Implementing Change

Illustrations by Katrina Stanley

Can better science save global health initiatives?

By Bob Grant

1 It turns out that villagers living near the wells were drinking from them, but they were also using non-well water in sufficient quantities to keep the cholera rate high. Because monitoring and evaluation were not incorporated into the design of the program, says Glass, the intervention seemed to be missing its mark. Though he was not involved with the project, Glass says that systematically monitoring people's preferences for, or aversions to, well water throughout the implementation of the program could have increased the success of the program, and possibly saved lives. "Scientifically, we did the right thing," Glass says, "but we didn't understand people's behavior."

Since that early failure, cholera rates in Bangladesh have indeed remained lower thanks in part to access to clean drinking water. (Unfortunately, no one was testing for arsenic...

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