials by heavily subsidizing Artemisinin Combination Therapies (ACTs) in 10 African countries. Without an increase in use of malaria diagnostics, our results from Kenya suggest that a vast amount of that subsidy money will go to antimalarials for people without malaria. The policy is still likely cost-effective—the bulk of malaria morbidity and mortality is from young children and this subsidy should dramatically increase their access to affordable, effective antimalarials. But there is a great opportunity here for subsidy money to be better targeted and for malaria treatment to be more rational by increasing access to diagnostics.

Authors

Jessica Cohen

Image Source: © Thierry Roge / Reuters

What Works in Development? - Thinking Big and Thinking Small

Thu, 21 Jan 2010 14:30:00 -0500

Event Information

January 21, 2010
2:30 PM - 4:00 PM EST

Falk Auditorium
The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

In What Works in Development? (Brookings Press, 2009), Brookings Nonresident Fellow Jessica Cohen and Nonresident Senior Fellow William Easterly bring together leading experts to address one of the most basic yet vexing issues in development: what do we really know about what works—and what doesn't—in fighting global poverty? The authors focus on this key question and the ongoing debate over which paths to development truly maximize results.

On January 21, the Global Economy and Development program at Brookings hosted a discussion on these fundamental global development questions with the book’s editors. Their discussion focused on the benefits and challenges of both a smaller grassroots development approach and a traditional big-picture development approach, with the goal of achieving a consensus on how to best leverage limited resources and time in the race to lift the lives of the world’s poorest. Devex President and Co-founder Raj Kumar moderated the discussion.

Audio

What Works in Development? Thinking Big and Thinking Small

Transcript

Transcript (.pdf)

Event Materials

20100121_development

Participants

Moderator

Raj Kumar

President and Co-founder, Devex

Panelists

What Works in Development? : Thinking Big and Thinking Small

Jessica Cohen and William Easterly, eds. — Tue, 01 Dec 2009 00:00:00 -0500

Brookings Institution Press 2009 250pp.

What Works in Development? brings together leading experts to address one of the most basic yet vexing issues in development: what do we really know about what works -- and what doesn't -- in fighting global poverty?

The contributors, including many of the world's most respected economic development analysts, focus on the ongoing debate over which paths to development truly maximize results. Should we emphasize a big-picture approach -- focusing on the role of institutions, macroeconomic policies, growth strategies, and other country-level factors? Or is a more grassroots approach the way to go, with the focus on particular microeconomic interventions such as conditional cash transfers, bed nets, and other microlevel improvements in service delivery on the ground? The book attempts to find a consensus on which approach is likely to be more effective.

Contributors include Nana Ashraf (Harvard Business School), Abhijit Banerjee (MIT), Nancy Birdsall (Center for Global Development), Anne Case (Princeton University), Jessica Cohen (Brookings), William Easterly (NYU and Brookings), Alaka Halla (Innovations for Poverty Action), Ricardo Hausman (Harvard University), Simon Johnson (MIT), Peter Klenow (Stanford University), Michael Kremer (Harvard), Ross Levine (Brown University), Sendhil Mullainathan (Harvard), Ben Olken (MIT), Lant Pritchett (Harvard), Martin Ravallion (World Bank), Dani Rodrik (Harvard), Paul Romer (Stanford University), and David Weil (Brown).

Related Book Launch: What Works in Development? Thinking Big and Thinking Small. Thursday January 21, 2010.

Related Conference: What Works in Development? Thinking Big and Thinking Small. Thursday May 29 and Friday May 30, 2008.

ABOUT THE EDITORS

Jessica Cohen

William Easterly

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What Works in Development? Thinking Big and Thinking Small

Thu, 29 May 2008 13:00:00 -0400

Event Information

May 29-30, 2008

The Brookings Institution
1775 Massachusetts Ave., NW
Washington, DC

Bill Easterly and Jessica Cohen of Brookings recently convened a conference with leading development experts to explore one of the most vexing issues of global development: what do we really know about what works and what doesn’t when fighting global poverty? The conference focused on the ongoing debate over which paths to development really maximize results: a big-picture approach focusing on the role of institutions, macroeconomic policies, growth strategies and other country-level factors; or a more grassroots approach focusing on particular microeconomic interventions such as conditional cash transfers, bed nets, teaching materials and other micro-level improvements in service delivery on the ground. The conference objective was to shed light on both schools of thought, with the goal of achieving a consensus on how to best leverage limited resources and time in the race to lift the lives of the world’s poorest.

Related Book: What Works in Development? Thinking Big and Thinking Small

The related conference papers detail critical lessons from development experiences and propose new ways of tackling some of the toughest issues.

View the conference agenda »

DRAFT CONFERENCE PAPERS:

The New Development Economics: We Shall Experiment, But How Shall We Learn?
Author: Dani Rodrik (Harvard University, Kennedy School of Government)
Discussants: Sendhil Mullainathan (Harvard University) & Martin Ravallion (World Bank)
Breaking Out of the Pocket: Do Health Interventions Work? Which and in What Sense?
Authors: Simon Johnson (International Monetary Fund) & Peter Boone (London School of Economics, Centre for Economic Performance)
Discussants: Anne Case (Princeton University) & Jessica Cohen (Brookings Institution)
Pricing and Access: Lessons from Randomized Evaluations in Education and Health
Author: Michael Kremer (Harvard University and the Brookings Institution)
Discussants: David Weil (Brown University) & Paul Romer (Stanford University)
The Policy Irrelevance of the Economics of Education: Is ‘Normative as Positive’ Just Useless, or is it Worse?
Author: Lant Pritchett (Harvard University, Kennedy School of Government)
Discussants: Ben Olken (Massachusetts Institute of Technology) & Nancy Birdsall (Center for Global Development)
High Bandwidth Economic Policies: Strategies To Speed Up Productive Transformation
Author: Ricardo Haussman (Harvard University, Kennedy School of Government)
Discussants: Nava Ashraf (Harvard University Business School) & Ross Levine (Brown University)
Big Answers For Big Questions: The Illusions of Macroeconomics
Author: Abhijit Banerjee (Massachusetts Institute of Technology)
Discussants: Peter Klenow (Stanford University) & William Easterly (NYU and Brookings Institution)

Event Materials

Participants

Panelists

Dani Rodrik

Harvard University, Kennedy School of Government

Simon Johnson

International Monetary Fund

Peter Boone

London School of Economics, Centre for Economic Performance

Lant Pritchett

Harvard University, Kennedy School of Government

Ricardo Haussman

Harvard University, Kennedy School of Government

Abhijit Banerjee

Massachusetts Institute of Technology

Free Distribution Or Cost-Sharing? Evidence From A Randomized Malaria Prevention Experiment

Jessica Cohen and Pascaline Dupas — Fri, 21 Dec 2007 12:00:00 -0500

ABSTRACT

It is widely believed that cost-sharing—charging a subsidized, positive price—for a health product is necessary to avoid wasting resources on those who will not use or do not need the product. We explore this argument in the context of a field experiment in Kenya, in which we randomized the price at which pregnant women could buy long lasting anti-malarial insecticide-treated nets (ITNs) at prenatal clinics. We find no evidence that cost-sharing reduces wastage on those that will not use the product: women who received free ITNs are not less likely to use them than those who paid subsidized positive prices. We also find no evidence that cost-sharing induces selection of women who need the net more: those who pay higher prices appear no sicker than the prenatal clients in the control group in terms of measured anemia (an important indicator of malaria). Cost-sharing does, however, considerably dampen demand. We find that uptake drops by 75 percent when the price of ITNs increases from 0 to $0.75, the price at which ITNs are currently sold to pregnant women in Kenya. We combine our estimates in a cost-effectiveness analysis of ITN prices on infant mortality that incorporates both private and social returns to ITN usage. Overall, given the large positive externality associated with widespread usage of insecticide-treated nets, our results suggest that free distribution to pregnant women is both more effective and more cost-effective than cost-sharing.

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Authors

Jessica Cohen
Pascaline Dupas