Evidence is important. We want to know what we are doing works (or doesn't work). But, what happens when particular types of evidence are required to get funding, and what impact does this have on the types of work that is supported by donors? These questions are engaged with in the edited volume "The Politics of Evidence and Results in International Development: Playing the Game to Change the Rules?" (2015) edited by Rosalind Eyben, Irene Guijt, Chris Roche and Cathy Shutt. The book emerged out of a conference and was supported by an on-going blog conversation (one that has died of recent). For anyone concerned about the how evidence could be political, the experiences presented by a range of authors in this book is well worth reading. Alternatively, it would be useful for advocates who believe that RCTs are the only means by which we can determine what we ought to do in development activity.

One of the values of edited volumes is that multiple views can be presented in a single book. Some contributors are critical of the ways in which evidence (and specifically shifts such as the emphasis on "value for money") has been politicized and negatively affected international development activity. Others recognize the benefits that the newfound emphasis on evidence offers. For example: "Love it or hate it, engaging with VfM [Value for Money] is encouraging healthy and long-overdue debates that force practitioners to make explicit the reasons why we think we offer value and the values we use to asses that." (p. 74) In addition to seeing where the conversation about evidence adds benefit, it was further argued that such a shift creates opportunities: "Nevertheless, there is room to manoeuver. It can offer power-aware practitioners opportunities to increase accountability to citizens and each other; VfM [Value for Money] also creates possibilities to influence discourse about links between value and money and to debate what kind of development is valued." (p. 58)

Although human rights did not play a key role in the book, I believe that one of the most important conflicts in the debates around cost effectiveness and value for money is that with human rights. At the outset of the book this was alluded to: "The number of agencies, particularly international NGOs, using rights language has continued to increase, but the contradiction between rights-based approaches and their political and process approach to intangible goals such as empowerment and the increasing popularity of results-based management has become very apparent. It is harder to manage support for transformational approaches when one is required to report tangible, easy-to-measure changes" (p. 9) However, the issue of human rights was not taken up in detail by any of the contributors. In fact, one notes the absence of human rights: "focusing on unit cost and things that can be measured misses the importance of politics, relationships and networks in creating exponential value through difficult-to-measure change… linear, results-based management thinking and associated VfM [Value for Money] assessment techniques may have limited use for complex transformational initiatives." (p. 69) To these concerns, I have raised that of human rights and justice. If donors emphasize value for money and impact per dollar, we tend to focus our efforts – by necessity – on the easiest to reach, but not necessarily those most in need, or those most deserving (based upon local or regional inequality).

Accountability is important. But, accountability to whom? Organizations tend to focus on accountability to donors. But, little accountability to those for whom organizations claim to work is done. One of the chapters in this volume presents an interesting example of an organization that grappled with this question, and largely, where those efforts failed: "My central proposition is that, despite some significant efforts by the organization to become more accountable to those is sought to benefit, this agenda never became 'mission critical.' In part this was because of other organizational priorities becoming more pressing – particularly as growth in funding stagnated – and in part because we failed to recognize and align the many different perspectives on accountability that existed in the agency." (p. 80) As this book highlights, I believe we need to be far more critical not only about what evidence is demanded, but for whom evidence is prioritized.

An essential read, whether you are in development studies, anthropology or medicine, is Paul Farmer's Infections and Inequalities (1999). "This book examines inequalities in the distribution and outcome of infectious diseases. It asks why people like Annette Jean and her siblings are likely to die of infections such as tuberculosis and AIDS and malaria, while others are spared this risk. It explores the creation and maintenance of such disparities, which are biological in their expression but are largely socially determined" (p. 4). Parts of the book reflect the moment(s) in which it was written, much of it offers insight that will apply well beyond the specifics of drug resistant TB and HIV treatment in the 1990s. In re-reading this book I am struck by the passion that comes through the pages, a powerful voice driven by a strong sense of social justice. He writes: "Our challenge, therefore, is not merely to draw attention to the widening income gap, but also to attack it, to dissect it, and to work with all our capacity to reduce this gap" (p. xxvi) and that only "by struggling for higher standards for the destitute sick will we avoid another unappealing role – that of academic Cassandras who prophesy the coming plagues, but do little to avert them" (p. xxviii).

Opposition to offering high-cost treatment in developing countries, Farmer argues, "may be justified as 'sensible' or 'pragmatic,' but as a policy it is tantamount to the differential valuation of human life, for those who advocate such a policy, regardless of their nationality, would never accept such a death sentence themselves" - it is only because the "victims tends to be poor, and thus less valuable, that such policies appear reasonable" (p. 278). He writes, "it slowly became clear to me that I'd been taken in by some of the pieties of development work. Talk of "appropriate technology" and "sustainability" had sounded good to me, at least initially. The problem was that these sounded silly, even sinister, to the landless peasants with whom I worked" (p. 21).

"Market utilitarianism" Farmer writes, "is a strange beast, since it seems to permit all sorts of inefficiencies as long as they benefit the right people – namely the privileged… confident claims about what is cost effective and what is not should be viewed with some suspicion" (p. xxiv). Another of the justifications is not imposing "standards of care" upon others, the "irony of which will not be lost on those whose experiences are described in this book. Americans may impose – through the World Bank or the International Monetary Fund, say, or through foreign policy writ large – social and economic policies that drive up inequalities, leaving the destitute sick out of the frame of analysis. But heaven forfend that we should require that the Third World poor be subjected to "culturally inappropriate" medical standards" (p. 35). Throughout the book Farmer deconstructs this discourse as illogical and "morally unsound" (p. 278).

Farmer wages a critique against the emphasis upon individual agency, one which remains valid in 2016: "In each of the sociomedical studies I have critiqued, a well-intentioned effort to incorporate the patients points' of view has served, paradoxically, to shift the blame onto the sick-poor by exaggerating their agency" (p. 254). In doing so, programs offer 'culturally sensitive education' and through "this cognitivist legerdemain, we have expediently moved the locus of the problem – and this the focus of the interventions – away from certain features of an inegalitarian society toward the women deemed "at risk"" (p. 86).

On the gendered experience:

• "Among the myriad mystifications that obscure the nature of women's risk, three are recurrent and important. One is the focus on local factors and local actors to the exclusion of broader analyses that would implicate powerful forces and powerful actors outside the field of view. A second is the conflation of structural violence and cultural difference. A third, centrally related to the others, is the absence of series consideration of social class" (p. 84-85).
  

On anthropology and anthropologists, he writes:

• "For many physicians and public health specialists, anthropologists are expected to "do the culture piece." We're expected to elicit the local beliefs and customs that hamstring sensible efforts to treat or prevent illness; we've supposed to reveal what it is that makes the natives tick… And very often, we have been willing to fill this restricted role, even if it means not talking about the forces and structures that ultimately determine tuberculosis outcomes" (p. 254)
  

Cochrane, L. and Thornton, A. (2016) Charity Rankings: Delivering Development or Dehumanizing Aid? Journal of International Development DOI: 10.1002/jid.3201

Abstract

• Individuals want to know which organisations to donate to, and a variety of organisations have developed ranking systems to guide them. This paper explores charity ranking, with a particular focus on the increasing role of impact and 'cost-effectiveness'. Ranking systems are composed of a selection of metrics, which may miss important components and, as a result, create a set of unintended outcomes. We argue that an emphasis on cost-effectiveness and impact in ranking promotes simple, technocratic activities, negatively affects human rights-based interventions and de-prioritises inventions that work in remote, complex settings. The topic of charity ranking and its influence on private donors is limited in the literature, and this paper seeks to make a contribution to this important debate.
  

The full article is gated. Abstract and further publication details available via the link above. If you would like a copy of the article, send me an email.