“I cannot answer the big question, whether aid did  any good or not. It’s not the Middle Ages anymore,  it’s the 21st century. And in the 20th century,  randomized, controlled trials have revolutionized  medicine by allowing us to distinguish between drugs  that work and drugs that don’t work. And you can  do the same randomized, controlled trial for social  policy. You can put social innovation to the same  rigorous, scientific tests that we use for drugs. And in  this way, you can take the guesswork out of policy making by knowing what works, what doesn’t work  and why.” Esther Duflo

There is currently a tremendous amount of debate about the effectiveness  of foreign aid and about  what kind of projects can  engender social and economic  development. Development  practitioners constantly face  an inner conflict, asking  themselves if what they are  doing is really making an  impact in the long run. As  Esther Duflo states in her  famous Ted Talk, “Social  Experiments to Fight  Poverty,” there is no simple answer.

In recent  years, however, there is movement toward using randomized controlled trials (RCTs) to accumulate credible,  concrete knowledge of what works in development and what does not. This idea of producing credible research in order to offer evidence-based solutions to the world’s most vulnerable people is of the foundation of the work of the Population  Council, the NGO where  I conducted a 4-month internship during my studies in Glocal.

Through biomedical, social science,  and public health research in  50 countries, the Population  Council works with their  partners to deliver solutions  that lead to more effective  policies, programs, and  technologies that improve lives  around the world. I managed a Zambia based observation team  as part of my internship.  In Zambia, the Population  Council is implementing and  evaluating the Adolescent  Girls Empowerment Program  (AGEP), which aims to mitigate the range of risks and  vulnerabilities adolescent girls  in Zambia face. These include  high rates of gender-based violence, unsafe sex that  puts girls at risk for unwanted  pregnancy and HIV infection,  school dropout, and others.  The program is comprised of  three major components. First,  are the safe spaces groups,  weekly girls’ group meetings  in which 20 to 30 girls get  together with a mentor—a  young woman from their  community—for short training  sessions on a variety of topics.  The second component is  the vouchers entitling girls to  health services provided by  facilities in the community. The  final component is a savings  account. 

To determine the effectiveness  of these program elements,  participating community areas  had been randomly assigned  to one of four study arms.  Randomized designs such as  this are widely considered a  gold standard for attributingcause and effect between  the intervention and the  outcomes. The study arms  of the Adolescent Girls Empowerment Program  are: Group 1 - girls will  attend mentor-led, girls-only  meetings; Group 2 - girls will  attend mentor-led, girls-only  meetings and receive health  vouchers; Group 3 - girls will  attend mentor-led, girls-only  meetings, receive health  vouchers, and gain access  to savings accounts, and;  Group 4 - girls will receive  no program services. The  control group is essential  and will allow the Council to  determine whether any of the  program combinations are  effective, and to what extent.  The research aims to identify  the impact of the intervention  on the following key indicators: HIV prevalence,  HSV-2 prevalence, age at  first sex, age at first birth,  contraceptive use, experience  of gender-based violence, and  educational attainment. 

While observing the girls in the  safe space meetings with my  team, I heard some success  stories such as a girl opening  a Samosa stall in order to pay  for high school studies since  her family could not afford  it and she did not want to  drop out of school. Another  success story in one of the  rural sites was from a girl that  learned about good ways of  making money as part of her  attending AGEP sessions;  she harvested corn and sold  it so she could buy shoes. There was a story about the  way one of the mentors and  site coordinators helped a  girl who had been married off  at a young age to leave that  relationship because it had  become abusive. 

The question is whether or not those stories can give us the  full picture of the influence on  the girls’ lives. There is a huge  financial investment in all of  those projects that are trying  to have a positive impact and  to address the challenges girls  are facing. How will we know  what is working and why?  At this point the data we  collected has been sent to the  head office in NY for analyzing  and will be collected again  once the program finishes next  year. Therefore, we do not yet  have supported conclusions  about if and to what extent  the AGEP program has an  impact on the girls’ lives. It  is hoped that this cluster design randomized controlled  trial (RCT) will provide clear  evidence of the impact of  AGEP.

Yalee Azan