30 July 2010

Resurrecting the e-word at UNICEF

Earlier this week I was invited to be on a panel designed to help stress-test UNICEF's new "equity approach" to its programming. The panel was chaired by the new Executive Director, Tony Lake.

The hypothesis that Lake and his team have advanced is that the way to improve the cost-effectiveness of their work and to accelerate progress towards the MDGs is to focus on the groups of children and women who are most deprived in terms of indicators such as under 5 mortality rates, maternal mortality and undernutrition.

Over the course of the day presentations were made by a team of UNICEF analysts, exploring this hypothesis. The team worked through several questions: when is it more expensive to reach the most deprived? Is the per-person impact of doing so larger than the impact on the less deprived? What does this translate into in terms of overall disease burdens? What do the resulting benefit-cost ratios look like?

What does a more equity focused strategy look like? The two key differences from business as usual were a greater reliance on conditional cash transfers and on community engagement. The former has proven to be one way to really reach the poorest and the latter has proven (in some narrow ways such as community lay health workers) to be effective in bringing in those previously excluded from access to quality services.

The analytical work was creative in that it pulled together different bodies of knowledge in innovative ways (the Tanahashi "bottleneck" literature (see here for an application), the marginal bottleneck for budgeting literature, and 23 systematic literature reviews on median impact effects of various interventions).

The review panel poked and prodded and helped the UNICEF team to identify weak points in the modelling, the most fragile assumptions and the narrowest evidence bases.

I can't share the results because they are preliminary (to be refined and unveiled at the MDG Summit in September), but they did challenge some of my preconceived ideas and they made me think that the equity focus can be persuasive on an instrumental as well as a values basis.

It was so refreshing to see a major UN organisation pick up the equity banner in an unapologetic manner. Tony Lake's leadership is clearly having a huge positive impact on the UNICEF staff. Based on his engaged participation in the day's discussions it is not difficult to see why.

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