Here’s a quote from Making Innovation Policy Work: Learning from experimentation, a book by the OECD and the World Bank being launched today in Washington. “River blindness is the result of a parasitic infestation of the eye. The parasite is transferred by the bite of the blackfly.” Moses Katabarwa, senior epidemiologist for the Carter Center’s River Blindness program told CNN what the disease means for people infected. They don’t all go blind, but the itching is so bad they may break clay pots to scratch themselves with, and other attempts to relieve the symptoms include pouring boiling water over themselves, or running a red-hot machete up and down the spine. It’s not a fatal disease, but as Katabarwa says, the itching, disfigurement and insomnia it provokes make life so miserable that some sufferers are driven to suicide.
The fight to eradicate river blindness (onchocerciasis) is one of the examples quoted by Making Innovation Policy Work to show how innovation can help to improve the lives of those at the “bottom of the pyramid”, the world’s poorest citizens. The disease was eliminated by 2002 in 11 West African countries thanks to the Onchocerciasis Control Programme (OCP) a 20-year programme to spray insecticide to kill the flies, but because of the extensive forest cover and larger distances, this approach was not feasible in Central and East Africa, where 70 million people were still affected. The breakthrough came thanks to a drug developed by Merck to treat cattle parasites that also proved effective against the onchocerciasis parasites. Merck was prepared to donate the drug ““to anyone who needed it, for as long as it was needed.” but didn’t have a distribution partner until 1987 when William Foege, Director of the Carter Center, agreed to lead a programme at the Task Force for Child Development and Survival, an affiliate of Emory University.
The project shows that successful innovation doesn’t just mean inventions or technologies. Logistics and programme management can be innovative too. The African Programme for Onchocerciasis (APOC), launched in 1995, pioneered a community-directed treatment through which hundreds of thousands of communities, trained by the public health systems and participating NGOs, organised and managed the treatment (as well as distributing other drugs). Another thing that was new at the time was “Africanisation”. In the 1970s programme, 75% of the OCP’s professional staff were expatriates, but by the 2000s 99% of the staff of both the OCP and APOC were African).
Another success factor was the built-in operational research component, representing 10% of the annual budget. This made it possible to adjust the programme as it evolved. For example when monitoring showed that the blackfly became resistant to the original insecticide, seven back-up insecticides were use in rotation to break the resistance. Operational research was also critical in determining whether community-based approach would be cost-effective and what level of participation would be necessary. It also mapped the disease throughout Africa so that APOC operations could be scaled up as necessary.
It’s great to learn about the successes, but “learning from experimentation” also means learning from failures and mistakes – being allowed to “fail & learn fast”. The Indian government’s Akash Tablet Computer, intended to take advantage of the potential of computers and the Internet to revolutionise education in India ran into a number of design, procurement and production problems. Manufacturers didn’t have the capacity to meet the specifications for example, but they in turn argue that the specifications were unrealistic for a low-cost device. The first models were unsuccessful, but later products benefitted from a number of improvements. The project demonstrates the importance of clear specifications and testing procedures and of transparency in the procurement process.
Many of the devices were actually made in China, showing that to stimulate innovation and to get a reliable product at the lowest cost it is necessary to open procurement to the global market. That’s exactly what India did to find a cure for rotavirus, the most common cause of severe diarrhoea among infants and young children. India has the most rotavirus deaths in the world – almost 10% of all under-5 deaths. The Ministry of Science’s Department of Biotechnology lead an international effort involving public research institutes, universities, a local biotech firm and the Gates Foundation to develop India’s first indigenous rotavirus oral vaccine, that will be sold for less than a dollar a dose.
Finally, what’s true of innovation is also true for innovation policymaking and policy makers. Policy makers need to learn from experience and mistakes that they make, and understand how to encourage more entrepreneurial experimentation and appropriate risk-taking in policy making itself.