Page 17 - IB November 2019

Economics Economics

A SAMPLE OF RCTS
AND PACIFIC PRACTICE
Development and health trials
focussing on the outcome metric because ultimately that’s what they’re judged on.” Law and Justice in PNGWho? 2000 people in 40 village clusters in Bougainville
Some economics and academics have criticised RCT’s as being very costly, with What? Can transferring policing power to community members improve
legal protection in PNG? This study looked at the impact of the Community
academics such as Sanjay Reddy in Foreign Policy magazine writing that “RCTs take
Auxiliary Police, a program that devolves policing powers to carefully selected
a long time and cost a lot (running quite easily into hundreds of thousands of dollars community members.
each).” Why? To examine whether training of unarmed, uniformed offices in Bougain-
villean villages can reduce and mediate conflict.
Hoy dismisses this charge in the Pacific context.
Who’s doing it? Researchers are partnering with the Bougainville and New
“I think the worry about cost, people who say that don’t actually know what Zealand police.
they’re talking about to be honest. They’re thinking about a scenario which will never https://www.povertyactionlab.org/evaluation/can-transferring-policing-power-commu-
nity-members-improve-legal-protection-papua-new
play out. Nobody’s thinking about a scenario in which every policy, or everything
that a government ever does, you’re fielding giant surveys. We’re in a situation now Allocating development funds in Solomon Islands
whereby there have been less than five completed randomised controlled trials in Who? 80 villages participating in the Solomon Islands Rural Development
Program
PNG and the Pacific, whereas there has been over 5000 around the rest of the world.
What? Can vouchers reduce elite capture of local development projects? House-
We’re not in a situation where we need to be paranoid about overuse of these sort of holds in treatment areas were provided with vouchers which they could use to
techniques.” contribute to development projects or redeem at a discount for a private capital
good. The control communities received block grants to fund local public goods.
Hoy says in the case of the PNG tax RCT, the Australian Department of Foreign
Why? External funding of local public goods can create ‘political resource curses’.
Affairs and Trade is paying for the researchers’ time and for paying for the things that The result? Vouchers increased community participation in local decision-mak-
would have been done anyway by the tax office, “it costs nothing because the data we ing, change allocations and improved satisfaction with allocation outcomes.
https://www.sciencedirect.com/science/article/abs/pii/S0047272718300379
are collecting now is through the tax administration system, it’s administrative data
and we’re doing it for ‘free’.”
Any research into RCTs quickly turns up concerns that they are “unethical”,
RCTs are more traditionally associated with medical trials, for example:
because people are being denied a treatment (or development support). Hoy says his
position is “if you have a program or an intervention that you are 100 per cent sure Diabetes
has a positive impact and you have the resources to reach everyone at once, such as Who? Marshall Islands communities in the US
What? An RCT conducted with 384 Marshall participants from 32 churches in
a vaccination program, then obviously you should do it and doing a randomised
Arkansas, Kansas, Missouri, and Oklahoma to compare the effectiveness of faith-
controlled trial on it makes no sense at all.” based health programs, to the “culturally adapted” Diabetes Prevention Program,
“For the 99.9 per cent of cases where you aren’t able to reach everyone immediate- which focusses on family and communities.
Why? Because Pacific Islander populations, including Marshallese, suffer poorer
ly, and you’re not 100 per cent sure what the impact is, this is the perfect way to find
health than the general population.
out.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959435/
Hoy believes current and previous RCTs have positioned PNG as a global leader
Kava
amongst lower and middle-income countries, and envisages a time when PNG tax
Who? Participants at the Centre for Human Psychopharmacology (Swinburne
office staff for example, could run their own randomised controlled trials. “What I University of Technology), and the Academic Discipline of Psychiatry (The
am advocating for is that eventually we establish an office, ideally one in Port Moresby University of Queensland)
What? This research aims to assess the effectiveness of an ‘aqueous noble cultivar
and one in Suva, whereby we’d actually by looking at engaging in a full-time capacity
rootstock extract’ of kava in treating generalised anxiety disorder (GAD).
Pacific islanders, so they can be involved at every step of the way through the research Why? GAD is a chronic and pervasive condition that generates high levels of
process. It’s definitely a medium term vision to try to set this up so that there will be psychological stress, and it is difficult to treat in the long term. If this study
demonstrates kava is a superior treatment for GAD, and shows that it is safe,
local people able to do this sort of work.”
then this plant-medicine can be considered a ‘first-line’ therapy for GAD. (Ed
Accolades from the Nobel Prize winners’ contemporaries mention how they note: the impact of this for Pacific Island kava producing communities could be
have transformed development economics. As the World Bank’s Hoff writes: “ significant).
Who’s paying: The Australian National Health and Medical Research Council
Banerjee, Duflo, and Kremer have changed the working lives of many development
and MediHerb (Integria Healthcare (Australia) Pty. Ltd).
economists. In the past, their visits to the field stimulated important new ideas, but https://www.ncbi.nlm.nih.gov/pubmed/26527536
most development economists did their work at a desk, drawing out deductions.
Cervical cancer
Now many more development economists do experimental work, with lots of time
Who? Adult women in Yap, Federated States of Micronesia
working in the field.” What? An RCT compared cervical HPV/DNA in women who provided
That’s a view Hoy supports: “This is development economics research in the 21st self-collected urine and those who underwent pap smears/examinations. HPV or
human papillomavirus is usually harmless and goes away by itself, but some types
century. It’s not people sitting around trying to guess what the growth rate is going
can lead to cancer or genital warts.
to be of a country, it’s sitting there alongside policy makers, working there with them Why? This study could address barriers to pap screening, especially in under re-
to try and make sure their goals can be achieved and from our perspective, what sourced areas such as Yap, which has a low level of screening and a high incidence
of cervical cancer.
knowledge can be created so that we can learn what works in this situation, but also
The result? Overall, HPV DNA detection was significantly lower in urine than
learn what works in situations elsewhere, that are similar to this. Ultimately we want cervical samples for any HPV and high-risk HPV. Urine is less sensitive but more
to learn what works and what doesn’t.” specific than directed cervical sampling for detection of abnormalities and may
be useful for screening older women when clinically-collected samples cannot be
obtained.
editor@islandsbusiness.com http://www.joghr.org/article/joghr-02-e2018016
Islands Business, November 2019 17