Nature
Volume 524 Number 7566 pp387-510 27 August 2015
http://www.nature.com/nature/current_issue.html
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12 August 2015
Can randomized trials eliminate global poverty?
A new generation of economists is trying to transform global development policy through the power of randomized controlled trials.
Jeff Tollefson
In 70 local health clinics run by the Indian state of Haryana, the parents of a child who starts the standard series of vaccinations can walk away with a free kilogram of sugar. And if the parents make sure that the child finishes the injections, they also get to take home a free litre of cooking oil.

These simple gifts are part of massive trial testing whether rewards can boost the stubbornly low immunization rates for poor children in the region. Following the model of the randomized controlled trials (RCTs) that are commonly used to test the effectiveness of drugs, scientists randomly assigned clinics in the seven districts with the lowest immunization rates to either give the gifts or not. Initial results are expected next year. But smaller-scale experiments suggest that the incentives have a good chance of working. In a pilot study conducted in India and published in 2010, the establishment of monthly medical camps saw vaccination rates triple, and adding on incentives that offered families a kilogram of lentils and a set of plates increased completion rates by more than sixfold1.

“We have learned something about why immunization rates are low,” says Esther Duflo, an economist at the Massachusetts Institute of Technology (MIT) in Cambridge, who was involved in the 2010 experiment and is working with Haryana on its latest venture. The problem is not necessarily that people are opposed to immunization, she says. It is that certain obstacles, such as lack of time or money, are making it difficult for them to attend the clinics. “And you can balance that difficulty with a little incentive,” she says.

This is one of a flood of insights from researchers who are revolutionizing the field of economics with experiments designed to rigorously test how well social programmes work. Their targets range from education programmes to the prevention of traffic accidents. Their preferred method is the randomized trial. And so they have come to be known as the ‘randomistas’…