Esther Duflo, one of the three awardees of the 2019 Nobel Prize in Economics, sparked a war of words with Kerala health officials over her remarks in a paper titled ‘The Economist as Plumber’ that was published in March, 2017.
Duflo, whose work with fellow-awardee and husband Abhijit Banerjee for their “experimental approach to alleviating global poverty” included popularising the use of Randomised Control Trials (RCT) in economics. As part of their research, they visited Kerala in early 2017 to meet with health officials to study Kerala’s Aardram Mission (which was an initiative to scale up primary health centres into family health centres).
According to a Manorama Online report, Duflo and Abhijit tried to persuade Kerala health officials of the merits of using RCTs in determining the effects of the mission. However, they received a cold response from officials, which they documented in their paper in a section titled ‘Why policy makers need the plumbers’.
Duflo said that Kerala health planners lacked clarity on their goals and often chose to delegate tasks to experts. When pressed on the efficacy of their methods, they did “not have any answer to these questions” and “showed no real interest in even entertaining them”.
Duflo used the example to argue that policy-makers do not make good ‘plumbers’—offering a distinction between economists who deal with problems theoretically and ‘plumbers’ who deal with the practical aspects of implementation.
The Manorama Online report, however, quoted former additional chief secretary (Health) Rajeev Sadanandan, who had invited Banerjee and Duflo tio Kerala, who said that there was another reason why Duflo was upset. “It is not as if the officials here did not understand what she and others asked. It is just that local level planners felt that their technique was not suitable to measure the outcomes of Aardram.”
Part of Duflo’s criticism was that Sadanandan, described as a ‘top bureaucrat’, had abruptly left their meeting to deal with the issue of the then-ongoing doctor’s strike, writing that, “He handed us over to a retired professor and a retired doctor, who have been charged with designing the specifics of the policy. This in itself is symptomatic: top policymakers usually have absolutely no time for figuring out the details of a policy plan, and delegate it to ‘experts’.”
Sadanandan responded saying that the two did not know how Kerala functions and that the people who interacted with them were part of the team that “evolved the Aardram Mission.”
The two sides differed on the applicability of RCTs as well, with officials arguing that such methods would prove discriminatory due to the need for a control group who would be denied the detailed interventions being given to the intervention group.
The debate over the use of RCTs in development economics is rich, with many scholars arguing for and against their use. A highly-cited paper by Christopher B. Barett says that RCTs bring about "ethical dilemmas, uncontrollable treatments that result in a ‘faux exogeneity’ [a misunderstanding of the role of external effects on the subject] distortion of the research agenda, and a tendency to estimate interventions' abstract efficacy rather than their effectiveness in practice."
Barett stops short of arguing that RCTs should be done away with altogether, however, stating instead that there needs to be a plurality of methods combined with awareness of each of their shortcomings.
Another paper looked at how likely a study was to be replicated by other scholars, and found that RCT-based studies were more likely to result in other scholars attempting to replicate their findings. The replicability of studies is a growing challenge faced in the social sciences, and this suggests that RCT-based trials could lead a to a more rigorous scientific approach.
Using demonetisation as an example, Duflo argues that experimentation is important before major policy decisions can be executed. "The failure to experiment, the failure to notice, and the grip of ideology combine in what Banerjee and Duflo (2012) described as the “Three I’s” (ideology, ignorance, inertia). Policymakers tend to design schemes based on the ideology of the time, in complete ignorance of the reality of the field, and once these policies are in place, they just stay in place. "
But, a Planning Board member interviewed by Manorama Online felt that implementing control groups in a matter that involved decided whether locals get access to expert healthcare or not would lead to public protests.